Holder ELECTRICAL IMPEDANCE TOMOGRAPHY

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

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This volume is dedicated to

Brian Brown and David Barber,
for their pioneering work in
Electrical Impedance Tomography.
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.
1.5.
1.6.
1.7.
1.8.
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
Contents
1.9.
1.10.
1.11.
1.12.
1.13.
PART 2
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
39
40
42
42
44
45
47
50
52
52
53
54
56
HARDWARE
65
2. EIT INSTRUMENTATION
Gary J Saulnier
2.1.
2.2.
2.3.
2.4.
2.5.
2.6.
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
33
36
67
67
67
69
69
70
79
80
80
86
87
88
88
90
90
93
94
95
96
98
101
103
Contents
PART 3
APPLICATIONS
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.
3.3.
3.4.
3.5.
3.6.
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
4. ELECTRICAL IMPEDANCE TOMOGRAPHY OF

BRAIN FUNCTION
David Holder and Thomas Tidswell
4.1.
4.2.
4.3.
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
xi
105
107
107
107
107
109
110
110
110
112
112
113
113
113
114
114
117
117
117
118
122
123
123
127
127
129
129
136
137
137
141
146
xii
Contents
4.4.
4.5.
4.6.
4.7.
4.8.
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
EIT in stroke
EIT of neuronal depolarization
Conclusion and future work
References
5. BREAST CANCER SCREENING WITH ELECTRICAL

IMPEDANCE TOMOGRAPHY
Alex Hartov, Nirmal Soni and Ryan Halter
5.1.
5.2.
5.3.
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
6. APPLICATIONS OF ELECTRICAL IMPEDANCE

TOMOGRAPHY IN THE GASTROINTESTINAL TRACT
Clare Soulsby, Etsuro Yazaki and David F Evans
6.1.
6.2.
6.3.
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
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148
149
154
155
156
157
159
160
161
167
167
167
168
169
171
171
172
172
173
173
174
178
181
182
186
186
188
188
188
188
189
190
Contents
6.4.
6.5.
6.7.
6.8.
6.9.
6.10.
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
7. OTHER CLINICAL APPLICATIONS OF ELECTRICAL

David Holder
7.1.
7.2.
7.3.
PART 4
191
191
191
191
192
193
194
194
195
196
198
198
198
200
201
201
202
203
205
207
Hyperthermia
EIT imaging of intra-pelvic venous congestion
Other possible applications
References
207
208
209
209
NEW DIRECTIONS
211
8. MAGNETIC INDUCTION TOMOGRAPHY

H Griths
8.1.
8.2.
8.3.
8.4.
8.5.
xiii
Introduction
The MIT signal
Coils and screening
Signal demodulation
Cancellation of the primary signal
213
213
214
215
218
218
xiv
Contents
8.6.
8.7.
8.8.
8.9.
8.10.
8.11.
8.12.
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
9. MAGNETIC RESONANCE ELECTRICAL IMPEDANCE

TOMOGRAPHY (MREIT)
Eung Je Woo, Jin Keun Seo and Soo Yeol Lee
9.1
9.2.
9.3.
9.4.
9.5.
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
220
220
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225
228
230
230
231
232
233
233
239
239
242
244
244
245
246
247
249
249
249
256
256
257
258
258
259
259
260
261
Contents
9.6.
9.7.
9.8.
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
10. ELECTRICAL TOMOGRAPHY FOR INDUSTRIAL

APPLICATIONS
Trevor York
10.1.
10.2.
10.3.
10.4.
10.5.
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
xv
262
263
265
266
266
270
273
274
274
280
288
289
291
295
295
298
299
302
303
305
306
307
307
312
312
316
318
326
330
335
338
340
340
xvi
Contents
11. EIT: THE VIEW FROM SHEFFIELD

D C Barber
11.1.
11.2.
11.3.
11.4.
11.5.
11.6.
11.7.
11.8.
11.9.
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
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
348
348
349
350
351
352
355
356
356
358
359
359
361
363
364
365
365
366
366
367
367
368
368
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373
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388
388
391
395
398
399
400
400
401
Contents
13.9.
13.10.
13.11.
13.12.
Paying for it
People
Meetings
Concluding remarks
Complete Bibliography
Selected Abstracts
Appendix A BRIEF INTRODUCTION TO BIOIMPEDANCE

David Holder
A.1.
A.2.
A.3.
A.4.
A.5.
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
xvii
403
404
405
406
407
410
411
411
416
418
418
419
420
421
422
Appendix B INTRODUCTION TO BIOMEDICAL ELECTRICAL

423
David Holder
B.1.
B.2.
B.3.
B.4.
B.5.
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
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
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
S Y Lee
Department of Biomedical Engineering, Impedance Imaging Research Center
(IIRC), Kyung Hee University, 1 Seochun, Kiheung, Yongin, Kyungki, South
Korea 449-701
W R B Lionheart
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
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
N Soni
C Soulsby
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
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
E1 2AJ, UK
T A York
School of Electrical Engineering and Electronics, UMIST, PO Box 88, Sackville
Street, Manchester M60 1QD, UK
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.
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,
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
PART 1
ALGORITHMS
Chapter 1
The reconstruction problem
William Lionheart, Nicholas Polydorides and
Andrea Borsic
1.1.
WHY IS EIT SO HARD?
In conventional medical imaging modalities, such as x-ray computerized tomography (CT), a collimated beam of radiation passes through the object in a
straight line, and the attenuation of this beam is aected only by the matter
which lies along its path. In this sense x-ray CT is local, and it means that
the pixels or voxels of our image aect only some (in fact, a very small proportion) of the measurements. If the radiation were at lower frequency (softer xrays) the eect of scattering would have to be taken into account and the eect
of a change of material in a voxel would no longer be local. As the frequency
decreases this non-local eect becomes more pronounced until we reach the
case of direct current, in which a change in conductivity would have some
eect on any measurement of surface voltage when any current pattern is
applied. This non-local property of conductivity imaging, which still applies
at the moderate frequencies used in EIT, is one of the principal reasons that
EIT is dicult. It means that to nd the conductivity image one must solve a
system of simultaneous equations relating every voxel to every measurement.
Non-locality in itself is not such a big problem provided we attempt to
recover a modest number of unknown conductivity parameters from a
modest number of measurements. Worse than that is the ill-posed nature
of the problem. According to Hadamard a mathematical model of a physical
problem is well posed if
1. for all admissible data, a solution exists,
2. for all admissible data, the solution is unique, and
3. the solution depends continuously on the data.
The problem of recovering an unknown conductivity from boundary data is
severely ill-posed, and it is the third criterion which gives us the most trouble.
In practice that means for any given measurement precision, there are
arbitrarily large changes in the conductivity distribution which are undetectable by boundary voltage measurements at that precision. This is clearly bad
news for practical low frequency electrical imaging. Before we give up EIT
altogether and take up market gardening, there is a partial answer to this
problemwe need some additional information about the conductivity
distribution. If we know enough a priori (that is in advance) information,
it constrains the solution so that the wild variations causing the instability
are ruled out.
The other two criteria can be phrased in a more practical way for our
problem. Existence of a solution is not really in question. We believe the
body has a conductivity. The issue is more that the data are suciently
accurate to be consistent with a conductivity distribution. Small errors in
measurement can violate consistency conditions, such as reciprocity. One
way around this is to project our infeasible data on to the closest point in
the feasible set. The mathematicians problem of uniqueness of solution is
better understood in experimental terms as suciency of data. In the mathematical literature the conductivity inverse boundary value problem (or
Calderon problem) is to show that a complete knowledge of the relationship
between voltage and current at the boundary determines the conductivity
uniquely. This has been proved under a variety of assumptions about the
smoothness of the conductivity [80]. This is only a partial answer to the
practical problem as we have only nitely many measurements from a xed
system of electrodes; the electrodes typically cover only a portion of the surface
of the body and in many cases voltage are not measured on electrodes driving
currents. In the practical case the number of degrees of freedom of a parameterized conductivity we can recover is limited by the number of independent
measurements made and the accuracy of those measurements.
This introductory section has deliberately avoided mathematical treatment, but a further understanding of why the reconstruction problem of
EIT is dicult, and how it might be done, requires some mathematical
prerequisites. The minimum required for the following is a reasonably
thorough understanding of matrices [145], and a little multi-variable
calculus, such as are generally taught to engineering undergraduates. For
those desirous of a deeper knowledge of EIT reconstruction, for example
those wishing to implement reconstruction software, an undergraduate
course in the nite element method [138] and another in inverse
problems [20, 22, 72] would be advantageous.
1.2.
MATHEMATICAL SETTING
Our starting point for consideration of EIT should be Maxwells equations

(see Box 1.1). But for simplicity let us assume direct current or suciently
Box 1.1.
Maxwells equations
In the main text we have treated essentially the direct current case. The
basic eld quantities in Maxwells equations are the electric eld E and
the magnetic eld H which will be modelled as vector-valued functions
of space and time. We will assume that there is no relative motion in our
system. The elds, when applied to a material or indeed a vacuum,
produce uxeselectric displacement D and magnetic ux B. The
spacial and temporal variations of the elds and uxes are linked by
Faradays law of induction
rE
@B
@t
and Coulombs law

rH
@D
J
@t
where J is the electric current density. We dene the charge density by

r E , and as there are no magnetic monopoles r B 0. The
material properties appear as relations between elds and uxes. The
simplest case is of non-dispersive, local, linear, isotropic media.
The magnetic permeability is then a scalar function > 0 of space
and the material response is B H, and similarly the permittivity
" > 0 with D "E. In a conductive medium we have the continuum
counterpart to Ohms law where the conduction current density
Jc E. The total current is then J Jc Js , the sum of the conduction and source currents.
We will write Ex; t ReEx ei!t , where Ex is a complex
vector-valued function of space. We now have the time harmonic
Maxwells equations
r E i!H
and
r H i!"E J:
We can combine conductivity and permittivity as a complex admittivity
i!" and write ( ) as
r H i!"E Js :
In EIT the source term Js is typically zero at frequency !. The
quasi-static approximation usually employed in EIT is to assume !H
is negligible, so that r E 0 and hence on a simply-connected
domain E r for a scalar .
low a frequency current that the magnetic eld can be neglected. We have a
given body , a closed and bounded subset of 3D space with a smooth (or
smooth enough) boundary @. The body has a conductivity which is a
function of the spatial variable x (although we will not always make this
dependence explicit for simplicity of notation). The scalar potential is
and the electric eld is E r. The current density is J r, which
is a continuum version of Ohms law. In the absence of interior current
sources, we have the continuum Kirchos law1
r r 0:
1:1
The current density on the boundary is

j J n r n
where n is the outward unit normal to @. Given , specication of the
potential j@ on the boundary (Dirichlet boundary condition) is sucient
to uniquely determine a solution to (1.1). Similarly specication of
boundary current density j (Neumann boundary conditions) determines
up to an additive constant, which is equivalent to choosing an earth point.
From Gauss theorem, or conservation of current,
the boundary current
density must satisfy the consistency condition @ j 0. The ideal complete

data in the EIT reconstruction problem is to know all possible pairs of
Dirichlet and Neumann data j@ ; j. As any Dirichlet data determines
unique Neumann data we have an operator : j@ 7! j. In electrical
terms this operator is the transconductance at the boundary, and can be
regarded as the response of the system we are electrically interrogating at
the boundary.
Practical EIT systems use sinusoidal currents at xed angular frequency
!. The electric eld, current density and potential are all represented by
complex phasers multiplied by ei! . Ignoring magnetic eects (see Box 1.1),
we replace the conductivity in (1.1) by the complex admittivity
i!", where " is the permittivity. In biological tissue one can expect
" to be frequency dependent which becomes important in a multi-frequency
system.
The inverse problem, as formulated by Calderon [31], is to recover
from . The uniqueness of solution, or if you like the suciency of the
data, has been shown under a variety of assumptions, notably in the work
of Kohn and Vogelius [84] and Sylvester and Uhlmann [147]. For a summary
of results see Isakov [80]. More recently, Astala and Paivarinta [1] have
shown uniqueness for the 2D case without smoothness assumptions. There
is very little theoretical work on what can be determined from incomplete
There is a recurring error in the EIT literature of calling this Poissons equation. However, it is a
natural generalization of Laplaces equation.
Box 1.2.
Sobolev spaces
In the mathematical literature you will often see the assumption that
lies in the Sobolev space H 1 , which can look intimidating to the
uninitiated. Actually these spaces are easily understood on an intuitive
level and have a natural physical meaning. For mathematical details
see Folland [53]. A (generalized) function f is in H k for integer k if
the square kth derivative has a nite integral over . For non-integer
and negative powers Sobolev spaces are dened by taking the Fourier
transform, multiplying by a power of frequency and demanding that
the result is square integrable. For the potential we are simply demanding that jrj2 dV < 1 which is equivalent, provided the conductivity
is bounded, to demanding that the ohmic power dissipated is nitean
obviously necessary physical constraint. Sobolev spaces are useful as a
measure of the smoothness of a function, and are also convenient as
they have an inner product (they are Hilbert spaces). To be consistent
with this nite power condition, the Dirichlet boundary data j@
must be in H 1=2 @ and the Neumann data j 2 H 1=2 @. Note that
the current density is one derivative less smooth than the potential on
the boundary as one might expect.
data, but knowing the Dirichlet to Neumann mapping on an open subset of

the boundary is enough [151]. It is also known that one set of Dirichlet and
Neumann data, provided it contains enough frequency components, is
enough to determine the boundary between two homogeneous materials
with diering conductivities [2]. These results show that the second of Hadamards conditions is not the problem, at least in the limiting, innitely many
electrodes case. As for the rst of Hadamards conditions, the diculty is
characterizing admissible data and there is very little work characterizing
what operators are valid Dirichlet-to-Neumann operators. The real problem,
however, is in the third of Hadamards conditions. In the absence of a priori
information about the conductivity, the inverse problem 7! is extremely
unstable in the presence of noise. To understand this problem further it is
best to use a simple example. Let us consider a unit disk in two dimensions
with a concentric circular anomaly in the conductivity

1 < jxj < 1
x
:
2 jxj
Although this is a 2D example, it is equivalent to a 3D cylinder with a central
cylindrical anomaly provided we consider only data where the current
density is zero on the circular faces of the cylinder and translationally
invariant on the curved face (think of electrodes running the full height of a
cylindrical tank).
The forward problem can be solved by separation of variables giving
cos k k
1 2k
cos k
1 2k
1:2
and similarly for sin, where 1 2 =1 2 . We can now express

any arbitrary Dirichlet boundary data as a Fourier series
1;
1
X
ak cos k bk sin k
and notice that the Fourier coecients of the current density will be
k1 2k =1 2k ak and similarly bk . The lowest frequency component
is clearly most sensitive to the variation in the conductivity of the anomaly.
This of itself is a useful observation indicating that patterns of voltage (or
current) with large low frequency components are best able to detect an
object near the centre of the domain. This might be achieved, for example,
by covering a large proportion of the surface with driven electrodes and
exciting a voltage or current pattern with low spacial frequency. We will
explore this further in section 1.9.3. We can understand a crucial feature of
the nonlinearity of EIT from this simple examplesaturation. Fixing the
radius of the anomaly and varying the conductivity, we see that for high
contrasts the eect on the voltage of further varying the conductivity is
reduced. A detailed analysis of the circular anomaly was performed by
Seagar [133] using conformal mappings, including oset anomalies. It is
found, of course, that a central anomaly produces the least change in boundary data. This illustrates the positional dependence of the ability of EIT to
detect an object. By analogy to conventional imaging problems one could
say that the point spread function is position dependent.
Our central circular anomaly also demonstrates the ill-posed nature of
the problem. For a given level of measurement precision, we can construct
a circular anomaly undetectable at that precision. We can make the change
in conductivity arbitrarily large and yet by reducing the radius we are still
not able to detect the anomaly. This shows (at least using the rather severe
L1 norm) that Hadamards third condition is violated.
While still on the topic of a single anomaly, it is worth pointing out that
nding the location of a single localized object is comparatively easy, and
with practise one can do it crudely by eye from the voltage data. Box 1.4
describes the disturbance to the voltage caused by a small object and explains
why, to rst order, this is the potential for a dipole source. This idea can be
made rigorous, and Ammari [3] and Seo [135] show how this could be applied
locating the position and depth of a breast tumour using data from a T-scan
measurement system.
Measurements and electrodes

1.3.
MEASUREMENTS AND ELECTRODES
A typical electrical imaging system uses a system of conducting electrodes

attached to the surface of the body under investigation. One can apply
current or voltage to these electrodes and measure voltage or current respectively. Let us suppose that the subset of the boundary in contact with the lth
electrode is El , and 1 l L. For one particular measurement the voltages
(with respect to some arbitrary reference) are Vl and the currents Il , which we
arrange in vectors2 as V and I 2 CL . The discrete equivalent of the Dirichletto-Neumann map is the transfer admittance, or mutual admittance, matrix
Y, which is dened by I YV.
Assuming that the electrodes are perfect conductors for each l we have
that jEl Vl , a constant. Away from the electrodes where no current ows
@=@n 0. This mixed boundary
value problem is well-posed, and the result
ing currents are Il El @=@n. It is easy to see that the vector
1 1; 1; . . . ; 1T is in the null space of Y, and that the range of Y is orthogonal to the same vector. Let S be the subspace of CL perpendicular to 1;
then it can be shown that YjS is invertible from S to S. The generalized
inverse (see section 1.4) Z Y is called the transfer impedance. This follows
from uniqueness of solution of the so-called shunt model boundary value
problem, which is (1.1) together with the boundary conditions
@=@n Il
for 0 l L
1:3
El
@=@n 0
on 0
1:4
r n 0
on
1:5
where l El and @ . Condition (1.5) is equivalent to demanding that is constant on electrodes.

The transfer admittance, or equivalently transfer impedance, represents
a complete set of data which can be collected from the L electrodes at a single
frequency for a stationary linear medium. From reciprocity we have that Y
and Z are symmetric (but for ! 6 0 not Hermitian). The dimension of the
space of possible transfer admittance matrices is clearly no bigger than
LL 1=2, and so it is unrealistic to expect to recover more unknown parameters than this. In the case of planar resistor networks the possible transfer
admittance matrices can be characterized completely [42], a characterization
which is known at least partly to hold in the planar continuum case [77]. A
typical electrical imaging system applies current or voltage patterns which
form a basis of the space S, and measures some subset of the resulting
Here Cn is the set of complex column vectors with n rows, whereas Cm n is the set of complex
m n matrices.
2
10
voltages which, as they are only dened up to an additive constant, can be

taken to be in S.
The shunt model with its idealization of perfectly conducting electrodes
predicts that the current density on the electrode has a singularity of the form
Or1=2 , where r is the distance from the edge of the electrode. The potential
, while still continuous near the electrode, has the asymptotics Or1=2 .
Although some electrodes may have total current Il 0, since they are not
actively driven, the shunting eect means that their current density is not
only nonzero but innite at the edges.
In medical applications with electrodes applied to skin, and in phantom
tanks with ionic solutions in contact with metal electrodes, a contact impedance layer exists between the solution or skin and the electrode. This modies the shunting eect so that the voltage under the electrode is no longer
constant. The voltage on the electrode is still a constant Vl , so now on El
there is a voltage drop across the contact impedance layer
zl
@
Vl
@n
1:6
where the contact impedance zl could vary over El but is generally assumed
constant. This new boundary condition, together with (1.3) and (1.4), form
the complete electrode model (CEM). For experimental validation of this
model see [37], theory [143] and numerical calculations [117, 155]. A nonzero
contact impedance removes the singularity in the current density, although
high current densities still occur at the edges of electrodes (g. 1.1). For
asymptotics of with the CEM see [45].
The singular values (see section 1.4.3) of Z, sometimes called characteristic
impedances, are sensitive to the electrode model used and this was used by [37]
to validate the CEM. With no modelling of electrodes and a rotationally
symmetric conductivity in a cylindrical tank, the characteristic impedances
tend toward a 1=k decay, as expected from (1.2) with sinusoidal singular
vectors of frequency k, as the number of electrodes increases.
1.4.
REGULARIZING LINEAR ILL-POSED PROBLEMS
In this section we consider the general problem of solving a linear ill-posed

problem, before applying this specically to EIT in the next section. Detailed
theory and examples of linear ill-posed problems can be found in [22, 50, 75,
149, 160]. We assume a background in basic linear algebra [145]. For
complex vectors x 2 Cn and b 2 Cm and a complex matrix A 2 Cm n , we
wish to nd x given Ax b. Of course, in our case A is the Jacobian,
while x will be a conductivity change and b a voltage error. In practical
measurement problems it is usual to have more data than unknowns, and
if the surfeit of data were our only problem the natural solution would be
11
to use the MoorePenrose generalized inverse

xMP A b A A1 A b
1:7
which is the least squares solution in that

xMP arg minx jjAx bjj
1:8
(here arg minx means the argument x which minimizes what follows). In
MATLAB3 the backslash (left division) operator can be used to calculate
the least squares solution, for example x Anb.
1.4.1.
Ill-conditioning
It is the third of Hadamards conditions, instability, which causes us

problems. To understand this rst we dene the operator norm of a matrix
kAk maxx 6 0
kAxk
:
kxk
This can be calculated as the square root of the largest eigenvalue of A A.

There is another norm on matrices in Cm n , the Frobenious norm, which is
dened by
kAk2F
m X
n
X
jaij j2 trace A A
i1 j 1
which treats the matrix as simply a vector rather than an operator. We also
dene the condition number
A kAk kA1 k
for A invertible. Assuming that A is known accurately, A measures the
amplication of relative error in the solution.
Specically if
Ax b and Ax x b b
then the relative error in solution and data are related by
kxk
kbk
A
kxk
kbk
as can be easily shown from the denition of operator norm. Note that this is
a worst case error boundoften the error is less. With innite precision,
3
MATLAB1 is a matrix-oriented interpreted programming language for numerical calculation
(The MathWorks Inc, Natick, MA, USA). While we write MATLAB for brevity, we include its
free relatives Scilab and Octave.
12
(a) Current density on the boundary for passive and active electrodes
(b) The eect of contact impedance on the potential beneath an electrode
Figure 1.1. The current density on the boundary with the CEM is greatest at the edge of
the electrodes, even for passive electrodes. This eect is reduced as the contact impedance
increases.
13
(c) Interior current ux near an active electrode
(d) Interior current ux near a passive electrode
Figure 1.1.
(Continued)
any nite A shows that A1 is continuous, but in practice error in data
could be amplied so much the solution is useless. Even if the data b were
reasonably accurate, numerical errors mean that, eectively, A has error, and
kxk
kAk
A
:
kxk
kAk
14
(Actually this is not quite honest: it should be a perturbation boundsee

[75].) So in practice we can regard linear problems with large A as illposed, although the term ill-conditioned is better for the discrete case.
1.4.2.
Tikhonov regularization
The method commonly known as Tikhonov regularization was introduced to

solve integral equations by Phillips [120] and Tikhonov [150], and for nite
dimensional problems by Hoerl [76]. In the statistical literature, following
Hoerl, the technique is known as ridge regression. We will explain it here
for the nite dimensional case. The least squares approach fails for a badly
conditioned A, but one strategy is to replace the least squares solution by
x arg minx kAx bk2 2 kxk2 :
1:9
Here we trade o actually getting a solution to Ax b and not letting kxk get
too big. The number controls this trade-o and is called a regularization
parameter. Notice that as ! 0, x tends to a generalized solution A b. It
is easy to nd an explicit formula for the minimum
x A A 2 I1 A b:
The condition number A A 2 I1 is
1 2 =
n 2 , where
i are the eigenvalues of A A, which for

n small is close to
1 = 2 1,
so for a big the matrix A A 2 I we seek to invert is well conditioned.
Notice also that even if A does not have full rank (
n 0), A A 2 I does.
1.4.3.
The singular value decomposition
The singular value decomposition (SVD) is the generalization to non-square

matrices of orthogonal diagonalization of Hermitian matrices. We describe
the SVD in some detail here due to its importance in EIT. Although the
topic is often neglected in elementary linear algebra courses and texts
([145] is an exception), it is described well in texts on inverse problems,
e.g. [22].
For A 2 Cm n , we recall that A A is a non-negative denite Hermitian
so has a complete set of orthogonal eigenvectors vi with real eigenvalues
1
2 0. These are normalized so that p
V v1 j v2 j j vn is
a unitary matrix V V1 . We dene i
i and for i 6 0,
ui i 1 Avi 2 Cm . Now notice that A Avi
i vi 2i vi . And

2
A ui 1
i A Aui i ui . Also AA ui i ui , where i are called singular
4
values vi and ui right and left singular vectors respectively.
The use of for singular values is conventional in linear algebra, and should cause no confusion
with the generally accepted use of this symbol for conductivity.
15
We see that the ui are the eigenvectors of the Hermitian matrix AA , so
they too are orthogonal. For a non-square matrix A, there are more eigenvectors of either A A or AA , depending on which is bigger, but only
minm; n singular values. If A < minm; n some of the i will be zero. It
is conventional to organize the singular values in decreasing order
1 2 minm;n 0.
If rankA k < n then the singular vectors vk 1 ; . . . ; vn form an orthonormal basis for null A, whereas u1 ; . . . ; uk form a basis for rangeA. On
the other hand, if k rankA < m, then v1 ; . . . ; vk form a basis for A ,
and uk 1 ; . . . ; um form an orthonormal basis for null A . In summary
Avi i ui
i minm; n
A ui i v i
i minm; n
Avi 0
rankA < i n
A ui 0
rankA < i m
ui uj
ij ;
vi vj ij
1 2 0:
It is clear from the denition
that for any matrix A, kAk 1 , while the
p
P
1
2
Frobenius norm is kAkF
i i . If A is invertible, then kA k 1=n .
The singular value decomposition (SVD) allows us to diagonalize A
using orthogonal transformations. Let U u1 j j um then AV U,
where is the diagonal matrix of singular values padded with zeros to
make an m n matrix. The nearest thing to diagonalization for nonsquare A is
U AV
and
A UV :
Although the SVD is a very important tool for understanding the illconditioning of matrices, it is rather expensive to calculate numerically and
the cost is prohibitive for large matrices.
In MATLAB the command s=svd(A) returns the singular values and
[U,S,V]=svd(A) gives you the whole singular value decomposition. There
are special forms if A is sparse, or if you only want some of the singular
values and vectors.
Once the SVD is known, it can be used to rapidly calculate the Moore
Penrose generalized inverse from
A V U
where is simply T with the nonzero i replaced by 1=i . This formula is
valid whatever the rank of A and gives the minimum norm least squares solution. Similarly the Tikhonov solution is
x VT U b
16
where T is T with the nonzero i replaced by i =2i 2 . As only T

varies with , one can rapidly recalculate x for a range of once the
SVD is known.
1.4.4. Studying ill-conditioning with the SVD
The singular value decomposition is a valuable tool in studying the illconditioning of a problem. Typically we calculate numerically the SVD of
a matrix which is a discrete approximation to a continuum problem, and
the decay of the singular values gives us an insight into the extent of the
instability of the inverse problem. In a simple example [72], calculating kth
derivatives numerically is an ill-posed problem, in that taking dierences
of nearby values of a function is sensitive to error in the function values.
Our operator A is a discrete version of integrating trigonometric polynomials
k times. The singular vectors of A are a discrete Fourier basis and the singular
value for the ith frequency proportional to ik . Problems such as this where
i Oik for some k > 0 are called mildly ill-posed. If we assume sucient
a priori smoothness on the function the problem becomes well-posed. By
contrast problems such as the inverse Laplace transform, the backward
heat equation [72] and linearized EIT, the singular values decay faster than
any power ik , and we term them severely ill-posed. This degree of illposedness technically applies to the continuum problem, but a discrete
approximation to the operator will have singular values that approach this
behaviour as the accuracy of the approximation increases.
In linearized EIT we can interpret the singular vectors vi as telling us that
the components vi x of a conductivity image x are increasingly hard to determine as i increases, as they produce voltage changes i ui x. With a relative
error of " in the data b we can only expect to reliably recover the components
vi x of the image when i =1 > ". A graph of the singular values (for EIT we
typically plot i =0 on a logarithmic scale) gives a guide to the number of
degrees of freedom in the image we can expect to recover with measurement
at a given accuracy. See gure 1.2.
Another use of the graph of the singular values is determination of
rank. Suppose we collect a redundant set of measurements, for example
some of the voltages we measure could be determined by reciprocity. As
the linear relations between the measurements will transfer to dependencies
in the rows of the Jacobian, if n is greater than the number of independent
measurements k, the matrix A will be rank decient. In numerical linear
algebra linear relations are typically not exact due to rounding error, and
rather than having zero singular values we will nd that after k the singular
values will fall abruptly by several decades. For an example of this in EIT
see [25].
The singular values themselves do not tell the whole story. For example,
two EIT drive congurations may have similar singular values, but if the
17
Figure 1.2. Singular values plotted on a logarithmic scale for the linearized 3D EIT
problem with 32 electrodes, and cross sections of two singular vectors.
singular vectors vi dier then they will be able to reliably reconstruct dierent
conductivities. To test how easy it is to detect a certain (small as we have
linearized) conductivity change x, we look at the singular spectrum V x. If
most of the large components are near the top of this vector the change is
easy to detect, whereas if they are all below the lth row they are invisible
with relative error worse than l =0 . The singular spectrum U b of a set of
measurements b gives a guide to how useful that set of measurements will
be at a given error level.
1.4.5.
More general regularization
In practical situations the standard Tikhonov regularization is rarely useful

unless the variables x represent coecients with respect to some well chosen
basis for the underlying function. In imaging problems it is natural to take
our vector of unknowns as pixel or voxel values, and in EIT one often
takes the values of conductivity on each cell (e.g. triangle or tetrahedron)
of some decomposition of the domain, and assumes the conductivity to be
constant on that cell. The penalty term kxk in standard Tikhonov prevents
extreme values of conductivity but does not enforce smoothness, nor
constrain nearby cells to have similar conductivites. As an alternative we
choose a positive denite (and without loss of generality, Hermitian)
18
matrix P 2 Cn n and the norm kxk2P x Px. A common choice is to use an

approximation to a dierential operator L and set P L L.
There are two further renements which can be included. The rst is that
we penalize dierences from some background value x0 , which can include
some known non-smooth behaviour and penalize kx x0 kP . The second is
to allow for the possibility that we may not wish to t all measurements to
the same accuracy, in particular as some may have larger errors than
others. This leads to consideration of the term kAx bkQ for some diagonal
weighting matrix Q. If the errors in b are correlated, one can consider a nondiagonal Q so that the errors in Q1=2 b are not correlated. The probabilistic
interpretation of Tikhonov regularization in Box 1.3 makes this more
explicit. Our generalized Tikhonov procedure is now
xGT arg minx kAx bk2Q kx x0 k2P
which reduces to the standard Tikhonov procedure for P I, Q 2 I,
~ P1=2 x x0 ,
x0 0. We can nd the solution by noting that for x
1=2
1=2
1=2
~
~
, and b Q b Ax0
A Q AP
~x
~ ~bk2 k~
x k2
xGT x0 P1=2 arg minx~ kA
Box 1.3.
Probabilistic interpretation of regularization
The statistical approach to regularization [160, ch 4] gives an alternative

justication of generalized Tikhonov regularization. For a detailed
treatment of the application of this approach to EIT see [81]. Bayes
theorem relates conditional probabilities of random variables
Pxjb
PbjxPx
:
Pb
The probability of x given b is the probability of b given x times

Px=Pb. We now want the most likely x, so we maximize the posterior
Pxjb, obtaining the so called maximum a-posteriori (MAP) estimate.
This is easy to do if we assume x is multivariate Gaussian with mean
x0 and covariance covx P1 , and e has mean zero and cove Q1 :
Pxjb
1
exp 12 kAx bk2Q exp 12 kx x0 k2P
Pb
where we have used that x and e are independent so

Pb bjx Pe b Ax. We notice that Pxjb is maximized by minimizing
kAx bk2Q kx x0 k2P :
Regularizing EIT
19
which can be written explicitly as

~ A
~ I 1 A
~ ~b
xGT x0 P1=2 A
x0 A QA P1 A Qb Ax0
or in the alternative forms
xGT A QA P1 A Qb Px0

1
x0 PA AP1 A Q1 b Ax0 :
As in the standard Tikhonov case, generalized Tikhonov can be explained in
~ , which can be regarded as the SVD of the operator A
terms of the SVD of A
with respect to the P and Q norms. Sometimes it is useful to consider a noninvertible P; for example, if L is a rst-order dierence operator L L has a
non-trivial null space. Provided the null space can be expressed as a basis
of singular vectors of A with large i the regularization procedure will still
be successful. This situation can be studied using the generalized singular
value decomposition (GSVD) [72].
1.5.
REGULARIZING EIT
We dene a forward operator F by Fs V, which takes the vector of degrees

of freedom in the conductivity s to the measured voltages at the boundary V.
Clearly F is nonlinear. We will leave aside the adaptive current approach
(section 1.9.3) where the measurements taken depend on the conductivity.
As the goal is to t the actual measured voltages Vm , the simplest approach,
as in the case of a linear problem, is to minimize the sum of squares error
jjVm Fsjj2F
the so called output least squares approach. We have emphasized the
Frobenius norm here as Vm is a matrix. However, in this section we will
use the notational convenience of using the same symbol when the matrix
of measurements is arranged as a column vector. In practice it is not usual
to use the raw least squares approach, but at least a weighted sum of squares
reects the reliability of each voltage. More generally (Box 1.3) we use a
norm weighted by the inverse of the error covariance. Such approaches are
common both in optimization and the statistical approach to inverse
problems. To simplify the presentation we will use the standard norm on
voltages, or equivalently that they have already been suitably scaled. The
more general case is easily deduced from the previous section.
Minimization of the voltage error (for simple parameterizations of ) is
doomed to failure as the problem is ill-posed. In practice the minimum lies in
a long narrow valley of the objective function [26]. For a unique solution one
20
must include additional information about the conductivity. An example is

to include a penalty Gs for highly oscillatory conductivites in our minimization, just as in the case of a linear ill-posed problem. We seek to minimize
f s jjVm Fsjj2 Gs:
In EIT a typical simple choice [155] is
Gs 2 jjLs sref jj2
1:10
where L is a matrix approximation to some partial dierential operator and

sref is a reference conductivity (for example, including known anatomical
features). The minimization of f represents a trade-o between tting the
data exactly and not making the derivatives of too large, the trade-o
being controlled by the regularization parameter .
A common choice [122, 157] is to use a discrete approximation to the
Laplacian on piecewise constant functions on the mesh. For each element a
sum of the neighbouring element values is taken, weighted by the area (or
length in 2D) of the shared faces and the total area (perimeter length) of the
element multiplied by the element value subtracted. This is analogous to the
common ve-point dierence approximation to the Laplacian on a square
mesh. Where elements have faces on the boundary, there are no neighbours
and the scheme is equivalent to assuming an extension outside the body
with the same value. This enforces a homogeneous Neumann boundary condition so that the null space of L is just constants. As constant conductivity
values are easily obtained in EIT the null space does not diminish the regularizing properties of this choice of G. Similarly one could choose a rst-order
dierential operator for L [152]. Other smooth choices of G include the inverse
of a Gaussian smoothing lter [16], eectively an innite order dierential
operator. In these cases where G is smooth and for large enough, the Hessian
of f will be positive denite, we can then deduce that f is a convex function [160,
ch 2], so that a critical point will be a strict local minimum, guaranteeing the
success of smooth optimization methods. Such regularization, however, will
prevent us from reconstructing conductivities with a sharp transition, such
as an organ boundary. However, the advantage of using a smooth objective
function f is that it can be minimized using smooth optimization techniques.
Another option is to include in G the total variation, i.e. the integral of
jrj. This still rules out wild uctuations in conductivity while allowing step
changes. We study this in more detail in section 1.6.
1.5.1.
Linearized problem
Consider the simplied case is where Fs is replaced by a linear approximation

Fs0 Js s0
Regularizing EIT
21
where J is the Jacobian matrix of F calculated at some initial conductivity

estimate s0 (not necessarily the same as sref ). Dening s s s0 and
V Vm Fs0 , the solution to the linearized regularization problem for
the choice of regularization in (1.10) (now a quadratic minimization
problem) is given by
s J J 2 L L1 J V 2 L Lsref s0
1:11
or any of the equivalent forms [149]. While there are many other forms of
regularization possible for a linear ill-conditioned problem, this generalized
Tikhonov regularization has the benet that (see Box 1.3) the a priori information it incorporates is made explicit and that under Gaussian assumptions
it is the statistically defensible MAP estimate. If only a linearized solution is
to be used with a xed initial estimate s0 , the Jacobian J and a factorization
of J J 2 L L can be precalculated o-line. The eciency of this calculation is then immaterial and the regularized solution can be calculated using
the factorization with complexity ON 2 for N degrees of freedom in the
conductivity (which should be smaller than the number of independent
measurements). Although LU factorization would be one alternative,
perhaps a better choice is to use the GSVD [72], which allows the regularized
solution to be calculated eciently for any value of . The GSVD is now a
standard tool for understanding the eect of the choice of the regularization
matrix L in a linear ill-conditioned problem, and has been applied to linearized EIT [16, 152]. The use of a single linearized Tikhonov regularized
solution is widespread in medical industrial and geophysical EIT, the
NOSER algorithm [35] being a well known example.
1.5.2.
Back-projection
It is an interesting historical observation that in the medical and industrial

applications of EIT numerous authors have calculated J, and then proceeded
to use ad hoc regularized inversion methods to calculate an approximate
solution. Often these are variations on standard iterative methods which, if
continued, would for a well posed problem converge to the MoorePenrose
generalized solution. It is a standard method in inverse problems to use an
iterative method but stop short of convergence (Morozovs discrepancy
principle tells us to stop when the output error rst falls below the measurement noise). Many linear iterative schemes can be represented as a lter on
the singular values. However, they have the weakness that the a priori
information included is not as explicit as in Tikhonov regularization. One
extreme example of the use of an ad hoc method is the method described
by Kotre [89], in which the normalized transpose of the Jacobian is applied
to the voltage dierence data. In the Radon transform used in x-ray CT
[113], the formal adjoint of the Radon transform is called the back-projection
operator. It produces at a point in the domain the sum of all the values
22
measured along rays through that point. Although not an inverse to the
Radon transform itself, a smooth image can be obtained by back-projecting
smoothed data, or equivalently by back-projecting then smoothing the
resulting image.
The Tikhonov regularization formula (1.11) can be interpreted in a loose
way as the back-projection operator J , followed by application of the spatial
lter J J 2 L L1 . Although this approach is quite dierent from the
ltered back-projection along equipotential lines of Barber and Brown [9,
130], it is sometimes confused with this in the literature. Kotres back-projection was until recently widely used in the process tomography community for
both resistivity (ERT) and permittivity (ECT) imaging [163], often supported
by fallacious arguments, in particular that it is fast (it is no faster than the
application of any precomputed regularized inverse) and that it is commonly
used (only by those who know no better). In an interesting development the
application of a normalized adjoint to the residual voltage error for the linearized problem was suggested for ECT, and later recognized as yet another reinvention of the well-known Landweber iterative method [162]. Although there
is no good reason to use pure linear iteration schemes directly on problems
with such a small number of parameters, as they can be applied much faster
using the SVD, an interesting variation is to use such a slowly converging
linear solution together with projection on to a constraint set; a method
which has been shown to work well in ECT [30].
1.5.3.
Iterative nonlinear solution
The use of linear approximation is only valid for small deviations from the
reference conductivity. In medical problems conductivity contrasts can be
large, but there is a good case for using the linearized method to calculate
a change in admittivity between two states, measured either at dierent
times or with dierent frequencies. Although this has been called dynamic
imaging in EIT the term dierence imaging is now preferred (dynamic
imaging is better used to describe statistical time series methods such as
[154]). In industrial ECT modest variations of permittivity are commonplace.
In industrial problems and in phantom tanks it is possible to measure a reference data set using a homogeneous tank. This can be used to calibrate the
forward model; in particular the contact impedance can be estimated [74].
In an in vivo measurement there is no such possibility, and it may be that
the mismatch between the measured data and the predictions from the
forward model is dominated by the errors in electrode position, boundary
shape and contact impedance rather than interior conductivity. Until these
problems are overcome it is unlikely, in the authors opinion, to be worth
using iterative nonlinear methods in vivo using individual surface electrodes.
Note, however, that such methods are in routine use in geophysical problems
[95, 96].
23
The essence of nonlinear solution methods is to repeat the process of

calculating the Jacobian and solving a regularized linear approximation.
However, a common way to explain this is to start with the problem of minimizing f , which for a well chosen G will have a critical point which is the
minimum. At this minimum rf s 0, which is a system of N equations
in N unknowns which can be solved by the multi-variable NewtonRaphson
method. The GaussNewton approximation to this, which neglects terms
involving second derivatives of F, is a familiar Tikhonov formula updating
the nth approximation to the conductivity parameters sn :
sn 1 sn Jn Jn 2 L L1 Jn Vm Fsn 2 L Lsref sn
where Jn is the Jacobian evaluated at sn , and care has to be taken with signs.
Notice that in this formula the Tikhonov parameter is held constant throughout the iteration. By contrast, the LevenbergMarquardt [110] method
applied to rf 0 would add a diagonal matrix
D in addition to the
regularization term 2 L L, but would reduce
to zero as a solution was
approached. For an interpretation of
as a Lagrangian multiplier for an
optimization constrained by a trust region, see [160, ch 3]. Another variation
on this family of methods is, given an update direction from the Tikhonov
formula, to do an approximate line search to minimize f in that direction.
Both methods are described in [160, ch 3].
The parameterization of the conductivity can be much more specic
than voxel values or coecients of smooth basis functions. One example is
to assume that the conductivity is piecewise constant on smooth domains
and reconstruct the shapes parameterized by Fourier series [73, 83, 86, 87]
or by level sets [34, 39, 49, 129]. For this and other model based approaches
the same family of smooth optimization techniques can be used as for simpler
parameterizations, although the Jacobian calculation may be more involved.
For inclusions of known conductivities there are a range of direct techniques
we shall briey survey in section 1.12.2.
1.6.
TOTAL VARIATION REGULARIZATION
The total variation (TV) functional is assuming an important role in the

regularization of inverse problems belonging to many disciplines, after its
rst introduction by Rudin et al [127] in the image restoration context.
The use of such a functional as a regularization penalty term allows the
reconstruction of discontinuous proles. As this is a desirable property,
the method is gaining popularity.
Total variation measures the total amplitude of the oscillations of a function. For a dierentiable function on a domain the total variation is [48]
TV f jrf j:
1:12
24
The denition can be extended to non-dierentiable functions [62] as
TV f sup
f div v
1:13
v2V
where V is the space of continuously dierentiable vector-valued functions

that vanish on @ and kvk 1.
As the TV functional measures the variations of a function over its
domain, it can be understood to be eective at reducing oscillations in the
inverted prole, if used as a penalty term. The same properties apply, however,
to l2 regularization functionals. The important dierence is that the class of
functions with bounded total variation also includes discontinuous functions,
which makes the TV particularly attractive for the regularization of nonsmooth proles. The following 1D example illustrates the advantage of
using the TV against a quadratic functional in non-smooth contexts.
Let F f f : 0; 1 ! R j f 0 a; f 1 bg, then we have:
. minf 2 F 01 j f 0 xj dx is achieved by any monotonic function, including

discontinuous
ones.
. minf 2 F 01 f 0 x2 dx is achieved only by the straight line connecting the

points 0; a and 1; b.
Figure 1.3 shows three possible functions f1 , f2 , f3 in F. All of them have the
same total variation, including f3 which is discontinuous. Only f2 , however,
minimizes the H 1 semi-norm
1 2 !1=2
@f
dx
:
1:14
j f jH 1
@x
0
Figure 1.3. Three possible functions: f1 , f2 , f3 2 F. All of them have the same TV, but only
f2 minimizes the H 1 semi-norm.
25
The quadratic functional, if used as a penalty, would therefore bias the

inversion towards the linear solution and the function f3 would not be
admitted in the solution set as its H 1 semi-norm is innite.
Two dierent approaches were proposed for application of TV to EIT,
the rst by Dobson and Santosa [65] and the second by Somersalo et al [141]
and Kolehmainen [88]. The approach proposed by Dobson and Santosa is
suitable for the linearized problem and suers from poor numerical eciency.
Somersalo and Kolehmainen successfully applied Markov Chain Monte
Carlo (MCMC) methods to solve the TV regularized inverse problem. The
advantage in applying MCMC methods over deterministic methods is that
they do not suer from the numerical problems involved with nondierentiability of the TV functional. They do not require ad hoc techniques.
Probabilistic methods, such as MCMC, oer central estimates and error bars
by sampling the posterior probability density of the sought parameters. The
sampling process involves a substantial computational eort: often the
inverse problem is linearized in order to speed up the sampling. What is
required is an ecient method for deterministic Tikhonov style regularization, to oer a nonlinear TV regularized inversion in a short time. We
will briey describe the primal dual interior point method (PDIPM) to TV
applied to EIT [14, 15], which is just such a method. In section 1.10 we
present some numerical results using this method for the rst time for
3D EIT.
A second aspect, which adds importance to the study of ecient MAP
(Tikhonov) methods, is that the linearization in MCMC methods is usually
performed after an initial MAP guess. Kolehmainen [88] reports calculating
several iterations of a Newton method before starting the burn-in phase of
his algorithm. A good initial deterministic TV inversion could therefore
bring benet to these approaches.
Examining the relevant literature, a variety of deterministic numerical
methods have been used for the regularization of image denoizing and
restoration problems with the TV functional (a good review is oered by
Vogel in [160]). The numerical eciency and stability are the main issues
to be addressed. Use of ad hoc techniques is common, given the poor performance of traditional algorithms. Most of the deterministic methods draw
from ongoing research in optimization, as TV minimization belongs to the
important classes of problems known as minimization of sum of norms
[4, 5, 41] and linear l1 problems [11, 165].
1.6.1.
Duality for Tikhonov regularized inverse problems
In inverse problems, with linear forward operators, the discretized TV

regularized inverse problem can be formulated as
P
min 12 kAx bk2 kL xk

x
1:15
26
where L is a discretization of the gradient operator. We will label it as the

primal problem. A dual problem to (P), which can be shown to be
equivalent [14], is
D
max min 12 kAx bk2 yT Lx:
y:kyk1
1:16
The optimization problem

min 12 kAx bk2 yT Lx
1:17
has an optimal point dened by the rst-order conditions

AT Ax b LT x 0:
1:18
Therefore the dual problem can be written as

D
max
y:kyk1
AT Axb LT y0
1
2 kAx
bk2 yT Lx:
1:19
The complementarity condition for (1.15) and (1.19) is set by nulling the
primal dual gap
1
2 kAx
bk2 kLxk 12 kAx bk2 yT Lx 0
1:20
which with the dual feasibility kyk 1 is equivalent to requiring that

Lx kLxky 0:
1:21
The PDIPM framework for the TV regularized inverse problem can thus be
written as
kyk 1
T
1:22a
T
A Ax b L y 0
1:22b
Lx kLxky 0:
1:22c
It is not possible to apply the Newton method directly to (1.22) as (1.22c) is

not dierentiable for Lx 0. A centring condition has to be applied, obtaining a smooth pair of optimization problems (P ) and (D ) and a central path
parameterized by . This is done by replacing kLxk by kLxk2 1=2 in
(1.22c).
1.6.2.
Application to EIT
The PDIPM algorithm in its original form [33] was developed for inverse
problems with linear forward operators. The following section (based
on [14]) describes the numerical implementation for EIT reconstruction.
The implementation is based on the results of the duality theory for inverse
problems with linear forward operators. Nevertheless it was possible to apply
the original algorithm to the EIT inverse problem with minor modications,
27
and to obtain successful reconstructions. The formulation for the EIT inverse
problem is
srec arg mins f s
f s 12 kFs Vm k2 TVs:
1:23
With a similar notation as used in section 1.6.1, the system of nonlinear equations that denes the PDIPM method for (1.23) can be written as
kyk 1
JT Fs Vm LT y 0
1:24
Ls Ey 0
p
2
with E diag jLi sj where Li is ithe row of L, and J the Jacobian of
the forward operator Fs. Newtons method can be applied to solve (1.24)
obtaining the following system for the updates s and y of the primal and
dual variables:
T

T
J J LT s
J Fs Vm LT y
1:25

y
Ls Ey
HL E
with
H I E1 diagyi Li s
1:26
which in turn can be solved as

JT J LT E 1 HL s JT Fs Vm LT E 1 Ls
1:27a
and
y y E 1 Ls E 1 HL s:
1:27b
Equations (1.27) can therefore be applied iteratively to solve the nonlinear

inversion (1.23). Some care must be taken on the dual variable update, to
maintain dual feasibility. A traditional line search procedure with feasibility
checks is not suitable as the dual update direction is not guaranteed to be an
ascent direction for the penalized dual objective function D . The simplest
way to compute the update is called the scaling rule [5], which is dened to
work as
yk 1
yk yk
1:28
maxf
:
kyk yk k 1g:
1:29
where
An alternative way is to calculate the exact step length to the boundary,
applying what is called the steplength rule [5]
yk 1 yk min1;
yk
1:30
28
where
maxf
: kyk
yk k 1g:
1:31
In the context of EIT, and in tomography in general, the computation

involved in calculating the exact step length to the boundary of the dual
feasibility region is negligible compared with the whole algorithm iteration.
It is convenient therefore to adopt the exact update, which in our experiments
resulted in a better convergence. The scaling rule has the further disadvantage of always placing y on the boundary of the feasible region, which
prevents the algorithm from following the central path. Concerning the
updates on the primal variable, the update direction s is a descent direction
for P ; therefore, a line search procedure could be opportune. In our
numerical experiments we have found that for relatively small contrasts
(e.g. 3 : 1) the primal line search procedure is not needed, as the steps are
unitary. For larger contrasts a line search on the primal variable guarantees
the stability of the algorithm.
1.7.
JACOBIAN CALCULATIONS
In optimization-based methods it is often necessary to calculate the derivative of the voltage measurements with respect to a conductivity parameter.
The complete matrix of partial derivatives of voltages with respect to
conductivity parameters is the Jacobian matrix, sometimes in the medical
and industrial EIT literature called the sensitivity matrix, or the rows are
called sensitivity maps. We will describe here the basic method for calculating this eciently with a minimal number of forward solutions. Let it be
said rst that there are methods where the derivative is calculated only
once, although the forward solution is calculated repeatedly as the conductivity is updated. This is the dierence between NewtonKantorovich
method and Newtons method. There are also quasi-Newton methods in
which the Jacobian is updated approximately from the forward solutions
that have been made. Indeed this has been used in geophysics [96]. It is
also worth pointing out that where the conductivity is parameterized in a
nonlinear way, for example using shapes of an anatomical model, the
Jacobian with respect to those new parameters can be calculated using the
chain rule.
1.7.1.
Perturbation in power
Using the weak form of r r 0 (or Greens identity), for any w
@
dS:
1:32
r rw dV
w
@n

@
29
We use the complete electrode model. For the special case w we have the
power conservation formula

X
@
@
@
2

dS
dS
1:33
jrj dV

V l zl

@n
@n
@n

@
El
l
hence
jrj dV
X
l
El

@ 2 X

Vl Il :
zl
@n
1:34
This simply states that the power input is dissipated either in the domain or
by the contact impedance layer under the electrodes.
In the case of full time harmonic Maxwells equations (Box 1.1) the
H. The complex power crosspower ux is given by the Poynting vector E
ing the boundary is then equal to the complex power dissipated and stored in
the interior (the imaginary part representing the power stored as electric and
magnetic energy)
H n dS E E i!H H dV
1:35
E
@
which generalizes (1.34).

1.7.2.
Standard formula for Jacobian
We now take perturbations ! , ! and Vl ! Vl Vl ,

with the current in each electrode Il held constant. We calculate the rstorder perturbation, and argue as in [28, 31] that the terms we have neglected
are higher order in the L1 norm on . The details of the calculation are
given for the complete electrode model case in [122]. The result is
X

Il Vl jrj2 dV:
1:36
This gives only the total change in power. To get the change in voltage
on a particular electrode Em when a current pattern is driven in some or all of
the other electrodes, we simply solve for the special measurement current
pattern I~lm lm . To emphasize the dependence of the potential on a
vector of electrode currents I I1 ; . . . ; IL we write I. The hypothetical
measurement potential is uIm ; by contrast the potential for the dth drive
pattern is Id . Taking the real case for simplicity and applying the power
perturbation formula (1.36) to Id Im and Id Im and then
subtracting gives the familiar formula
Vdm rId rIm dV:

1:37
30
While this formula gives the Frechet derivative for 2 L1 , considerable

care is needed to show that the voltage data is Frechet dierentiable in other
norms, such as those needed to show that the total variation regularization
scheme works [161]. For a nite dimensional subspace of L1 a proof
of dierentiability is given in [81].
For full time harmonic Maxwells equations the power conservation
formula (1.35) yields a sensitivity to a perturbation of admittivity exactly
as in (1.37), but the electric eld E is no longer a gradient and sensitivity
to a change in the magnetic permeability is given by H H [140].
In the special case of the Sheeld adjacent pair drive, adjacent pair
measurement protocol, we have potentials i for the ith drive pair and
voltage measurement Vij for a constant current I:
1
1:38
Vij 2 ri rj dV:
I
To calculate the Jacobian matrix one must choose a discretization of the
conductivity. The simplest case is to take the conductivity to be piecewise
constant on polyhedral domains such as voxels or tetrahedral elements.
Taking to be the characteristic function of the kth voxel k we have for
a xed current pattern
@Vdm
Jdm k

ruId rIm dV:
1:39
@k
k
Some EIT and capacitance tomography systems use a constant voltage
source and in this case the change in power of an increase in admittivity
will have the opposite sign to the constant current case.
A common variation in the case of real conductivity is to use the resistivity
1= as the primary variable, or more commonly to use log [10, 26, 155],
which has the advantage that it does not need to be constrained to be positive.
With a simple parameterization of conductivity as constant on voxels, g is
constant on voxels as well, for any function g. In this case from the chain rule
we simply use the chain rule, dividing the kth column of Jacobian we have calculated by g0 k . The regularization will also be aected by the change of variables.
Some iterative nonlinear reconstruction algorithms, such as nonlinear
Landweber, or nonlinear conjugate gradient (see section 1.8.3 and [160])
require the evaluation of transpose (or adjoint) of the Jacobian multiplied
by a vector J z. For problems where the Jacobian is very large it may be
undesirable to store the Jacobian and then apply its transpose to z. Instead
the block of zi corresponding to the ith current drive is written as distributed
source on the measurement electrodes. A forward solution is performed with
this as the boundary current pattern so that when this measurement eld is
combined with the eld for the drive pattern as (1.39), this block accumulates
to give J z. For details of this applied to diuse optical tomography see [6],
and for a general theory of adjoint sources see [160].
Box 1.4.
31
Sensitivity to a localized change in conductivity
Studying the change in voltage from a small localized change in conductivity is a useful illustration of EIT. Suppose we x a current pattern,
and a background conductivity of , which results in a potential . Now
consider a perturbed conductivity which results in a potential,
with the same current drive, . From r r 0
we see that
r r r r r r 0:
The same procedure used to calculate the Jacobian can be used to show
that the last term is O 2 so that to rst order
r r r r:
Now for simplicity take 1 and we have the Poisson equation for :
r2 r r:
If we now take to be a small change, constant on a small ball near some
point p, then the source term in this Poisson equation approximates a
dipole at p whose strength and direction is given by r. Observing at
the boundary we see it as a dipole eld from which a line through p can
be estimated by eye. This goes some way to explain the ease with which
one small object can be located, even with only a small number of current
patterns. It also illustrates the depth dependence of the sensitivity as the
dipole eld decays with distance, even if the electric eld is relatively
uniform. Typically the electric eld strength is also closer to the boundary.
This continuum argument is paralleled in Yorkeys compensation
method in resistor networks [164]. A resistor in a network is changed
and Yorkey observes that to rst order the change in voltage at each
point in the network is equivalent to the voltage which would result if
a current source were applied in parallel with that resistor.
The potential due to a dipole source at the centre of a homogeneous disk.
32
For fast calculation of the Jacobian using (1.39) one can precompute
the integrals of products of nite element (FE) basis functions over
elements. If non-constant basis functions are used on elements, or higher
order elements are used, one could calculate the product of gradients of
FE basis functions at quadrature points in each element. As this depends
only on the geometry of the mesh and not the conductivity, this can be
precomputed unless one is using an adaptive meshing strategy. The same
data is used in assembling the FE system matrix eciently when the conductivity has changed but not the geometry. It is these factors particularly
which make current commercial FE method software unsuitable for use in
an ecient EIT solver.
1.8.
SOLVING THE FORWARD PROBLEM: THE FINITE

ELEMENT METHOD
To solve the inverse problem one needs to solve the forward problem for some
assumed conductivity so that the predicted voltages can be compared with the
measured data. In addition, the interior electric elds are usually needed for
the calculation of a Jacobian. Only in cases of very simple geometry, and
homogeneous or at least very simple conductivity, can the forward problem
be solved analytically. These can sometimes be used for linear reconstruction
algorithms on highly symmetric domains. Numerical methods for general
geometry and arbitrary conductivity require the discretization of both the
domain and the conductivity. In the nite element method (FEM), the 3D
domain is decomposed in to (possibly irregular) polyhedra (e.g. tetrahedra,
prisms or hexahedra) called elements, and on each element the unknown
potential is represented by a polynomial of xed order. Where the elements
intersect they are required to intersect only in whole faces or edges or at
vertices, and the potential is assumed continuous (or derivatives up to a certain
order continuous), across faces. The FEM converges to the solution (or at least
the weak solution) of the partial dierential equation it represents, as the
elements become more numerous (provided their interior angles remain
bounded) or as the order of the polynomial is increased [146].
The nite dierence method and nite volume method are close relatives
of the FEM, which use regular grids. These have the advantage that more
ecient solvers can be used at the expense of the diculty in accurately representing curved boundaries or smooth interior structures. In the boundary
element method (BEM) only surfaces of regions are discretized, and an
analytical expression for the Green function is used within enclosed volumes
that are assumed to be homogeneous. BEM is useful for EIT forward modelling provided one assumes piecewise constant conductivity on regions with
smooth boundaries (e.g. organs). BEM results in a dense rather than a
sparse linear system to solve, and its computational advantage over FEM
Solving the forward problem: the nite element method
33
diminishes as the number of regions in the model increases. BEM has the
advantage of being able to represent unbounded domains. A hybrid
method where some regions assumed homogeneous are represented by
BEM, and inhomogeneous regions by FEM, may be computationally
ecient for some applications of EIT [134].
In addition to the close integration of the Jacobian calculation and the
FEM forward solver, another factor which leads those working on EIT
reconstruction to write their own FEM programme for the complete
electrode model (CEM) is a non-standard type of boundary condition not
included in commercial FEM software. It is not hard to implement and
there are freely available codes [122, 157], but it is worth covering the basic
theory here for completeness. A good introduction to FEM in electromagnetics is [138], and details of implementation of the CEM can be
found especially in the theses [123, 155].
1.8.1.
Basic FEM formulation
Our starting point is to approximate the domain as union of a nite

number of elements k , which for simplicity we will take to be simplices. In
two dimensions a simplex is a triangle and in three dimensions a tetrahedron.
A collection of such simplices is called a nite element mesh, and we will
suppose that there are K simplices with N vertices. We will approximate
the potential using this mesh by functions which are linear on each simplex,
and continuous across the faces. These functions have the appealing feature
that they are completely determined by their values at the vertices. A natural
basis is the set of functions wi that are one on vertex i and zero at the other
vertices, and we can represent the potential by the approximation
FEM x
N
X
i wi x
1:40
i1
so that 1 ; . . . ; n T 2 CN is a vector which represents our discrete

approximation to the potential.
As our basis functions wi are not dierentiable, we cannot directly
satisfy (1.1). Instead we derive the weak form of the equation. Multiplying
(1.1) by some function v and integrating over ,
v r r dV 0 in
1:41
and we demand that this vanishes for all functions v in a certain class. Clearly
this is weaker than assuming directly that r r 0.
Using Greens second identity and the vector identity
r v r r rv vr r
1:42
34
equation (1.41) is changed to
r v r dV r rv dV 0:
1:43
Invoking the divergence theorem
r v r dV
v r n dS
1:44
@
gives
r rv dV
r nv dS
r nv dS
1:45
@
S
where l El is the union of the electrodes, and we have used the fact that
the current density is zero o the electrodes. For a given set of test functions
v, (1.45) is the weak formulation of the boundary value problem for (1.1)
with current density specied on the electrodes.
Rearranging the boundary condition (1.6) as
r n
1
V
zl l
on El for zl 6 0 and incorporating it into (1.45) gives
L
X
1
r rv dV
Vl v dS:
z

l 1 El l
1:46
1:47
In the nite element method weP

use test functions from the same family
used to approximate potentials v N
i 0 vi wi ; substitution of this and FEM
for gives for each i
N
L
X
X
1
rwi rwj dV j
wi wj dS j

E l zl
j1
l1
L
X
1
wi dS Vl 0:
El z l
l1
Together with the known total current
N
X
1
1
1
Vl dS
Vl
wi dS i
Il
El z l
El z l
El z l
i
and if we assume zl is constant on El this reduces to
N
1
1X
wi dS i
Il jEl jVl
zl
zl i
El
1:48
1:49
1:50
where jEl j is the area (or in two dimensions, length) of the lth electrode.
35
We now need to choose how to approximate , and a simple method is

to choose to be constant on each simplex [piecewise constant (PWC)]. The
characteristic function j is one on the jth simplex and zero elsewhere, so we
have an approximation to
k
X
PWC
j j
1:51
j 1
which has the advantage that the j can be taken outside of an integral over
each simplex. If a more elaborate choice of basis is used it would be wise to
use a higher-order quadrature rule.
Our FE system equations now take the form

0
AM AZ AW
1:52
T
V
I
AW
AD
where AM is an N N symmetric matrix
K
X
k
AM;ij rwi rwj dV
k1
k
rwi rwj dV
1:53
which is the usual system matrix for (1.1) without boundary conditions, while
L
X
1
wi wj dS
1:54
AZ;ij
z
l 1 El l
1
AW;ij
w dS
1:55
z l El i
and

jEl j
AD diag
1:56
zl
implement the CEM boundary conditions. One additional constraint is
required as potentials are only dened up to an added constant. One elegant
choice is to change the basis used for the vectors V and I to a basis for the
subspace S orthogonal to constants, for example the vectors

T
1
1
1
1
;...;
; 1;
;...;
1:57
L1
L1
L1
L1
while another choice is to ground an arbitrary vertex i by setting i 0. The
resulting solution can then have any constant added to produce a dierent
grounded point.
As the contact impedance decreases the system, (1.52) becomes illconditioned. In this case (1.6), in the CEM can be replaced by the shunt
model, which simply means the potential is constrained to be constant on
each electrode. This constraint can be enforced directly replacing all nodal
voltages on electrode El by one unknown Vl .
36
It is important for EIT to notice that the conductivity only enters in the
system matrix as linear multipliers of
sijk
rwi rwj dV jk jrwi rwj
k
which depend only on the FE mesh and not on . These coecients can be
pre-calculated during the mesh generation, saving considerable time in the
system assembly. An alternative is to dene a discrete gradient operator
D : CN ! C3K , which takes the representation as a vector of vertex values
of a piecewise linear function to the vector of r on each simplex (on
which of course the gradient is constant). On each simplex dene
k k =jk jI3 , where I3 is the 3 3 identity matrix, or for the anisotropic
case simply the conductivity matrix on that simplex divided by its volume,
and diagk IK . We can now use
AM DT D
1:58
to assemble the main block of the system matrix.

1.8.2.
Solving the linear system
We now consider the solution of the system (1.52). The system has the
following special features. The matrix is sparse: the number of nonzeros in
each row of the main block depends on the number of neighbouring verticies
connected to any given vertex by an edge. It is symmetric (for complex
conductivity and contact impedance that means real and imaginary parts
are symmetric), and the real part is positive denite. In addition, we have
multiple right-hand sides for the same conductivity, and we wish to solve
the system repeatedly for similar conductivities.
A simple approach to solving Ax b is LU-factorization [66], where an
upper triangular matrix U and lower triangular matrix L are found such that
A LU. As solving a system with a diagonal matrix is trivial, one can solve
Lu b (forward substitution) and then Ux u (backward substitution). The
factorization process is essentially Gaussian elimination and has a computational cost On3 , while the backward and forward substitute have a cost
On2 k for k right-hand sides. An advantage of a factorization method
such as this is that one can apply the factorization to multiple right-hand
sides, in our case for each current pattern. Although the system matrix is
sparse, the factors are in general less so. Each time a row is used to eliminate
the nonzero elements below the diagonal it can create more nonzeros above
the diagonal. As a general rule it is better to reorder the variables so that rows
with more nonzeros are farther down the matrix. This reduces the ll in of
nonzeros in the factors. For a real symmetric or Hermitian matrix the
symmetric multiple minimum degree algorithm [55] reduces ll in, whereas
the column multiple minimum degree algorithm is designed for the general
Box 1.5.
37
FEM as a resistor network
It may help to think of the nite element method in terms of resistor

networks. For the case we have chosen with piecewise linear potentials
on simplicial cells and conductivity constant on cells there is an exact
equivalence [138]. To construct a resistor network equivalent to such
an FEM model, replace each edge by a resistor. To determine the
conductance of that resistor consider rst a triangle (in the 2D case),
and number the angles j opposite the jth side. The resistor on side j
has a conductance cot i . When the triangles are assembled into a
mesh the conductances add in parallel, summing the contribution
from triangles both sides of an edge. In the 3D case j is the angle
between the two faces meeting at the edge opposite edge j, and of
course several tetrahedra can meet at one edge.
Conductance 1 cot 1 2 cot 2 =2
The corresponding resistor network for a 2D FEM mesh.
With a resistor mesh assembled in this way, voltages i at vertex i are

governed by Ohms law and Kirchhos law, and the resulting system
of equations is identical to that derived from the FEM. The situation
is not reversible as not all resistor networks are the graphs of edges of
a 2D or 3D FE mesh. Also some allocation of resistances do not correspond to a piecewise constant isotropic conductivity. For example, there
may be no consistent allocation of angles j so that around any given
vertex (or edge in 3D) they sum to 2 .
The question of uniqueness of solution, as well as the structure of
the transconductance matrix for real planar resistor networks, is well
understood [42, 43].
case. For an example see gure 1.4. The renumbering should be calculated
when the mesh is generated so that it is done only once.
For large 3D systems direct methods can be expensive and iterative
methods may prove more ecient. A typical iterative scheme has a cost of
On2 k per iteration and requires fewer than n iterations to converge. In
fact the number of iterations required needs to be less than Cn=k for some
38
Figure 1.4. Top left: the sparsity pattern of a system matrix which is badly ordered for llin. Bottom left: sparsity pattern for the U factor. On the right, the same after reordering
with colmmd.
C depending on the algorithm to win over direct methods. Often the number
of current patterns driven is limited by hardware to be small, while the
number of vertices in a 3D mesh needs to be very large to accurately
model the electric elds, and consequently iterative methods are often
preferred in practical 3D systems. The potential for each current pattern
can be used as a starting value for each iteration. As the adjustments in
the conductivity become smaller this reduces the number of iterations
required for forward solution. Finally it is not necessary to predict the
voltages to full oating point accuracy when the measurements system
itself is far less accurate than this, again reducing the number of iterations
required.
The convergence of iterative algorithms, such as the conjugate gradient
method (see section 1.8.3), can be improved by replacing the original system
39
by PAx Pb for some matrix P which is an approximation to the inverse of

A. A favourite choice is to use an approximate LU-factorization to derive P.
In EIT one can use the same preconditioner over a range of conductivity
values.
1.8.3.
Conjugate gradient and Krylov subspace methods
The conjugate gradient (CG) method [18, 66] is a fast and ecient method for
solving Ax b for real symmetric matrices A or Hermitian complex
matrices. It can also be modied for complex symmetric matrices [29]. The
method generates a sequence xi (iterates) of successive approximations to
the solution and residuals ri b Axi , and search directions pi and
qi Api used to update the iterates and residuals. The update to the iterate
is
xi xi 1 i pi
1:59
where the scalar i is chosen to minimize

r A1 r
1:60
where r ri 1 ri 1 explicitly, and

i
kri 1 k2
:
pi Api
1:61
The search directions are updated by

pi r i i 1 pi 1
1:62
where using
i
kri k2
kri 1 k2
1:63
ensures that pi are orthogonal to all Apj and ri are orthogonal to all rj , for
j < i. The iteration can be terminated when the norm of the residual falls
below a predetermined level.
Conjugate gradient least squares (CGLS) method solves the least
squares problem (1.7) AT Ax AT b without forming the product AT A
(also called CGNR or CGNE conjugate gradient normal equations [18, 32])
and is a particular case of the nonlinear conjugate gradient (NCG) algorithm
of Fletcher and Reeves [52] (see also [160, ch 3]). The NCG method seeks a
minimum of cost functions f x 12 kb Fxk2 , which in the case of CGLS
is simply the quadratic 12 kb Axk2 . The direction for the update in (1.59) is
now
pi rf xi Ji b Fxi
1:64
40
where Ji F 0 xi is the Jacobian. How far along this direction to go is determined by

i arg min >0 f xi 1 pi
1:65
which for non-quadratic f requires a line search.

CG can be used for solving the EIT forward problem for real conductivity, and has the advantage that it is easily implemented on parallel
processors. Faster convergence can be used using a preconditioner, such as
an incomplete Cholesky factorization, chosen to work well with some predened range of conductivities. For the non-Hermitian complex EIT forward
problem, and the linear step in the inverse problem, other methods are
needed. The property of orthogonal residuals for some inner product
(Krylov subspace property) of CG is shared by a range of iterative methods.
Relatives of CG for non-symmetric matrices include generalized minimal
residual (GMRES) [128], bi-conjugate gradient (BiCG), quasi-minimal
residual (QMR) and bi-conjugate gradient stabilized (Bi-CGSTAB). All
have their own merits [18] and, as implementations are readily available,
have been tried to some extent in EIT forward or inverse solutions. Not
much [68, 97] is published, but applications of CG itself to EIT
include [108, 116, 121, 124] and to optical tomography [6, 7]. The application
of Krylov subspace methods to solving elliptic PDEs as well as linear inverse
problems [32, 70] are active areas of research, and we invite the reader to seek
out and use the latest developments.
1.8.4.
Mesh generation
Mesh generation is a major research area in itself, and poses particular

challenges in medical EIT. The mesh must be ne enough to represent the
potential with sucient accuracy to predict the measured voltages as a function of conductivity. In medical EIT this means we must adequately represent
the surface shape of the region to be images, and the geometry of the
electrodes. The mesh needs to be ner in areas of high eld strength and
this means in particular near the edges of electrodes. Typically there will
be no gain in accuracy from using a mesh in the interior which is as ne.
As we are usually not interested so much in conductivity changes near the
electrodes, and in any case we cannot hope to resolve conductivity on a
scale smaller than the electrodes, our parameterization of the conductivity
will inevitably be coarser than the potential. One easy option is to choose
groups of tetrahedra as voxels for conductivity; another is to use basis functions interpolated down to the FE mesh. If there are regions of known
conductivity, or regions where the conductivity is known to be constant,
the mesh should respect these regions. Clearly the electric eld strengths
will vary with the current pattern used, and it is common practice to use a
mesh which is suitable for all current patterns, which can mean that it
Figure 1.5.
41
A mesh generated by NETGEN for a cylindrical tank with circular electrodes.
would be unnecessarily ne away from excited electrodes. The trade-o is

that the same system matrix is used for each current pattern.
Any mesh generator needs to have a data structure to represent the
geometry of the region to be meshed. This includes the external boundary
shape, the area where the electrodes are in contact with the surface and
any internal structures. Surfaces can be represented as a triangularization,
by more general polygons, or by spline patches. The relationship between
named volumes, surface curves and points must also be maintained, usually
as a tree or incidence matrix. Simple geometric objects can be constructed
from basic primitive shapes, either with a graphical user interface or from
a series of commands in a scripting language. Set theoretic operations such
as union and intersection can be performed together with geometric operations such as extrusion (e.g. a circle into a cylinder).
As each object is added consistency checks are performed and incidence
data structures maintained. For general objects these operations require
dicult and time consuming computational geometry.
For examples of representations of geometry and scripting languages see
the documentation for QMG [158], NETGEN [132] and FEMLAB [36].
Commercial FE software can often import geometric models from
computer aided design programs, which makes life easier for industrial applications. Unfortunately human bodies are not supplied with blueprints from
their designer. The problem of creating good FE meshes of the human body
remains a signicant barrier to progress in EIT, and of course such progress
would also benet other areas of biomedical electromagnetic research. One
approach [13] is to segment nuclear magnetic resonance or x-ray CT
images and use these to develop an FE mesh specic to an individual subject.
42
Another is to warp a general anatomical mesh to t the external shape of the

subject [59], measured by some simpler optical or mechanical device.
Once the geometry is dened, one needs to create a mesh. Mesh generation software generally use a combination of techniques such as advancing
front, octtree [159] and bubble-meshing [137]. In a convex region, given a
collection of vertices, a tetrahedral mesh of their convex hull can be found
with the Delaunay property that notes trahedron contains any vertex in
the interior of its circumsphere, using the QuickHull algorithm [8].
The standard convergence results for the FEM [146] require that, as the
size of the tetrahedra tend to zero, the ratio of the circumscribing sphere to
inscribing sphere is bounded away from zero. In practice this means that for
an isotropic medium without a priori knowledge of the eld strengths tetrahedra which are close to equilateral are good, and those with a high aspect ratio
are bad. Mesh generators typically include methods to smooth the mesh. The
simplest is jiggling, in which each interior vertex in turn is moved to the centre
of mass of the polyhedron dened by the verticies with which it shares an edge
(its neighbours). This can be repeated for some xed number of iterations or
until the shape of the elements ceases to improve. Jiggling can be combined
with removal of edges and swapping faces which divide polyhedra into two
tetrahedra. In EIT, where the edges of electrodes and internal surfaces need
to be preserved, this process is more involved.
1.9.
MEASUREMENT STRATEGY
In EIT we seek to measure some discrete version of or 1

. We can choose
the geometry of the system of electrodes, the excitation pattern and the
measurements that are made. We have to strike a balance between the
competing requirements of accuracy, speed and simplicity of hardware.
Once a system of electrodes of L has been specied the complete relationship between current and voltage at the given frequency is summarized by the
transfer impedance matrix Z 2 CL L . The null space of Z is spanned by the
constant vector 1, and for simplicity we set the sum of voltages also to be
zero, Z1 0, so that Z is symmetric, Z ZT (note transpose, not conjugate).
1.9.1.
Linear regression
We will illustrate the ideas mainly using the assumption that the currents are
prescribed and the voltages are measured, although there are systems which do
the opposite. In this approach we regard the matrix of voltage measurements
to be contaminated by noise, while the currents are known accurately. This
should be compared with the familiar problem of linear regression where we
aim to t a straight line to experimental observations. Assuming a relationship
of the form y ax, we will assume an intercept of zero and mean x of zero.
43
The abscissae xi are assumed accurate and the yi contaminated with noise.
Assembling the xi and yi into row vectors x and y, we estimate the slope a by
a^ arg mina ky axk2 :
1:66
Of course the solution is a yx , another way of expressing the usual regression formulae. The least squares approach can be justied statistically [112].
Assuming the errors in y have zero correlation, a^ is an unbiased estimator for
a. Under the stronger assumption that the yi are independently normally
distributed with identical variance, a^ is the maximum likelihood estimate
of a, and is normally distributed with mean a. Under these assumptions we
can derive condence intervals and hypothesis testing for a [112, p 14].
Although less well known, linear regression for several independent
variables follows a similar pattern. Now X and Y are matrices and we seek
^ YX has the same
a linear relation of the form Y AX. The estimate A
desirable statistical properties as the single variable case [112, ch 2].
Given a system of K current patterns assembled in a matrix I 2 CL K
(with column sums zero), we measure the corresponding voltages as V ZI.
Assuming the currents are accurate but the voltages contain error, we then
^ VI . If we have two few linearly independent currents
obtain our estimate Z
of rank I < L 1, then this will be an estimate of a projection of Z on to a
subspace, and if we have more than L 1 current patterns then the generalized
^ . Similarly we
inverse averages over the redundancy, reducing the variance of Z
ML
can make redundant measurements. Let M 2 R
be a matrix containing the
measurement patterns used (for simplicity the same for each current pattern),
so that we measure VM MV. For simplicity we will assume that separate
electrodes are used for drive and measurement, so there is no reciprocity in
the data. Our estimate for Z is now M VM I . For a thorough treatment of
the more complicated problem of estimating Z for data with reciprocity see
[46]. In both cases redundant measurements will reduce variance. Of course it
is common practice to take multiple measurements of each voltage, and the
averaging of these may be performed within the data acquisition system
before it reaches the reconstruction programme. In this case the eect is
identical to using the generalized inverse. The benet in using the generalized
inverse is that it automatically averages over redundancy where there are
multiple linearly dependent measurements. If quantization in the analogueto-digital converter (ADC) is the dominant source of error, averaging over
dierent measurements reduces the error, in a similar fashion to dithering
(adding a random signal and averaging) to improve the accuracy of an ADC.
Some EIT systems use variable gain ampliers before voltage measurements
are passed to the ADC. In this case the absolute precision varies between
measurements and a weighting must be introduced in the norms used to
dene the least squares problem.
For the case where the voltage is accurately controlled and the current
measured, an exactly similar argument holds for estimating the transfer
44
admittance matrix. However, where there are errors in both current and
voltage, for example caused by imperfect current sources, a dierent estimation procedure is required. What we need is multiple correlation analysis [112,
p 82] rather than multiple regression.
One widely used class of EIT systems which use voltage drive and
current measurement are ECT systems used in industrial process
monitoring [30]. Here each electrode is excited in turn with a positive voltage
while the others are at ground potential. The current owing to ground
through the non-driven electrode is measured. Once the voltages are adjusted
to have zero mean this is equivalent to using the basis (1.57) for YjS .
We know that feasible transfer impedance matrices are symmetric, and
^ by
so employ the orthogonal projection on to the feasible set and replace Z
T
1
^
sym Z where sym A 2 A A . This is called averaging over reciprocity
error. The skew-symmetric component of the estimated Z gives an indication
of errors in the EIT instrumentation.
1.9.2. Sheeld measurement protocol
The space of contact impedances is a subset of the vector space of symmetric
L L matrices with column and row sums zero, which has dimension
LL 1=2. In addition the real part of ZjS is positive denite, otherwise
there would be direct current patterns which dissipate no power. There are
other conditions on Z, given in the plane case by [42], associated with
being connected, and it is shown in the planar case that the set of feasible
Z is an open subset of the vector space described above. This conrms that
we can measure up to LL 1=2 independent parameters. Some systems,
however, measure fewer than this, primarily to avoid measuring voltage on
actively driven electrodes.
The Sheeld mark I and II systems [12] use a protocol with L 16 electrodes which are typically arranged in a circular pattern on the subject. Adjacent
pairs El and El 1 are excited with equal and opposite currents, for L ranging
from 1 to L 1. These can be assembled into a matrix IP 2 RL L 1 with
lk lk 1 in the lk position. Clearly the columns of IP span S. Measurements
are made similarly between adjacent pairs and IPT gives the measurement
patterns so that the matrix of all possible voltages measured is ZP IPT ZIP , a
symmetric L 1 L 1 matrix of full rank. However, when the lth electrode pair is excited, the measurement pairs l 1, l and l 1 are omitted
(indices are assumed to wrap around when out of range). The subset of ZP
which is actually measured by the Sheeld system is shown in gure 1.6 and
a simple counting argument shows that the number of independent measurements is L 2L 1=2 1 LL 3=2, or 104 for L 16.
In practice a Sheeld mark I or II system aiming at speed rather than
accuracy measures a non-redundant set of exactly 104 measurements. For
the rst two drive patterns all 13 patterns are measured, and for subsequent
45
Figure 1.6. Each column corresponds to a drive pair and each row to a measurement pair.
A l indicates a measurement that is taken and a k one which is omitted.
drives one less is measured each time. If reciprocity error is very small this is
an acceptable strategy.
A pair drive system has the advantage that only one current source is
needed, which can then be switched to each electrode pair. With a more
complex switching network other pairs can be driven at the expense of
higher system cost and possibly a loss of accuracy. A study of the dependence
of the SVD of the Jacobian for dierent separations between driven electrodes
can be found in [25].
One feature of the Sheeld protocol is that on a 2D domain the adjacent
voltage measurements are all positive. This follows as the potential itself is
monotonically decreasing from source to sink. The measurements also
have a U-shaped graph for each drive. This provides an additional feasibility
check on the measurements. Indeed if another protocol is used, Sheeld data
ZP can be synthesized to employ this check.
1.9.3.
Optimal drive patterns
The problem of optimizing the drive patterns in EIT was rst considered by
Seagar [133], who calculated the optimal placing of a pair of point drive electrodes on a disk to maximize the voltage dierences between the measurement
of a homogeneous background and an oset circular anomaly. Isaacson [78]
and Gisser et al [60] argued that one should choose a single current pattern
to maximize the L2 norm of the voltage dierence between the measured Vm
and calculated Vc voltages constraining the L2 norm of the current patterns
in a multiple-drive system. This is a simple quadratic optimization problem
Iopt arg minI 2 S
kVm Vc Ik
kIk
1:67
46
to which the answer is that Iopt is the eigenvector of jZm Zc j corresponding

to the largest eigenvalue (here jAj A A1=2 ). One can understand this
eigenvector to be a current pattern which focuses the dissipated power in
the regions where actual and predicted conductivity diers most. If one is
to apply only one current pattern then in a particular sense this is best.
The eigenvectors for smaller eigenvalues are increasingly less useful for
telling these two conductivities apart and one could argue that eigenvectors
for eigenvalues which are smaller than the error in measurement contain no
useful information. In [60] it is argued that the eigenvector for this eigenvalue
can be found experimentally using the power method, a classical xed-point
algorithm for numerically nding an eigenvector.
Later the authors of [61] used a constraint on the maximum dissipated
power in the test object which results in the quadratic optimization problem
Iopt arg minI 2 S
kVm Vc Ik
kVm Ik
1:68
which is a generalized eigenvalue problem. The argument here is that the

dissipated (and stored) power should be limited in a medical application,
rather than the rather articial constraint of sum of squares of current.
Optimal current patterns can be incorporated in iterative reconstruction
algorithms, at each iteration the optimal current pattern to distinguish
between the actual and conductivity and the latest approximation can be
applied, and the voltage data from this pattern is used in the next iterative
update. As the current pattern used will change at each iteration eventually
all the information in Zm will be used. Alternatively, more than one of the
eigenvectors of jZm Zc j can be used, provided the resulting voltage dierences are above the noise level. In practice this method is an improvement
over pair drives even for simulated data [27].
Driving current patterns in eigenvectors requires multiple programmable
current sources with a consequent increase in cost and complexity. There is
also the possibility that a pair drive system could be made with suciently
better accuracy, which counteracts the advantage of a multiple-drive system
with optimal patterns. Even neglecting the errors in measurement, there is
numerical evidence [26] that using optimal currents produces better reconstructions on synthetic data. In this respect one can also use synthetic optimal
voltage patterns [118].
The framework used to dene optimal current patterns is the ability to
distinguish between two transfer impedance matrices. In the context of
reconstruction algorithms, we can use an inability to distinguish between
Zc and Zm to measurement accuracy as a stopping criterion for an iterative
algorithm. In another context we can consider hypothesis testing, in the
classical statistical sense. As an example suppose we have reconstructed an
EIT image of a breast that shows a small anomaly in a homogeneous backgroundperhaps a tumour. We can test the hypothesis that Vm Vc and I
Numerical examples
47
are not linearly related, i.e. the null hypothesis H0 : Zm Zc 0, which can
be tested using a suitable statistic with an F-distribution [112, p 133]. If only
one current normalized pattern is used the optimal current will give a test
with the greatest power. In the statistical terminology, power is the conditional probability, so we reject the hypothesis H0 given that it is false.
Kaipio et al [82] suggest choosing current patterns that minimize the total
variance of the posterior. In this Bayesian framework the choice of optimal
current patterns depends on the prior and a good choice will result in a tighter
posterior. Demidenko et al [47] consider optimal current patterns in the framework conventional optimal design of experiments, and dene an optimal set of
current patterns as one that minimizes the total variance of Z.
Eyoboglu and Pilkington [51] argued that medical safety legislation
demanded that one restricts the maximum total current entering the body,
and if this constraint was used the distinguishability is maximized by pair
drives. Cheney and Isaacson [38] study a concentric anomaly in a disk,
using the gap model for electrodes. They compare trigonometric, Walsh
and opposite and adjacent pair drives for this case giving the dissipated
power, as well as the L2 and power distinguishabilities. Koksal and
Eyoboglu [85] investigate the concentric and oset anomaly in a disk using
continuum currents. Further study of optimization of current patterns
with respect to constraints can be found in [93].
1.10.
NUMERICAL EXAMPLES
In this section we exhibit some numerical examples to illustrate points made

elsewhere in the text. The forward simulations are done on modest meshes, so
that readers may repeat the experiments themselves without excessive
computational requirements. It is not our intention to present these results
Figure 1.7. Mesh used for potentials in reconstruction. A coarser mesh, of which this is a
subdivision, was used to represent the conductivity.
48

(a)
(b)
(c)
Figure 1.8. (a) Original smooth conductivity distribution projected onto the coarser mesh
(Mayavi surface map). (b) Smoothly regularized GaussNewton reconstruction of this
smooth conductivity. (c) TV regularized PDIPM reconstruction of the same smooth
conductivity.
Numerical examples
49
as state of the art, although we do intend to indicate that the use of a 3D

forward model and CEM boundary conditions should be a minimal starting
point for testing EIT reconstruction algorithms, so that they have a chance of
tting experimental data. In addition to the smoothly regularized Gauss
Newton method of section 1.5.3, we also exhibit PDIPM for solution of
the TV regularized problem of section 1.6to our knowledge the rst such
results for 3D EIT.
The simulated data, using a ner mesh than that used for reconstruction,
models a cylinder with 28 rectangular electrodes on the curved side
(gure 1.7). First we reconstruct a smooth conductivity of the form
x; y; z 3 x y 10z (gure 1.8). Of course, using a smoothing prior
to this is relatively easy to recover. The reconstruction, using a coarser
mesh, is the standard regularized GaussNewton using an approximation
to the Laplacian for L, very similar to the examples in the EIDORS 3D
code [122]. The results of the reconstruction are shown in gure 1.8. The
reconstruction was also performed with TV regularization using the
PDIPM code of Borsic [14]. The results (gure 1.8(c)) exhibit the characteristic blocky image which reects the prior distribution inherent in TV
regularization.
By contrast, a test object consisting of two homogeneous spheres of
higher conductivity (gure 1.9) was reconstructed with both smooth and
TV regularization (gure 1.10). The TV regularization is clearly superior at
recovering the jump change in conductivity.
The reconstructions in this section were performed with synthetic
data with Gaussian pseudo-random noise. The reconstructions degraded
signicantly when the standard deviation of the noise went above 1% or
the 2-norm of the vector of voltage measurements.
Figure 1.9. Electrodes, mesh and two spheres test object. The test object consisted of
two spheres of conductivity 1 in a background of 3. An unrelated ner mesh was used
to generate the simulated data.
50
(a)
(b)
Figure 1.10. Reconstruction of a two-spheres test object from gure 1.9 using regularized
GaussNewton and TV PDIPM. (a) Regularized GaussNewton reconstruction, shown
using cut-planes. (b) Total variation reconstruction from PDIPM.
1.11.
COMMON PITFALLS AND BEST PRACTICE
The ill-posed nature of inverse problems means that any reconstruction

algorithm will have limitations on what images it can accurately reconstruct,
and the images will degrade with noise in the data. When developing a reconstruction algorithm it is usual to test it initially on simulated data. Moreover,
the reconstruction algorithms typically incorporates a forward solver. A
natural rst test is to use the same forward solver to generate simulated
data with no simulated noise and to then nd to ones delight that the
simulated conductivity can be recovered fairly well, the only diculties
arising if it violates the a priori assumptions built into the reconstruction
and the limitations of oating point arithmetic. Failure of this basic test is
used as a diagnostic procedure for the programme. On the other hand, claiming victory for ones reconstruction algorithm using these data is what is
Common pitfalls and best practice
51
slightly jokingly called an inverse crime [44, p 133] (by analogy with the
variational crimes in FEM perhaps). We list a few guidelines to avoid
being accused of an inverse crime and to lay out what we believe to be best
practice. For slightly more details see [94].
1. Use a dierent mesh. If you do not have access to a data collection system
and phantom tank, or if your reconstruction code is at an early stage of
development, you will want to test with simulated data. To simulate the
data use a ner mesh than is used in the forward solution part of the
reconstruction algorithm. But not a strict renement. The shape of any
conductivity anomalies in the simulated data should not exactly conform
with the reconstruction mesh, unless you can assume the shape is known
a priori.
2. Simulating noise. If you are simulating data you must also simulate the
errors in experimental measurement. At the very least there is quantization error in the analogue-to-digital converter. Other sources of error
include stray capacitance, gain errors, inaccurate electrode position,
inaccurately known boundary shape, and contact impedance errors. To
simulate errors sensibly it is necessary to understand the basics of the
data collection system, especially when the gain on each measurement
channel before the ADC is variable. When the distribution of the voltage
measurement errors is decided this is usually simulated with a pseudorandom number generator.
3. Pseudo-random numbers. A random number generator models a draw
from a population with a given probability density function. To test the
robustness of your reconstruction algorithm with respect to the magnitude
of the errors it is necessary to make repeated draws, or calls to the random
number generator, and to study the distribution of reconstruction errors.
As our inverse problem is nonlinear, even a Gaussian distribution of
error will not produce a (multivariate) Gaussian distribution of reconstruction errors. Even if the errors are small and the linear approximation good,
at least the mean and variance should be considered.
4. Not tweaking. Reconstruction programmes have a number of adjustable
parameters such as Tikhonov factors and stopping criteria for iteration,
as well as levels of smoothing, basis constraints and small variations of
algorithms. There are rational ways of choosing reconstruction parameters based on the data (such as generalized cross validation and Lcurve), and on an estimate of the data error (Morotzovs stopping criterion). In practice one often nds acceptable values empirically which work
for a collection of conductivities one expects to encounter. There will
always be other cases for which those parameter choices do not work
well. What one should avoid is tweaking the reconstruction parameters
for each set of data until one obtains an image which one knows is
close to the real one. By contrast an honest policy is to show examples
52

of where a certain algorithm and parameters perform poorly, as well as
the best examples.
1.12.
FURTHER DEVELOPMENTS IN RECONSTRUCTION

ALGORITHMS
In this review there is not space to describe in any detail many of the exciting
current developments in reconstruction algorithms. Before highlighting some
of these developments it is worth emphasizing that for an ill-posed problem,
a priori information is essential for a stable reconstruction algorithm, and it
is better that this information is incorporated in the algorithm in a systematic
and transparent way. Another general principle of inverse problems is to think
carefully what information is required by the end user. Rather than attempting
to produce an accurate image, what is often required in medical (and indeed
most other) applications is an estimate of a much smaller number of parameters which can be used for diagnosis. For example, we may know that a
patient has two lungs as well as other anatomical features, but we might
want to estimate their water content to diagnose pulminary oedema. A sensible
strategy would be to devise an anatomical model of the thorax and t a few
parameters of shape and conductivity rather than pixel conductivity values.
The disadvantage of this approach is that each application of EIT gives rise
to its own specialized reconstruction method, which must be carefully designed
for the purpose. In the authors opinion the future development of EIT
systems, including electrode arrays and data acquisition systems as well as
reconstruction software, should focus increasingly on specic applications,
although of course such systems will share many common components.
1.12.1.
Beyond Tikhonov regularization
We have discussed the use of more general regularization functionals

including total variation. For smooth G traditional smooth optimization
techniques can be used, whereas for total variation the PDIPM is promising.
Other functionals can be used to penalize deviation from the a priori information: one such choice is the addition of the MumfordShah functional, which
penalizes the Hausdorf measure of the set of discontinuities [126]. In general
there is a trade-o between incorporating accurate a priori information and
speed of reconstruction. Where the regularization matrix L is a discretized
partial dierential operator, the solution of the linearized problem is a
compact perturbation of a partial dierential equation. This suggests that
multigrid methods may be used in the solution of the inverse problem as
well. For a single linearized step this has been done for the EIT problem
by McCormick and Wade [107], and for the nonlinear problem by
Borcea [19]. In the same vein adaptive meshing can be used for the inverse
Further developments in reconstruction algorithms
53
problem as well as the forward problem [98, 108, 109]. In both cases there is
the interesting possibility of exploring the interaction between the meshes
used for forward and inverse solution.
At the extreme end of this spectrum we would like to describe the prior
probability distribution and for a known distribution of measurement noise
to calculate the entire posterior distribution. Rather than giving one image,
such as the MAP estimate, we give a complete description of the probability
of any image. If the probability is bimodal, for example, one could present
the two local maximum probability images. If one needed a diagnosis, say
of a tumour, the posterior probability distribution could be used to calculate
the probability that a tumour-like feature was there. The computational
complexity of calculating the posterior distribution for all but the simplest
distributions is enormous; however, the posterior distribution can be
explored using the Markov Chain Monte Carlo method which has been
applied to 2D EIT [81]. This was applied to simulated EIT data [54], and
more recently to tank data, for example [111]. For this to be a viable
technique for the 3D problem, highly ecient forward solution will be
required.
1.12.2.
Direct nonlinear methods
Iterative methods which use optimization methods to solve a regularized

problem are necessarily time consuming. The forward problem must be
solved repeatedly and the calculation of an updated conductivity is also
expensive. The rst direct method to be proposed was the layer stripping
algorithm [139]. However, this is yet to be shown to work well on noisy
data. An exciting recent development is the implementation of a scattering
transform (@ or d-bar) algorithm proposed by Nachman. Siltanen et al [136]
showed that this can be implemented stably and applied to in vitro data [105].
The main limitation of this technique is that it is inherently 2D and no-one
has found a way to extend it to three dimensions; also, in contrast to the
more explicit forms of regularization, it is not clear what a priori information
is incorporated in this method as the smoothing is applied by ltering the
data. A strength of the method is its ability to accurately predict absolute
conductivity levels. In some cases where long electrodes can be used, and
the conductivity varies slowly in the direction in which the electrodes are
oriented, a 2D reconstruction may be a useful approximation. This is perhaps
more so in industrial problems such as monitoring ow in pipes with ECT or
ERT. In some situations a direct solution for a 2D approximation could be
used as a starting point for an iterative 3D algorithm.
Two further direct methods show considerable promise for specic
applications. The monotonicity method of Tamburrino and Rubinacci
[148] relies on the monotonicity of the map 7! R , where is the real resistivity and R the transfer resistance matrix. This method, which is extremely
54
fast, relies on the resistivity of the body known to be one of two values. It
works equally well in two and three dimensions and is robust in the presence
of noise. The time complexity scales linearly with the number of voxels
(which can be any shape) and scales cubically in the number of electrodes.
It works for purely real or imaginary admittivity (ERT or ECT), and for
magnetic induction tomography for real conductivity. It is not known if it
can be applied to the complex case and it requires the voltage on current
carrying electrodes.
Linear sampling methods [24, 71, 131] have similar time complexity and
advantages as the monotonicity method. While still applied to piecewise
constant conductivities, linear sampling methods can handle any number
of discrete conductivity values provided the anomalies are separated from
each other by the background. The method does not give an indication of
the conductivity level but rather locates the jump discontinuities in conductivity. Both monotonicity and linear sampling methods are likely to nd
application in situations where a small anomaly is to be detected and located,
for example breast tumours.
Finally, a challenge remains to recover anisotropic conductivity which
arises in applications from brous or stratied media (such as muscle),
ow of non-spherical particles (such as red blood cells), or from compression
(e.g. in soil). The inverse anisotropic conductivity problem at low frequency
is known to suer from insuciency of data, but with sucient a priori
knowledge (e.g. [92]) the uniqueness of solution can be restored. One has
to take care that the imposition of a nite element mesh does not predetermine which of the family of consistent solutions is found [119]. Numerical
reconstructions of anisotropic conductivity in a geophysical context
include [116], although there the problem of non-uniqueness of solution
(dieomorphism invariance) has been ignored. Another approach is to
assume piecewise constant conductivity with the discontinuities known, for
example from an MRI image, and seek to recover the constant anisotropic
conductivity in each region [56], [57].
1.13.
PRACTICAL APPLICATIONS
We have presented an overview of EIT reconstruction algorithms, but a

question remains as to which techniques will be usefully applied to clinical
problems in EIT. The major algorithms presented here have all been tested
on tank data. Yorkey [164] compared Tikhonov regularized Gauss
Newton with ad hoc algorithms on 2D tanks; Goble and co-workers [63,
64] and Metherall and co-workers [101, 102] applied one-step regularized
GaussNewton to 3D tanks. Vauhkonen and co-workers [153, 156] applied
a fully iterative regularized GaussNewton method to 3D tank data using
the complete electrode model. More recently the linear sampling
Practical applications
55
method [131] and the scattering transform method [105] have been applied
to tank data. However, there is a paucity of application of nonlinear
reconstruction algorithms to in vivo human data.
Most of the clinical studies in EIT assume circular or other simplied
geometry and regular placement of electrodes. Without the correct modelling
of the boundary shape and electrode positions [91] the forward model cannot
be made to t the data by adjusting an isotropic conductivity. A nonlinear
iterative reconstruction method would therefore not converge, and for this
reason most clinical studies have used a linearization of the forward problem
and reconstruct a dierence image from voltage dierences. This linearization has been regularized in various ways, using both ad hoc methods such
as those used by the Sheeld group [9, 10] and systematic methods such as
the NOSER method [35] of RPI. Studies of EIT on the chest such as [79,
106, 144] assume a 2D circular geometry, although some attempts have
been made to use a realistic chest shape [90] (see also chapter 13, gure
13.9). Similar simplications have been made for EIT studies of the head
and breast. 3D linear reconstruction algorithms have been applied to the
human thorax [21, 101, 114] (see also chapter 13, gure 13.10). However,
3D measurement has not become commonplace in vivo due to the diculty
of applying and accurately positioning large numbers of individual
electrodes. One possible solution for imaging objects close to the surface is
to employ a rigid rectangular array of electrodes. This is exactly the approach
taken by the TransScan device [100], which is designed for the detection of
breast tumour, although reconstructions are essentially what geophysicists
would call surface resistivity mapping, rather than tomographic reconstruction. Reconstruction of 3D EIT images from a rectangular array using
NOSER-like methods has been demonstrated in vitro by Mueller et al [103],
and in vivo on the human chest using individual electrodes [104]. If the array
is suciently small compared with the body, this problem becomes identical
to the geophysical EIT problem [98] using surface (rather than bore-hole)
electrodes.
The EIT problem is inherently nonlinear. There are of course two
aspects of linearity of a mapping: in engineering terminology, that the
output scales linearly with the input, and that the principle of superposition
applies. The lack of scaling invariance manifests itself in EIT as the
phenomenon of saturation, which means the linearity must be taken into
account to get accurate conductivity images. For small contrasts in conductivity, linear reconstruction algorithms will typically nd a few isolated small
objects, but underestimate their contrast. For more complex objects, even
with small contrasts the lack of the superposition property means that
linear algorithms cannot resolve some features. A simple test can be done
in a tank experiment. With two test objects with conductivity 1 and 2
one can test if Z1 Z2 Z1 2 within the accuracy of the
measurement system. If not then it is certainly worth using a nonlinear
56
reconstruction algorithm. However, to use a nonlinear algorithm the forward

model used must be able to t the data accurately when the correct conductivity is found. This means that the shape, electrode position and electrode
model must all be correct. Until an accurate model is used, including a
method of constructing accurate body-shaped meshes and locating electrodes is perfected, it will not be possible to do justice to the EIT hardware
by giving the reconstruction algorithms the best chance of succeeding. Fortunately work is proceeding in this direction [13, 59] and we are optimistic that
nonlinear methods will soon be commonplace for in vivo EIT.
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PART 2
EIT INSTRUMENTATION
Chapter 2
EIT instrumentation
Gary J Saulnier
2.1.
INTRODUCTION
Since the introduction of the rst systems in the early 1980s, EIT instrumentation has continued to evolve in step with advances in analogue and digital
electronics. While early instruments were designed using primarily analogue
techniques, newer instruments are shifting much of the processing to the
digital domain, making extensive use of digital signal processors and
programmable logic devices. Along with advances in technology have
come advances in system performance, particularly in the areas of system
bandwidth and precision. While the original systems used relatively low
frequency excitationgenerally in the 1020 kHz rangenewer systems
can apply waveforms up to the 110 MHz range. The ability to apply excitation signals over a signicant range of frequencies makes it possible to
perform impedance spectroscopy in which the variation of impedance with
frequency can be used as a discriminating factor for imaging. With this in
mind, some newer systems have been designed to acquire data at multiple
frequencies simultaneously.
This chapter discusses some of the general issues involved in the design
and implementation of the major functions required for EIT instrumentation. Some of these issues have also been discussed in several survey papers
[4, 26]. Later, the structure of several particular systems is discussed in detail.
2.2.
EIT SYSTEM ARCHITECTURE
While there are many dierent EIT system designs, most systems apply
currents and measure voltages and can be classied according to the
number of current sourceseither as a single source system or a multiple
68
EIT instrumentation
Figure 2.1.
Single source EIT system.
source system. The general structure of a system using a single source is

shown in gure 2.1. The waveform used in the system, in most cases a sinusoid, is produced by the waveform synthesis block. The waveform is fed to a
dual current source or dual voltage-to-current converter, which produces a
pair of currents having equal magnitude but opposite polarities. A 2-to-N
multiplexer allows these sources to be applied to one pair of electrodes at a
time. The currents are supplied to the electrodes through shielded cables in
which a driven shield is used to protect the signals from noise, as well as to
minimize the cable capacitance and capacitance variation when the cables
are exed. Electrode voltages are measured using either single-ended or
dierential voltmeters. Dierential voltage measurement, i.e. measurement
of the voltage between pairs of electrodes, is often used to reduce the dynamic
range requirements relative to single-ended (referenced to ground) voltage
measurements. While a single voltmeter can be multiplexed to measure all
electrode voltages, using more voltmeters (up to N) introduces parallelism
that reduces measurement time at the expense of more hardware. In general,
the voltmetering process is performed synchronously, requiring a timing
reference and/or reference waveform from the waveform synthesis block.
In the multiple source system shown in gure 2.2, the current source pair
is replaced with N current sources, one for each electrode. The system operates by applying patterns of currents, where a pattern denes the current
source value for each electrode. In all cases the sum of the currents applied
to the electrodes must equal zero. The remainder of the system is the same
as for the single source system.
The following sections will discuss the issues involved in the design and
implementation of the basic building blocks for these EIT systems. The goal
Signal generation
Figure 2.2.
69
Multiple source EIT system.
is to illuminate the fundamental design problems and present some typical

solutions.
2.3.
2.3.1.
SIGNAL GENERATION
Waveform synthesis
While early EIT systems used analogue oscillators to produce a reference

sinusoidal waveform, all recent designs utilize digital waveform synthesis
techniques. There are two basic approaches to sinusoidal digital synthesis.
The rst involves storing all or part of a sinusoid in programmable readonly memory (PROM) and sequentially stepping through these stored
values. Coupling the PROM with some logic enables the lookup table to
be as small as 1/4 of a cycle of the sinusoid. The second approach is to use
a direct digital synthesizer (DDS) integrated circuit. In both cases, an
analogue waveform is produced by feeding the digital samples through a
digital-to-analogue converter (DAC). The performance of the synthesis is
measured by the spectral purity and signal-to-noise ratio (SNR) of the
resulting waveform.
As shown in gure 2.3, a DDS system is constructed around a sinusoid
ROM lookup table. A phase increment, , is fed into a phase accumulator
that, in turn, provides addressing to the lookup table. The size of the phase
increment along with the clock frequency sets the output frequency.
There are some important performance dierences between using a
custom PROM and a DDS to generate a waveform. With a DDS, the
70
EIT instrumentation
Figure 2.3.
Direct digital synthesis.
frequency can be adjusted by varying the size of the phase increment.

However, the limited size of the ROM requires rounding or truncation of
the phase value that is used to access values in the ROM, resulting in periodic
phase jitter that introduces line spectra (spurs) in the frequency spectrum of
the resulting sinusoid [10]. This phase jitter can be removed by restricting the
choice of output frequency to those that require phase values corresponding
to entries in the lookup table. This conguration is essentially what is
achieved using a custom PROM. To help mitigate the spectral impurity
introduced by the phase truncation, many DDS chips utilize phase dithering
to reduce the coupling between the phase error and the particular point in the
sinusoid cycle.
The amount of noise present in the synthesized waveform after the DAC
is a function of many things, including the resolution of the DAC, the
sampling frequency and the noise present in the digital waveform itself. If
we consider only the noise due to the digital-to-analogue conversion using
a voltage-output DAC, namely the quantization noise, the resulting voltage
noise spectral density can be expressed as
p
A
vNQ b p V= Hz
2 12fs
where A is the peak-to-peak voltage range of the waveform, b is the number
of bits of resolution in the DAC and fs is the sampling rate. This result is
based on the common assumption that the quantization noise is white.
Figure 2.4 shows the voltage noise spectral density as a function of the
number of bits in the DAC and the sampling frequency when A 2. Increasing the DAC resolution and/or increasing the sampling frequency results in a
decrease in noise density. As a reference, typical low-noise operational
p ampliers have a voltage noise spectral density in the range 110 nV= Hz.
2.3.2. Current sources
Most of the current sources used in EIT systems are more appropriately
called voltage-to-current converters, since they produce an output current
that is proportional to an input voltage. Ideally, a current source should
have an innite output shunt impedance, Z0 , resulting in the current
Signal generation
Figure 2.4.
frequency.
71
Voltage noise spectral density as a function of DAC resolution and sampling
delivered to the load being independent of the load voltage, VL . Real current
sources, however, have a nite Z0 impedance that is usually characterized as
the parallel equivalent of a resistance R0 and capacitance C0 . Figure 2.5(a)
shows an ideal current source driving a load, where the load current IL
equals the source current IS . When a real current source drives a load, as
shown in gure 2.5(b), the current owing in Z0 varies with VL ; consequently, the relationship between IL and IS varies with the value of the
load impedance.
The variation in IL with VL that occurs with nite current source output
impedance is made worse by the presence of additional stray or parasitic
capacitances. Though not associated with the current source itself but,
rather, due to capacitance between wire and/or printed circuit board
Figure 2.5.
Ideal and real current sources.
72
EIT instrumentation
traces, this capacitance provides an additional means for current to be

shunted away from the load to ground, eectively reducing the output
impedance of the source. In determining the required current source
output impedance for a given application, it is essential to consider the
impact of this stray capacitance. As will be discussed later, the use of
a driven shield around the cables to the electrodes helps reduce stray
capacitance.
2.3.2.1.
Floating and single-ended sources
In a single source EIT system, it is necessary to produce a current that ows

into the body at one electrode and out of the body at another electrode.
These currents can be produced using one oating current source that, as
shown in gure 2.6(a), makes a current that ows through a load without
a reference to ground potential. The gure shows the presence of the current
output impedance Z0 , as well as stray capacitance CS . In an idealized case,
where Z0 is innite and CS is zero, I1 I2 IS , as desired. With nite
Z0 , the load currents will be equal and opposite, but their relationship to
IS will vary with the load seen between the electrodes. The addition of the
stray capacitance will make I1 and I2 dependent on the voltages between
the corresponding electrode and ground, potentially producing a nonzero
common-mode current of value I1 I2 . An additional electrode must be
used to provide a path for this common-mode current to ground.
Another way to produce the desired currents is to use a balanced pair of
single-ended current sources, each of which produces a current that ows
from a ground as shown in gure 2.6(b). For innite Z0 and zero CS , IS1
should equal IS2 to make I1 equal I2 . The inclusion of nite Z0 and
non-zero CS will again result in the currents applied being unequal to the
source currents, as well as the possibility of a common-mode current.
Multiple source EIT systems can be constructed using either oating or
single-ended sources, though most use the latter. In both cases, the number of
Figure 2.6.
Floating and single-ended current sources.
Signal generation
73
sources equals the number of electrodes. With a multiple source system,

common-mode current arises whenever the sum of the currents from all
the sources does not equal zero. Keeping this common-mode current
below a desired level with variations in the load impedance seen by the
electrodes requires a higher Z0 and lower CS as the number of electrodes
increases.
2.3.2.2.
Current source requirements
The current source in an EIT system must be able to deliver current with a
desired precision over a specied frequency range to load impedances
within an expected range of values. These requirements translate into
specications for the frequency response, output impedance and voltage
compliance of the current source. Both the voltage compliance and the
output impedance requirements are functions of the expected load
impedance. Since the voltage compliance of the source is the range of load
voltages for which the current source continues to behave as a current
source, it must exceed the voltage when the maximum current is sourced to
(or sinked from) the load with the highest impedance. In medical applications
with single sinusoid excitation, maximum peak current values in the range
0.15 mA are common, with smaller current values being used at lower
frequencies due to safety concerns. Load impedances, which are a function
of electrode size, excitation frequency and the tissue being imaged, typically
range from 100
to 10 k
, with the lower values observed at higher frequencies. With these currents and impedances, voltage compliance in the range of
a few volts is generally sucient.
The required output impedance is also a function of the load impedance.
However, there are two ways to look at the problem. In order to maintain a
desired accuracy of the applied current, i.e. keeping IL and IS of gure 2.5(b)
equal to within a given tolerance, it is necessary to consider the maximum
load impedance that the current source will encounter. The error current
equals the current through the output impedance of the source, IZ0 , which
is given by
IZ0
ZL max
I
Z0 ZL max S
where ZL max is the maximum load impedance and Z0 is the current source
output impedance. For the IL to be accurate to within b bits of precision
requires that the current error be less than one least signicant bit (LSB)
or, equivalently, 1=2b . The output impedance requirement then becomes
Z0 2b 1ZL max :
In this case, a system with 16 bit accuracy with a maximum load impedance
of 10 k
requires a current source with an output impedance of over 655 M
.
74
EIT instrumentation
A second way to look at the problem is to consider the fact that, in

general, EIT systems are more concerned with the precision of the current
values than with their accuracy. In other words, it is more important that
the variation in load current between a minimum and maximum load
impedance be within the desired tolerance than it is for the current to be
exactly equal to a desired value. This property is true for both single
source and multiple source systems. In a single source system, it is the
same source that is applied to multiple loads (electrode pairs) to collect
data for an image. In a multiple source system, dierent sources, each of
which satises some minimum output impedance specication, are applied
to the dierent loads. In both cases, the dierence in load current with
maximum and minimum load impedances of ZL max and ZL min , respectively,
is given by

Z0
Z0
IL max IL min

I :
Z0 ZL min Z0 ZL max S
To determine the minimum Z0 required to obtain b bits of precision,
determine Z0 such that IL max IL min =IS 1=2b .
Figure 2.7 shows the output impedance in megohms that is needed to
achieve a given number of bits of resolution for several ranges of load
impedance. These results assume that all the impedances are real (resistive),
whereas the impedances are generally complex. In a medical application, the
larger load impedance values would generally be encountered at lower
frequencies and the smaller values at higher frequencies. The rst group of
results, showing load impedance ranges from zero to some maximum
value, represent the case where the accuracy of the applied current is being
maintained. The next group considers the case where the load impedance
is expected to remain within 20% of a nominal value, while the last
group considers the case where load impedance remains within 10% of a
nominal value. The plot demonstrates the benet, in terms of reduced
output impedance requirements, of considering the current precision over
a restricted range of load impedances. However, high precision systems
with relatively large load impedances still require high current source
output impedance. For example, a 16 bit system with load impedances in
the range 911 k
requires a current source output impedance in excess of
120 M
.
While a higher level of precision is generally desired, current accuracy
is also important. Higher accuracy can be obtained through current
source calibration, where the current source is calibrated to deliver an
accurate current to a test load having an impedance that is within the
range of expected load impedances. Calibration is very important in a
multiple source system since it is necessary to account for gain dierences
between the sources in order to avoid problems with common-mode
currents.
Signal generation
Figure 2.7.
2.3.2.3.
75
Required Z0 as a function of desired precision and load impedance range.
Multiple source systems
Multiple current source systems generally require higher precision current

sources than single source systems. The reason for this additional precision
is that it is necessary to keep common-mode current, i.e. the sum of all the
currents, small. In a single source system, there are actually two sources
supplying currents that ideally sum to zero. If each source has the same
precision, meaning that the error in the current delivered by each source is
within 1/2 LSB, the maximum error is 1 LSB and this error occurs
when each source has the maximum error with the same polarity. In a
multiple source system with N independent sources that, again, ideally sum
to zero, this maximum error is N=2 LSB.
With N suciently large, it is better to look at the situation stochastically rather than considering the worst case, since it is very unlikely that
all the errors would occur in the same direction. Here, we model the
output of each current source as the ideal current value and an independent
additive noise component. If each current source has b bits of precision, we
can assume that the noise term is uniformly distributed over 1/2 LSB
producing a noise power of 2 =12, where is the size of 1 LSB. For the
case where the peak-to-peak full scale current value is 1 A, then 2 b A.
76
EIT instrumentation
The common-mode current is the sum of the currents from the N sources.
The ideal current values sum to zero, making the common-mode current equal
to the sum of N independent noise sources. Since they are independent, the
power in the sum is N times the power in each source, i.e.
p
2 N 2
PCM N
:
12
12
From this equation it can be seen that in order to achieve PCM 2 =12, it is
necessary
to make the step size for the individual current sources equal
p
= N . Therefore, in order to achieve b bits of precision with respect to
the common-mode current, it is necessary to have
b0 b 0:5 log2 N
bits of precision for the individual sources. For a 64 electrode system with 16
bits of precision, the precision of each current source must be 19 bits.
2.3.2.4.
Stray capacitance and Z0
Stray capacitance, when in parallel with the output of the current source,
increases the eective output capacitance of the source and, consequently,
reduces the magnitude of the output impedance. Figure 2.7 shows the
required output impedance for a given precision and these values will now
be related to an allowable total capacitance at the current source output.
Figure 2.8 shows the capacitive reactance presented by capacitors of various
values as a function of frequency. To obtain even the modest output
impedance of 1 M
at approximately 20 kHz requires a total capacitance
of less than 10 pF. At 200 kHz, the allowable capacitance drops to 1 pF
and at 2 MHz it drops to 0.1 pF.
Figure 2.8.
Capacitive reactance as a function of frequency and capacitance.
Signal generation
2.3.2.5.
77
The stray capacitance problem
Clearly, when implementing a high precision system, requiring output

impedances on the order of tens of megohms, it is necessary to have
extremely small stray capacitancesvalues much smaller than can be
realistically achieved using any type of circuit wiring. There are two
common approaches to this problem in EIT systems. One approach is to
employ some type of capacitance cancellation system to reduce the eective
capacitance seen by the current source. A second approach, for use when the
load impedance is resistive or nearly resistive, is to reduce the sensitivity to
stray capacitance by measuring only the real part of the load voltage [12].
To see how measuring the real voltage reduces the impact of stray
capacitance, consider the circuit shown in gure 2.9. Here a current source
drives a resistive load, RL , which has a parallel capacitance, C. In the ideal
case, where C 0, the load voltage VL is real and equal to IRL . When the
capacitor is present, VL becomes complex due to the phase shift introduced
by C. The normalized error equals IRL VL =IRL and can be expressed as
normalized error
2pfCRL 2
2pfCRL
j
:
2
1 2pfCRL
1 2pfCRL 2
For the case where 2pfCRL < 1, the normalized imaginary (reactive) part of
the error exceeds the real part. Consider, for example, the case where
C 20 pF and RL 1 k
for which the real and reactive normalized error
voltages are plotted in gure 2.10 as a function of frequency. For 16 bits
of precision, the normalized error should be less than 2 16 15 10 6 .
In considering the real voltage only, the system can operate up to approximately 10 kHz with an error below this level. The error in the reactive voltage
is below this value only at very low frequencies. Note that, for these values of
C and RL , 2pfCRL exceeds unity for frequencies of approximately 8 MHz
and above where, on gure 2.10, the error for the real voltage moves
above that for the reactive voltage.
By measuring only the real part of the load voltage, it is not possible to
make images of the permittivity of the object. In order to achieve high precision while maintaining the ability to image both resistivity and permittivity, it
is necessary to employ techniques to either cancel the stray capacitance or
render it ineective.
Figure 2.9.
Current source with stray capacitance and a resistive load.
78
Figure 2.10.
EIT instrumentation
Errors in real and reactive voltages as a function of frequency.
Figure 2.11(a) illustrates the concept of using a negative capacitance [6]

to cancel the positive capacitance that is present due to the current source
output capacitance C0 and the stray capacitance CS . Since capacitors add
in parallel, the compensating capacitance should equal the negative of the
sum of the other capacitance present in the circuit. Figure 2.11(b) illustrates
the second technique that uses an inductance to produce a parallel resonant
circuit with the capacitance [19]. At resonance, the impedance of a parallel
LC circuit goes to innity, eectively cancelling the much lower impedance
presented by the capacitor itself. However, there are two drawbacks to the
parallel resonant approach. First, the eect of the capacitance is cancelled
at the resonant frequency only, making it unsuitable for systems that use
an excitation other than a pure tone. For a system that employs variable
frequency, the compensation must be tuned to accommodate any frequency
change. The second disadvantage is that the resonant circuit has start-up and
stop transients that depend on the quality factor Q of the circuit. This Q
varies with the load and current source output resistances.
It is also possible to compensate for nite current source output
impedance and additional stray capacitance by increasing the applied current
by an appropriate amount. If the value of current source output impedance
(including stray capacitance) and the load voltage are known, the amount of
Signal generation
Figure 2.11.
79
Current source compensation: (a) negative capacitance; (b) inductance.
current that is shunted away from the load can be calculated. Increasing the
applied current value to compensate for this current loss will result in the
desired current being applied to the load [27]. While the output impedance
and stray capacitance can be estimated using a calibration procedure, the
current through this impedance is a function of the load voltage, which
varies with the load impedance seen at the electrode as well as the applied
current. Consequently, this approach is necessarily iterative where currents
must be applied to determine the value of the load impedance and then
adjusted to compensate for shunt impedance [20].
2.3.3.
Driving the current source
The current sources used for EIT are generally voltage-to-current converters,
producing a current that is proportional to an input voltage. This input must
be scaled appropriately to set the desired current amplitude. In cases where
the excitation waveform is distributed in analogue form, this scaling process
can be performed using a multiplying DAC (MDAC) as shown in gure 2.12.
The selected MDAC must perform 4-quadrant multiplication to enable both
positive and negative amplitude values. A problem with this approach is that
many MDACs, particularly those implemented using MOS technology,
introduce a code-dependent phase shift into the waveform, meaning that
the phase of the output waveform is somewhat dependent on the digital
current amplitude value. Bipolar MDACs, which do not have the same
phase-shift problem, typically perform only 2-quadrant multiplication and,
consequently, are unable to invert the waveform. A technique is described
in [6], which uses two bipolar MDACs and a high resolution audio DAC
to convert a digital waveform and digital amplitude control value into a
scaled analogue waveform without the phase-shift problem.
Another approach to producing the amplitude-scaled waveform is to
use a 4-quadrant analogue multiplier to multiply the analogue excitation
waveform by an analogue amplitude setting [3, 28]. A conventional DAC
can be used to convert a digital amplitude value into a d.c. signal. Analogue
multipliers, however, are often limited in bandwidth and dynamic range and,
also, introduce harmonic distortion into the signal [3].
An all-digital approach can also be used in which a digital excitation waveform is scaled before passing through the DAC. This approach overcomes
80
Figure 2.12.
EIT instrumentation
Amplitude scaling using a multiplying DAC.
most of the limitations described above, though a higher resolution DAC may
be desirable in this case due to the larger dynamic range of the digital waveform. In a multiple-source system, however, this approach requires additional
digital processing on the individual channels.
2.3.4. Multiplexers
Multiplexers are required in single current source systems, as well as systems
that share voltmeters between multiple electrodes. These devices have many
non-ideal properties that make them undesirable in EIT systems, including a
nonzero on resistance that is somewhat dependent on the applied voltage,
limited o isolation, with lower values at high frequencies, and charge
injection during switching. The most signicant problem, however, is the
relatively large capacitance of multiplexer devices. Typically the input
capacitance is in the range 3050 pF and the output capacitance on each
line is in the range 510 pF. Multiplexers made using smaller devices will
have lower capacitance values at the cost of higher on resistance.
2.3.5. Current source and compensation circuits
Since they operate at relatively low frequencies, generally below 1 MHz,
EIT systems are able to use current sources that are built using operational
ampliers or transconductance ampliers. Current sources constructed
using these devices generally provide higher output impedance than simpler
sources constructed using discrete transistors, and have the capability to both
source and sink current. Here, a few of the current source circuits commonly
found in EIT instruments will be discussed.
Figure 2.13 shows a schematic diagram for a oating current source that
is commonly used in single source EIT systems. The transformer provides
d.c. isolation between the source and loadan important feature for patient
safety in medical applicationsand allows the load voltage to oat with
respect to ground potential. The voltage compliance and output impedance
Signal generation
Figure 2.13.
81
Floating current source with transformer coupling.
of the circuit are limited by the non-ideal behaviour of the operational

amplier and the transformer. As shown, the circuit includes a current
sensing resistor RS which enables direct measurement of the current on the
load side of the transformer through the measurement of the voltage drop
across the resistor. Measuring the current in this way, as opposed to relying
on ideal behaviour by the operational amplier and transformer, will
enhance the precision of the source.
There are a number of single-ended current source circuits that are used
in EIT systems. An operational transconductance amplier (OTA) is a
commercially-available integrated circuit (IC) that can be used as a current
source. An OTA is a voltage-in, current-out device that produces an
output current that is a function of the dierence between two input voltages
[8]. Examples are the CCII01 [21, 24] and OPA2662 [3, 25]. Figure 2.14 shows
a simplied schematic of an OTA driving a load. The OTA is constructed
around a unity gain amplier driving a xed load resistance R. Current
mirrors on both the positive and negative voltage supplies of the unity
gain amplier reproduce the supply currents in the unknown load
impedance. If the unity gain amplier has high input impedance, very little
current ows into its input and, due to conservation of current, the current
in R is nearly equal to the sum of the supply currents, I I , as indicated
on the diagram.
The OTA current source has the advantages of being adjustment-free
and simple, consisting of a single IC. However, the devices that are available
provide relatively low output impedance, with a value of 537 k
in parallel
with 28 pF being the highest reported value [21].
The supply-current sensing current source shown in gure 2.15 also uses
current mirrors [29]. The load current IL can be expressed as
IL
Vin VL =A

Ri
where is the current transfer ratio of the current mirrors and A is the open
loop gain of the operational amplier. An interesting property of this current
source is that it acts as an impedance multiplier. Assuming that the voltage
source driving the circuit is ideal, the output impedance of the current
82
Figure 2.14.
EIT instrumentation
Operational transconductance amplier current source.
source can be approximated as

Z0 ARi
meaning that, since is approximately unity, the impedance at the input is
multiplied by the open loop gain of the operational amplier. Reduction in
open loop gain at high frequencies, however, results in less impedance
gain, limiting the high frequency performance of the source. Additional
impedance multiplication can be achieved by cascading additional stages,
though output impedance is ultimately limited by shunt capacitance at the
Figure 2.15.
Supply-current sensing current source.
Signal generation
Figure 2.16.
83
Three-operational-amplier current source.
output. High output impedances have been achieved using this current
source for frequencies in excess of 100 kHz.
The three-operational-amplier current source is shown in gure 2.16
[17]. This current source uses an inverting, summing voltage amplier in
the forward path, a current sensing resistor RS and a non-inverting buer
amplier and an inverting amplier in the feedback path. When the resistor
values are properly adjusted, the current in RS and the load is maintained at a
value that is proportional to Vin :
IL Vin RS :
The primary advantage of the three-operational-amplier source is that it
can provide a reasonably high output impedance when properly trimmed.
A primary disadvantage of the source is degraded performance due to
phase shifts in the feedback path at high frequencies. Other disadvantages
are the fact that trimming is required and the high component count in the
current source.
The Howland current source, shown in gure 2.17, is a single op amp
source that oers good performance [8]. The topology of the current
source has a forward path consisting of an inverting amplier (the op amp
along with R1 and R2 ) and positive feedback. An alternative implementation
of the Howland source uses an instrumentation amplier in place of the
inverting amplier in the circuit [6]. For an ideal op amp, the output
impedance of the source is innite when the resistors satisfy the relationship
R4 =R3 R2 =R1 :
At this balance condition the load current can be expressed as
IL Vin =R3 :
The primary advantages of the Howland source are its simplicity and ability
to produce a high output impedance with the appropriate trimming. In
84
Figure 2.17.
EIT instrumentation
Howland current source.
practice, it is possible to trim for an innite output resistance by adjusting

one resistor, but the non-ideal op-amp behaviour results in a nonzero
output capacitance.
As discussed earlier, there are two ways to compensate for excessive
capacitanceinserting a negative capacitance and creating a parallel LC
circuit by introducing an inductor. A negative capacitance can be synthesized
using a negative impedance converter (NIC) circuit, as shown in gure 2.18
[9]. The impedance seen with respect to the ground when looking into the
input terminal is given by

R
Zin 1 Z:
R2
This impedance equals the impedance in the positive feedback path scaled
by a negative value dependent on the resistors. By making Z a positive
capacitor, a negative capacitance can be created having a value that is
adjustable through R1 and/or R2 .
In theory, the NIC can create a relatively broadband negative capacitance, which would make it possible to cancel capacitance over a substantial
frequency range. This behaviour is necessary for a multiple frequency EIT
system in which the multiple frequencies are applied simultaneously. In the
Figure 2.18.
Negative impedance converter circuit.
Signal generation
85
case where multiple frequencies are used one at a time, broadband compensation is desirable to avoid needing to retrim the source each time a new
frequency is used. However, in practice, the usefulness of the NIC is limited
by its tendency to oscillate. Stability can be improved by adding capacitance
to the resistive feedback network, but only at the cost of reducing the
frequency range over which the negative capacitance is produced.
The second compensation scheme is to create an LC resonant circuit by
introducing a parallel inductance [31]. This inductance can be synthesized
using a generalized impedance converter (GIC) circuit such as that shown
in gure 2.19 [22]. This circuit is one of several implementations of the
GIC. GICs are most commonly used to implement active lter equivalents
of RLC ladder lters.
The impedance seen looking into the GIC circuit is given by
Zin
Z1 Z3 Z5
:
Z2 Z4
By inserting a capacitor for Z4 and resistors for the remaining impedances,

the input impedance will be that of an inductance, i.e.
Zin s
R1 R3 R5 C4
sL:
R2
It is also possible to synthesize an inductance by inserting a capacitor for Z2

and a resistor for the other impedances, but having the capacitance in the Z4
location provides better performance.
Figure 2.19.
Generalized impedance converter circuit.
86
EIT instrumentation
The GIC circuit exhibits good stability and component sensitivity properties. However, as described earlier, the eect of the capacitance is removed
only at the LC resonant frequency, meaning that this compensation
approach cannot be used in systems that apply multiple frequencies
simultaneously, and retuning must occur whenever the frequency is changed
in multi-frequency systems that apply a single frequency at a time.
2.3.6.
Cable shielding
In many EIT systems the electrodes are located at some distance from the
electronics and are connected using cables. Exceptions to this are the few
systems where the electrodes are closely coupled to the driving electronics
[14]. Coaxial or triaxial cables are used to connect the electrodes, as opposed
to individual wires, in order to minimize coupling between the signals to/
from each electrode and reduce the noise susceptibility. Due to their much
higher output impedance, current source outputs are much more susceptible
to noise pick-up than voltage source outputs and need protection.
While coaxial cables can provide the desired shielding, they typically
present a signicant distributed capacitance, on the order of 40100 pF/m.
In addition, the capacitance tends to vary, particularly with the exing of
the cable. Grounding the shield results in this capacitance acting as a
shunt to ground, much like the stray capacitance and current source
output capacitance. Instead, the shield is commonly driven with a voltage
that is nearly equal to that on the conductor as shown in gure 2.20. Now,
since the voltage across the capacitance is zero, it does not carry current
and is essentially removed from the circuit.
When triaxial cables are used, a second grounded shield is positioned
around the driven shield, providing added protection. The primary complication of using a driven shield is the potential for instability as the shield driver
amplier provides a positive feedback path. Additionally, the shield driver
amplier is typically presented with a highly capacitive load, making it less
stable. Maintaining the gain of the shield driver somewhat less than unity
minimizes the risk of oscillation due to positive feedback through the
signal conductor at the expense of increasing the residual cable capacitance.
Figure 2.20.
Driven shield.
Signal generation
Figure 2.21.
87
Shield driver circuit for capacitive loads.
While a number of op amps are available that can drive large capacitive loads
at unity gain, the circuit shown in gure 2.21 is commonly used to enhance
the stability of the shield driver circuits. In this circuit, the combination of
the 100
series resistance and feedback capacitor allows negative feedback
that is less sensitive to the phase shift introduced by the capacitive load [23].
2.3.7.
Voltage sources
As discussed above, the precision requirements and, consequently, the

output impedance requirements for a multiple current source system can
be very large in order to avoid problems with common-mode currents. Implementing such high precision current sources requires relatively complex
circuitry, including circuits for mitigating the impact of stray capacitance,
and extensive calibration and/or tuning procedures. Some systems have
avoided this issue by applying voltages instead of currents [2, 3]. While this
approach can simplify the electronics, it is less desirable from a theoretical
point of view and tends to increase the sensitivity to electrode placement
and size errors [1].
When applying voltages, it is necessary to simultaneously measure the
applied current. Figure 2.22 shows a voltage source circuit. The basic conguration is a non-inverting op amp amplier with a current sensing resistor RS
inserted to enable the measurement of the current leaving the voltage source.
As shown, RS is contained within the feedback loop of the op amp, and for
ideal behaviour the load voltage VL will equal the input voltage Vin .
While voltage sources are simpler to implement than current sources,
they are not without problems. In practice, the limited open loop gain of
the op amp will result in VL being somewhat less than Vin in magnitude.
This eect can also be viewed as a result of the nonzero output resistance
of the voltage source. In either case, this voltage drop will result in errors
in the applied voltages. To mitigate this problem load voltage (the voltage
at the minus terminal of VS ) can be measured directly, rather than assuming
that the load voltage equals the input voltage. While this approach will not
make the load voltage equal to the desired value, it at least enables precise
knowledge of the actual load voltage. A bigger problem is inaccuracy in
88
EIT instrumentation
Figure 2.22.
Voltage source with current measurement.
the measurement of the load current IL . Figure 2.22 shows the presence of
stray capacitance CS in parallel with the load. A load-voltage-dependent
current will ow in this stray capacitance, meaning that the current measured
through RS is not exactly equal to the load current. This problem is equivalent to the output capacitance/stray capacitance problem with a current
source. Once again, techniques for cancelling the capacitance could be
applied, although this would make the circuitry signicantly more complex,
removing one of the advantages of using voltage sources.
2.4.
VOLTAGE MEASUREMENT
2.4.1. Dierential versus single-ended

Some EIT instruments measure dierential voltages, i.e. voltages between a
pair of electrodes, while others measure single-ended voltages, where the
measurement is made with respect to ground potential. Each approach has
its advantages and disadvantages. The primary advantage of performing
dierential measurements is the fact that the voltage between a pair of electrodes may be signicantly smaller than the voltage between each individual
electrode and ground potential, particularly when the electrodes are located
near each other on the body. This may result in a reduction in the dynamic
range of the voltage signals being measured, which, in turn, reduces the
dynamic range requirements for the ADC. Dierential voltage measurements are used extensively in single current source systems in which the
voltages are measured only on non-current carrying electrodes, and dierential voltages between adjacent electrodes can be much smaller than the
single-ended voltages. In practice, the voltage dierence between a pair of
electrodes is generally converted to a single-ended voltage by an instrumentation amplier for processing by the voltage measurement system. In
multiple source systems, particularly those that measure voltages on
current-carrying electrodes, the fact that adjacent electrodes may be carrying
large currents with opposite polarity makes using dierential measurements
less advantageous.
The primary disadvantage of dierential voltage measurements is a loss
of precision due to nonzero common-mode amplier gain. Figure 2.23(a)
Voltage measurement
89
Figure 2.23. Behaviour of an instrumentation amplier: (a) amplier showing actual

inputs; (b) block diagram showing how the output is produced from dierential and
common-mode inputs.
shows an instrumentation amplier and its inputs and outputs. These inputs
can be expressed in terms of a dierential signal, VD V1 V2 , and a
common-mode signal, VCM V1 V2 =2. If the instrumentation amplier
is ideal, the common-mode gain is zero and the output is determined solely by
the dierential gain AD and the dierence between the input voltages
VO AD VD AD V1 V2 :
A real instrumentation amplier, however, will respond to both VD and VCM ,
and its output is given by
VO AD VD ACM VCM
where ACM is the common-mode gain. Figure 2.23(b) is a block diagram that
illustrates the behaviour of the instrumentation amplier. A gure of merit
for an instrumentation amplier is its common-mode rejection ratio
(CMRR) given by
CMRR 20 log10 jAD =ACM j:
While an ideal dierential amplier has a CMRR of innity, real instrumentation ampliers generally have a CMRR that is large at d.c. and drops with
increasing frequency. Typical CMRR values at d.c. are in the range 100
120 dB, while values at 1 MHz that are in the range 060 dB are common.
The common-mode rejection of an instrumentation amplier is
degraded when there is an imbalance between the driving impedances for
each input. Figure 2.24 shows an instrumentation amplier with capacitors
Ci representing its input capacitance. A common-mode voltage is applied
through unequal resistances, R1 and R2 . The impact of the unequal driving
resistances is that the common mode input signal produces a dierential
voltage between the inputs to the instrumentation amplier. This dierential
voltage is then multiplied by the dierential gain of the amplier to produce
and output, even if the common-mode gain of the instrumentation amplier
90
EIT instrumentation
Figure 2.24.
Instrumentation amplier with input capacitance and driving impedances.
itself is zero. As discussed in [4] the degradation in common-mode rejection

due to mismatches in driving impedance impacts the reactive part of the
voltage more severely than the real part. Therefore, as with the case of
stray capacitance impacting the application of current, using only the real
part voltage from the output of the instrumenation amplier mitigates the
performance loss that this eect produces.
2.4.2.
Common-mode voltage feedback
Since it is dicult to achieve sucient insensitivity to common-mode

voltage, particularly at higher frequencies, some systems employ a voltage
feedback system to reduce the common-mode voltage presented to the
instrumentation amplier [11]. Since an ideal current source will produce a
current that is independent of its load voltage, it is possible, in principle,
to vary the load voltage in a way that minimizes the common-mode voltage
seen by the dierential voltage amplier without aecting the applied
current. In practice, however, the nite output impedance and/or stray
capacitance will produce some variation in current with changes in load
voltage, and the load voltage must be kept within the voltage compliance
of the current source. The compensation systems apply a voltage to an
additional electrode, typically located away from the electrodes being used
for imaging, that minimizes the common-mode voltage seen by the instrumentation amplier.
2.4.3.
Synchronous voltage measurement
EIT systems that image both the conductivity and permittivity in the body
require phase-sensitive voltage measurements, i.e. measurement of both the
real and reactive voltages on the electrodes. Likewise, systems that assume
that the load is resistive require phase-sensitive voltage measurements in
order to extract the real part of the electrode voltage. As discussed earlier,
measuring the magnitude of the electrode voltage would result in greater
sensitivity to stray capacitance. These phase-sensitive measurements are
generally made using a synchronous voltmeter that uses a coherent reference
obtained from the system waveform generator. While early systems
performed synchronous voltage measurement using analogue circuitry,
Voltage measurement
Figure 2.25.
91
Analogue synchronous voltmeter.
most newer EIT systems take a digital approach. A discussion of both the
analogue and digital approaches to phase-sensitive voltmetering is found
in [18].
An analogue implementation of a phase-sensitive voltmeter is shown in
gure 2.25. A reference square wave having the exact frequency as the input
sinusoidal waveform is used to control a switch that alternately applies
non-inverted and inverted versions of the input signal to a lowpass lter.
Generally, the square wave is supplied by the waveform synthesis block,
which also produces the system excitation waveform, to ensure that the
frequencies of the two signals are the same. The relative phase of the
reference signal determines whether the voltmeter measures the real voltage,
reactive voltage, or a combination of the two. Adjusting the reference phase
to maximize the output with a resistive load can be used to determine the set
of appropriate reference waveform phases to measure the real voltage. The
lowpass lter ideally retains only the d.c. component of the signal, which is
proportional to the sum of the input voltage waveform components that
are at the signal frequency and its odd harmonics.
The analogue synchronous voltmeter of gure 2.25 essentially mixes the
input signal with a square wave of the same frequency and keeps the d.c.
portion of the result. Integrated circuits such as the Analog Devices
AD630 are available to perform this operation. This analogue voltmeter
has several drawbacks, however. First, the output is sensitive to odd harmonics in the input signal, making it necessary to maintain spectral purity
through the system. Second, the lowpass lter provides limited rejection of
the non-d.c. components in its input signal, reducing the overall precision
of the system. A high-order lowpass lter may be required to achieve a
high degree of measurement precision. Finally, the structure is sub-optimal
with regard to additive broadband noise that may be present in the input
signal.
92
Figure 2.26.
EIT instrumentation
Digital synchronous voltmeter.
The limitations of the voltmeter in gure 2.25 are due to the limitations
of the lowpass lter and the fact that the reference waveform is a square wave
rather than a sinusoid. While a more complex analogue voltmeter with better
performance could be implemented, generally a digital approach is used
instead. Figure 2.26 is a block diagram of a digital implementation of a
phase-sensitive voltmeter that produces both real and reactive measurements. The voltage is sampled and quantized by the ADC, and the samples
are multiplied by sine and cosine reference waveforms of exactly the same
frequency. The products are subsequently accumulated over an integral
number of cycles of the signal frequency. For the system to work properly,
the sampling clock for the ADC must have the necessary relationship to
the signal frequency. This voltmeter structure is equivalent to a matched
lter used in the detection of communication signals, and it can be shown
that the SNR of the measured voltages is optimal for a given ADC precision
and integration period if the noise in the signal after the ADC is white, meaning that it has a at (frequency independent) power spectral density. Real and
reactive outputs in gure 2.26 are labelled, assuming that a real (resistive)
load produces a voltage waveform that is a cosine having a phase angle of
zero.
It is necessary to integrate over an integral number of cycles of the signal
in order to suppress the double-frequency components of the product of the
ADC samples and the reference sine and cosine. Essentially, multiplying two
sinusoids having the same frequency produces a result that consists of a d.c.
signal, having an amplitude that is dependent on the amplitudes of the
individual sinusoids and their relative phase, plus a sinusoid having double
the original frequency. Integrating over an integral number of periods of
the input signal frequency completely suppresses this double frequency and
all other harmonics of the excitation frequency, because the integration
lter has a frequency response with a j sin x=xj shape centred at d.c. and
nulls at frequencies k=T, where T is the integration period and k is any
Voltage measurement
93
integer not equal to zero. When T N=f , where f equals the signal
frequency, the nulls are at kf =N.
2.4.4.
Noise performance
The quantization noise from an ADC is generally assumed to be white with

power
2Q
2
12
where is the ADC quantization step size. Increasing the precision of the
ADC by one bit results in a reduction of by a factor of 2 and a corresponding decrease in the quantization noise power by a factor of 4. Using the
assumption that this noise is white, the power is uniformly distributed over
a bandwidth of fS Hz, where fS is the sampling frequency, resulting in a
noise power spectral density of
PSD
2
:
12fS
Consequently, increasing fS for a given ADC resolution results in a decrease

in the PSD of the quantization noise.
For the voltmeter, we can assume that the input signal itself has some
additive white noise that results from various noise sources, including
thermal noise in the electronic components. Integrating over a larger
number of cycles of the signal, i.e. oversampling, results in an improvement
in the SNR of the voltage measurements, where the noise consists of noise at
the ADC input plus the quantization noise of the ADC itself. If it is assumed
that this noise is white, meaning that noise samples are uncorrelated with
each other, and that the noise is uncorrelated with the sinusoidal signal
being measured, integrating the signal results in SNR improvement by a
factor that is equal to the number of samples being accumulated. There
are two ways to view how this improvement occurs. One way is to consider
the fact that the bandwidth of the integrator is inversely proportional to the
integration period. Integrating over M samples results in a decrease in bandwidth by a factor of M and a corresponding reduction in the output noise
power by a factor of M. Since the signal itself has zero bandwidth, reducing
the lter bandwidth does not reduce the signal power and the result is an
increase in SNR by a factor of M. The second view is that when summing
M samples in the integrator the signal samples (all the same d.c. value)
add coherently, resulting in a voltage increase by a factor of M and a
power increase by a factor of M 2 . The noise samples are uncorrelated and
add non-coherently, resulting in an increase in power by a factor of M.
SNR increases, then, by a factor of M 2 =M M. Since an additional bit of
precision corresponds to a factor of 4 decrease in noise power, every increase
94
EIT instrumentation
in integration period by a factor of 4 produces an additional bit of eective

resolution. Therefore, the resolution of the voltmeter is not strictly limited by
the resolution of the ADC itself, but can be increased by integrating over
multiple samples.
2.4.5. Sampling requirements
The increase in voltmeter precision through integration is predicated on the
assumption that the samples of the noise, whether due to quantization or
other noise sources, are uncorrelated. In the absence of noise at the input,
obtaining uncorrelated quantization noise samples requires that each
sample in the integration be taken at dierent phases of the input sinusoid.
Otherwise, if multiple samples are taken from the same point in the cycle
over multiple cycles of the sinusoid, the quantization noise for all these
samples will be identical. A sucient level of noise added to the sinusoid
at the input will work to decorrelate the quantization noise, even if samples
are taken at the same sinusoid phase over multiple cycles.
Two approaches are used to avoid having samples taken at the same
phase over multiple cycles. One approach takes an integral number of
samples during each cycle, but shifts all the sample times by a xed
amount between cycles [6]. In other words, within a single cycle, samples
are taken 2p=K radians apart, where K is the number of samples per cycle.
If the integration is to span L cycles, the phase of the samples is advanced
by 2p=LK radians from one cycle to the next. Figure 2.27 illustrates the
case where L 4 and K 5. The upper trace shows the actual sample
points distributed over four cycles. The lower trace shows these same samples
after they have been re-ordered and placed into a single cycle of the sinusoid.
In this lower trace, the sample points marked using the same symbol type
come from the same cycle of the original waveform. Note that the same
samples could be obtained by sampling over a single cycle of the waveform
at four times the sampling rate.
The same result can be obtained using a non-integer number of samples
per cycle [3]. In this case, the ratio of the sampling frequency to the excitation
frequency must be selected such that it can be reduced to a ratio of mutually
prime factors. Using this approach, the samples obtained will be exactly the
same as those obtained using the rst technique, though they will come in a
dierent order.
For the voltmeter, it is possible to sample at a rate that is below the
Nyquist rate, i.e. below twice the excitation frequency, as long as the reference waveforms are sampled the same way. In this case, the output of the
ADC as well as the reference sine and cosine waveforms will be aliased
versions of the actual excitation signals, having a lower frequency. This
property enables the use of high frequency excitation signals without using
a high sampling rate. It is important, however, that the analogue bandwidth
Example EIT systems
95
Figure 2.27. Waveform sampling arrangement with K 5 and L 4. Actual sampling

times over four cycles (top) and samples arranged in one cycle (bottom).
of the ADC be suciently wide to pass the excitation frequency, and its
aperture jitter be suciently small to avoid loss of ADC precision due to
timing uncertainty.
2.5.
EXAMPLE EIT SYSTEMS
There are a wide variety of EIT instruments that have been designed and
built with varying degrees of success in solving the basic problemthat of
determining the impedance distribution within a body from measurements
made on its surface. Probably the most important characteristic of each
instrument is whether it is a single-source system or a multiple-source
system. The choice of which type of instrument to build is fundamentally
one of complexity versus performance, with a single-source system having
much simpler hardware and a multiple-source system having, in theory,
better performance. A few systems of each type are described below.
96
EIT instrumentation
2.5.1. Single-source systems

2.5.1.1.
Sheeld systems
The most widely used EIT systems are the 16-electrode mark 1 and mark 2
single source systems developed at Sheeld [11, 12]. While the mark 1 and
mark 2 are both single frequency systems, this group has also developed
multiple frequency systems. The mark 3 system can apply eight frequencies
in the range 9.6 kHz to 1.2 MHz, with a single frequency being applied at a
given time. The mark 3.5 system applies 30 frequencies in the range 2 kHz
to 1.6 MHz simultaneously, using an FFT-based digital voltage measurement system [13]. The mark 3 system uses separate drive and receive
electrodes (eight of each), while the mark 3.5 system uses a total of eight electrodes. These systems all provide real-time imaging at roughly 25 images/s.
The mark 2 system [11] operates with a digitally-generated sinusoidal
excitation signal of 20.83 kHz, which is produced using a 12-bit DAC and
a 48-entry ROM look-up table clocked at 1 MHz. The applied current is
produced using a oating-load voltage-to-current converter like that
shown in gure 2.13. Direct measurement of the applied current, performed
using an in-line resistor and an instrumentation amplier, is used to account
for the presence of variations in phase and amplitude of the applied current
with variations in the load impedance at the electrodes. Two 1-to-16 multiplexers (Analog Devices DG506) are used to direct the currents to a single
pair of electrodes at a given time. A current amplitude of 5 mA peak-topeak is used.
Dierential voltage measurements are made between adjacent pairs of
electrodes. The electrode voltages are a.c.-coupled to a set of 16 instrumentation ampliers (Burr-Brown INA110), providing parallel measurement of all
the dierential voltages. The instrumentation amplier outputs are transformer-coupled to programmable-gain ampliers (PGAs), with gains from
1 to 256 in powers of 2. PGA output voltages are processed by synchronous,
phase-sensitive voltmeters. Only the real component of the measured
voltages is used in image reconstruction due to the greater impact of stray
capacitance on the accuracy of the reactive measurements.
A common-mode feedback circuit is used to reduce the common-mode
voltage applied to the instrumentation ampliers in the voltage measurement
circuit. Since all dierential voltages are measured simultaneously, the
common-mode voltage cannot be minimized for all voltage measurements
but, rather, the circuit reduces the common-mode voltage seen by all instrumentation ampliers. The circuit works using a pair of electrodes located
away from the electrodes used to collect image data. One electrode is used
to sense the common-mode voltage and the second electrode is driven with
a compensating voltage which acts to drive the common-mode voltage to
zero. The gain of the feedback loop must be kept suciently low (32 dB) in
order to avoid oscillation problems.
Example EIT systems
97
The Sheeld APT systems are the most widely used EIT systemsthe
hardware is compact and reliable and capable of producing real-time
images. The instrumentation has been well designed and its performance is
well documented. The systems have been optimized for obtaining the best
data available in the single current source conguration. However, the
system is ultimately limited by the need for multiplexers to switch the current
source between electrode pairs and the signicant shunting capacitance that
they introduce. While the problem is partially mitigated by using only the
measured real voltages, the penalty is an inability to image the reactive
component of the impedance.
2.5.1.2.
Russian Academy of Sciences systems
A series of single-source instruments have been produced by this group for

imaging the thorax and breast [5, 14, 15]. The system for imaging the
thorax [5] uses 16 electrodes with a single multiplexed current source and a
single multiplexed voltmeter. The breast imaging system [14, 15] also uses
a single source and voltmeter, and supports 256 electrodes arranged in a
round, planar matrix. This system requires approximately 20 s to collect
the data for a single image. A version of this system is being commercialized
by TCI Medical [30].
The 256-electrode breast imaging system produces currents using a three
op amp voltage-to-current converter driven by a DAC. A 1-to-256 multiplexer directs current to one electrode on the array, and a second remote
electrode that is placed on the wrist of the patient completes the circuit.
Current passes from one electrode on the array to this remote electrode.
The system can produce excitation signals up to 110 kHz, with higher
frequencies resulting in better coupling to the patient but greater losses due
to stray capacitance. Due to these considerations, an excitation frequency
of 50 kHz is generally used with a current amplitude of 0.5 mA. Because
some electrodes in the array may not be in contact with the patient, a voltage
threshold detector is used at the output of the current source to enable the
detection of bad contacts.
Dierence voltages are measured between all non-current carrying
electrodes on the array and a second remote electrode that is placed on the
other wrist of the patient. A 256-to-1 multiplexer is used to attach one
electrode at a time to an instrumentation amplier input, with the second
input permanently tied to the remote electrode. To produce an image, 255
voltage measurements are made for each applied current, resulting in a
total of 65 280 voltage measurements when all 256 electrodes are in contact
with the patient. The instrumentation amplier has programmable gain
that is adjusted based on the physical distance of the electrode from the
drive electrode, with gain increasing with distance. The electrodes are d.c.
coupled to the instrumentation amplier through the multiplexer and, as a
98
EIT instrumentation
result, the d.c. potential due to the electrode/patient interface appears at the
amplier input. The system utilizes a compensation system in which a DAC
drives the bias adjustment on the instrumentation amplier to compensate
for the contact potential. This correction is performed for each electrode
prior to the measurement of the a.c. voltage due to the applied current.
The instrumentation amplier output, after lowpass ltering, is sampled
and quantized by a 14-bit ADC, and digital synchronous detection is used
to measure the real part of the electrode voltage.
As a single source system, the system is limited by the stray capacitance
introduced by the multiplexers, ultimately limiting the excitation frequency
to approximately 50 kHz and not allowing measurement of permittivity.
Also, the system trades o real-time performance for a large number of
electrodes that, in theory, should provide improved image resolution.
However, resolution is a function of both the number of electrodes and the
measurement precision, and the limited measurement precision of the instrumentation may make it impossible to realize the resolution improvement
anticipated by using 256 electrodes.
2.5.2.
2.5.2.1.
Multiple-source systems
Oxford Brookes systems
This group has produced several multiple-source impedance tomographs,

including a system that uses voltage sources to produce currents
(OXPACT-II) [2]. The OXBACT-III system [27, 28] is a 32-source 64electrode system, in which 32 of the electrodes are used to apply currents
and the remaining 32 electrodes are used for sensing voltages. The system
operates in real time at a rate of 25 images/s, though only a subset of the
31 full set of current patterns are applied for each image.
The sinusoidal excitation waveform is generated using a ROM look-up
and converted into an analogue voltage signal for distribution to each of the
32 current sources. The analogue excitation voltage waveform is scaled for
input to the current sources using analogue multipliers. Digital codes
representing the 32 current amplitudes are produced by the system digital
signal processor (Texas Instruments TMS320C40) and are processed by a
MDAC to produce the scaling voltages used by each analogue multiplier.
Excitation frequencies of 10, 40 and 160 kHz are available. The system
uses supply-current sensing current sources with a reported output
impedance of approximately 680 k
at 160 kHz and higher values at lower
frequencies [27]. The system utilizes an automated calibration system in
which the output impedances (including stray capacitance) and transadmittances of the current sources are measured. Actual electrode current
is determined by adjusting the current owing through the measured current
source output impedance [27].
Example EIT systems
99
The 32 single-ended electrode voltages are rst fed through voltage

follower circuits and then multiplexed into a single video 12-bit ADC
(Analog Devices AD9005) operating at 5.12 MHz. Samples are taken
sequentially from each channel and fed into a digital signal processor for
digital synchronous voltmetering using 256 samples from each electrode,
producing an increase in eective resolution to 16 bits.
As a multiple-source system, the OXBACT III requires complex instrumentation to deliver precise currents to each electrode simultaneously. The
system uses an excellent current source implementation and, importantly, a
means of compensating for the current source output capacitance and
stray capacitance that should help minimize the common-mode current
problem. The compensation technique, which involves the measurement of
output impedance, is simpler from a hardware viewpoint than other techniques that cancel the capacitance, but does require some iteration to
produce the desired applied current patterns. The interaction between the
sources, resulting from the fact that the electrodes are attached to a single
body and changing one current impacts all the other currents to some
degree, may also limit the ability to iterate to the desired current pattern.
The multiplexing of the voltages through a single video ADC does provide
some savings in hardware complexity, though the settling time of the multiplexers may introduce some loss of precision.
2.5.2.2.
Dartmouth systems
This group has developed multiple-source systems for breast cancer detection
that incorporate both current and voltage sources. A recent system,
described in [3], supports 32 electrodes with a continuously selectable excitation frequency in the range from 1 kHz to 1 MHz. The waveform is generated
using a PC-based arbitrary waveform generation board (Datel PC-420) that
generates waveforms using a 12-bit DAC with a maximum sampling rate of
40 MHz. This waveform is distributed, in analogue form, to custom boards
that support eight electrodes each. The system rack can accommodate up
to 16 boards (128 electrodes) and the design has address space for up to
256 boards (2048 electrodes).
The system contains 32 voltage sources and 32 current sources, enabling
it to apply either voltages or currents to the electrodes. The current sources
are implemented using an OTA (Burr-Brown OPA2662), while the voltage
sources are implemented with unity gain operational amplier buers with
a current sensing resistor in the feedback loop. A current sensing resistor is
also used to enable direct measurement of the applied currents when the
current sources are being used.
The amplitude of the sinusoidal voltages feeding the OTAs and voltage
buers determine the amplitude of the applied signals. The analogue reference waveform is scaled at each channel using an analogue multiplier
100
EIT instrumentation
(Burr-Brown MPY600). The required scaling voltage is obtained by passing

a digital amplitude value through a 12-bit DAC. An analogue multiplier was
used in place of an MDAC, with the goal of obtaining greater bandwidth.
Voltage measurements (and current measurements) are performed using
a PC-based data acquisition board (Datel PCI-416M) that provides 16-bit
ADC on four channels, with rates up to 200 kHz. The digitized samples of
a voltage waveform are processed by a digital synchronous detector. An
undersampling/oversampling technique is utilized in which multiple samples
are obtained over multiple cycles of the waveform.
While an OTA-based current source may be useful in a single-source
system, it does not meet the higher precision requirements for a multiple
source system. As reported in [3], the measured output resistance of the
OTA source was approximately 5 k
, well below the required 4.1 M
for
12 bits of precision. Measuring the current applied to the load and adjusting
the current source output to compensate for the losses in the output
impedance cannot fully oset the poor performance of the current source.
Most likely due to these problems, results reported for this system focus
on its use in the applied voltage mode.
2.5.2.3.
Rensselaer Polytechnic Institute systems
This group has developed a series of adaptive current tomograph (ACT)

systems, with the primary application being the imaging of the thorax [6,
7, 16]. The ACT 3 [6, 7] system is a 32-channel, multiple current source
system that is capable of producing real-time images of conductivity and
permittivity at a rate of roughly 20 images/s. The system is fully parallel,
having 32 current sources and 32 voltmeters. A grounded thirty-third electrode is placed away from the measurement electrodes to provide a path
for residual common-mode current due to the applied currents not summing
exactly to zero.
A 10-bit digital sinusoidal reference waveform at 28.8 kHz is generated
using a PROM look-up table and distributed to each channel over a backplane. An amplitude-scaled analogue sinusoid waveform is produced from
this digital sinusoid using a four-quadrant MDAC that is constructed
using two bipolar two-quadrant MDACs (Analog Devices DAC10) and a
16-bit audio DAC (Analog Devices AD1856) [6]. This conguration,
though expensive from a hardware viewpoint, provides 16 bits of amplitude
control without introducing amplitude-dependent phase shifts in the
resulting analogue sinusoidal waveform. Voltage-to-current conversion is
performed using a Howland-type current source that is implemented using
an instrumentation amplier (Analog Devices AMP05). The current source
circuit includes a digital potentiometer (Dallas Semiconductor DS1867)
that allows adjustment of the output impedance of the source. An NIC
negative capacitance circuit, including a digital potentiometer to enable
Discussion and conclusion
101
automatic adjustment, is placed in parallel with the current source output to

perform capacitance cancellation.
Single-ended real and reactive voltages on all the electrodes are measured using 32 phase-sensitive voltmeters. Each electrode voltage is sampled
and quantized by a 12-bit ADC (Analog Devices AD678), and processed
by a digital matched lter voltmeter that is implemented in an Analog
Devices ADSP-2100 digital signal processor to obtain real and reactive
voltage values. The voltage waveforms are sampled ve times per cycle
over multiple cycles, with the number of cycles dependent on the desired
precision/image rate trade-o. With an imaging rate of approximately 20
images/s, 160 samples are collected per measurement, yielding an eective
precision of 15 bits. Integrating over 640 samples yields a precision of 16
bits and an imaging rate of approximately seven images/s.
The ACT 3 system includes an automated calibration system for adjusting the digital potentiometers in the current sources and NICs to optimize the
output impedance [6]. The calibration system also determines calibration
constants for the applied current amplitudes and the voltmeters. Frequent
calibration of the current sources is needed to maintain a small value of
common-mode current.
While most EIT system designs have made signicant compromises to
gain some savings in hardware complexity, the ACT 3 system was designed
to optimize performance with less concern for the physical size or cost of the
instrument. The result is a system with high precision but which is expensive
to build and not easily portable. While the use of NICs to cancel capacitance
was eective for this single frequency system, the inherent instability of these
circuits would make them dicult or impossible to use in a broadband,
multi-frequency instrument. The use of capacitance cancellation, however,
seems to be the most eective method for obtaining high precision currents,
since it allows the desired current to be delivered to the load without the
requirement for iteration.
2.6.
DISCUSSION AND CONCLUSION
This chapter has reviewed various approaches for implementing the major
components of an EIT system and discussed some of the advantages and
disadvantages of each approach. A few example systems were presented to
show how these components have been combined to produce EIT instruments. An unresolved question, however, is how should one design the
best EIT system for a given application? The answer is not always clear
and may vary with the constraints presented by the application.
What is clear is that, for a given number of electrodes, the best data for
making images comes from an instrument with the highest possible precision
and multiple sources. Such a system is also the most complex and expensive
102
EIT instrumentation
to build. Precision is important in several areasin the applied currents, the

voltage measurements, and in the placement of electrodes. Errors in any of
these areas will degrade the quality of the data. Both theory and practice
have shown that a multiple source system will provide better data for making
images than a single source system for a given number of electrodes, instrumentation precision and applied power. From a practical standpoint, the use of
multiple sources also makes it possible to obtain higher precision in applied
currents by avoiding the use of a multiplexer. A high precision current source
requires the use of some type of compensation to mitigate the eects of shunt
capacitance. The variation in the shunt capacitance presented by the multiplexer with electrode selection, combined with the nonzero multiplexer on
resistance, makes it dicult or impossible to compensate for all settings. As
described earlier, single source systems typically discard the imaginary component of the measurements as a result of uncompensated capacitance. Another
very important practical advantage of using multiple sources is that it reduces
the sensitivity of the data to errors in electrode placement.
If one considers a xed budget or, equivalently, a xed instrument
complexity, the best approach to instrument design is less well dened.
Single source instruments clearly compromise performance for hardware
simplicity and, for a given number of electrodes, a multiple source instrument
is superior. However, with a complexity constraint it is necessary to compare
a multiple source system with a certain number of electrodes to a single
source system with many more electrodes. This is a more dicult comparison
and I am not aware of any direct comparisons of these alternatives. It would
seem that having more electrodes will lead to greater resolution images and,
to some extent, this is true. However, due to the ill-posedness of the reconstruction problem, additional electrodes improve the imaging resolution
only to the extent that there is sucient instrument precision. A greater
number of electrodes may result in more pixels in the image but, with insucient precision, does not provide more information. Consider, for example,
the Russian Academy of Sciences system that uses a single source with 256
electrodes in a xed planar array. The xed array essentially eliminates
errors due to electrode placement and the system has sucient precision to
enable the reconstruction of 3D static images. While the performance of
this instrument may be better than that of a 16 or 32 electrode multiple
source instrument, a 256 electrode multiple source system would certainly
produce better data. The hardware complexity of a 256 electrode system
may be prohibitive, however, and the use of a single source approach may
be better for an achievable instrument with this number of electrodes.
So how should one approach the problem of building an EIT instrument
for a new application? If the object of the investigation is to determine
whether EIT is a useful imaging modality for that application, I believe
that it is essential that one implements the best instrument possible
preferably a high precision, multiple source device. Once the utility of EIT
References
103
is established for that application, the instrument can be simplied to

whatever extent is possible while maintaining acceptable performance.
Simplifying the hardware should only come after the utility of EIT is
established. Obtaining unsatisfactory results using a sub-optimal instrument can lead to EIT being dismissed as a viable approach when, in fact,
EIT may itself be useful and it is only the particular instrument that is
inadequate.
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electrical impedance tomography Physiol. Meas. 24 509516
PART 3
APPLICATIONS
Chapter 3
Imaging of the thorax by EIT
H J Smit, A Vonk Noordegraaf, H R van Genderingen
and P W A Kunst
3.1.
GENERAL INTRODUCTION
For the proper treatment of cardiac, circulatory and ventilatory disorders it

is often crucial to obtain anatomical and functional information from structures within the chest. At present, x-ray radiography, CT scanning and MRI
are mostly used to obtain anatomical information, whilst ultrasonic and
radio-isotope imaging provide more functional information. Each method
has its own advantages and disadvantages, strongly related to the pathophysiology involved. Electrical impedance tomography (EIT) has been suggested
as an alternative method with the advantages of being non-invasive and relatively cheap [15]. The variation of electrical impedance within the thorax is
strongly related to cardiac and ventilatory events. The air-lled lung has a
high resistivity which is linearly related to the degree of ination, enabling
the measurement of pulmonary ventilation. At 50 kHz, the resistivity of
deated lung tissue is around 12.5
:m and rises to about 25.0
:m when
inated [6]. Furthermore, since impedance and blood volume are inversely
related, blood volume changes within the lungs can be quantied by using
EIT. In this chapter we will discuss EIT applications for assessment of
cardiac function, pulmonary hypertension and regional lung function.
3.2.
3.2.1.
EQUIPMENT
Sheeld mark 1 system
Most studies have been performed by using the Sheeld Applied Potential
Tomograph mark 1, developed by Barber and Brown in the 1980s [7], and
its successor the Sheeld APT DAS-01P. Sixteen electrodes are placed
108
Figure 3.1. Principle of electrical impedance tomography according to the Sheeld

method. Current (I) is injected sequentially in adjacent electrode pairs and the potential
dierences (U) are measured in the remaining electrode pairs. Image reconstruction is
conducted along the equipotential lines (shown in gure) with ltered back-projection
(courtesy of I. Frerichs).
equidistantly around the thorax and one earth electrode is placed on the
abdomen. Current is injected at 50 kHz sequentially in adjacent electrode
pairs and the potential dierence is measured in the remaining electrode
pairs (gure 3.1).
Eorts to reconstruct images of absolute impedance distribution have
not so far led to satisfactory results. Therefore, dynamic images are produced
showing the distribution of relative impedance changes. This is done by
feeding voltage changes relative to a reference data set into the Sheeld
back-projection algorithm [8]. The reference data must be obtained from
the same subject to produce reliable results.
The spatial resolution of the system was estimated to be approximately
10% of the array diameter [9]. To obtain adequate noise reduction, special
averaging techniques were required. For cardiac and circulatory application
the method involves ECG-triggered averaging [10], yielding a time-series of
EIT images during a single heart beat from a set of at least 100 heart
beats. The temporal resolution is 0.04 s (25 Hz). For ventilatory applications,
a number of acquisition cycles are averaged leading to sample rates around
0.9 Hz. This temporal resolution is insucient to monitor tidal changes
with great accuracy, but enables the measurement of slow variations in
lung volume. By dening one or more regions of interest (ROI) in the EIT
image, local or regional time-series of relative impedance change can be
determined, which can be used to quantify the observed physiological
phenomena (gure 3.2). In addition, a so-called functional EIT (fEIT) can
be created, an image consisting of pixels that represents the time variation
Equipment
109
Figure 3.2. Regional analysis of a sequence of electrical impedance tomograms. The timecourse of the ventral impedance change (upper panel) during stepwise lung ination is
signicantly dierent from the dorsal pattern (lower panel).
of the local impedance change (gure 3.3). The fEIT analysis was not
included in the original Sheeld device, but in a later stage proposed by
Hahn et al [11].
3.2.2.
Newer systems
One of the successors of the Sheeld mark 1 is the Sheeld mark 3.5,
marketed by Maltron Inc. as the Pulmonary Scan mark 3.5. It is a multifrequency, eight-electrode system, specically designed for neonatal use, where
the space available for electrodes is limited. It operates on frequencies in the
range between 2 kHz and 1.6 MHz, which may enable tissue characterization
in future. Data collection speed is 25 frames/s. Signal-to-noise ratio was
markedly reduced in comparison with the mark 1. A number of other experimental EIT devices have been developed over the years. Recently, the
University of Gottingen group has developed the GoeMF II EIT system, a
multifrequency device with an acquisition rate of 1344 Hz. In essence, it
110
Figure 3.3. Functional electrical impedance tomogram (fEIT) recorded during stable
mechanical ventilation. The image is constructed by calculating the standard deviation
over time in each picture element. The two ventilated lungs are clearly visible in white
(large variation); the white spot in the middle is the heart.
operates in a way comparable with the Sheeld mark 1, but a substantial

noise reduction was achieved [12].
3.3.
3.3.1.
CARDIAC IMAGING
Introduction
McArdle et al showed for the rst time that EIT is able to localize the
impedance variations occurring during the cardiac cycle [13]. Imaging of
the heart by means of EIT is based on the principle that measured impedance
changes are caused by changes in blood volume. Since the blood volume
changes in the ventricles and atria are opposite to each other during the
cardiac cycle, this technique makes it possible to visualize ventricular and
atrial impedance related blood volume changes. Data collection can be
synchronized with the R-wave of the electrocardiogram, making it possible
to average more than one cardiac cycle in order to obtain an optimal data
set without respiratory artefacts.
3.3.2.
Electrode positioning
Most of the studies which have been performed in the eld of cardiac imaging
used the Sheeld DAS-01 P EIT system. The problems involved in cardiac
imaging by means of EIT are twofold. First, the volume changes in the
heart during the cardiac cycle are complex, with the heart moving through
a transversal plane. Second, the spatial resolution of the system is poor.
Therefore, the attachment of the electrodes for the EIT measurements is
Cardiac imaging
111
critical. Patterson et al showed that positioning of the electrodes in three

dierent transverse planes caused a large variability in the average resistivity
changes [14]. MRI studies showed that the ventricular and atrial areas are
optimally anatomically separated in the long axis plane of the heart. Based
on these results, it was found that EIT images of the heart can be improved
by using an oblique plane rotated from transverse to coronal over 258 passing
through the apex of the heart, as the most basal site of the heart is located
anteriorly in the thorax [15]. The ictus cordis, the place where the heart
contraction can be seen or felt on the outside of the chest, can be used as a
landmark for the anterior electrode position. A study was performed to
compare the transverse electrode plane and the oblique plane. The results
from this study showed that indeed a better spatial resolution of the heart
compartments can be obtained by using the oblique plane, although image
quality remains poor as a consequence of the technique. The EIT images
obtained by means of this electrode position make it possible to dene the
ventricular region from the atrial regions from the EIT images (gure 3.4).
Figure 3.4. Variations of cross-sectional areas in MRI images (upper curves) and
impedance in EIT images (lower curves) for the ventricles (rst column) and atria
(second column) during the cardiac cycle. The value of line A can be used as a value of
stroke volume.
112
3.3.3.

EIT and stroke volume
In the ventricular region, impedance increases during systole as a consequence of blood outow, whereas impedance in the atrial regions decreases
due to lling of the atria. Since the electrical current ow is not planar,
these images represent impedance changes several centimetres above and
below the electrode plane [16]. Furthermore, an earlier study showed that
the impedance changes as measured by means of EIT are proportionally
related to blood volume changes [17]. Based on these ndings, a study was
performed to investigate whether the peak systolic impedance change in
the ventricular region, which was dened automatically on the EIT images,
corresponds with stroke volume [18]. In a group of 26 patients scheduled
for right heart catheterization, stroke volume was assessed by means of the
thermodilution method during catheterization and compared with the EIT
measurement made within 2 h after the catheterization. The correlation
coecient between peak systolic impedance changes and stroke volume
was 0.63 in this study, although a much better relationship could be obtained
by taking the time of the cardiac cycle into account (r 0:86). Although this
study showed that EIT measurements at this level of the thorax and stroke
volume are related to each other, the weak correlation and large spread of
the EIT values indicate that EIT cannot replace the invasive techniques for
the measurement of stroke volume. Several arguments can be put forward
to explain this weak correlation. First, MRI studies revealed that, even by
using the long axis plane, ventricular and atrial regions cannot be dened
as a xed anatomical region in the thoracic cavity, since ventricles will replace
the atria and vice versa during the dynamic process of cardiac contraction.
For this reason, impedance changes in the ventricular and atrial region will
inuence each other to a great extent. Furthermore, the inuence of possible
confounding variables such as thoracic wall thickness, dierent positions of
the heart and the inuence of valvular diseases might further disturb the
relationship between EIT measures and stroke volume.
3.3.4.
Right ventricular diastolic function
For this reason it might be more benecial to derive qualitative information

from the ventricular and atrial impedance curves instead of quantitative
information. An attempt has been made by our group to assess the right
ventricular diastolic function. This is possible since the right atrial region
on the EIT image can be separated visually from the left atrial region [19].
Therefore, it is possible to study the impedance changes within the right
atrial region during the cardiac cycle and thus the lling of the right ventricle
during diastole. The lling of the right ventricle can be separated in time in an
early diastolic phase (passive) and a late diastolic phase (active due to atrial
contraction). Both phases can be visualized by means of EIT by plotting the
113
impedance changes of the right atrium over time. Since the diastolic function
of the right ventricle is dened as an index of early and late diastolic lling,
we investigated whether the corresponding impedance changes in the early
and late diastolic phase provide a measure for the right ventricular function.
In a group of COPD patients (characterized by persistent air ow limitation
and destruction of lung parenchyma) and healthy controls the correlation
between MRI and EIT measurements of right ventricular diastolic function
was 0.78 [20]. Since right ventricular diastolic function is closely related
to pulmonary artery pressure, the relationship between right ventricular
diastolic function measured by EIT and pulmonary artery pressure was
investigated in the same study in a group of 27 patients. This showed that
pulmonary artery pressure was closely related to the lling characteristics
of the right ventricle as measured by EIT (r 0:78).
3.3.5.
Summary
In summary, the role of EIT in the measurement of cardiac parameters has

only been investigated in relatively small patient studies, focused on the
measurement of stroke volume and right ventricular diastolic function.
Although the idea of using EIT on an intensive care unit as a non-invasive
tool to measure stroke volume is attractive, the outcomes of these studies
do not support this idea. Measurement of the right ventricular diastolic
function by EIT might be of more clinical value, especially for the diagnosis
of pulmonary arterial hypertension.
3.4.
3.4.1.
PULMONARY PERFUSION MEASUREMENTS

Introduction
The capacity of EIT to detect systolic blood volume changes in the lungs
oers the possibility of studying the pulmonary perfusion. Eyubogu et al
(1987) showed that ECG-gated dynamic EIT images of the thorax could
be performed; these represented thoracic impedance changes related to
cardiac activity [21]. Shortly afterwards, McArdle et al showed that, by
means of cardiac-gated EIT, pulmonary perfusion can be visualized by
means of this technique [22]. However, the quality of those images was
poor as a consequence of the relatively small changes in the resistivity of
the lungs due to pulmonary perfusion, in the presence of noise, and the
larger resistivity changes due to the ventilation [23]. Image quality could be
improved by multiple time averaging of cardiac-gated data, enabling separation of the perfusion-related impedance changes from the ventilation
inuence. The required number of data frames for this type of processing
is at least 100 cardiac cycles [22, 24, 25].
114
Until now, two types of study investigating the clinical application in

the eld of pulmonary perfusion have been performed. The rst type has
investigated the possibility of using EIT to detect pulmonary perfusion
defects, e.g. pulmonary embolism. The second type of study investigated
the possibility of EIT to diagnose pathological changes of the pulmonary
vascular bed (e.g. emphysema and pulmonary hypertension).
3.4.2.
Pulmonary perfusion defects
Leathard et al showed in 1994 that defects in pulmonary perfusion due to

pulmonary emboli could be diagnosed by means of EIT [26]. Pulmonary
embolism concerns thrombosis of the arterial pulmonary vessels, and is
potentially a life threatening disease. They compared the EIT images of ten
normal subjects with the images of two patients. In both patients, they
found very dierent cardiac related resistivity changes in the pathologic
regions. However, the described patients had large emboli. Due to the
poor spatial resolution of EIT, it is unlikely that segmental pulmonary
emboli can be clearly detected by this technique. It will be even harder to
detect small subsegmental emboli by this technique, but the clinical importance of these small clots is controversial. No other studies concerning
pulmonary emboli have been published until now. It is questionable whether
EIT will be of real value in the diagnostics of pulmonary emboli. Accurate
detecting or excluding pulmonary embolism requires a diagnostic test with
a high sensitivity and high specicity, as the mortality rate for untreated
pulmonary embolism is about 30%, but unnecessary treatment with anticoagulants contains a considerable risk of bleeding. Many other tools are available for diagnosing pulmonary emboli, like lung perfusionventilation
scanning and pulmonary artery angiography, which is still the gold standard
[27]. Multi-detector spiral CT scanning has improved CT diagnosis of
pulmonary embolism, and is widely available [28]. Recently, MRI has also
become available as a non-invasive method to detect pulmonary emboli
[29]. Since some of those techniques can also be applied to critically ill
patients (e.g. spiral CT scan), in our opinion there is no clinical need for
further research on EIT in this eld.
3.4.3.
3.4.3.1.
Pathological changes of the pulmonary vascular bed

Chronic obstructive pulmonary disease
Many pulmonary diseases involve the vessels of the pulmonary vascular bed.
Since the small pulmonary vascular bed is mainly responsible for blood
volume and thus impedance changes, EIT might be of value in the diagnosis
of diseases of the small pulmonary blood vessels. The most common disease
involving the pulmonary vascular bed is chronic obstructive pulmonary
115
disease (COPD), especially the lung emphysema type. This disease is not only
accompanied by a loss of the alveolar wall, but also by a signicant reduction
of the small pulmonary blood vessels. The rst clinical study investigating the
possibilities of EIT to detect the pathological changes of the pulmonary
vascular bed of these patients was performed by Vonk Noordegraaf et al
[30]. They found that in emphysematous patients, cardiac-gated lung
impedance changes are signicantly smaller in comparison with healthy
subjects. To test the hypothesis that indeed the small pulmonary vascular
bed is responsible for the EIT signal, the eects of vasoconstriction and
vasodilation of the small pulmonary blood vessels in a group of healthy
subjects and COPD patients were studied. Pulmonary vasoconstriction was
induced in healthy subjects by inhaling hypoxic air (14% oxygen), causing
a reduction of the EIT signal (gure 3.5). Pulmonary vasodilation was
Figure 3.5. Upper image: systolic related impedance changes (Zsys ) when seven healthy
subjects were breathing room air and 100% oxygen (N.S.). Same conditions for six emphysema patients, indicating release of hypoxic pulmonary vasoconstriction (HPV) in these
patients, detected by EIT (P < 0:05). Lower image: systolic related impedance changes
when seven healthy subjects were breathing room air and 14% oxygen. Induction of
HPV can by detected by EIT (P < 0:05).
116
studied in six emphysematous patients with active hypoxic pulmonary vasoconstriction. By inhaling 100% oxygen, release of hypoxic vasoconstriction
could be obtained in the patients. EIT measurements were performed
while breathing room air, and during hyperoxia. There was indeed a signicant increase in impedance changes during 100% oxygen, whereas stroke
volume and heart rate remained unchanged. These experiments indicate
that EIT is a sensitive method for detecting relaxation of hypoxic pulmonary
vasoconstriction [31]. The clinical importance of a non-invasive tool to
measure the presence of hypoxic pulmonary vasoconstriction can be
illustrated by a study conducted by Ashutosh et al [32]. In their study, 28
emphysematous patients received oxygen. They were able to divide those
patients into a responding group and a non-responding group, in which
response was dened as a minimal fall in the mean pulmonary artery pressure
of 5 mm Hg. After catheterization, all subjects were prescribed supplemental
oxygen. The authors reported a strong two-year survival benet and
improvement of quality of life in the responding group. Moreover, there
was no improvement in mortality in the non-responding group in comparison with patients who had not been treated with long-term domiciliary
oxygen therapy. So, it is important to select the COPD patients who are
still in a reversible stage, as only those patients will benet from long-term
oxygen therapy. EIT might be a suitable technique for selecting those
patients in a non-invasive way.
3.4.3.2.
Pulmonary arterial hypertension
A second disease in which the application of EIT has been studied is pulmonary arterial hypertension (PAH), characterized by elevated blood pressure in
the pulmonary arteries, due to obliteration of small pulmonary arterial
branches, caused by intima thickening, media hypertrophy and thrombosis
in the small vessels. PAH is a rare disease of the pulmonary vascular bed
that mainly aects young adults (mean age at diagnosis is 36 years), with a
preference for women [33, 34]. The earliest symptom in many cases of
PAH is the gradual onset of shortness of breath after physical exertion.
This shortness of breath is non-specic and is frequently ascribed to a lack
of physical tness. Thus, diagnosis of PAH is commonly delayed, sometimes
for more than two years after the onset of symptoms. Early diagnosis makes
it possible to start therapy at an earlier stage, before the pulmonary vessels
have already been irreversibly obliterated. Until now, the diagnosis of
pulmonary hypertension can only be assessed invasively. Recent studies
showed a low sensitivity and specicity of echo Doppler in the diagnosis of
pulmonary hypertension [35, 36]. Since an early diagnosis of pulmonary
hypertension might alter the course of this fatal disease, it is worthwhile to
test the diagnostic value of EIT for the diagnosis of pulmonary hypertension
in a large group of patients at risk of pulmonary hypertension. As the
117
pulmonary perfusion related impedance changes are determined by the

characteristics of the pulmonary vascular bed, reduced impedance changes
in those patients may be expected in comparison with normal subjects.
Preliminary data obtained in a group of 21 PAH patients and 30 agematched controls showed indeed that the EIT signal is signicantly reduced
in PAH in comparison with the healthy subjects (78 27 102 versus
215 57 102 Arbitrary Units, P < 0:0001) [37].
3.4.4.
Summary
In conclusion, EIT is an interesting tool to measure the characteristics of the

small pulmonary vascular bed in a non-invasive way. The clinical value of
EIT to diagnose PAH should be established in a large clinical trial.
3.5.
3.5.1.
ASSESSMENT OF REGIONAL LUNG FUNCTION

Introduction
During the mechanical ventilation of patients with acute respiratory distress

syndrome (ARDS), there is a need to assess regional lung function, and more
specic regional lung aeration and ventilation. ARDS is often characterized
by a reduction of functional residual capacity (resting volume of the lung)
and a decrease of respiratory system compliance (ratio of lung volume and
airway pressure change). Moreover, thoracic CT scans have shown a
strong heterogeneous distribution of lung aeration and ventilation in
diseased lungs [38]. In a supine patient, the dorsal lung regions (dependent
lung) are frequently collapsed or ooded, whereas the ventral lung regions
(non-dependent lung) are more healthy but prone to overdistension from
mechanical ventilation. The lung injury may be augmented by sub-optimal
ventilator settings. Lung protective ventilation was shown to minimize
ventilator-induced lung injury and thereby decrease patient mortality and
morbidity [39, 40]. Regional assessment of lung aeration and ventilation
may guide the intensivist to provide optimal ventilatory conditions, by
opening the dependent lung and preventing overdistension of the nondependent lung.
Chest radiography poorly predicts variation in regional aeration in the
anteriorposterior dimension. CT scanning is the gold standard for its
assessment, but requires transport of an unstable patient and is associated
with exposure to potentially harmful ionizing radiation. Radio-isotope
imaging can be used to assess regional lung ventilation, but is laborious
and does not provide continuous monitoring. Since changes in thoracic air
content yield large changes of thoracic impedance, it was suggested to
monitor regional lung function by EIT [41].
118
3.5.2. Experimental and clinical studies

For EIT to become a clinical tool, patient outcome studies will have to show
that patients treated by using EIT information are better o than a control
group. For EIT to become a research tool, it should provide reliable information in comparison with validated methods. EIT is still in the validation
stage. In 2000 Frerichs published an excellent review of experimental and
clinical activities regarding applications of EIT related to lung and ventilation [42]. Most studies were published in biomedical journals. Frerichs
(Gottingen EIT Group) and Kunst (Amsterdam EIT group) introduced
the method in the medical literature in the late 1990s.
As there are many validation studies, we will only review a relevant
selection. Most of the studies have been performed using the Sheeld APT
mark 1 and DAS-01P. Harris et al [43] demonstrated a consistent relationship between impedance change and the inspired volume of air in spontaneously breathing subjects. The volumetric accuracy of EIT was generally
within 10% of the spirometric measurements. Hahn et al [44] suggested the
determination of local lung function by EIT, and validated this in healthy
pigs during one lung ventilation. They concluded that the spatial resolution
was sucient to dierentiate lung areas of 20 ml tissue volume. In an
experimental study, Frerichs et al [45] induced lung injury in one lung, and
demonstrated reduced ventilation in the aected lung (41% of mean
impedance variation) in comparison with control and demonstrated
increased ventilation in the intact lung (20%). Kunst et al [46] applied a
slow ination methoda clinical technique to determine mechanical lung
characteristicsin lung-injured animals. They showed that the global
pressurevolume (PV) curve consisted of the sum of regional PV curves
(gure 3.6). Previously, it was postulated that the lower inection point of
the PV curve (the point where volume rapidly increases) coincides with opening of closed lung units, and therefore may be used to optimize ventilator
pressure settings [47, 48]. By partitioning the EIT image in half, Kunst et
al demonstrated that the dependent lung region required a signicantly
higher opening pressure than the non-dependent lung region (30 versus
22 cm H2 O). The signicance of this nding is that the lung may require a
higher airway pressure to be fully recruited than can be detected from the
global PV curve. In patients with acute respiratory failure, Kunst et al [49]
showed that the ventilation-induced impedance change in the dependent
part of the lungs increased signicantly more than in the non-dependent
part, when the end-expiratory airway pressure (PEEP) was increased. This
was a demonstration of the opening of collapsed alveoli in the dependent
lungs, leading to increased ventilation.
Frerichs et al [50] validated EIT by relating local impedance changes to
lung density changes, a measure of air content, by electron beam CT in
anaesthetized pigs. In this study, the Gottingen tomograph GoeMF was
119
Figure 3.6. Pressureimpedance curves with increasing severity of acute lung injury
(ALI). H, in healthy lungs of a pig; L1L3, after respectively one, two and three lung
lavages with saline; A, the anterior part of the lungs (non-dependent); P, the posterior
part of the lungs (dependent). Note that with increasing severity of ALI, higher pressures
are needed to open up the lung.
used. They found high correlation coecients between 0.81 and 0.93,
showing that local impedance changes were closely related to local changes
in air content. In mechanically ventilated critical care patients, Hinz et al
[51] compared end-expiratory lung impedance changes (ELIC), using the
Gottingen tomograph GoeMF to end-expiratory lung volume changes
(EELV) by open-circuit nitrogen washout. They found a linear correlation
according to the equation ELIC 0:98 EELV 0:68 with r2 0:95, and
concluded that EIT can be used as a bedside technique to monitor lung
volume changes during ventilatory manoeuvres.
Van Genderingen et al [52] elaborated further on the regional PV
observations by Kunst, by assessing the impedance change both during
lung ination and deation in lung-injured pigs. Using EIT, they found a
120
Figure 3.7. Predictive value of electrical impedance tomography to optimize mechanical

ventilator settings. Regional impedance changes during a quasi-static pressurevolume
manoeuvre are shown in the left-hand panel (light line is ventral; heavy line is dorsal).
Left-to-right physiological shunt fraction (right-hand panel) is shown as a function of
imposed mean airway pressure during high-frequency oscillatory ventilation. The airway
pressure on the deation limb at maximal slope of impedance decrease is a good predictor
for the lowest mean airway pressure where the lung is still suciently opened, i.e. where
shunt fraction is just below 10% (solid square).
heterogeneous behaviour during ination of the lung, but a homogeneous

pattern during deation. They suggested that it was possible to predict the
safe ventilatory pressures during mechanical ventilation from the PV deation characteristics. This hypothesis was tested by detecting lung collapse
during high-frequency ventilation from arterial deoxygenation when mean
airway pressure was stepwise decreased [53]. They found that the pressure
at the steepest part of the deation pressureimpedance curve was a good
predictor for the lowest safe mean airway pressure (gure 3.7). However,
they also observed a signicant baseline drift over a period of 4 h in endexpiratory impedance with a concomitant constant end-expiratory lung
volume, indicating that EIT may not be reliable in estimating lung volume
changes over a longer period of time. They attributed this to the large
accumulation of uid in the animals thorax.
Victorino et al [54] compared EIT with CT in critical care patients. They
found that regional impedance changes can be best explained by changes in
air-content (R2 0:92) (gure 3.8). Rightleft imbalances in ventilation
were detected with good agreement (bias 0%, limits of agreement 10
to 10%) (gure 3.9). Relative distribution of ventilation along the vertical
dimension could be assessed with good precision but with lower accuracy.
They postulated that a repositioning of electrodes (gure 3.10) may overcome
the image distortion caused by the asymmetrical body shape. Using an alternative electrode positioning, they found an improved agreement with CT.
121
Figure 3.8. Comparison of electrical impedance tomography and computed tomography

during slow lung ination in patients with acute respiratory distress. The plot shows the
relation between regional impedance changes and changes in air content determined
from CT in a corresponding region of interest. R2 is the within-subject coecient of
determination.
Figure 3.9. Comparison of electrical impedance tomography and computed tomography

during slow lung ination in patients with acute respiratory distress. The box plots
represent the distributions of tidal volume estimated by EIT (white) and CT (grey). The
left panel shows the minor ventilation imbalances between left and right areas. The right
panel displays the signicant imbalances between the upper (ventral) and lower (dorsal)
lung areas. A small but signicant dierence was found between EIT and CT in the
lower lung area ( , p 0:04).
122
Figure 3.10. Theoretic eects of dierent electrode positioning when the cross-section of
the body has a trapezoid shape (right). Using the standard electrode positioning,
impedance changes are projected over an electrical impedance tomogram (right), causing
deformation of lung areas. The result may be over-representation of the left lower lobe area
LLL in the EIT image. In the test positioning the mid-electrodes 5 and 13 were moved 3 cm
in the ventral direction. Electrodes 15 have a shorter inter-electrode distance than
electrodes 59. The authors [54] hypothesize that this repositioning will decrease the overrepresentation of area LLL.
3.5.3.
Future directions
Only recently, the medical profession has picked up interest in EIT to determine regional lung function, and at present a number of clinical studies are
being undertaken. In the future, EIT requires further validation, preferably
in patients in comparison with CT as the gold standard. The method
should be further optimized and standardized as follows:
1. Electrode positioning, i.e. the level on the thorax and inter-electrode
distance, needs optimizing and standardizing.
2. The role of the reference data set should be further explored. That is, do
we need to acquire the data set in a certain physiological state to obtain
reliable impedance data.
References
123
3. The use of regional analysis should be investigated. Should we report

mean impedance values in a region, or impedance integral? Also,
should we investigate impedance variations in the entire image, or in
the region of the lungs, previously identied as the area where impedance
variations are detected?
4. The consequence of current paths on image quality should be claried.
What is the image distortion, resulting from the human thorax not
being circular and homogeneous in impedance? What is the consequence
of out-of-plane currents?
5. Can multifrequency EIT bring us tissue characterization and thereby
overcome some of the pitfalls caused by changes in thoracic uid?
The near future may provide more answers that are required to prove that
EIT is a valuable clinical tool.
3.6.
GENERAL SUMMARY AND FUTURE PERSPECTIVES
EIT has now been under investigation for about 20 years, but the nal step to
routine clinical use has still not been made. EIT must still be regarded as a
research technique. Much eort over the past years has been put into
improvements of the technology. Validation studies have been published,
EIT can be used to analyse physiological phenomena in the lungs, and in
recent years more and more patient-related research has been conducted.
The most promising elds for the clinical application of EIT are in our
opinion the measurement of the characteristics of the pulmonary vascular
bed for the diagnosis of pulmonary hypertension and regional lung function,
in order to determine the optimal airway pressures for articial ventilation.
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Chapter 4
Electrical impedance tomography of
brain function
David Holder and Thomas Tidswell
4.1.
INTRODUCTION
In the neurosciences, two broad areas may be dened in which non-invasive

imaging methods could provide useful informationimaging of variations
or abnormalities in structure, and imaging of normal or abnormal functional
activity.
The ease of diagnosis of structural abnormalities in neurology has been
transformed since the development of x-ray computed tomography (CT) in
the 1970s and, more recently, magnetic resonance imaging (MRI). Both
are now capable of imaging structural abnormalities in the brain with an
accuracy of less than 1 mm. For the great majority of diagnostic requirements, the advantages of accurate spatial resolution outweigh the expense
and inconvenience of these methods. The advantages of electrical impedance
tomography (EIT) are that it is relatively inexpensive, safe, non-invasive and
portable. Set against this is a relatively poor spatial resolution. In currently
available devices, this is about 15% of the electrode array diameter. Its
spatial resolution will probably improve as technical advances are made,
but the technique must always be limited by the fact that current spreads
out throughout the whole subject, so that the inverse problem is less well
dened than in x-ray CT or MRI. It therefore seems most unlikely that
EIT will be able to compete directly with these techniques for high resolution
structural imaging in the foreseeable future. However, its advantages may
still enable it to be indispensable for monitoring structural changes at the
bedside, in casualty departments, or in remote locations where large scanners
are too expensive or impractical.
On the other hand, there is a great need for improved methods of
imaging functional activity in the nervous system. At present, a great deal
is known about behaviour and cellular neurophysiology, but there is poor
128
Electrical impedance tomography of brain function
understanding of how information is processed in neuroanatomical pathways. The problem is that such activity is widely distributed and occurs
with a timescale of the order of milliseconds. No system yet exists which
could measure such activity non-invasively and with a high temporal
resolution. One avenue of approach is to image changes in blood ow and
metabolic activity events which are related to nervous activity. These are
caused by the accumulation of the eects of many action potentials or
depolarizations. They are therefore easier to image, being large, but
change over several seconds and so can only give an indirect guide to nervous
activity. Such changes may already be imaged by positron emission tomography (Herholz & Heiss, 2004b) or functional MRI (Matthews & Jezzard,
2004). The temporal resolution of these techniques is seconds or tens of
seconds, because this is the timescale over which these changes in the brain
occur. Measurement of nervous activity with a much greater temporal
resolution of tens of milliseconds has been possible for decades with electroencephalography (EEG) (Michel et al, 2001a,b; Momjian et al, 2003) and,
more recently, by magnetoencephalography (MEG) (Wheless et al, 2004),
but these do not provide unique solutions and are of doubtful accuracy,
especially for deep or distributed sources.
If neuroimaging with EIT is successful, then it could be used in several
key clinical areas in which other methods of functional brain imaging are
unsuited. These include adults and infants receiving intensive care, and the
long term imaging of epilepsy on telemetry units, where prolonged periods
of monitoring are required in order to localize seizure activity in the preoperative assessment for epilepsy surgery. EIT may also be suited to provide
images of brain impedance changes brought about by cell swelling in cerebral
energy failure, in such pathological conditions as stroke, ischaemia, hypoxia
or hypoglycaemia. It also has the unique potential to provide a means of
imaging the tiny fast impedance changes due to opening of ion channels
during neuronal depolarization. This would provide a means of imaging
neuronal activity along neuroanatomical pathways with a temporal resolution of milliseconds, which would constitute a revolutionary development
in neuroscience technology.
The development of EIT for imaging brain function is relatively short.
An impedance scanning system for detecting brain tumours was designed
and tested (Benabid et al, 1978), but was not followed up with a practical
EIT device. Shortly after, Holder (Holder, 1987) independently proposed
EIT as a novel means for imaging the fast impedance changes known to
occur during neuronal activity in the brain. Pilot animal studies were then
performed in which simultaneous scalp and intracranial impedance measurements were made of the brain of anaesthetized rats during cerebral ischaemia
(Holder, 1992b). The conclusion was that measurements of brain impedance
could be made, non-invasively, by scalp electrodes, although these changes
were attenuated by the skull. This study indicated the practicality that EIT
129
could be used to image impedance changes in the human brain. At that time,
the only available EIT system was the Sheeld Mark 1 EIT system (Brown &
Seagar, 1987), which was limited in that current could only be applied
through adjacent electrodes. This system was unlikely to be able to image
impedance changes in the brain from scalp electrodes, as most of the applied
current would be shunted through the scalp. As the EIT technology was not
at the stage to inject current with more widely spaced electrodes, the Sheeld
Mark 1 was used, and experiments were designed to eliminate the eect of the
skull. In these, the eect of the skull was excluded by using a ring of electrodes placed on the exposed cortex of anaesthetized rats or rabbits. The
rst EIT study of brain activity was in articially induced stroke (Holder,
1992b), followed by EIT imaging during cortical spreading depression
(Boone et al, 1994), physiologically evoked responses (Holder et al, 1996b)
and during electrically induced seizures (Rao et al, 1997). The impedance
changes varied between a decrease of 2% and 5% during somatosensory
or visual stimulation, a 10% increase during seizures or up to 100%
during stroke, due mainly to cell swelling and blood volume changes.
Taking the evidence that functional activity changed brain impedance in
the rabbit by 25%, and that from rats the skull attenuated peak impedance
changes by a factor of 10, it seemed plausible that scalp impedance changes
of 0.20.5% might be detected non-invasively during functional activity in
humans. As this level of impedance change was within the sensitivity of an
EIT system, these initial studies paved the way for human functional imaging
studies. EIT of brain function has not yet broken through into routine
clinical use, but substantial progress has been made over the past decade
or so, largely in the authors group at University College London. We are
currently undertaking clinical trials in acute stroke and epilepsy.
In this chapter, we initially review the physiological basis for expecting
impedance changes during these conditions. We then review the development
and testing of hardware and reconstruction algorithms specically for
imaging brain function. Finally, we review animal and human studies in
the development of EIT for imaging brain function in the areas of EIT of
normal brain function, epilepsy and stroke.
4.2.
4.2.1.
PHYSIOLOGICAL BASIS OF EIT OF BRAIN FUNCTION

Bioimpedance of brain and changes during activity or
pathological conditions
The bioimpedance of tissues in the head is relevant in two main ways. EIT of
the brain poses an especially dicult, but not insuperable, problem, because
the brain is encased by a conductive covering, the cerebrospinal uid, two
layers with high resistivities, the pia mater and skull, and then the scalp,
130
which has a moderate resistivity. Secondly, there are changes in impedance in

the brain itself, which provide the opportunity for imaging with EIT. These
fall into two main categorieschanges over tens of seconds, due to cell
swelling and blood ow, which are relatively large, of the orders of 10
100%, and those due to the opening of ion channels during neuronal activity,
which occur over milliseconds, and are much smaller, of the order of 0.01% if
recorded on the scalp.
These are reviewed in reasonable detail in this section, as their magnitude is critical to the design of experiments to ascertain the utility of EIT
in imaging brain function. A knowledge of the basic anatomy and histology
of the brain has been assumed.
4.2.1.1.
Impedance of resting brain
Within the brain, applied current will be distributed through several

anatomical or physiological compartments. The cerebral blood volume fraction has been estimated at 310% (Derdeyn et al, 2002; Ochs & Van Harreveld, 1956); blood has a low resistivity of about 125
:cm at 50 kHz
(Pfutzner, 1984). The extracellular space has been estimated by dye dilution
techniques in rats as 1218% of the brain volume. Its resistivity can be
estimated from measurements of the ion concentration of the extracellular
space cat sensorimotor cortex (Dietzel et al, 1982), which is similar to
0.9% saline at 51
:cm (Geddes, 1967).
Neurones and glial cells comprise the remaining 80% of the volume of
the brain. Their contribution has been analysed in rabbit cerebral cortex
(Ranck, 1963). He calculated that the path of a low frequency current in
the brain would be predominantly through the large volume, low resistivity,
glial cells, conductive extracellular uid space and blood volume. This is
because, although the blood and extracellular space have a lower resistivity
than glial cells, they have less conductive volume, and the bulk of the current
ow would be through the glial cells. Glial cells are conductive because they
are permeable to potassium and chloride ions (Lux et al, 1986), unlike
neurones which have a highly insulating membrane that is only permeable
to ions during depolarization with the action potential or during cell
energy failure. As a result, only a small amount of current will conduct
through the intracellular space of neurons at rest. A little conduction does
occur through neurones at low frequencies, because some of the long
processes which enable transmission of nervous impulsesaxons and
dendritesmay be aligned with the direction of current ow. Compared
with the transverse case, the surface area of an individual neuronal process
is much greater if the current ows along it, so the resistance is lower and
more current enters the intracellular space.
On the macroscopic scale, the brain mainly comprises grey matter,
which is made up of neuronal cells and their immediate branching processes,
131
Resistivity of cerebral white and grey matter in vivo. All measurements were
made at body temperature (3738 8C) in vivo.
Table 4.1.
Reference
R cortex
(
:cm) S.D.
R white matter
(
:cm) S.D.
Frequency
Method
Freygang &
229 9
Landau (1955)
344
1 kHz
4 electrodes
Nicholson
(1965)
85800
20 Hz20 kHz
Point electrode and

remote electrode
Van Harreveld 208 6.

Specic impedance 1 kHz
et al (1963)
220 with correction of white matter/
for blood
cortex 4:6 0:2
conductivity
Grey and white

matter combined.
2 electrodes used
Ranck (1963)
256356
5 Hz5 kHz
Point electrodes on
cortex
Latikka et al
(2001)
351
50 kHz
Monopolar needle
electrode
391
and white matter, which comprises tracts of long nerve bres which connect
dierent regions of the brain. Nerve bres in the mammalian brain are largely
surrounded by an insulating myelin sheath, and so are anisotropic. There was
anisotropy of about 10 :1 in the impedance of cerebral white matter in cats
over 20 Hz to 20 kHz (Nicholson, 1965)for example, 890
:cm for the longitudinal bres compared with 80
:cm for the transverse ones at 20 Hz. Grey
matter is largely isotropic as nerves and their processes run randomly.
However, Ranck (Ranck, Jr., 1963) noted that there is lamination in the
cortex, so this is only true at distances greater than 200 mm. In rabbit cerebral
cortex in vivo, at 5 Hz, the resistivity was 321 45
:cm (mean S.D.), falling
to 230 36:7
:cm at 0.5 kHz. When the shunting eect of the blood vessels
was taken into account, the resistivity values rose to 356
:cm for 5 Hz and
256
:cm at 0.5 kHz. Latikka (Latikka et al, 2001) recorded the impedance
of white and grey matter in situ using a needle electrode in human subjects
undergoing brain surgery for deep brain tumours. The average resistivity at
50 kHz for grey matter was 351
:cm and 391
:cm for white matter from
nine subjects (table 4.1). In summary, brain grey matter impedance at frequencies below 100 kHz is about 300
:cm in vivo, and white matter, depending on
orientation, is about 50% higher.
4.2.1.2.
Impedance changes due to cell swelling during stroke, spreading

depression or epilepsy
When cerebral grey matter outruns its energy supply, a characteristic

sequence of events takes place. This is termed anoxic depolarization
(Bures, 1974), because it occurs during pure hypoxia, but the term has
132
been extended to include the similar events which occur in ischaemia, spreading depression or epilepsy. These events have been mostly studied in the
cerebral cortex, but also occur in other areas of grey matter in the brain.
When measured in the cerebral cortex, the characteristic event is that
spontaneous electrical activity ceases and a sustained negative shift of tens
of millivolts is recorded with an electrode on the cortical surface. These
events are accompanied by a substantial movement of ions and water, as
ionic homeostasis fails. Water follows sodium and chloride into cells, so
that the extracellular space shrinks by about 50% (Hansen & Olsen, 1980).
At frequencies up to 100 kHz, the great majority of current applied to the
brain passes through the extracellular uid. This component of current will
be resistive and so is measured by EIT systems, such as the Sheeld Mark
1 (Brown & Seagar, 1987), which measure the in-phase component of the
impedance. During anoxic depolarization, the impedance of grey matter in
the brain therefore increases, because the extracellular space shrinks.
Changes in temperature, the impedance of neuronal membranes and blood
volume may also contribute, but the eect due to cell swelling is greatly
predominant (gure 4.1). Changes of this type occur to diering degrees in
the pathological conditions of stroke (or cerebral ischaemia), spreading
depression and epilepsy. In each case, the cells run out of energy needed to
maintain the balance of water and solutes between the intracellular and
extracellular spaces. In stroke, this is because blockage of arteries leads to
an insuciency of blood; in spreading depression or epilepsy, it is because
intense neuronal activity exceeds the capacity of the blood to provide
energy supplies.
Large impedance increases of about 20100% occur during cerebral
ischaemia in species such as the rat (Holder, 1992a), cat (Hossmann, 1971)
and monkey (Gamache et al, 1975). Spreading depression is a phenomenon
which can be elicited in the grey matter of experimental animals by applying
potassium chloride solution or mechanical trauma. Intense activity of depolarized cells occurs, so that potassium and excitatory amino acids pass into the
extracellular space. These excite neighbouring cells by diusion. In this way a
concentric ripple of activity moves out from the site of initial disturbance
like a ripple in a pond. It moves at about 3 mm/min, and has been postulated
to be the cause of the migraine aura in humans (see Pearce, 1985). Impedance
increases of about 40% occur in various species (Bures, 1974). During epilepsy
induced in experimental animals, reversible cortical impedance increases of 5
20% have been observed during measurement at 1 kHz with a two-electrode
system in the rabbit or cat (Van-Harreveld & Schade, 1962). The changes
had a duration similar to the period of epileptic EEG activity and were due
to anoxic depolarization-like processes, as a negative d.c. shift occurred. Similar
changes have been observed in cat hippocampus, amygdala and cortex (Elazar
et al, 1966), and cat cortex (Shalit, 1965). Impedance increases of about 3%
have been recorded in humans during seizures (Holder et al, 1993).
133
Figure 4.1. Mechanisms of impedance change within the brain. Left gure: impedance decrease due to increased blood volume. During physiological
activity, a signal is sent to the blood vessels which increases blood ow and blood volume to that cortical area. As blood has a lower resistivity than the
surrounding brain (150 and 350
:cm, respectively), the increase in the lower resistivity volume of blood will allow more current to ow through that
area of tissue and decrease the bulk impedance of that volume of cortex. Right gure: impedance increase due to cell swelling. Cells expand during cell
swelling (bottom). At rest, the size of the conductive extra-cellular space (ECS) is about 20% of the brain volume. During epilepsy, moderate cell
swelling occurs as water and ions enter the glial cells and the neurones, and the volume of the low resistivity ECS is reduced. This increases the
bulk impedance of that volume of cortex. Larger changes of cell swelling and impedance occur during ischaemia and spreading depression.
134
4.2.1.3.

Slow impedance changes during functional activity
Impedance has been shown to change in the brain during physiological

stimulation, but by a much smaller amount. Adey et al (1962) measured
impedance at 1 kHz using chronically implanted electrodes in the limbic
system of the cat. They observed impedance decreases of about 2%, which
lasted for several seconds during physiological stimuli, such as presentation
of milk or exposure of a female to a male. Aladjalova (2004) observed similar
impedance changes in cerebral cortex after direct electrical stimulation.
The cause of such changes has not been directly investigated. The most
likely explanation is that blood volume and ow alter. Changes in blood
volume will alter tissue impedance, either by replacing a uid of dierent
resistivity (such as CSF), or by changing the cross-sectional area available
to current ow. Changes in blood ow can also alter impedance, because
erythrocyte alignment alters (Coulter & Pappenheimer, 1948). It is well
established that blood ow and volume increase in the brain during functional activity. For example, in cat visual cortex during visual stimulation,
changes in volume, recorded by reected light at 570 nm, occurred almost
immediately after stimulus onset and preceded change in ow recorded by
laser Doppler owmetry by 2 s; both changes peaked at 56 s after stimulus
onset and decayed to baseline within 6 s of stimulus cessation (Malonek et al,
1997). The blood volume therefore increased prior to changes in blood ow,
probably as a result of venous pooling in advance of arterial dilation. In rats,
contrast MRI was used to give high resolution maps of changes of cerebral
blood volume during forepaw and hindpaw stimulation (Palmer et al,
1999): a stimulus lasting 5 min increased blood volume 36 s after the onset
of stimulation, which returned to baseline 1351 s after stimulus cessation.
In humans, similar changes of regional cerebral blood ow during visual
stimulation have been observed, found with PET (Herholz & Heiss, 2004a)
and functional MRI (Matthews & Jezzard, 2004). The time course of the
blood ow response from fMRI studies is similar to that measured in
animals: blood ow increases 12 s after stimulus presentation, rises to a
peak at 57 s and then decays to baseline blood ow within 610 s of stimulus
cessation.
4.2.1.4.
Functional activity with the time course of the action potential
In both the possible applications described above, similar changes can at

present be imaged by other, existing, methods; the advantages of EIT
would be of a practical nature. There, is, however, a third possible application of EIT in neuroscience, in which it would have a unique advantage in
being able to image nervous activity with a temporal resolution of milliseconds. The application would be based on the well known change in
impedance of neural membranes which occurs on depolarization as ion
channels open. In the squid axon, impedance falls 40-fold (Cole & Curtis,
135
1939) when measured directly across the axon. There should therefore be
an impedance change across populations of cells in nervous tissue during
activity. The eect could be due to action potentials in white matter, or to
summated eects of synaptic activity in grey matter, which is the origin of
the EEG.
At the frequencies of measurement with EIT, most current passes in the
highly conductive extracellular space. The amplitude of the impedance
changes across tissue is therefore likely to be small. Klivington and Galambos (1968) measured impedance changes during physiologically evoked
activity in the auditory cortex of anaesthetized cats at 10 kHz. A maximum
decrease of about 0.005% was observed, which had a similar time course to
the evoked cortical response. Similar changes were measured in visual cortex
during visual evoked responses (Klivington & Galambos, 1967) and less
reproducible impedance decreases of up to 0.02% were observed in subcortical
nuclei during auditory or visual evoked responses in unanaesthetized cats
(Velluti et al, 1968). Freygang and Landau (1955) observed a maximum
decrease in impedance of 3.1%, measured with square wave pulses 0.3
0.7 ms long, during the evoked cortical response in the cat. There are therefore
discrepancies in the published data. Biophysical modelling and experimental
measurement, presented in section 4.7 below, suggests that changes are vanishingly small if recorded with a frequency of applied current above 1 kHz, so the
possibility exists that the above ndings were artefactual.
4.2.1.5.
Other mechanisms of impedance change: temperature and

CSF movements
There are two additional factors which may inuence the impedance of the
brain, but for which there is little experimental information. During
increased neuronal and, therefore, metabolic activity, an increased generation of heat may occur which would increase brain temperature. Decreased
brain temperature increases brain resistivity by approximately 23% per
8C (Ochs & Van Harreveld, 1956; Li et al, 1968). Cortical temperature
changes of up to 1 8C during functional activity, with an average 0.2 8C
decrease in temperature after 12 min of visual stimulation, have been
detected with MRI and fMRI, in humans (Yablonskiy et al, 2000). Such
cortical temperature changes could produce changes in impedance, which
could be detected by EIT, but these would occur over minutes, rather than
changes over seconds expected by blood volume change.
The thickness of the cerebro-spinal uid (CSF) which overlies the
activated cortex is another possible cause of apparent impedance change in
recording with scalp electrodes: an expansion of local cerebral blood
volume, such as during epileptic seizures, might shift small amounts of CSF
overlying adjacent supercial cortex to areas of lower volume (VollmerHaase et al, 1998). Changes of CSF pressure, monitored by indwelling
136
intracranial pressure sensors, have been recorded during seizures in seven

subjects (Gabor et al, 1984; Minns & Brown, 1978).
4.2.2. Eect of coverings of the brain when recording EIT with
scalp electrodes
The principal problem in imaging with scalp electrodes is the relatively high
impedance of the skull. Bone is anisotropic. Axial, circumferential and radial
mean resistivities for the tibia measured at 100 kHz were 1600, 15 800 and
21 500
:cm (Saha & Williams, 1993), compared with approximately
9000
:cm for excised rat femur at 10 kHz (Kosterich et al, 1983). Fourterminal measurements, made at 100 Hz on a post-mortem dried human
skull immersed in saline, revealed resistivities between 13 600
:m at a
suture line and 21 400
:m at compact bone (Law, 1993).
Rush and Driscoll (1968) found the eective resistivity of skull, when
soaked with a conducting uid, to be 80 times that of the uid. If the uid
were to be CSF, the skull resistivity would be 45
:m. More recently, it has
been suggested that the contrast between skull resistivity and that of brain
was much less than this value, which has been widely used in EEG inverse
source modelling calculations (Oostendorp et al, 2000). At 100 Hz10 kHz,
using a 4-electrode measurement method, they found that in vitro the average
resistivity was 6500
:cm at 37 8C. They also made in vivo estimates of resistivity in two subjects by tting a model of the head to impedance recordings
made with scalp electrodes. The resistivities calculated gave 490
:cm for
brain and scalp and 7600
:cm for skull, giving a ratio of 15:7 3:5. More
recently, lower resistivities of 12503125
:cm have been recorded in
human skull at 10 Hz immediately after removal at surgery. These values
are lower than those recorded by other investigators; it is unclear if this is
because they were fresher or because of technical factors, such as the presence
of saline around the samples (Hoekema et al, 2003). There is therefore some
disagreement in the literature over the correct value for the skull resistivity.
The most reliable value appears to be that from Oostendorp et al (2000),
which suggests a ratio of about 20 :1 between skull resistivity and that of
the scalp or brain.
The resistivity of scalp has not been accurately measured, to our
knowledge, but is probably similar to that of mammalian skeletal muscle,
which has been reported to be between 435 and 1130
:cm measured at
10100 kHz in various species (Geddes & Baker, 1967). Cerebrospinal uid
has a low resistivity of 69
:cm.
It is therefore clear that the resistivity of the skull is substantially higher
than that of the brain and scalp (tables 4.1 and 4.2). Current applied for
impedance measurement to the scalp will therefore tend to ow through
the scalp and not pass through the skull into the brain. The relative size of
these values determines how much current ows into the brain compartment.

Table 4.2.
137
Resistivity of tissues in the head. All measurements were made at body

temperature and with a four electrode method.
Tissue
Resistivity
(
:cm)
Reference
Frequency
(kHz)
White matter
Grey matter
Blood
CSF
Skull
344
229
125
69
6500
Freygang & Landau (1955)

Freygang & Landau (1955)
Pfutzner (1984)
Baumann et al (1997)
Oostendorp et al (2000)
1
1
50
0.0110
0.110
This has been investigated by applying current to a skull inside a saline lled
tank (Rush & Driscoll, 1968). Closely spaced current injection electrodes
produced negligible current penetration within the skull, but when electrodes
were widely spaced across the skull (in polar positions), 45% of the applied
current entered the skull cavity. The current that does traverse the skull will
tend to shunt through the highly conductive cerebrospinal uid. The eect of
all this will be to decrease the signal-to-noise ratio, in the sense that the
signal will be sensitive to local changes in the scalp, and relatively insensitive
to events in the brain. One of the challenges in attempting brain EIT has been
to try and maximize the current owing into the brain itself.
4.3.
4.3.1.
EIT SYSTEMS DEVELOPED FOR BRAIN IMAGING

Hardware
The rst EIT recordings of brain function were made with the Sheeld Mark
1 system (Brown & Seagar, 1987). This employed 16 electrodes in a ring;
current was applied and voltage was recorded through adjacent pairs of
electrodes; the algorithm employed the assumption that the problem was
2D and that the imaged subject initially had a uniform resistivity. This was
used in specialized circumstances, where the experimental preparation was
designed to match the limitiations of the system. In anaesthetized rats or
rabbits, the entire upper surface of the skull and brain coverings (the dura
mater) were removed, and a ring of 16 spring-mounted electrodes were
placed on the exposed upper brain surface. As most of the activity occurred
in a layer of cerebral cortex about 3 mm thick, and the upper surface of the
brain in these species is almost planar, this was a good approximation to a 2D
uniform problem, and images were successfully obtained during stroke
(Holder, 1992b), epilepsy (Rao et al, 1997), spreading depression (Boone
et al, 1994) and evoked activity (Holder et al, 1996b).
138
Imaging in this way was helpful in demonstrating proof of concept but,

clearly, for use for imaging with scalp electrodes in humans during neurological conditions, the requirements were greater. In our group at UCL,
we therefore set out to develop a new hardware design which permitted the
following:
1. Software selectable electrode driving, so that dierent electrode protocols
could easily be produced in an experimental setting. The particular idea
was to use diametrically opposed electrodes for current injection, as
this would enable more current to pass through the brain.
2. The ability to image at low frequencies (about 200 Hz), as the theoretical
considerations above indicated that changes in cell swelling during stroke
or epilepsy would be larger at low frequencies, as more current would pass
in the changing extracellular space.
3. The system should be suitable for recording in ambulatory patients. For
example, we wished to record in patients with epilepsy being monitored
on a ward over days until they had several seizures documented. This
could be achieved by changing the physical conguration of the EIT
system so a small headbox could be worn on the subject, with a long
lead of 10 m or so, which passed back to a base station and PC.
Our rst system permitted the rst two of these. It was based on a HewlettPackard HP4284 impedance analyser. This was adapted to make four
electrode impedance recordings through a multiplexer able to address any
combination of 32 electrodes. The HP impedance analyser is highly accurate
but slow, as it utilizes a balancing bridge procedure. As a result, a single image,
comprising about 300 serial recordings from dierent electrode combinations,
took about 25 s. The system was shown to work well in saline lled tanks
(Tidswell et al, 2001a), and was used to make the rst series of EIT recordings
with scalp electrodes in humans and neonates during physiologically evoked
responses (Tidswell et al, 2001b,d) (gure 4.2(a)).
139
Figure 4.2. (a) EIT system based on a Hewlett-Packard impedance analyser (opposite),
being used for human evoked response recording. (b) The UCLH Mark 1a employed in
chest imaging. (c) The UCLH Mark 1b. (d) The UCLH Mark 2.
140
The next system, termed the UCLH Mark 1a or 1b, was similar, but was
purpose built and based on a single impedance measuring circuit similar to the
Sheeld Mark 1 system. A constant current was applied to a pair of electrodes
and the impedance was calculated from the in-phase component of voltage
measurement from another pair. It diered from the Sheeld Mark 1 in
that it could record at much lower frequencies, electrodes could be addressed
exibly from software, and it was suitable for ambulatory recording. Recording could be performed at one of 18 frequencies from 77 to 225 kHz; up to 64
electrodes could be addressed (16 in the Mark 1a and 64 in the Mark 1b). It
comprised a headbox about the size of a paperback book into which the electrode leads were inserted, which could be worn in a waistcoat by the subject;
this connected to the base station by a lead 10 m long (gure 4.2(b)) (Yerworth
et al, 2002). It produced acceptable images down to 200 Hz in saline lled tanks
(Holder et al, 1999; Tidswell et al, 2003a) and has been successfully employed
for the rst ever EIT recordings in human subjects during epilepsy and
epileptic seizures (Bagshaw et al, 2003a; Fabrizi et al, 2004).
Although the Mark 1 systems were capable of applying currents of
dierent frequencies, they were not optimized for multi-frequency measurement and have only been used for time dierence imaging. The next generation device, termed the UCLH Mark 2, was designed with the aim of
imaging stroke, where time dierence imaging is not practicablea single
image needs to be acquired in a novel subject who already has brain pathology. We planned to do this by making dierence images across frequency.
The design is based on a single impedance measuring circuit of the Sheeld
multi-frequency Mark 3 system (Hampshire et al, 1995) for use with up to 64
electrodes through the use of cross-point switches (Yerworth et al, 2003). The
system injects currents from 2 kHz to 1.6 MHz. Some compromise is introduced by the use of the cross-point switches, so that the bandwidth for
good image quality is reduced to 800 kHz and the CMRR reduced by
10 dB to 80 dB. However, acceptable and reproducible images of multifrequency objects such as a banana in a saline lled tank could still be
obtained (gure 4.3). Our conclusion was that there were signicant practical
advantages in being able to address up to 64 electrodes in a software selectable way, and the reduction in signal quality appeared to be acceptable, at
least in tank studies (Yerworth et al, 2003). The system at present comprises
a power supply, a base box and a headnet and so is only suitable for sedentary recording. It is currently being used for a clinical trial of EIT frequency
dierence imaging in acute stroke. A smaller system with a headbox similar
to the Mark 1b, intended for ambulatory recording in epilepsy patients, is
being developed and we anticipate completion before the end of 2004.
Other groups have also been interested in EIT of the head. The earliest
attempts to image in the head were undertaken by a group at Oxford Brookes,
who constructed a system similar to the Sheeld Mark 1. It was intended for
imaging of intraventricular haemorrhage in the neonate, but no validated data
141
Figure 4.3. EIT images acquired with the UCLH Mark 2 EITS system. Banana, cucumber and Perspex were placed in 0.2% saline in a cylindrical tank with 16 electrodes in a
single ring. Time dierence imaging was performed at 640 kHz. The frequency dierence
image was collected at 640 kHz and referenced to 8 kHz (Yerworth et al, 2003).
series were produced (Murphy et al, 1987). A group in Amsterdam has recently
become interested in obtaining absolute conductivity estimates of the skull and
intracranial tissues for the purpose of setting model values for inverse source
modelling of the EEG (Goncalves et al, 2003). They employed a single
constant current source at 60 Hz and a conventional EEG machine with 64
electrodes to record voltages. The data were tted to a boundary element
model of the head which was optimized for a single parameter, the ratio of
mean skull resistivity to the brain. This varied from a ratio of 23 to 56,
mean 42 for six subjects. This represents the rst attempt to perform absolute
resistivity estimation in the head. Abboud and colleagues have been interested
in the possible use of EIT to record resistance changes during cryosurgery to
destroy brain tumours and have produced modelling studies which demonstrate the feasibility of the proposal (Radai et al, 1999; Zlochiver et al, 2002).
4.3.2.
Reconstruction algorithms for EIT of brain function
In parallel with the historical development of hardware, there have been

developments in reconstruction algorithms for the especially dicult case
of imaging brain function within the head. The majority of eort has again
been within our group at University College London, but there have been
contributions from other groups too who, like us, have been intrigued by
the special problem which the high resistivity of the skull poses.
4.3.2.1.
2D reconstruction algorithms employed for imaging brain function
When we rst attempted EIT of brain function, the only available hardware
was the Sheeld Mark 1 EIT system, which employed a 2D ltered
142
back-projection reconstruction algorithm. This proved to be remarkably

eective in imaging brain function, for the limited circumstances in which
a ring of 16 electrodes was placed on the exposed superior surface of the
brain of anaesthetized rats or rabbits (see section 4.3.1).
The ultimate goal was to be able to image in three dimensions with scalp
electrodes. A major practical step was achieved when Richard Bayford
joined our group in 1994 and added the ability to produce and rene reconstruction algorithms. The rst step was to develop a method which would
enable imaging through the skull. Tarassenko, a member of the team
which attempted EIT of the neonatal head in 1985 (Tarassenko et al,
1985), had made the observation that current injection with electrodes
placed on opposing sides of the head was more likely to inject current into
the brain, which supported the earlier tank studies by Rush and Driscoll
(1968). The other innovation was to use numerical models, such as nite
or boundary element models (FEM or BEM respectively), of the head to
permit use of realistic models of the head in the forward solution of
reconstruction algorithms.
Both polar current injection and numerical models were utilized rst by
Bayford et al, who implemented a 2D algorithm based on back-projection
and constrained optimization with a numerical model of the head as concentric
layers. It enabled reconstruction of data from a 2D phantom with a circular
plaster of Paris ring to simulate the presence of a skull (Bayford et al, 1995,
1996). The method produced acceptable images in simulated data and the
tank studies, but the penalty of using polar drive electrodes was a reduced
spatial resolution compared with injection with adjacent ones. However, this
blurring could be diminished by the use of additional electrodes; resolution
improved in tank studies with up to 64 electrodes (gure 4.4).
There have been some other similar approaches in 2D. Gibson et al
(2000) suggested a 2D circular FEM solution to model impedance changes
in the centre of the neonatal head and their resultant boundary voltage
changes, but did not actually perform any reconstructions with this model.
The problem of stroke detection and monitoring was approached by Clay
and Ferree (2002) using a circular FEM with four concentric regions
representing brain, CSF, skull and scalp. Images of simulated data were
reconstructed using an iterative approach and a high correlation was
shown between simulated and reconstructed impedance changes.
4.3.2.2.
4.3.2.2.1.
3D reconstruction algorithms employed for imaging brain function

Linear reconstruction with the head modelled as a
homogeneous sphere
Since current is not conned to two dimensions in the 3D head, it is more

appropriate to employ 3D models. Our group at UCL took a rst step
towards 3D imaging with an algorithm in which the forward solution
143
Figure 4.4. A plastic rod or sponge was immersed in 0.9% saline and placed at one of four
dierent positions. Data were collected with the UCLH Mark 1b system at 50 kHz with 16,
32 or 64 electrodes, and reconstructed with back-projection and constrained optimization.
The spatial resolution increased with increasing numbers of electrodes.
employed a model of the head as a uniform homogeneous sphere. This was

used to generate a sensitivity matrix and images were produced by matrix
inversion employing truncated singular value decomposition (tSVD). With
this, we were able to produce images of resistance changes in hemispherical
and head-shaped saline lled tanks (Gibson, 2000; Tidswell et al, 2001a).
These studies showed that, in the presence of a real or simulated resistive
skull, the homogeneous algorithm reconstructed impedance changes too
centrally, suggesting the need to take the skull into account in future algorithms. In a head-shaped tank, a 12% resistance change achieved by a
sponge was localized with an error of 625 mm without the presence of the
skull and 2036 mm with the skull in place. However, a simple radial correction appeared to compensate for this eect to a large extent; localization
accuracy was similar for reconstructions from tanks with and without the
simulated skull when a radial correction factor of 1.6 was introduced. This
algorithm is clearly based on an oversimplication, but we adopted it as
we did not at the time have the ability to implement more realistic models.
The approach was used in the rst series of human recordings with scalp
electrodes, during physiologically evoked responses (Tidswell et al, 2001d).
Unfortunately the resulting images were not suciently similar to fMRI or
144
PET during similar activation, but it was not clear which of several factors
were responsible.
4.3.2.2.2.
Linear reconstruction with the head modelled as a

concentric sphere
Since then, we have implemented an algorithm based on analytical solutions

for concentric spheres. EIT images were reconstructed using an analytical
four-shell spherical model and an algorithm optimized for reconstructing
images of an inhomogeneous object (Liston et al, 2004). As expected, use
of the four-shell model was shown to produce more accurate image reconstruction of resistance changes within concentric shells than when the
images were constructed using a homogeneous model. The model was also
moderately successful for image reconstruction of impedance changes
within realistic head-shapes, tanks and human subjects, when best-t electrode positions were used and the reconstructed images were warped.
Several other groups have published proposals for EIT reconstruction
algorithms for the head, based on similar models. A similar approach,
based on perturbation, was employed by Morruci et al (1995) to reconstruct
an o-centre perturbation in an otherwise homogeneous sphere. A direct
sensitivity matrix was produced, using BEM, for a square grid describing
the upper hemisphere and 40 electrodes arranged in rings from its equator
to its apex. There are two examples of the use of analytical, layered sphere
models in the literature. The solution for potential was derived by Ferree
et al (2000) for injection of current through point electrodes on a four-shell
sphere in order to estimate the regional head tissue conductivities in vivo.
A similar method was employed by Goncalves et al (2000) in order to
better specify regional head conductivities when solving for the EEG
problem, but their analytical model included only three layers. Neither
papers reported reconstruction of images. Another spherical model of the
head was produced by Towers et al (2000). They used the Ansoft Maxwell
FEM package to solve for one hemisphere of a sphere consisting of four
concentric shell layers (scalp, skull, CSF and brain) with a ring of 16 scalp
electrodes attached around its equator. They did not produce images, but
showed the requirements of voltage measurement sensitivity to be 100
120 dB in order to detect changes in regional cerebral blood ow due to
application of a carotid artery clamp.
4.3.2.2.3.
Linear reconstruction with the head modelled with an

anatomically realistic mesh
The next step was to utilize an anatomically realistic model of the head,
obtained by segmenting MRI or x-ray CT images of the head. A method for
this computationally demanding task has been presented by Bayford et al
(2001), using integrated design engineering analysis software (IDEAS).
145
Figure 4.5. Finite element mesh used for reconstruction algorithm with realistic geometry.
The four layers (brain, CSF, skull and scalp) are shown.
Using this, our group at UCL produced a tSVD algorithm in which the
head was modelled as an FEM with four realistically shaped compartments
for brain, cerebrospinal uid, skull and scalp (gure 4.5). This produced
clear improvements in image quality in selected individual examples
drawn from tank studies, or recordings in humans during evoked activity or
epileptic seizures (Bagshaw et al, 2003a). However, it is possible that the
complexity introduced by additional computation and the ne meshes used
may outweigh the theoretical advantages of more accurate geometry.
Objective validation with respect to this issue is currently in progress in our
group; EIT images collected during evoked responses in adults and neonates
and during epileptic seizures will be evaluated using a tSVD algorithm and
ne FEM of the head, in comparison with an analytical multishelled model.
Realistic head models have also been implemented by Polydorides et al
(2002), who reconstructed images iteratively from simulation of a visual
evoked response using an FEM model with ve compartments and electrodes
arranged in a ring. In another study, the change in transfer impedance was
studied for a 3040% impedance change due to a 10 cm3 central oedema,
as simulated by an FEM model with realistic head geometry, including 13
dierent tissues and using hexahedral elements (Bonovas et al, 2001).
However, no images were presented using this technique.
4.3.2.2.4.
Nonlinear reconstruction algorithms for EIT of brain function
All the above methods employ an assumption of a linear relationship between

changes in conductivity in a subject and the resulting change in voltage on the
boundary. This approximation appears valid in saline lled tanks up to
146
changes in resistivity of 20% (Holder & Khan, 1994). In time dierence

imaging, in which there are relatively small changes in a small region in the
subject, this assumption appears to yield acceptable images. Recently, we
have attempted to undertake multi-frequency imaging of the brain, with the
intention of imaging acute stroke. Attempts at reconstruction of simulated
or tank data have indicated that the image quality is unacceptable (Yerworth
et al, 2004). This is presumably because changes in conductivity occur over
much of the imaged volume and may be large when images are produced by
frequency, as opposed to time, dierence imaging. We have recently implemented a nonlinear algorithm which employs a realistic FEM mesh and an
iterative solution. The inverse solution was found to be optimal with the
methods of conjugate gradients with regularized search direction and Brent
line search (Horesh et al, 2004). Computational time on a well specied PC
is currently excessiveabout 2 h for each image with a moderate neness
mesh. It is also not yet clear whether there will be practical benets in image
quality, as modelling errors may counterbalance the improvements anticipated
from having a nonlinear approach. We will be assessing these in tanks and
human subjects shortly after onset of stroke.
4.3.3.
Development of tanks for testing of EIT systems
In order to test hardware and reconstruction algorithm improvements, we

have developed a series of saline lled tanks. Before starting this work,
there were some published methods for this approach. Griths (1988) developed the Cardi phantom which comprised a circular array of resistances
and capacitances, which has been widely used for calibration of hardware
in our and other laboratories. Several groups have employed saline lled
tanks in which highly conductive metal or resistive Perspex objects are
suspended (e.g. Sinton et al, 1992), but this poses a large impedance contrast
which does not fully examine the ability of the system to image the lower
contrasts that are usually seen in in vivo applications. Other groups have
produced lesser contrasts by using agar test objects (Sadleir & Fox, 1998)
or semipermeable tubing containing uid (Thomas et al, 1994), which
contain a salt concentration dierent to the bathing solution. Unfortunately,
these dierent saline concentrations will diuse, leading to uncertain boundaries of the test objects.
This may be overcome by the use of a test object such as a gel or
sponge immersed in saline, in which the impedance contrast is produced
by insulating the material itself; the bathing uid permeates the pores of
the test object, so it is stable over time. Resistance increases of 10200%
were produced using polyacrylamide gels (Holder & Khan, 1994). For testing
multi-frequency systems, it is desirable to utilize test objects which comprise
capacitance as well as resistance. Unfortunately, it appears that only biological materials contain the high capacitance needed to simulate human
147
tissues. Cucumber in potassium chloride solution and packed red cells

appeared suitable and were stable over several hours. Impedance contrasts
of 520% in both resistance and reactance could be produced in the
packed red cell solution by immersing polyurethane sponges of diering
densities (Holder et al, 1996a).
The above tanks were all cylindrical. We wished to develop tanks for testing our 3D reconstruction algorithms. The rst step was a spherical tank for
testing the eect of introducing concentric shells to simulate the shunting
eect of the high frequency of a skull. This was achieved, with some diculty,
by creating a hollow sphere from plaster of Paris (gure 4.6(a)). This was
(a)
(b)
(c)
Figure 4.6. (a) Spherical tank containing a hollow plaster of Paris shell to simulate the
skull. Left: lower half of the tank and simulated skull. Right: the assembled tank with
no simulated skull. (b) and (c) Realistic phantoms, containing a human skull, for simulating the human head. (b) Latex tank with 0.2% saline simulating brain and scalp. Half
the tank is cut away to show the scalp inside. (c) Marrow tank in which the brain is
simulated by 0.2% saline, the scalp by alginate, and the skin by the skin of a marrow or
giant zucchini.
148
employed either as concentric hemispheres (Tidswell et al, 2001a) or a full

complete sphere, with a small azimuthal hole to admit a test object (Liston et
al, 2004). The next step was to construct a tank with realistic head geometry
for testing reconstruction algorithms which contained accurate anatomical
head models. A simpler design contained a real human skull in a tank made
from watertight latex, lled with 0.2% saline. A gap 5 mm wide surrounded
the skull, which simulated the scalp (Tidswell et al, 2001a; Liston et al, 2002)
(gure 4.6(b)). This contained the barrier of the skull and realistic geometry,
but not a layer to simulate the impedance properties of skin. The most realistic
tank simulated electrical properties of skin with the use of the skin of the
marrow, or giant zucchini. This was plastered over a human skull and a layer
of slow setting dental alginate, to simulate the scalp. The interior cavity was
watertight, and the brain was simulated by 0.2% saline (gure 4.6(c)). Acceptable images could be acquired with this and a reconstruction algorithm, in
which the head was modelled with realistic geometry (Tidswell et al, 2003b).
4.4.
EIT OF SLOW EVOKED PHYSIOLOGICAL ACTIVITY

IN THE BRAIN
There are good grounds for expecting that EIT could produce images of
increases in blood ow and volume, and related changes, which occur when
part of the brain is physiologically active. These changes have been the basis
of functional MRI and PET studies for over a decade, and have been reviewed
in section 4.2.1.3. If successful, EIT could provide a low-cost portable system,
which would produce similar images to fMRI and be widely used in cognitive
neuroscience in healthy and neurological or psychiatric subjects.
The local changes in the brain are small (a few per cent) and occur over
seconds or tens of seconds following the onset of activity. As the mechanism
of impedance dierence is probably changes in resistivity due to a changed
proportion of blood to brain, these may be imaged at any suitable frequency
which can distinguish these. In principle, a low frequency is desirable. This is
because the standing resistivity of brain becomes higher at low frequencies,
because applied current is restricted to the extracellular space (Ranck, Jr.,
1963), so the contrast between brain and the conductive blood will be greater.
On the other hand, instrumentation errors due to skin impedance may be
expected to be greater, as skin impedance is higher at low frequencies
(Rosell et al, 1988). An applied frequency of 50 kHz, as used in the Sheeld
Mark 1 system, appeared to be a good compromise.
4.4.1.
Proof of concept in animal studies
The rst EIT images during evoked physiological activity were collected with a
Sheeld Mark 1 system, using a ring of 16 spring mounted electrodes placed
149
Figure 4.7. EIT images of rabbit cortex during visual stimulation. Images displayed were
collected every 30 s. An impedance decrease may be seen over the posterior visual cortex
which persists for about 30 s after cessation of stimulation.
on the exposed supercial surface of the brain of anaesthetized rabbits (Holder

et al, 1996b) (gure 4.7). In eight rabbits, evoked responses were produced by
stimulation with ashing lights or forepaw stimulation, lasting 2.5 or 3 min
respectively, and EIT images were collected by averaging over consecutive
15 s periods. Reproducible impedance decreases of 2:7 0:8% (visual) and
4:5 0:9% (somatosensory) (mean S.E.) were consistently observed in the
appropriate region of the brain. An unexpected nding was that, in addition
to the expected impedance decreases, there were adjacent smaller increases.
The explanation was unclearit could have been a ringing artefact due to
the Sheeld back-projection reconstruction algorithm, or due to steal of
blood volume from neighbouring regions.
4.4.2.
Human studies
The development of the Hewlett-Packard impedance analyser-based EIT

system at UCH and a 3D reconstruction algorithm allowed us to extend
these ndings to human recording with scalp electrodes (Tidswell et al,
2001d). In these experiments, an EIT image was reconstructed from the
impedance data collected from 258 four-electrode polar pattern impedance
measurements, made with 31 silver/silver chloride scalp EEG electrodes;
each image was acquired over 25 s. These impedance changes were produced
by ashing lights (visual), electrical stimulation at the wrist (somatosensory)
and active motor movements of the hand (motor), in a block paradigm,
with stimuli lasting 75 s with 150 s baseline periods either side of the stimulus.
Each experiment was repeated up to 12 times in order to determine whether
impedance changes measured during stimulus presentation were reproducible.
We rst examined raw impedance data, collected as voltage changes
from individual four-electrode combinations. Encouragingly, these showed
signicant impedance changes of about 0.5%, dened as those electrode
combinations where the impedance during stimulation was more than two
standard errors of the mean from the baseline in two or more consecutive
stimulus frames, in 51/52 experiments performed in 39 healthy adults. As
150
Figure 4.8. Examples of impedance changes in the raw impedance data. Impedance
changes from single channel four-electrode impedance recordings, during motor (top
row, eight repetitions) or visual stimulation (bottom row, n 12). On the left, data
from a single electrode combination are shown; all repetitions are superimposed. Reproducible impedance changes are seen at selected electrode combinations with the same time
course as the stimulation paradigms. The y axis indicates the percentage change from baseline impedance. Impedance measurements were made every 25 s; the lines between these
measurements are drawn for clarity. Both impedance increases and decreases were
observed. On the right are shown all 258 electrode combinations for the same subjects,
displayed as a sorted waterfall graph. The 812 runs for each electrode combination
were averaged together. The averages were sorted according to the size of the impedance
change during stimulation and stacked on the vertical axis. Measurements with baseline
noise greater than the impedance changes are excluded from these plots so that these
changes are not obscured. Signicant stimulus-related impedance increases and decreases
are seen in approximately 25% of electrode measurements in these subjects.
in the rabbit experiments, the predominant changes were decreases; but

increases were also seen (gure 4.8). The observed impedance changes
appeared to indeed arise from within the skull, as there were no signicant
changes in local scalp impedance recorded simultaneously in a further ve
subjects during a motor task, over electrodes whose combinations showed
the largest impedance changes.
151
Unfortunately, the reconstructed images from this data were noisy, and
the impedance changes were not consistently localized to the appropriate
areas of cortex. The reconstruction algorithm used a simple analytical
model of the human head in the forward solution, based on a homogeneous
conductivity sphere (see section 4.3.2.2) (Gibson, 2000). It was likely that the
use of this simple model of the human head led to image errors when used on
real human data. The source of such reconstruction errors could have been
due to dierences in shape, absence of the four layers of scalp, the skull,
CSF and the brain, or there may have been errors in electrode position
between the human head and the reconstruction model.
As the actual impedance changes that occur in the human brain during
stimulation are unknown, the 3D reconstruction algorithm, based on the
homogeneous spherical model of the head, was tested in tanks of increasing
degrees of dierence from the head model employedthe spherical tank
(section 4.3.3, gure 4.6(a)), or the latex tank with a realistic head shape
(gure 4.6(b)), with or without the skull (Tidswell et al, 2001c). EIT images
of a sponge, 14 cm3 volume, with a resistivity contrast of 12%, were acquired
in three dierent positions in tanks lled with 0.2% saline. In the hemispherical tank, 19 cm in diameter, the sponge was localized to within 3.410.7% of
the tank diameter. In a head-shaped tank, the errors were between 3.1 and
13.3% without a skull and between 10.3 and 18.7% when a real human
skull was present. This demonstrated that a signicant increase in localization error occurred if an algorithm based on a homogeneous sphere was
used on data acquired from a head-shaped tank. In addition, the localization
error was mainly due to the presence of the skull, as no signicant increase in
error occurred if a head-shaped tank was used without the skull present,
compared with the localization error within the hemispherical tank. The
error due to the skull signicantly shifted the impedance change within the
skull towards the centre of the image by up to 8% of the image diameter.
As soon as an improved reconstruction algorithm became available, in
which the head was modelled with four realistic compartments (section
4.3.2.2, gure 4.5), the data was re-analysed. The images produced using
this reconstruction algorithm showed a clear improvement. Correctly localized impedance changes with the same time course as the stimulus were
found in 38/51 images19 when reconstructed with the algorithm which
employed a homogeneous sphere head model (gure 4.9). Unfortunately,
despite these improvements the EIT images were still noisy and contained
multi-focal impedance changes, even after statistical thresholding.
In summary, the evoked response studies have been encouraging, but
are not yet at a stage where EIT systems could be condently used as a
robust tool for human psychophysical or clinical studies. The reason for
the bottleneck in image quality is not entirely clear. The size of changes
about 1% in human studies with scalp electrodesis close to the noise
from electronic and physiological sources, but the reliable raw impedance
152
Figure 4.9. Impedance changes in four subjects during right motor stimulation (repetitive movements of the ngers of the right hand). These all
show an impedance decrease in the area of the contralateral motor cortex on the left, and are more in keeping with the hypothesis that blood
volume is increased in the area of cortex expected to be stimulated by the motor stimulus.
153
154
data suggests that this is not an insuperable obstacle. Although we used a

realistic head model in the reconstruction algorithm, the model and electrode
positions were idealized and the same one was used to reconstruct data from
all subjects. We plan further studies in which improved reconstruction
algorithms, with individually optimized meshes from MRI and directly
measured electrode positions, are used.
4.5.
EIT OF EPILEPSY
Because EIT systems can produce several images a second, and are portable
and safe, they are ideally suited to image blood ow and related changes
that occur during epileptic activity with a high time resolution. EIT could be
employed to localize the part of the brain that produces epileptic seizures, so
that resective surgery can be performed. At present, about 80% of patients
with epilepsy can be satisfactorily treated with medication. Of the remainder,
some can be cured or improved by surgery. In order to perform this, it is
essential that the correct source of epilepsy in the brain is localized. This is
usually performed with a prior stay in hospital of several days. EEG and
video are monitored continuously, so that they are recorded when a number
of seizures occur. The EEG is usually performed with scalp electrodes but, if
the seizure onset zone is unclear, it may be performed with subdural mat or
depth electrodes, inserted at operation. Together with psychometry and
neuroimaging studies, the onset zone is usually localized, and a decision as
to whether to embark on surgery is undertaken.
EIT could be run concurrently with scalp EEG during this pre-surgical
EEG telemetry. EIT images would be recorded about once a second over a
period of days while the patient was observed on the ward. When a seizure
occurred, the EIT images would be retrospectively analysed to see if changes
in impedance occur at the same time as EEG activity. Imaging of this nature,
with a temporal resolution or seconds, is not presently possible by any other
method. In principle, the same information could be obtained if a subject had
a seizure when in an fMRI scanner, but this is not practicable. Recent
advances in neuroimaging have lessened the need for invasive recordings
with depth or subdural mat electrodes, but these still need to be performed
in patients in whom pre-surgical ndings are not congruent. While subdural
electrodes carry a low risk, depth electrodes which penetrate into the cerebral
substance carry a signicant morbidity and mortality. Haemorrhage resulting in permanent neurological damage occurred in 0.8% in one report (879
patients); in another, two patients of a series of 140 died (see Van Buren,
1987). Ictal EIT could be performed safely and non-invasively with EEGtype scalp electrodes, and may become a routine additional method to
EEG during telemetry. If successful, it would reduce further the need for
invasive depth EEG recordings and so have a direct benet for patient
EIT of epilepsy
155
health if epilepsy surgery were to be undertaken. In addition, the success rate

of surgery is only about 70%. The cause of this is not entirely clear, but it
may be partly because intracranial electrodes can only be sampled at a
limited number of sites. EIT would enable information to be obtained
from all sites in the sensitive volume of the brain.
In addition, EIT might also be used in epilepsy diagnosis. Patients with
epileptic seizures often have abnormalities in the EEG between seizures,
which are evident in routine out-patient EEG recordings. These usually
take the form of spikes, which are surface negative discharges lasting less
than 70 ms. Although these are not usually apparent clinically, they cause
a small increase in blood ow to the aected region, and this can be detected
in about 50% of patients with fMRI, by back-averaging using the
EEG recorded spikes as triggers (Lemieux et al, 2001). EEG spike-triggered
EIT could provide a low-cost portable system for imaging spike-related
blood ow increases, which could become a routine diagnostic tool in
EEG laboratories.
4.5.1.
Proof of concept in animal and single channel human studies
The rst EIT studies in epilepsy were, as for evoked responses, collected with
a Sheeld Mark 1 system using a ring of 16 spring mounted electrodes placed
on the exposed supercial surface of the brain of anaesthetized rabbits.
Epileptic seizures were induced by focal electrical stimulation and were
either localized or spread to involve the entire brain (Rao, 2000; Rao et al,
1997) (gure 4.10). Reproducible predominant impedance increases of
7:1 0:8% (localized) and 5:5 0:8% (generalized) were present in EIT
images in nine animals at the sites where the epilepsy was initiated. As in
the previous animal study in evoked responses, there were smaller adjacent
impedance decreases apparent in the images. In this study (which followed
that of evoked potentials), two probes were placed on the brain near the
site of seizure onset and about 10 mm away, to try to elucidate the physiological mechanisms and establish if the impedance increases and decreases were
physiological or due to reconstruction algorithm artefact. Local impedance
measured at both sites was always an increase. Extracellular potassium,
temperature, d.c. potential and laserDoppler owmetry were all consistent
with the expected mechanism of cell swelling as the explanation for the
increased impedance. The probable increase was about 10%, but was
oset slightly by a concurrent decrease of a few per cent due to increased
temperature and blood volume. The decreases appeared to be due to noise
or to a reconstruction artefact.
In relation to this, some single channel studies were performed in
humans. The previous literature (section 4.2.1.2) demonstrated impedance
increases in animals. The proportion of glial cells in humans is greater, so
the theoretical possibility existed that impedance changes might not occur
156
Figure 4.10. EIT images during a partial epileptic seizure. A ring of 16 electrodes was
placed on the exposed brain of an anaesthetized rabbit. EIT images were collected every
5 s, while a seizure was elicited by electrical stimulation at the site of the small arrow
(near electrode 10). The electrocorticogram was recorded from the same electrodes, and
selected ECoG and EIT images every 30 s are shown. An impedance decrease may be
seen to develop and fade away in concert with the ECoG changes, at the site corresponding
to the electrical onset.
in humans during seizures. Impedance was recorded in ve subjects during

telemetry, at 50 kHz, using four contacts on subdural mats over the temporal
cortex or ne wire electrodes in deep temporal structures such as the
amygdala (Holder et al, 1993). In two patients with supercial parietal foci
and recording with subdural mats, reproducible impedance increases of
4:5 0:3% and 2:4 0:3% were observed. In a third patient with a supercial temporal focus, consistent impedance increases of 3:6 0:2% (5,
p < 0:05) were observed with both temporal subdural and amygdala depth
electrodes. The changes commenced within 20 s of the onset of ictal EEG
activity and lasted for 12 min. These results indicated that substantial
impedance changes do occur in the cerebral cortex of some human subjects.
Encouraged by these preliminary ndings, we have undertaken a pilot study
in epileptic subjects using the UCLH Mark 1b system at 38 kHz, scalp electrodes and the linear reconstruction algorithm with an idealized realistic
model of the head (Bagshaw et al, 2003b; Fabrizi et al, 2004) (gure 4.11).
EIT images were recorded continuously three times per second in nine
EIT in stroke
157
Figure 4.11. Example of EIT images collected with the UCLH Mark 1b during two
epileptic seizures in a subject undergoing EEG telemetry as assessment prior to surgery
for intractable epilepsy. The EIT headbox is visible in his left breast pocket. Independent
investigations, including MRI and EEG, indicated seizures originated from the left
temporal lobe; blood ow changes occurred in the appropriate region in both seizures
imaged. Only the images at the onset of the seizures are shown, but images recorded
three times a second reveal blood ow changes evolving over tens of seconds. Similar
changes have been observed in four other subjects.
subjects with temporal lobe epilepsy, receiving continuous EEG monitoring

as in-patients on a telemetry ward. Several seizures were recorded in each
subject, and the EIT changes were correlated with the EEG and other
investigations to localize the site of onset. In ve subjects, reproducible
impedance changes of 25% occurred in EIT images in the temporal lobe
at physiologically reasonable sites which correlated with independent
diagnostic information from EEG and neuroimaging.
As with the evoked response study, this was encouraging, but the images
are not yet of a quality suitable for condent clinical use. A larger study is in
progress at the time of writing. Technical improvements we plan to introduce
are the use of individual meshes from MRI with directly recorded electrode
positions, and the use of multi-frequency recording with a UCLH Mark 2
system to try to reduce the specic problem of movement artefact.
4.6.
EIT IN STROKE
Stroke is a leading cause of death and long-term disability in the UK and is

associated with high costs. Treatment with thrombolytic (clot-dissolving)
158
drugs is eective for ischaemic stroke due to occlusion of arteries, but needs to
be undertaken within 3 h of the onset of symptoms. A brain scan is required
prior to treatment onset to dierentiate between ischaemic and hemorrhagic
strokes; thrombolytic drugs cannot be used where there is a haemorrhage as
they may extend it. In practice, it is dicult to obtain rapid scans because of
the diculty of obtaining access to a scanner and rapid reporting. There is
therefore a need for a neuroimaging system which could be utilized in casualty
departments or health centres, which is inexpensive, rapid and safe. EIT could
be ideal for this purpose. It could be used with an array of elasticated scalp
electrodes, which may be easily applied by a technician or nurse in a few
minutes. Interpretation could be performed by a trained technician or by a
radiologist using remote reporting over a network or the internet. It could
also be useful for research studies in which new treatments for stroke
needed to be assessed over days as a stroke evolved.
However, unlike the applications above, time dierence imaging could
not be performed as the clinical need is for a single image on presentation.
This could be achieved by absolute imaging, but this has not yet been
shown to be practicable for clinical studies. The possibility exists, however,
for achieving this by multi-frequency imaging in which dierence images
are produced by referencing one frequency against another (Brown et al,
1995). The main principle will be that the impedance spectrum of blood in
the range 1 kHz1 MHz will be dierent from brain and recently ischaemic
brain.
Holder (1992a) performed pilot single channel impedance measurements in a reversible model of cerebral ischaemia in the anaesthetized rat.
With a single applied frequency of 50 kHz, increases of 1560% were
recorded. Scalp recording from the same electrode combinations revealed
changes decreased to 1020%. This suggested that the changes were large
enough to be recorded through the skull, at least in this animal model. The
rst EIT images taken with scalp electrodes were then recorded in the
same animal model. Clear reversible changes of 10% were apparent on
images (Holder, 1992b). However, these were collected with the Sheeld
Mark 1 system and 2D back-projection algorithm. The accuracy of the
images was not clear, as no independent standard was available for
comparison. There were some unexpectedly large posterior changes, so it is
probable that errors occurred, but this work at least qualitatively supported
the principle that this could be possible.
We are not aware of other further physiological studies, but a group has
published a proposal for a reconstruction algorithm for imaging stroke (Clay
& Ferree, 2002). We have developed the UCLH Mark 2 system specically
with this application in mind (Yerworth et al, 2003, 2004). It is capable of
imaging vegetable samples with similar properties to brain and blood in
cylindrical tanks, but a nonlinear algorithm must be used as the large changes
in impedance contrast throughout the tissue, a necessary consequence of
EIT of neuronal depolarization
159
multi-frequency referencing, violating the assumptions used in linear algorithms. A clinical trial of this approach in subjects with acute stroke is
currently under way in our group.
4.7.
EIT OF NEURONAL DEPOLARIZATION
The novel applications presented above all make use of the low cost and portability of EIT, but similar images can already be obtained with fMRI or PET.
However, EIT could in principle be used to image neuronal activity over
milliseconds (section 4.2.1.4). The proposed application would be to record
EIT images from one or more rings of electrodes, either around the brain
in experimental animals or human surgical subjects, or, ultimately, around
the scalp. Data would be gathered after a repeated stimulus, in the same
way as somatosensory or visually evoked responses. An EIT image would
subsequently be reconstructed for each millisecond or so of the recording
window. In this way, it would be possible to determine the waveform of activity in any selected pathway during evoked responses. This is not currently
possible by any existing method, and, if possible, this would be a substantial
advance. Unfortunately, it poses a formidable technical challenge. The
reconstruction algorithms developed for EIT of the brain (section 4.3.2)
could be employed as they stand, and the small changes would probably
be suitable for linear reconstruction approaches.
The physiological basis is clear, but an important issue is the magnitude
of the likely changes. This has been modelled using cable theory (Boone &
Holder, 1995; Boone, 1995; Liston, 2004). The model was initially for the
ideal case of unmyelinated peripheral nerve. The rst observation was that
the frequency of recording was critical: above about 100 Hz, the resistance
changes during activity fell o steeply. For a four-electrode measurement
for a mean bre diameter of 1 mm, the calculated impedance change was
3.7% at d.c. but 0.009% at 30 kHz (Boone, 1995). Further work and renements, such as the inclusion of incomplete depolarization of the nerve and
the eects of the capacitance of the membrane, were made to the model
(Liston, 2004). At d.c., the new model predicted a resistance decrease of
2.8%. This has been experimentally validated with recordings in crab
nerves (Barbour, 1998), where resistance changes at d.c. of 1:1 0:1%
were recorded.
The modelling has been extended to estimating the resistance changes in
cerebral cortex (Boone, 1995; Liston, 2004). The size of the change depends
critically on the proportion of neurones that depolarize in an active part of
the brain, which is unknown. Assuming this was 10% of available neurons,
the model estimated the resistance change to be 0.6% locally within brain
tissue. For a physiologically reasonable volume of cortex near to the surface,
the resulting peak scalp resistance changes were 0.06%. Ahadzi has modelled
160
this using a realistic nite element model of the head in order to determine
whether more sensitive measurement could be obtained by the use of
magnetoencephalography to detect magnetic elds (Ahadzi et al, 2004). His
conclusion was that peak changes were about 0.03%, and that the signal-tonoise ratio was very similar to those predicted for electrical measurement.
This prediction has not, to the authors knowledge, been fully tested.
Boone (1995) recorded changes of 0.010.03% in preliminary measurements
at low frequency in the cortex of anaesthetized rabbits during physiologically
evoked responses. Published data reviewed in section 4.2.1.4 claimed changes
of about this order in cat brain (Klivington & Galambos, 1968), but these
were at 10 kHz, at which the model predicts vanishingly small changes, so
the validity of these ndings is unclear. Holder (1989) was unable to detect
any reproducible changes larger than 0.002% at 50 kHz during evoked
responses in human subjects.
The application of EIT to imaging these changes is intriguing, but these
estimates of its magnitude place the changes at the extreme limits of detectability. Sensitive impedance recording circuits can detect changes of the order
of 0.01% at low frequencies with prolonged averaging, but this is for peak
changes for relatively large volumes of cortex near the surface. For imaging
to be useful, deeper changes need to be imaged, and recording times for
multiple electrode combinations need to be practicable. At present, it is
not clear if these diculties could be overcome in practice to yield acceptable
EIT images in the half hour or so a subject could be expected to tolerate
recording.
4.8.
CONCLUSION AND FUTURE WORK
At rst sight, EIT of brain function might have been supposed to be too dicult, in view of the resistance barrier of the skull. The substantial preliminary
work presented in this chapter, in tanks and animals, suggests that this is not
the case, and that satisfactory images can indeed be obtained with the use of
specialized reconstruction algorithms and recording equipment. If EIT can
be shown to produce acceptable images, then there is little doubt that the
portability and low cost of EIT could enable it to provide an essential
additional imaging technique when the applied frequency is set up to
image blood ow, cell swelling and related changes. Applications in epilepsy
and stroke are currently the leading areas in this, but there are several others,
such as in monitoring head injury or cryosurgery (Radai et al, 1999). If
imaging of neuronal depolarization were possible, this would be a uniquely
important advance.
However, the critical issue is whether the inherent limitations of EIT
low spatial resolution and sensitivity to noisy measurementcan be
suciently overcome to yield clinically robust data. Preliminary ndings in
References
161
human recordings in evoked responses and epilepsy have been encouraging

in that reproducible raw impedance changes were recorded, but the reconstructed images were disappointing. The approach in our group at UCL is
now to try to improve image quality by making technical improvements on
several frontsto the reconstruction algorithm method itself, enhanced
accuracy of the model employed, electrode contact, and in instrumentation,
by the use of wireless electronics. Clinical trials with these improving
methods are under way at the time of writing, and we look forward to the
results in the near future.
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simulation of EIT for monitoring impedance variations within the human head
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2004 Magnetoencephalography MEG and magnetic source imaging (MSI) Neurologist 10 138153
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Chapter 5
Breast cancer screening with electrical
impedance tomography
Alex Hartov, Nirmal Soni and Ryan Halter
5.1.
5.1.1.
RATIONALE FOR USING IMPEDANCE MEASUREMENTS

FOR BREAST CANCER SCREENING
Introduction
Approximately one woman in eight will develop breast cancer over a lifetime
in the US [1]. The prognostic for women diagnosed with the disease is greatly
inuenced by the stage at which it is discovered. Long term survival is
signicantly improved for women found with small tumours in the early
stages of development. Periodic mammograms for women over 40 or 50
years of age constitute the principal tool used in screening for breast
cancer and can be credited with saving many lives. However, mammography
has not reached the level of perfection desirable for a mass screening tool.
Exposure to x-rays, although minimal in mammograms, is one objection
that is raised, particularly for women who are advised to have more frequent
exams and to start at an earlier age, due to a family proclivity. It is thought
that the cumulative x-ray exposure, beyond a reasonable lifetime quota, may
itself become a health risk.
More immediately of concern for women who undergo the examination is
the signicant discomfort caused by the need to squeeze the breasts to a thickness of a few centimetres against a detector plate. The procedure is thought to
discourage some women from submitting to regular examinations.
From a public health point of view, the greatest objections to x-ray
mammography is its imprecision as a diagnostic tool. Studies estimate that
a woman with a tumour may remain undiagnosed following a mammogram
(false negative) 1025% of the time [24]. This means a sensitivity of up to
90%. Conversely, women who undergo periodic examinations will have a
high probability of an abnormal nding; nearly a 50% chance after 10
visits according to one study [5]. Such ndings typically call for biopsies to
168
Breast cancer screening with electrical impedance tomography
be performed, which in 80% of cases reveals benign abnormalities [6]. The

diagnostic eectiveness of mammography diminishes as it is applied to
women with denser breast tissue. This generally corresponds to younger
women who undergo the procedure because of a family history and who
are usually at a higher risk. The high rate of false positive ndings (lack of
specicity) represents a great cost to the health care system, and women
undergoing the process could be spared the distress it causes if a better
diagnostic tool were available.
The idea of measuring the impedance of tissues is not new, but until
methods were devised to measure non-invasively the impedance of internal
structures, it was only of interest to researchers. Computers make it possible
now, using advanced algorithms, to reconstruct the electric properties of
internal tissues from non-invasive surface measurements. Electrical
impedance tomography, in its various forms, has been applied to several
areas in medical diagnosis and monitoring, including the measurement of
breast tissue impedance. Preliminary data strongly indicate that cancerous
tissues have electrical properties that are signicantly dierent from their
normal surroundings. This has spurred a wave of activity, which it is
hoped will result in improved screening for breast cancer.
5.1.2.
Other methods in use for breast cancer detection
Standard practice has established x-ray mammography as the primary and

most used method of breast cancer screening. Breast self-examination has
been advocated as a possible alternative, but its eectiveness compared
with x-ray mammography is very limited. The size of tumours that are
detectable by palpation is typically much larger than that of abnormalities
that are detectable by mammography.
Given the less than perfect performance of mammography as a screening tool, several procedures are in use to specify the nature of abnormalities
that are detected in normal periodic examinations. These are used mostly as
follow-up on the results of mammography and are not generally used as the
primary screening tool. In this category are ultrasound and MRI.
Ultrasound alone does not compete with mammography. The image
quality, although greatly improved in the past few years, is not comparable
with x-ray mammography. However, because it is much more exible and
interactive, with the user able to scan the desired area repeatedly and from
dierent angles, it is often used to inspect more closely suspicious masses
or cysts. It is typically used to distinguish between tumour types for diagnostic purposes, and also for the placement of biopsy needles.
MRI mammography is usually used to verify a diagnosis, and rarely as
the primary screening tool. The cost of MRI, particularly when compared
with inexpensive x-ray mammography, will preclude it for the foreseeable
future from becoming the standard in breast cancer screening. However, it
Impedance measurements for breast cancer screening
169
is currently being investigated in Britain [7] for screening younger high-risk

women who generally have denser breasts, which proved to be more dicult
to screen with x-ray mammography. In addition, centres have appeared
which have dedicated MRIs for breast examinations, although not exclusively for cancer screening. It is oered in one centre, for example, for
diagnosis of breast implant rupture, cosmetic surgery planning, staging of
breast cancer and treatment planning, post-surgery and post-radiation
follow-up, dense breast tissue evaluation, and monitoring of high-risk
patients with a non-radiation alternative.
Electrical impedance is still in the research stage and its clinical eectiveness remains to be demonstrated. There are other technologies being investigated in view of applying them to breast cancer screening. Many groups
worldwide are investigating light attenuation and scattering, particularly in
the near infrared (NIR) region, as a method of detection [8, 9]. Microwave
imaging (MWI) is also being investigated in several groups worldwide for
breast imaging [10]. In a fashion very reminiscent of EIT, it seeks to image
conductivity and permittivity of irradiated tissues by reconstructing a tomographic section of a breast, although at a much higher frequency range
(300 MHz3 GHz). MRI-based elastography (MRE) is another technique
that is being explored for breast cancer screening [11]. It relies on MRIs ability to detect very slight motion (100 mm). A periodic motion is imparted by
a mechanical shaker to one side of the breast and the resulting displacement
eld inside the breast is captured by the MRI. Computational techniques can
recover the tissues shear modulus (which corresponds more or less to hardness) from the motion data. It is thought that hardness may be a reliable
indicator of a malignant tumour. It is well established that cancerous
tumours are felt as hard nodules when reaching a certain size. There is
currently under way a project at Dartmouth College (Hanover, NH, USA)
which will culminate in a clinical study, which explores concurrently and
on the same group of patients all four imaging modalities presented here:
NIR, MWI, MRE and EIT [12].
5.1.3.
Breast impedance data from preliminary studies
Research on the use of impedance measurements for breast cancer screening

has been ongoing for some time, with some of the earliest data on breast
tissue impedance published in 1926 [13]. Review articles have been published
which present good overviews of the eld. The most recent we know is the
article by Zou and Guo [14]. We would like here to present a brief summary
of the existing experimental data which provides the rationale for using
electrical impedance measurements for breast cancer detection.
Tissues, like any material, can let currents ow with more or less ease
and, given an applied potential, hold more or less electric charge. Conductivity is a materials ability to allow current ow: as it increases, greater current
170
is established for a given potential dierence. Permittivity is a measure of a

materials ability to hold charge, with greater permittivity corresponding to
greater amounts of charge stored, for a given potential dierence.
Conductivity () and permittivity (") are distributed properties of a
tissue. They aect the ow of alternating currents and this eect can be measured. For a given geometry, the impedance (Z) or its inverse, admittance
(Y 1=Z), relate directly to the distributions of and " in the material.
Admittance can be expressed as the complex value Y G j!C, with G
the conductance relating to the tissues conductivity () and C the capacitance relating to the tissues permittivity ("). Distributed complex properties
have been dened which correspond to impedance and admittance; they are
impedivity and admittivity, respectively. Admittivity can be expressed in
terms of conductivity and permittivity: j!"0 "r , where j is the
imaginary unity, ! the angular frequency, "0 the dielectric constant of
vacuum and "r the relative permittivity of the tissue. Impedivity can be
expressed as the inverse of admittivity.
Early experimenters reported data obtained from excised tissues which
indicated signicant dierences between cancerous and non-cancerous
tissues. Since not all the data were collected under comparable conditions
and although there are some reasons to believe that even freshly excised
tissues will have their properties altered in the process, these data nevertheless should be interpreted as indicating that a measurable dierence in
electrical properties does exist in cancerous tissue compared with their
surroundings.
The oldest study we are aware of, that of Fricke [13], found a signicant
dierence in the capacitances of their excised samples, with benign tumours
having lower capacitances than cancerous tumours.
Jossinet conducted two studies, in 1985 [15] and in 1996 [16], both of
which reect measurable dierences. In the earlier study, it is reported that
the magnitude of impedivity is smaller for cancerous tumours than for
surrounding tissue by a factor of approximately 5 at 1 kHz. In the later
study, the magnitude of impedivity of cancerous tumours is compared with
several other classes of tissues. It is found that carcinoma has lower impedivity (magnitude) than subcutaneous fat and connective tissue, but is greater
than bro-adenoma. However, at higher frequencies cancer tissue has the
greatest reactive (capacitive) response of all the tissues tested. Furthermore,
no signicant dierences have been observed between the impedivity of the
normal or benign tissue types.
Several other studies have been published which generally conrm these
results [1720], although not all cover the same frequency range. One study
found no signicant dierences in the conductivity or permittivity of benign
and malignant tumours [17]; however, the data were recorded at a very high
frequency (3.2 GHz), at which dierent phenomena may be taking place in
tissues.
Dierent approaches to breast EIT
171
Many more studies can be found that have published data on ex vivo
breast impedance. Most of the results reviewed here seem to concur that
cancer tumours have lower impedance than normal surrounding tissues.
Many fewer studies have published data based on in vivo invasive
measurements. One of the few groups to publish such data, Morimoto et al
[21], used a specially designed probe inserted in breast tumours on anaesthetized patients, and measured impedances between the needle tips and an
abdominal patch electrode, using a three-lead technique. Measurement
data from these studies was presented in the form of equivalent lumped
components Re, Ri and Cm, forming a network in which Re is in parallel
with a series combination of Ri and Cm. This way of presenting the data
makes it dicult to compare with other studies. In this study Re and Ri
were found to be higher in tumours, while Cm decreased in tumours,
compared with normal tissues. Although this study showed that signicant
dierences in the electrical responses of the dierent types of tissue could
be used for dierentiation, it is largely in disagreement with other data
regarding the direction of the changes, presenting an increase in impedance
instead of a drop for cancerous tumours.
A few groups have performed non-invasive two points impedance
measurements on breasts with and without tumours [22, 23]. The reports
based on these experiments indicate again a drop in resistance and an
increase in capacitance [22] for cancerous tumours, or at least that dierentiation is possible [23].
5.2.
DIFFERENT APPROACHES TO BREAST EIT
Dierent approaches have emerged for imaging internal tissue impedances

using non-invasive techniques. Two categories present themselves based on
the arrangements of the electrodes: tomographic systems and planar or
mapping systems. The tomographic type systems led to the adoption of the
term electrical impedance tomography or EIT. We use the term impedance
imaging to encompass all methodologies.
5.2.1.
Impedance mapping
Impedance mapping systems are simpler in two respects. The electrode

arrangement is planar, usually an n n square array of electrodes, which
is used to press the breast against the chest wall. In this arrangement,
breast tissue constitutes a relatively shallow layer between the array and
the rib cage. A current is applied sequentially between each electrode in
the array and a distal electrode, usually held in the patients hand. In the
simplest version of this type of system, the impedance sensed at each electrode in the array is represented as a shade of grey in an image, in the position
172
of the electrode. The planar array is easier to construct than circular

arrangements, which require being adjustable for dierent breast sizes, and
the reconstruction is usually simplistic, although algorithms have been
developed to compute the impedance map at dierent planes away from
the electrodes. Two main versions of this type of system are in existence,
one developed in Israel and marketed by Siemens [24], another designed by
the research group in Yaroslavl in Russia [25].
5.2.2.
Tomographic imaging
In a tomographic system, the electrodes are arranged so as to surround the

region of the body to be imaged, in our case the breast. The electrodes,
usually arranged in a circular array, dene a plane of intersection for
which the spatial distribution of electrical properties is sought. Multiple
planes can also be used simultaneously, in which case the region of interest
is the enclosed volume rather than a plane. In both cases predened patterns
of currents or voltages are applied and the corresponding voltages or
currents are measured. The recorded data are used to reconstruct the desired
properties. Tomographic systems further distinguish themselves by the
reconstruction methods for which they were optimized [26, 27].
5.2.3.
Limitations of impedance measurements
Two-dimensional tomographic systems usually base their reconstruction

method on the assumption that current ow is restricted to the imaging
plane. This assumption holds approximately for shallow phantoms, but it
is clearly not realistic in the case of breasts or other body regions. The
eect of ignoring current ow through the out-of-plane volume results in
lost accuracy in the reconstructed images. Full 3D solutions represent an
advantage in this respect for both planar and 3D data, in spite of their
added complexity.
The sensitivity of impedance imaging systems to variations in tissue
properties decreases with distance from the nearest electrode. In a circular
array conguration, this means that the central portion of the imaged
plane has the least sensitivity. In the case of a planar array, sensitivity
decreases as the distance from the electrode plane increases.
In addition to uneven sensitivity, impedance imaging techniques suer
from a poor spatial resolution, compared with other imaging technologies.
Physicians used to seeing a great deal of detail (sub mm) with x-ray mammography, for example, will be disappointed by the typical 5 mm spatial resolution of impedance imaging systems. With tomographic systems, the spatial
resolution is prescribed by the physical arrangement of the electrodes, their
number and the number of dierent excitation patterns that are used. In a
system with 16 electrodes, for example, it is possible to apply 15 optimal
173
patterns forming a complete orthogonal set (i.e. additional patterns would

not theoretically add any information). Each pattern corresponds to 16
measurements and so we have 16 15 measurements or 240 independent
measurements. For a 10 cm cross-section, if we divide it evenly we have
240 patches of roughly 0.33 cm2 or square patches 5.7 mm on a side. This
is a very simplied estimation of the spatial resolution of tomographic
impedance imaging; in reality the resolution is best on the periphery and
worst at the centre, as has been shown experimentally [28].
In planar impedance imaging systems, the spatial resolution is more or
less equivalent to the electrode density of the array. This will deteriorate with
distance away from the contact plane. Planar array with 16 16 electrodes
have been presented, which measure 12 cm on a side [25], which corresponds
to a spatial resolution at the contact plane of 8 mm.
Adding electrodes may be a way to increase spatial resolution, at least
in the case of planar arrays. With tomographic systems, the addition of
electrodes on the periphery of the imaged cross-section improves spatial
resolution at the periphery, but only slightly in the central region.
5.2.4.
Advantages of impedance as a screening tool
At this time it does not appear likely that impedance imaging will unseat
mammography as the primary method of screening for breast cancer. Its
poor spatial resolution, compared with x-ray, represents a barrier to its
being adopted, even if its sensitivity and specicity were to improve.
However, given the current performance of x-ray mammography, it is
quite conceivable that impedance will be adopted as a second step in the
standard examination, when an abnormality is discovered. EIT systems
could be designed to be relatively inexpensive to purchase (<$10 000) and
very inexpensive to use. Examinations could be very rapid (<10 min), and
very safe. They do not involve x-ray exposure and could be repeated as
often as needed.
5.3.
CLINICAL RESULTS SUMMARIES
Few groups to date have presented clinical results of breast cancer screening.
Most of the results published were based on planar array instruments such as
the T-Scan (marketed by Siemens as the TS2000), which has received FDA
approval for use as an adjunct to mammography [29] and has been used
by several groups worldwide in clinical trials.
The only clinical experiments we are aware of, using the tomographic
approach based on circular arrays, is under way at Dartmouth [30]. The
clinical trial which is to conclude their ongoing project has not been
concluded yet and so will not be presented here. However, a few preliminary
174
studies and ndings have been published by that group which will be briey
discussed here.
5.3.1.
5.3.1.1.
Planar arrays
Piperno 1990 [31]
This is a large-scale study based on 6000 patients using the Mamoscan device,
an early version of the planar array system now marketed under the TS2000
name. Although this is not the rst such study, it is the largest and most
signicant evaluation of impedance imaging. Of this patient group, 745 have
undergone biopsies to verify a suspicious nding in mammography. Every
patient in the group submitted to mammography, palpation, transillumination, thermography and ultrasound exams. This study set out to compare all
these modalities against each other. The rst nding was that there were
nine cases in which impedance imaging was the only modality to ag as
highly suspicious exams that all other modalities did not detect and which
were conrmed by histopathology. The presentation of the results in that
publication makes it impossible to compute the usual statistics regarding the
rates of true positive (etc.) or the sensitivity and specicity of each modality.
In their tabulated results, it is shown that the Mammoscan was correct (i.e.
true positive true negative) in 454/745 cases and incorrect (i.e. false
positive false negative) in 119/745 cases. The remaining cases were labelled
as borderline cases with no further indication of outcomes. For x-ray
mammography the results are 395/745 correct ndings, and 154/745 incorrect
ndings. The number of correct ndings is greatest for impedance imaging,
compared with all the other exam types, and the number of incorrect ndings
is the lowest for impedance imaging as well. This early study was interpreted as
very encouraging for impedance imaging at the time of its publication.
5.3.1.2.
Malich 2000 [32]
This study, based on 52 patients with 58 suspicious mammogram ndings, was

conducted using the TS2000 commercial electrical impedance scanning system
marketed by Siemens. The system consists of a planar arrangement of 256 electrodes in a 16 16 arrangement. Patients were examined with the impedance
imaging system in low and high resolution mode, both breasts in every case.
Patients also had breast MRI mammograms and biopsies or surgical removal
of the abnormalities. In this study, the high resolution scanning mode correctly
identied 27/29 malignant lesions (93.1% true positive), and also correctly
classied 19/29 (65.5% true negative) benign lesions (10/29 benign lesions
resulted in false positive). The report indicates a negative predictive value of
90.5% and a positive predictive value of 73% for the TS2000 in its high resolution mode. In standard resolution mode the results were 22/29 (75.9%) TP and
TN, giving the TS2000 a sensitivity of 75.9% and a specicity of 72.4%. Skin
175
imperfections (lesions, scratches, moles etc.) and air bubbles resulting from
placement constitute a reported practical limitation to the eectiveness of the
TS2000.
5.3.1.3.
Cherepin 2001 [25]
The system used here is very similar to the TS2000, consisting of a planar array
of 256 electrodes 12 cm on a side. The image reconstruction is slightly dierent
in that impedances are computed at dierent planes away from the electrode
array in order to reconstruct a 3D map of the volume facing the array. Slices
of the volume between the electrode array and the chest wall were computed
every 8 mm and for up to 6 cm depth. Twenty-one patients with tumours in
sizes ranging from 1.5 to 5 cm in one breast were examined. Both breasts
were imaged, with the contralateral breast used as a normal reference. Imaging
was performed twice, with the patients standing and reclining, resulting in 84
data sets. The data sets were divided into ve groups, including (1) 42
normal breasts, and (2) 42 malignant tumours. Group (2) was subdivided,
based on whether the tumours were visible as white spots, into groups (3)
16 studies without focal abnormalitiesand (4)26 studies with visible
abnormalities. Group (5) contained 13 studies, selected from group (4) for
their high conductivity peaks. Tumours were correctly identied in 14 out of
a total of 21 cases (67%), as evidenced by clearly visible white spots on the
reconstructed images. Four more were identied as anomalies due to the
inhomogeneous aspect of the images, which brings the TP rate to 85.7%.
The analysis was repeated using more sophisticated statistical methods instead
of visual inspection. With this approach, groups (3) and (4) (malignant
tumoursboth types) could be identied in 19 of 21 cases (90.5%), on the
basis of signicant statistical dierences in the property distributions.
Although this study shows that malignant tumours can be identied when
compared with normal breast examinations, it does not tackle the more
important question of whether impedance imaging can be used to discriminate
between malignant and other types of abnormalities, which is where
mammography comes short.
5.3.1.4.
Malich 2001a [33]
This study concentrated on determining the incremental benet of using

impedance imaging in addition to mammography. In this study, 210 women
were examined who presented 240 suspicious ndings in mammograms or
ultrasounds. All lesions were veried by histological inspection of removed
tissue. The results were that 86 of 103 malignant lesions and 91 of 137 benign
lesions were correctly classied by the impedance examinations (87.8% sensitivity, 66.4% specicity). Predictive values were also presented, with NPV
and PPV of 84.3 and 65.2% respectively. A sensitivity of 85.5% is reported
for all cases and, for invasive cancers alone, a sensitivity of 91.7%. Ductal
176
carcinoma in situ (DCIS) resulted in a much poorer sensitivity (57.1%, n 14).

Combining impedance mapping to mammography and ultrasound increased
the sensitivity of the exams from 86.4 to 95.1%, while the accuracy decreased
from 82.3 to 75.7%.
5.3.1.5.
Malich 2001b [34]
In this study, the authors set out to determine whether impedance mapping
duplicates or augments the clinical results obtained with ultrasound and
MRI, as an adjuvant to mammography. One hundred patients were examined with ultrasound, impedance imaging and MRI, following ambiguous
abnormal ndings in their mammograms. In all, 100 abnormalities were
studied. Ultrasound and MRI ndings were categorized by experienced
radiologists using the LOS (level of suspicion) scale, with LOS values corresponding to: 1 normal, 2 most likely benign lesion, 3 probably benign, 4
probably malignant, 5 most likely malignant. Ultrasound ndings with
LOS of 2 or 3 were categorized as non-malignant ndings, while LOS 4
and 5 were categorized as malignant ndings. Impedance imaging images
were categorized as indicative of a malignant nding if a bright spot was
visible, and could not be discarded as artefact due to poor contact or the
presence of the nipple. Sixty-four such lesions were identied on impedance
maps and were categorized as positive ndings. Impedance imaging showed a
sensitivity of 81% and a specicity of 63%, ultrasound had a sensitivity of
77% and a specicity of 89%, and MRI had a sensitivity of 98% and a
specicity of 81% on this group of patients. These ndings correspond to
the individual modalities individual performances. Statistical analysis
further showed that impedance imaging adds clinical information to ultrasound, but that MRI and impedance imaging are mostly similar in the
information they contribute to the diagnosis.
5.3.1.6.
Cherepin 2002 [35]
This study uses the same hardware as was presented above for that group, with
one change in the hardware: the planar array consisting of 256 electrodes is
now arranged in a circular pattern which increases the utilization factor for
the electrodes. In the previous square arrangement, electrodes in the corners
tended not to make contact with the patients. Furthermore, the array is
somewhat smaller, increasing the electrode density, and as a result the spatial
resolution is achievable with the device. This study did not seek to evaluate the
performance of impedance mapping in breast cancer screening; rather it sets
out to establish baseline measurements for women in several categories.
Fifty-seven women were examined in ages ranging from 18 to 61. The patients
were selected to t in ve groups: (1) 12 women (18 to 45 years) in the rst
menstrual phase (1 to 10 days); (2) 12 women (18 to 45 years) in the second
menstrual phase (16 to 28 days); (3) 14 women (18 to 39 years) during their
177
pregnancy (37 to 40 weeks); (4) 14 women (18 to 39 years) during lactation

(three to ve days post labour); and (5) ve postmenopausal women (47 to
61 years, one year post menopause).
The ndings in this study, although not directed at breast cancer, are still
interesting. Dierences in the appearance of the impedance images were noted
which were consistent within groups. However, a systematic analysis of the
data is based on the average conductivity value obtained in the second plane
away from the array (1.2 cm depth). Signicant dierences were few between
the groups. Of the ve groups presented here, all consisting of healthy
women (i.e. no abnormalities expected), only group 5 presented a statistically
dierent and consistent dierence in conductivity. Particularly of interest is the
fact that hormonal changes during the menstrual cycle may not aect noticeably impedance measurements. This has been a consideration in the clinical
application of impedance imaging. Should periodic hormonal uctuations
aect it, then this should be taken into account in scheduling examinations.
5.3.1.7.
Glickman 2002 [36]
In this study, using data collected with the TS2000 impedance imaging system,
the authors implemented an automatic algorithm to identify bright spots which
correspond to conductivity increases and generally to malignant tumours.
They also rened the algorithm to discriminate more reliably between malignant and benign lesions. Their algorithm is based on two main predictors,
the phase at 5 kHz and the crossover frequency (where the imaginary part of
admittance peaks). A learning process was used to adjust the identication
thresholds which were trained on data from 461 examinations, with 83 malignant and 378 benign cases. The designation of every case was based on biopsy
results. With this methodology, they applied their algorithm to a separate
group of 240 examinations (87 malignant, 153 benign). Under these conditions
they reported a sensitivity of 84% and a specicity of 52% in properly identifying malignant and benign impedance images.
5.3.1.8.
Martin 2002 [37]
In this study, 74 patients were examined using impedance imaging as well as

mammography, and a systematic comparison between the two imaging
modalities as well as the histopathology ndings was undertaken. Impedance
imaging was conducted using the TS2000 on patients from several centres.
Of this patient group, 77% were classied as having mammograms suspicious
for malignancies. In their ndings, histopathological diagnosis and impedance
imaging positivity were positively correlated and impedance imaging showed a
true positive rate of 92%. In addition, all the cases diagnosed as in situ
carcinoma, based on histopathology, were positive in impedance imaging. In
cases of ductal carcinoma or as ductal carcinoma plus in situ carcinoma,
92% were positively identied by impedance imaging and all the cases of
178
lobular carcinoma also had positive impedance imaging diagnoses. Only three
of 50 cases of malignant disease (6%) had negative impedance imaging diagnoses. The false positive rate of impedance imaging was 17%, while for this
group of patients the false positive rate for mammography was 17.5%.
5.3.2. Circular arrays
5.3.2.1.
Osterman 2000 [30]
This is an early non-blinded report based on Dartmouths rst-generation EIT

system [27]. Examinations of 13 participants were conducted in order to
investigate the feasibility of delivering breast examinations on a routine
basis. A 16-electrodes circular array was used with 10 signal frequencies
from 10 kHz to 1 MHz. Both breasts were imaged on all patients except for
one who had had a mastectomy (25 data sets). A custom examination table
was used, on which the patients lie prone with the breast to be imaged pendant
in the electrode array that is located below the table. Measurement data were
used to reconstruct absolute images of permittivity and conductivity. In all
cases electrode artefacts were evident on the periphery (near the surface) of
the images. Several ndings were reported. Permittivity images were generally
more informative than conductivity images. Specically, normal breasts
appear to have consistent permittivity and conductivity images across subjects
(gure 5.1). When abnormalities were present and detectable in the images,
their location on the images corresponded with expectation (gure 5.2).
Figure 5.1. Reconstructed conductivity (left) and permittivity (right) image of a normal
subject at 125 kHz using Dartmouth generation 1 EIT system.
179
Figure 5.2. (Top) 125 kHz permittivity images in three dierent planes. The left image is
0.5 cm above the lesion, the right one passes through it, and the bottom one is 2 cm below
it. A 3.5 cm tumour is present at 4 oclock. (Bottom) Diagram of where the lesion is located
relative to the three viewing planes [41].
Twelve of the examined breasts were mammographically normal. The

remainder included the following pathologies: three invasive breast carcinoma; one benign mass; six cases of brocystic disease including four
cysts; and two cases of brocystic change without a discrete cyst. In addition,
there were three patients who had had lumpectomies and radiation on one of
their breasts. Of the four known tumour cases (3 Ca, 1 benign), all were
conrmed as having abnormalities in the appropriate breast in the EIT
images. In one case the heterogeneous appearance of the images was considered to be a false positive for that patient who had no known pathology.
Using the coecient of variation (standard deviation/mean) as an objective measure of heterogeneity in the central region of the image (60% radius
to eliminate electrode artefact zone), abnormal designations were conrmed
in 10 out 14 cases (true positive) and wrongly assigned in three out of 11 cases
180
(false positive). Similarly, normal designations were given correctly in eight

out of 11 cases (true negative), while misattributed in four out of 14 cases
(false negative).
While this preliminary report had few participants and was not
conducted in a blinded fashion, it constituted the rst data presenting tomographic reconstructions of absolute electrical properties in a comparative
normal and abnormal study. Because of the small size of the study, a meaningful comparison of the results between malignancies and all other cases was
not possible, which reduces the value of this study. Its ndings, however are
supporting the notion that spectrographic absolute tomographic images of
dielectric properties of breast tissue could be used for breast cancer diagnosis.
5.3.2.2.
Halter 2004 [40]
The work presented here describes an EIT system that has multi-frequency
broadband capabilities suitable for use in a clinical setting. It possesses a
fast acquisition rate to minimize exam time and includes patient safety
considerations. Also, because of 3D artefacts present in 2D imaging systems
it incorporates 3D measurement capabilities. Its range of frequency is
10 kHz10 MHz, an order of magnitude higher than its predecessor. The
design of a second generation of electronics, based on a digital signal processing (DSP) architecture, centred around a 66 MHz ADSP-21065L SHARC
processor and a recongurable eld programmable gate array (FPGA) operating at frequencies up to 80 MHz. These two devices are reprogrammable,
giving the design an unprecedented level of exibility both in terms of the
algorithms it can execute and the conguration of the digital circuitry. The
signal-level performance of the system shows very signicant improvements
over previous implementations in accuracy, bandwidth and speed. For
example, signal-to-noise ratio (SNR) is better than 80 dB at high frequency,
compared with 6070 dB previously.
With the development of a high-frequency design based on wedgeshaped circuit boards in close proximity to the electrodes, we realized the
breast interface shown in gure 5.3 which consists of four levels of 16 electrodes, where the electronics are integrated with the electrode-positioning
system. The radial translation stages utilize electrode holding rods arranged
in a sliding pattern under stepper motor control. This results in a very
compact unit consisting of 64 channels, with leads from the electrodes to
the electronic cards not exceeding 4 in (10 cm). We integrated the complete
EIS system with a stereotactic biopsy table by tting it into a sliding assembly
that resides on a custom cart designed to dock against the biopsy table. The
system engages tracks mounted under the table and is locked in position
during an EIS exam. The biopsy table is still fully functional for x-ray
exposures for lesion localization and surface ducial marking prior to an
EIS exam.
181
Figure 5.3. Current instrument attached to a stereotactic biopsy table. The unit ts below
the exam table and above the x-ray tube (top left). Four levels of electrode arrays face the
opening in the table (top right). The patient is prone on the table during exams (bottom).
5.3.3.
Discussion of the clinical trials
The rst observation one makes regarding clinical results using impedance
imaging is that it almost exclusively consists of experiments with planar
array devices. Work on the development of such devices seems to have
started around 1979 [38], and this may explain the predominance of these
types of device. In addition, planar devices are generally simpler and do
not require a complex procedure to reconstruct impedance mapsin some
cases no reconstruction at all is used, the impedances sensed by each electrode simply being displayed in the correct arrangement. When reconstruction computations are used they consist of reconstructing impedance maps
at dierent depths and can be performed very rapidly, allowing real-time
updating of the display.
The only data discussed here that is based on a tomographic impedance
device is still preliminary and does not constitute truly a clinical trial. Such a
trial from the same group is under way, however, which should be concluded
in early 2004.
182
It is worth remarking that imaging is incidental in reaching the goal of

using impedance in breast cancer screening. In one of the studies presented
here (Glickman) [36], a group tried with some success to automatically classify impedance maps into dierent diagnostic categories. If such an approach
is taken, the displaying of images becomes secondary in importance, and may
only be of value to assist the operator in performing the examination.
Some work is under way [39], in which the raw data obtained from a
tomographic (circular array) EIT device are used to compute directly the
relationship between the applied currents and the measured voltagesthe
impedance matrix. This step is much simpler than the computations required
to reconstruct a tomographic image, yet in principle the impedance matrix
contains the same information. By analysing directly the impedance
matrix, using advanced statistical methods, it is possible to distinguish
between dierent types of image in phantom experiments, and it is expected
that eventually sophisticated algorithms will be able to classify patient examination data reliably as well, based directly on the measurement data.
Of the clinical results presented here, the salient facts are that notable
dierences exist between the impedance of malignant and non-malignant
tissues (including normal and benign lesions), which can be reliably agged
by impedance imaging systems. Most planar scanning systems presented
do not use absolute impedance parameters; rather they rely on the relative
impedance as sensed across the array, which show as white spots on the
display. The reason given for using this approach is that there is a large variation in absolute property values between patients, which is dicult to
account for, while the relative local dierences are a consistent indicator of
abnormality and easier to identify. In all the results reported here, the ability
of impedance imaging to dierentiate between malignant and other tissues
was conrmed. What is lacking in these reports is an evaluation of how
small a tumour impedance imaging can detect.
It seems to be accepted by most researchers whose work is mentioned
here that impedance imaging, if it proves itself clinically, will be used as an
adjunct to x-ray mammography, joining ultrasound and MRM as secondtier examinations. It is hoped, and the data presented here seem to support
it, that the combined use of x-ray mammography and impedance imaging
will have greater precision overall than current practice in correctly identifying breast cancers.
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[35] Cherepenin V A, Karpov A Y, Korjenevsky A V, Kornienko V N, Kultiasov Y S,
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Dartmouth College
Chapter 6
Applications of electrical impedance
tomography in the gastrointestinal tract
Clare Soulsby, Etsuro Yazaki and David F Evans
6.1.
RATIONALE FOR EIT WITHIN THE GASTROINTESTINAL

TRACT
The gastrointestinal tract (GIT) in man comprises a long hollow viscus with
entry at the mouth and exit at the anus. The physiological role of the GIT is
to process and transport nutrient into the organism to act as fuel to sustain
life; it is an essential organ to life. In man, it is a complex series of biologically
active tubes divided into compartments that function dierentially to convert
ingested nutrient into molecules which can be transported across the epithelium into the blood stream. Via the bloodstream, energy is provided to drive
all other body systems.
We can simplify the physiology into three main processes: digestion,
absorption and transit. The structure of the human GIT is shown in gure
6.1 and can be divided into its main compartments. Sphincters (biological
valves) separate the compartments and control transit within and between
the compartments. The residence time in any one compartment varies
widely depending on the function of that compartment. In the oesophagus
the transit time is about 6 s. In the stomach, the residence time of ingesta
can vary from as little as 510 min up to 68 h, depending on the composition
of the meal. These widely variant periods are essential in that they control the
time required to optimize the processes of assimilation of nutrients.
This large variation in gastric residence time can be understood by
explaining the physiology of normal gastric motility. The stomach has two
main functions: (1) to store food, as we can ingest nutrients faster than we
can digest them; (2) to alter the texture of ingesta using physical and chemical
disruption to produce a viscous uid of nely particulate nutrients known as
chyme. This partly processed ingesta is presented to the small intestine in a
suitable consistency for digestion and absorption. In the fed state, the
Rationale for EIT within the gastrointestinal tract
Figure 6.1.
187
Structure of GI tract in relation to its functional compartments.
stomach has three phases of motility: receptive relaxation which allows the
stomach to accommodate a large volume of ingesta; mixing, which consists
of strong contractions that agitate and mix stomach contents with acid
and enzymes; and an emptying phase when the antrum grinds food before
releasing the partially digested chyme into the small intestine. Solid foods
take longer to empty than liquids as it takes time to render solids to a suitable
texture for the small intestine. High energy/high fat foods are also emptied in
a controlled way so that they are presented to the small intestine at a rate that
does not exceed digestive capacity. Thus non-nutritive liquids such as water
empty most quickly (gastric emptying half-time approximately 20 min),
nutritive liquids such as milk empty more slowly (gastric emptying halftime approximately 90 min) and large complex meals such as beefburgers
can take up to 360 min. In some cases, food remnants can be found in the
stomach over 8 h after ingestion.
EIT detects alterations in resistivity within thick slices of body tissue. This
principle is utilized to monitor the movement of luminal materials through
dierent compartments of the GIT in order to study normal physiology,
pathophysiology and the eects of transit modifying substances used in the
treatment of gut transit disorders. The term used to describe this movement
is motility. The area of the GIT that has been most widely studied using
EIT is the stomach, and measurements are made of gastric residence and
emptying times of ingested meals. Transit through other compartments such
as the small and large intestine and the rectum have been attempted without
much success. There are few data to support its use in these areas and this
will not be discussed further in this chapter.
188
6.2.
Applications of electrical impedance tomography

METHODS OF MEASUREMENT OF GASTRIC EMPTYING
Measurement of gastric emptying has two major purposes:

1. to increase our understanding of physiology and pathophysiology of
gastric and small intestinal function; and
2. to aid diagnosis in patients with suspected foregut motility disorders.
There have been many techniques developed over the years to investigate
gastric motility and transit. These are briey outlined below. Some, such
as radiology and scintigraphy, are routinely used in clinical practice; others
are mainly used mainly in research
6.2.1.
Radiology (barium contrast)
While radiology detects mucosal disease or mechanical obstruction very well,

it gives much less information with gastrointestinal motility (Camileri et al
1998). Limited information can be gleaned from a contrast swallow or
follow through, which maps the transit of barium-based liquids through
the gut, providing some measure of rates of ow through the various
compartments including the stomach. However, this is somewhat nonphysiological as barium is a dense, heavy liquid, whereas the liquids and
solids that make up a normal diet have a density closer to water. Also, this
method uses ionizing radiation, so it is not suitable for certain subjects or
repeated studies over short periods because of the signicant radiation
employed to visualize the contrast media.
6.2.2.
Manometry
Manometry identies patterns of motility and can detect abnormalities of

gastrointestinal motility suggestive of myopathy, neuropathy or obstruction
(Camileri et al 1998). It cannot directly assess transit, although abnormal
gastric and small intestinal motility patterns are used indirectly to assess
accelerated or retarded transit through the foregut.
6.2.3.
Gamma scintigraphy
Gamma scintigraphy measures gastric emptying by tracking the passage of a

radionuclide-labelled test meal, using a gamma camera, as it moves out of the
stomach. Changes in radionucleotide counts within the gastric region reect
the amount of the meal remaining in the stomach, and a gastric emptying
curve is produced. It can be used to assess gastric emptying of both liquid
and solid meals. When measuring gastric emptying, frequent images
should be taken (every 10 min) to allow identication of the lag time, and
recording should continue for 34 h after the meal is ingested to identify
Methods of measurement of gastric emptying
189
any gastric stasis. Gamma scintigraphy is currently regarded as the gold

standard for measuring gastric emptying (Akkermans and Van Isselt 1994;
Vantrappen 1994 Supplement), and has been used to validate other, less
invasive methods such as EIT.
Although regarded as the gold standard, gamma scintigraphy has a
number of disadvantages which should be taken into consideration when
reviewing the EIT validation studies. Gamma scintigraphy measures gastric
emptying by tracking the passage of a radionuclide marker which is physically
bound to one part of the meal; other parts of the meal and gastric secretions
are not measured. Gastric secretions contribute up to 188 ml/h of gastric
volume in normally fed adults (Lin and Van Citters 1997), and most meals
are in fact complex mixtures of protein, carbohydrate and emulsion of fat
(Horowitz and Dent 1991), so dierent phases of the meal are likely to be
emptied from the stomach at dierent rates. If a single marker which binds
to the protein molecules is used, gastric emptying of the other portions (fat,
carbohydrate and liquid) will not be monitored. Markers may separate from
the protein phase and empty as a non-nutritive liquid, resulting in erroneous
results; commonly used isotopes lose up to 25% of binding from the solid
phase per hour (Camileri et al 1998). It is possible to simultaneously monitor
both solid and liquid components of a mixed test meal (Piessevaux et al 2003),
but dierent isotopes must be used to label the separate components. After
measurement studies are analysed, a gastric emptying curve is obtained.
From this, half emptying time (t1=2 ) and lag time are calculated, and it is
possible to calculate t1=2 for the antrum and fundus separately to identify
the function of each region of the stomach (Piessevaux et al 2003).
6.2.4.
Chemical
This method measures gastric emptying by assessing the time it takes for
certain drugs or markers that are not absorbed in the stomach, but which
are rapidly absorbed from the small intestine, to appear in circulation or
the breath. What is actually measured is the total time including digestion,
absorption and metabolism, as well as the time taken for gastric emptying.
These methods are often referred to as indirect, and an assumption is
made that gastric emptying is the rate limiting step. Substances that have
been used as chemical markers are paracetamol or acetophamine, where
appearance of the marker in the blood is the surrogate for gastric emptying,
or carbon labelled breath tests (acetate, bicarbonate, octanoin and spirulina),
where appearance of the marker in the breath is the surrogate for gastric
emptying.
Paracetamol absorption: A few years ago there was interest in this
method as its non-invasive nature allowed its use in vulnerable subjects
such as critically ill patients. However, as it is used only to measure gastric
emptying of the non-nutrient liquid phase of the meal it is an unsatisfactory
190
Table 6.1.
Test meal
Marker
Liquid
Chicken liver
Egg white
Chicken liver
Puree potato
Liver pate
Pancake
Nondigestible solid particles
Olive oil
Butter
99m
Tc
Tc
99m
Tc
99m
Tc
99m
or 113m In or 111 In (non-absorbable, non-chelating)

(in vivo labelled)
(in vitro labelled)
(in vitro labelled)
111
In labelled resin beads

Tc (V) thiocyanate olive oil
75
Se glycerol triether butter
99m
method for most circumstances when there is a need to measure gastric

emptying (Horowitz et al 1994).
Labelled carbon dioxide (CO2 ) breath tests: Breath tests, using stable
isotopes, have been developed as an alternative to gamma scintigraphy.
Both solids and liquids can be measured (Fried 1994 Supplement) separately
and simultaneously. The technique was rst introduced in the early 1990s
(Ghoos et al 1993) and since then a number of validation studies have
taken place (see table 6.1). Renement of the technique and the introduction
of a simple mun meal (Bromer et al 2002) led the authors to describe breath
testing as an oce-based test for gastric emptying (Lee et al 2000; Bromer
and Parkman 2001). Certainly carbon-labelled breath testing shows great
promise and is easy to perform with a minimum of patient discomfort.
Compared with gamma scintigraphy, breath tests signicantly reduce [14 C]
or completely avoid [13 C] exposure to radiation, so allowing these methods
to be used in groups such as children, pregnant women or critically ill
patients.
6.3.
ULTRASONOGRAPHY
Ultrasonography is used to evaluate transpyloric ow and attenuation of

diameter of the distal stomach. More recently (Gilja et al 1997), a 3D technique
has been developed whereby multiple images are taken in a stepwise fashion of
the whole stomach. The ultrasound transducer is rotated through 908 and a
device records the position and orientation of the images. A 3D model of
the stomach is obtained by computerized processing of the images, from
which gastric volume and intra-gastric meal distribution can be obtained.
However, this method is time consuming and requires a dedicated ultrasonographer.
Electrical impedance tomography to measure gastric emptying

6.4.
6.4.1.
191
ELECTRICAL IMPEDANCE TOMOGRAPHY TO

MEASURE GASTRIC EMPTYING
EIT system
The vast majority of work performed in this area has been undertaken using
the single frequency Sheeld Mark 1 system developed by Brown and Barber
(1987). More recently, we and others have attempted to adopt the multifrequency system but with less success. This will be discussed later in the
chapter.
6.4.2.
Equipment and general methods
The Sheeld Mark 1 EIT system (Medical Physics, Sheeld) equipment

(gure 6.2) consists of a data collection unit, video display unit and computer.
The equipment is designed on the original concepts of back-projection of a
128 128 impedance tomogram against a cross sectional slice of the abdomen
immediately and surrounding the transmitting/receiving electrodes attached to
the abdominal wall. Serial measurements are made at regular intervals (usually
1 min for the stomach) against the reference frame and during and after
ingestion of a test meal. The lling and emptying of the meal can therefore
be plotted against the original reference frame as it is back-projected by the
software against the reference.
6.4.3.
Experimental method
Sixteen electrodes are placed in a circular array around the trunk, at the level
of the eighth costal margin, and are attached to the data collection unit
Figure 6.2.
Sheeld EIT Mark 1 system. Single frequency DOS based software.
192
Figure 6.3.
Normal electrode positioning for gastric emptying studies.
(gure 6.3). A current of 1 mA at 50 kHz is passed between two adjacent

electrodes (the drive electrodes) and the potential dierence is measured at
the remaining pairs of electrodes. Each pair of electrodes in turn acts as
the drive electrode. Electrode contact is monitored with an oscilloscope
which displays either the potential required to drive the 1 mA current or
the measured potential dierence. An initial dataset is rst recorded. When
a meal of low resistivity is ingested, the resistivity of the gastric region falls
and returns to fasting values as the stomach empties. Any subsequent datasets are then back-projected against the initial set to produce a cross sectional
image of the change in the distribution of the resistivity in the area of the
electrodes. Figure 6.4 illustrates a typical dataset for a liquid meal.
At the end of the study, the position of the stomach is marked on the
image obtained directly after ingestion of the meal, and the change in resistivity within this region of interest is calculated for this and subsequent
images (gure 6.5). The values are expressed as a percentage of the change
in resistivity of the rst image following ingestion of the meal to yield a
prole of gastric emptying (gure 6.6).
6.4.4. Analytical methods
All calculations were performed using dedicated software supplied by the
manufacturers. Original versions used DOS-based monochrome software.
As computing power increased and Windows-based software became
increasingly available, a novel system was adopted using purpose-designed
Electrical impedance tomography to measure gastric emptying
Figure 6.4.
193
Data set acquired after ingestion of 400 ml beef extract drink at 37 8C.
Windows software WIN7 (Boon & Holder). This enabled greater manipulation of data and statistical comparison could be made. Ultimately, all EIT
systems were supplied with Sheeld-designed Windows-based software
and this is currently used by our Unit.
6.4.5.
Suitable test meals
Because gastric emptying uses a back-projection method, and it is assumed

that the changes in resistivity in the gastric region are due to the meal emptying
out of the stomach, in theory a suitable test meal could be either highly
conductive or highly non-conductive. However, it is important that the test
meal is of xed resistivity so that changes in resistivity are attributed to changes
in gastric volume. Gastric acid, which is secreted during a meal, is a source of
Figure 6.5. Region of interest drawn around the stomach. This is identied from
summated frames after the study is completed.
194
Figure 6.6. Impedance gastric emptying curve drawn from serial values of ROIs detected
by the data collection unit. Gastric residence and emptying values can be calculated from
these data sets.
hydrogen ions, which are highly conductive. Thus if a non-conductive meal is

used, it would become conductive during a gastric emptying study as hydrogen
ions are added and its resistivity alters. Highly conductive meals are most
suitable and allow the measurement of gastric volume of both the test meal
and gastric acid. Any monovalent positive ions such as sodium, potassium
or hydrogen will increase conductivity. The addition of salt (sodium chloride)
to a test meal increases conductivity and is both practical and palatable. Beef
or vegetable extract (Oxo) is generally used as a non-nutritive liquid test meal,
one cube being made up to 200 ml with water (31 mmol Na, 15 kcal per cube).
Porridge made from oatmeal with added salt (37 mmol Na, 315 kcal per 150 ml
bowl) is used as a standard solid test meal.
6.5.
6.5.1.
PUBLISHED DATA IN SUPPORT OF EIT AS A VALID METHOD

TO ASSESS GASTRIC VOLUME AND RESIDENCE TIME
Validation of EIT in vitro
Initial research on the use of EIT as a measure of gastric emptying was

performed in Sheeld under the guidance of the developers of the system.
Published data in support of EIT
195
Validation in vitro of the Sheeld system was carried out (Avill et al

1987) using an oval Perspex tank, designed to simulate the cross section of
the human abdomen. Glass rods of varying diameters were immersed
centrally in the tank at a constant depth, beyond the sensitive area of the
electrodes, and images were taken (Avill et al 1987). The experiment was
also carried out after moving one rod to the halfway point between the
centre and the edge of the tank. Changes in resistivity were directly
proportional to the square of the radius of the glass rod (r 0:99). The
EIT value when a rod was placed centrally in the tank was 58:2 1:5 U
(mean SEM, n 5), and when the rod was moved laterally it was
56:2 1:2 U (p 0:05).
In a separate series of experiments (Avill et al 1987), a 5 ml capacity
balloon was anchored vertically in the centre of the tank with the maximum
diameter of the balloon level with the plane of the electrodes. The balloon
was progressively inated with 1 ml aliquots of water and one image was
taken after each addition. This was repeated 10 times. There was a highly
signicant linear relationship between the volume of the balloon in the
tank and the EIT values of resistivity (r 0:99).
6.5.2.
6.5.2.1.
Accuracy of EIT
Position of EIT electrodes
The use of the eighth costal cartilage as a valid position for placing electrodes
to measure gastric resistivity by EIT was investigated using 19 healthy
volunteers (Avill et al 1987). Three electrodes were marked with a 57 Co
marker and a drink of soup containing 100 mCi 99m Tctin colloid was
given. Gastric radioactivity was imaged using a -camera. The electrodes
were shown to be situated at the level of the body or the fundus of the
stomach in all 19 subjects.
Another study (Wright 1995) assessed the eect of electrode placement
using six male volunteers. On the day prior to EIT, the shape and position
of the stomach was imaged in ve of the volunteers using 200 ml of orange
juice labelled with 1 MBq 99m TcDTPA. On the following day, EIT electrodes
were placed at the assumed level of the gastric antrum based on the previous
days scintigraphy. A 57 Co marker was taped to the subjects back at the level
of the EIT to determine the position of the electrodes in relation to the
stomach. Following a pre-meal EIT baseline recording a liquid meal of
500 ml Oxo labelled with 2 MBq 99m TcDTPA, simultaneous EIT and
scintigraphy was recorded (EIT at 1 min intervals and scintigraphy at 8 min
intervals). The study ended when less than 30% of the marker, determined
by scintigraphy, remained in the stomach. Of the six subjects, electrodes
were placed high in one subject, low in two and at the antral level in three.
196
In the subjects with low electrodes there was an apparent delay in emptying
recorded by EIT, possibly due to duodenal lling.
6.5.2.2.
Measurement of intragastric balloon volumes by EIT
The accuracy of EIT to measure volume changes was assessed in six volunteers
(Avill et al 1987) using intragastric balloons. Each volunteer swallowed a nasogastric tube with a balloon positioned 10 cm distal to the gastro-oesophageal
junction. The balloon was serially inated with 50 ml aliquots of air until
the subject felt discomfort or 250 ml had been inserted. Gastric secretions
were aspirated continuously. Images taken at each volume were compared
with a reference image taken with the tube in position, but the balloon deated.
EIT values were directly proportional to the volume of air in the gastric
balloon (r 0:99).
6.5.2.3.
Baseline variation in EIT
Baseline variation was assessed in four fasted healthy volunteers 90 min after
taking cimetidine. EIT frames were recorded for 45 min at 1 min intervals.
The subjects then drank 500 ml of Oxo. The fasting variation in the areas
of interest corresponding to the position of the stomach identied after
ingestion of the Oxo drink was plotted as a percentage of the maximum
EIT value, obtained immediately after the drink had been ingested. Baseline
variation usually amounted to no more than 10% of values obtained after
ingestion of the Oxo drink, although occasionally variations up to 20%
could occur.
6.5.3.
6.5.3.1.
Gastric emptying of liquid meal

Comparison of gastric emptying of a liquid meal measured
by EIT compared with dye dilution
The rate of emptying of a 750 ml of a 5% sucrose solution was measured

simultaneously by EIT and dye dilution in 10 healthy volunteers (Avill
et al 1987). Subjects were intubated with a double lumen tube, positioned
in the dependent region of the stomach. Gastric contents were aspirated
and the stomach was washed out with 200 ml of water containing 0.6 mg
of phenol red dye. Ten minutes after drinking the sucrose 20 ml of a solution containing 6.25 mg of phenol red dye per 100 ml was injected into
the tube and gastric contents were thoroughly mixed. This was repeated
at 10 min intervals until the stomach was empty; the dye concentration
was doubled each time. 10 mls of gastric contents were withdrawn and
the concentration of phenol red was determined by spectrophotometry at
560 nm, before and after each introduction of dye. The correlation
197
coecient describing the relationship between half-time for the two methods was 0.83 ( p < 0:001).
6.5.3.2.

by EIT compared with gastric residuals in infants
Gastric emptying was measured by EIT in 47 term and pre-term infants

(Nour et al 1995) who were intubated with naso-gastric tubes. The liquid
meal was formula milk (either Cow & Gate or SMA) in 20 cases or Dioralyte,
and infants were given 25 ml/kg of either feed via the naso-gastric tube. At
the end of the study, gastric contents were aspirated and the percentage of
the meal remaining was calculated and compared with those obtained by
EIT. Scintigraphy or dye dilutions were not used, as their use was considered
unjustied in asymptomatic infants. There was good agreement between EIT
and gastric residuals for 16 of the 20 milk-fed infants. The other four infants
had marked dierences. Again, there was good agreement for 24 out of 27
Dioralyte-fed infants, with three showing marked dierences.
6.5.3.3.

by EIT compared with scintigraphy
Simultaneous measurements were taken for eight healthy volunteers (Avill

et al 1987) comparing EIT with readings from a single -camera (Pho/
Gamma III, model 1201, Nuclear Chicago, Europa, NY). The liquid meal
was 300 ml of consomme, sieved and diluted to 50% with water containing
100 mCi 99m Tctin colloid. Images of the distribution of radioactivity were
collected every 2 min for 46 min. The gastric emptying prole was obtained
by identifying the region of interest around the stomach and normalizing
the radioactivity within this area and correcting for isotope decay. These
were compared with EIT proles taken at 1 min intervals. Correlation
coecient describing the relationship between the half-times for gastric
emptying between the two methods was 0.801 ( p 0:05).
Wright (1995) compared EIT with scintigraphy in 11 male volunteers on
two separate occasions at least 14 days apart, without acid inhibition or
having taken 400 mg of cimetidine 2 h prior to the study. Following a premeal EIT baseline recording a liquid meal of 500 ml Oxo labelled with
2 MBq 99m TcDTPA, simultaneous EIT and scintigraphy was recorded
(EIT at 1 min intervals and scintigraphy at 8 min intervals). The study
ended when less than 30% of the marker, determined by scintigraphy,
remained in the stomach. When half-time measured by EIT versus scintigraphy was compared, there was a signicant association between the half-times
in controls (r 0:77, p 0:006) and with acid inhibition (r 0:87,
p 0:001).
198
6.5.4.
6.5.4.1.

Gastric emptying of a semi-solid meal
Comparison of gastric emptying of a semi-solid meal measured
by EIT compared with scintigraphy
Wright (1995) assessed gastric emptying of porridge. EIT was compared with
scintigraphy in eight volunteers on two separate occasions at least 14 days
apart, without acid inhibition (control group) or having taken 400 mg of
cimetidine 2 h prior to the study. Following a pre-meal EIT baseline recording, a semi-solid meal of 500 ml of porridge with salt and labelled with 3 MBq
99m
TcDTPA added to the uid prior to cooking, simultaneous EIT and
scintigraphy was recorded (EIT at 1 min intervals and scintigraphy at
10 min intervals). The study continued for approximately 200 min maximum.
The results from 10 studies were available for analysis. In the EIT
control group, the study ended before half-time for gastric emptying was
reached, and there was a signicant dierence between gastric emptying
measured by scintigraphy and EIT ( p 0:04). There was no signicant
dierence in the acid inhibited group. The administration of cimetidine
increased the half-time in the scintigraphy group ( p 0:04). The correlation
between half-times for EIT and scintigraphy was r 0:87, p 0:05 in the
control group, and r 0:89, p 0:04 in the cimetidine group.
6.5.5.
6.5.5.1.
Gastric emptying of a solid meal

Comparison of gastric emptying of a solid meal compared
with scintigraphy
Simultaneous measurements were taken for eight healthy volunteers (Avill et al

1987) comparing EIT with readings from a single -camera (Pho/Gamma III,
model 1201, Nuclear Chicago, Europa, NY). The solid meal was 85 g of
instant mashed potato, mixed with 300 ml of water containing 100 mCi
99m
Tctin colloid. Images of the distribution of radioactivity were collected
for 2 h, every 2 min for the rst 40 min and then every 5 min for the remaining
80 min. The gastric emptying prole was obtained by identifying the region of
interest around the stomach and normalizing the radioactivity within this area
and correcting for isotope decay. These were compared with EIT proles taken
at 1 min intervals. Cimetidine was administered 90 min and 15 min prior to
ingestion of the meal. Correlation coecient between half-times for the two
methods was 0.73 ( p < 0:05).
6.5.6.
Eect of acid secretion on measurement of gastric emptying by EIT
Gastric acid secretion increases markedly during feeding, and it has been
suggested that it may aect the accuracy of measurements obtained by
EIT (Avill et al 1987).

6.5.6.1.
199
Eect of gastric acid on EIT measurements
Avill et al (1987) induced acid secretion in three healthy volunteers using

pentagastrin (6 mg/kg body weight), and took measurements of EIT before
and after administration of pentagstrin. They found that pentagastrin
induced acid secretion and increased gastric conductivity in all subjects.
6.5.6.2.
Eect of type of H2 blocker on rate of gastric emptying
6.5.6.2.1. In a crossover study, Mushambi et al (1992) compared gastric

emptying measured by EIT when acid secretion was inhibited by ranitidine
or cimetidine in 10 normal volunteers. There was no control group in
whom acid remained uninhibited. There was a signicant delay in gastric
emptying following the administration of ranitidine compared with
cimetidine ( p < 0:04).
6.5.6.2.2. Wright (1995) compared liquid and solid meals in 16 healthy
volunteers. Liquid meals were one Oxo cube diluted in 500 ml of water;
the semi-solid meals were 500 ml of porridge containing 4.5 g of salt. Each
subject was studied on six separate occasions. For both the liquid and the
semi-solid meals, measurements were taken with no acid suppression, after
an oral dose of 400 mg cimetidine 2 h prior to the study or 40 mg of
omeprazole at 12 h (20 mg) and 2 h prior to the study. For the liquid meal,
there was no overall dierence in liquid emptying between males and females.
In the acid suppressed studies, gastric emptying was quicker than controls
( p 0:06 cimetidine, p 0:09 omeprazole). For the semi-solid meals,
emptying was quicker in males than females; this achieved statistical signicance in the control ( p 0:01) and the cimetidine ( p 0:02) groups. In both
males cimetidine emptied the quickest, followed by controls then omeprazole. In the females both cimetidine and omeprazole emptied more quickly
than controls. For semi-solids, female lag phases were longer than males
( p 0:002). In controls, the lag phase was signicantly longer in the semisolid group and the liquid group for both males ( p 0:04) and females
( p 0:04). When acid was inhibited, the percentage lag phase for both
solids and liquids were similar.
6.5.6.3.
Eect of acid secretion on reproducibility of EITliquid meals
The eect of administration of cimetidine on gastric emptying was shown in

eight healthy volunteers in a randomized blind study (Avill et al 1987). Two
pairs of experiments were carried out on each volunteer. Subjects were given
800 mg of cimetidine or a placebo at the same time on two consecutive days.
The test meal was an Oxo cube made up to 500 ml with warm water. There
was strong correlation between half-emptying times from the rst and
second studies when cimetidine was administered (r 0:90), but when acid
secretion was not inhibited there was no signicant correlation (r 0:19).
200
6.5.6.4.
Eect of acid secretion on reproducibility of EITsolid meals
In another study looking at a beefburger meal (Mangnall et al 1991), scintographic and EIT measurements were carried out simultaneously using a
single -camera (Pho/Gamma III, model 1201, Nuclear Chicago, Europa,
NY). Subjects were fed a radio-labelled beefburger weighing 160 g (vol
137 ml, 20 g fat, 23 g protein, 8 g carbohydrate, 2.5 g NaCl). The beefburger
was labelled with 100 mCi 99m Tcsulphur colloid, which was beaten into the
egg before incorporation into the raw meat. In eight volunteers scintigraphy
was carried out without inhibition of acid secretion; in 12 volunteers gastric
acid secretion was inhibited by administration of 400 mg of cimetidine 60 min
before the test and a further 800 mg at the start. Images of distribution of
radioactivity were collected for 4 h at 5 min intervals, starting before ingestion of the food. EIT measurements were collected at 2 min intervals for
10 min prior to and 4 h after ingestion of the meal. Images were obtained
in 19/20 subjects; in one subject gastric lling was not detected. There was
signicant correlation between the two methods for half (r 0:713,
p < 0:02) and quarter time (r 0:825, p < 0:01), but the results failed to
reach signicance for the lag period (r 0:585) when gastric acid was
inhibited. When gastric acid secretion was not inhibited, EIT was slower
than scintigraphy in 5/8 studies and there was no correlation for half-time
(r 0:058), lag phase (r 0:376). The half-time was within 10% of the
value obtained by scintigraphy in only 2/8 studies.
6.7.
PAEDIATRIC STUDIES
The use of EIT for paediatric applications is highly desirable for both safety
and operational reasons. As EIT is totally non-invasive and does not require
any exposure to ionizing radiations of any kind, it has been welcomed by
paediatricians as a means of assessment of gastric function in infants and
children with suspected foregut dysfunction. Lamont et al (1988) examined
its role in hypertrophic pyloric stenosis. Milla and Ravelli (1994) detected
both gastric stasis and GOR in children with childhood vomiting and
reux, and Nour et al (1994, 1995) performed extensive studies in these
groups.
In children, the limitations of EIT are similar to those in adults. In addition, there are other problems related to the size and overall compliance of
the subjects:
diculty nding sucient space for 16 electrodes on the abdomen of a
small subject;
. certain electrodes (e.g. ECG electrodes) do not give very good conductivity
in children;
. necessary length of recording period for solid test meals;
.
Summary
201
movement artefacts aecting recording;

maintenance of stable position for the extended monitoring period;
. acceptance of validated test meals;
. lack of normal paediatric data of varying ages on test meals.
.
.
6.8.
RECENT APPLICATIONS: USE OF EIT TO MEASURE

GASTRIC EMPTYING DURING CONTINUOUS
INFUSION OF NASOGASTRIC FEED
The technique has recently been developed as a method for research and
monitoring enteral feed tolerance, particularly in critically ill patients
(Soulsby et al awaiting publication). In the hospital setting enteral feed is
usually administered as a continuous naso-gastric infusion. Enteral feed
tolerance is monitored by aspirating the stomach contents via the nasogastric tube and measuring the volume aspirated, which is known as the
gastric residual volume. If the gastric residual volume is less than a critical
amount, usually 150200 ml, the patient is considered to be tolerating the
feed. This approach has been criticized for being based on assumptions
that are not physiologically sound (McClave and Snider 2002). In fact
there are no available data patterns of gastric emptying during continuous
infusion, other than those hypothesized using mathematical models
(Lin and Van Citters 1997; Burd and Lentz 2001). We have developed the
technique to investigate continuous infusion of enteral feed (Soulsby et al
2003), and to investigate patterns of gastric emptying during naso-gastric
infusion in critically ill patients (Soulsby et al awaiting publication) and
volunteers.
6.9.
SUMMARY
In vitro, EIT can accurately measure volume changes of glass rods/balloons

in a phantom.
. In humans, EIT can accurately measure gastric volume changes (balloons)
in experimental conditions.
. Placement of electrodes on the eighth costal cartilage is suciently accurate
for gastric EIT measurements. Slight misplacement does not aect results;
however, slightly high is better than slightly low due to the possibility of
measuring the antral/duodenal area.
. When gastric emptying is measured by EIT:
1. For liquid meals there is good correlation with dye dilution. How
closely this reects gastric emptying under normal conditions is unclear
due to the removal of gastric secretions.
2. Non-nutritive liquid meal correlates with scintigraphy.
.
202
3. Semi-solid and solid meals measured by EIT only correlate with scintigraphy when acid is suppressed.
4. The time to reach gastric emptying t1=2 measured by EIT always takes
longer than when measured by scintigraphy, and when gastric acid is
suppressed, the lag phase measured by EIT is signicantly shorter than
when measured by scintigraphy. Thus EIT is more likely to be measuring
gastric volume, including secretions, whereas scintigraphy only measures
gastric emptying of the radio-labelled portion of the meal.
. Although scintigraphy is the gold standard for measurement of gastric
emptying and has been used in the literature to validate EIT, there are
some aws in this approach:
1. Most studies have use of a single marker, but most solid meals are in
fact complex mixtures or particles and have a solid and a liquid
phase. As the most commonly used marker binds to the protein portion
of the meal, the gastric emptying of the other portions (fat, carbohydrate and liquid) are not monitored.
2. Radionuclide markers may separate from the solid phase of the meal
and empty with the liquid phase, resulting in erroneous results.
3. Gastric secretions provide a signicant contribution to the gastric
volume during meals, and inuence gastric emptying patterns by
progressively diluting both liquid and solid markers. External gamma
counting cannot measure the volume of gastric secretion within or
emptied from the stomach, so this important aspect of gastric emptying
is not monitored.
. Thus while it is necessary to compare EIT with the gold standard, lack of
agreement may in fact reect dierences between the dierent methodologies, particularly the inability of scintigraphy to monitor gastric secretions
(Nour et al 1995).
. The literature has used correlation coecients to compare gastric emptying
measured by EIT and scintigraphy. It is probably better to use other
methods, such as a BlandAltman plot, which may aect some of the
conclusions drawn.
6.10.
GENERAL CONCLUSIONS
Electrical impedance tomography is a novel, non-invasive method of

measurement of volume transit through certain hollow visci in man. It has
found most use in gastroenterology to assess ow of ingesta through the
gastric region as an alternative to radionuclide studies, which are still
regarded by clinicians as the gold standard. As it measures gastric volume
rather than gastric residence time (emptying), it does not and would not be
expected to correlate with gamma scintigraphy unless all physiological
secretions into the gastric lumen are inhibited.
References
203
In spite of its attraction, EIT is not widely used in the UK or elsewhere

for gastric emptying measurements. This failure to be adopted for general
clinical applications is because of diculties associated with the transfer of
the new technology in relation to personnel and facilities within the healthcare services in the UK. Specic problems are outlined below.
1. Lack of eective commercialization including marketing and manufacturing, and service and technical support.
2. Training facilities for healthcare specialists in optimal use of equipment.
3. Development of standardized protocols within the clinical setting.
4. Establishment of normal physiological values for a wide range of test
meals.
5. Acceptance of the technique by clinicians.
In addition, the use of gastric emptying as a clinical tool is not widely
requested. This is in part because of failure of recognition of the value of
such an investigation in diagnosis and management of patients, but also
due to a general lack of understanding in foregut pathology and symptoms.
EIT could play a major role in this area with some foresight and imagination
on the part of clinicians and scientists in this eld of medicine.
At present, EIT continues to be used by a few centres as a research tool,
and eective commercialization and further development have therefore
been hampered by lack of investment. This situation will not improve
unless a major benet is perceived over existing diagnostic methods in gastroenterology.
REFERENCES
Akkermans L M A and Van Isselt J W 1994 Gastric motility and emptying studies with
radionuclides in research and clinical settings Dig. Dis. Sci. 39(12) 95S96S
Avill R et al 1987 Applied potential tomography Gastroenterology 92(4) 10191026
Bromer M Q and Parkman H P 2001 Oce-based testing for gastric emptying: a breath
away? J. Clinical Gastroenterology 32(5) 374-376
Bromer M Q et al 2002 Simultaneous measurement of gastric emptying with a simple
mun meal using [13C]octanoate breath test and scintigraphy in normal subjects
and dyspeptic patients Dig. Dis. Sci. 47(7) 16571663
Brown B H and Seagar A D 1987 The Sheeld Data Collection System Clin. Phys. Physiol.
Meas 8 Suppl A 9197
Burd R S and Lentz C W 2001 The limitations of using gastric residual volumes to monitor
enteral feedings: a mathematical model Nutrition in Clinical Practice 16(6) 349356
Camileri M et al 1998 Measurement of gastrointertinal motility in the GI laboratory
Gastroenterology 115(3) 747762
Fried M 1994 (Supplement) Methods to study gastric emptying Dig. Dis. Sci. 39(12) 114S
115S
Ghoos Y F et al 1993 Measurement of gastric emptying rate of solids by means of carbon
labeled octanoic acid breath test Gastroenterology 104 16401647
204
Gilja O D et al 1997 Intragastric distribution and gastric emptying assessed by three dimensional ultrasonography Gastroenterology 113 3849
Horowitz M and Dent J 1991 Disordered gastric emptying: mechanical basis, assessment
and treatment Ballieres Clinical Gastroenterology 5(2) 371407
Horowitz M et al 1994 Role and integration of mechanisms controlling gastric emptying
Dig. Dis. Sci. 39(12) 713S
Lamont G L et al 1988 An evaluation of applied potential tomography in the diagnosis of
infantile hypertrophic pyloric stenosis Clin. Phys. Physiol. Meas. 9 Suppl A, 6569
Lee J S et al 2000 Toward oce based measurement of gastric emptying in symptonmatice
diabetics using [13C] octanoic breath test Am. J. Physiology 95(10) 27512761
Lin H C and Van Citters G W 1997 Stopping enteral feeding for arbitary gastric residual
volume may not be physiologically sound: results of a computer simulation model J.
Parenteral and Enteral Nutrition 21(5) 286289
Mangnall Y F et al 1991 Applied potential tomography: noninvasive method for measuring gastric emptying of a solid test meal Dig. Dis. Sci. 36(12) 16801684
McClave S A and Snider H L 2002 Clinical use of gastric residual volumes as a monitor for
patients on enteral tube feeding J. Parenteral and Enteral Nutrition 26(6) S43S48
Mushambi M C et al 1992 A comparison of gastric emptying rate after cimetidine and
ranitedine measured by applied potential tomography British J. Clin. Pharmacol.
34 287280
Nour S et al 1991 Measurement of gastric emptying in infants using applied potential
tomography Gut 32 A1233
Nour S et al 1995 Applied potential tomography in the measurement of gastric emptying in
infants J. Paediatric Gastroenterology and Nutrition 20(1) 6572
Piessevaux H et al 2003 Intragastric distribution of a standardised meal in health and functional dyspepsia: correlation with specic symptoms Neurogastroenterology Motility
15 447455
Ravelli A M and Milla J 1994 Detection of gastroesophageal reux by electrical impedance
tomography J. Paediatric Gastroenterology and Nutrition 18(2) 205213
Soulsby C T et al 2003 Measurement of gastric emptying during continuous nasogastric
infusion of enteral feed Clinical Nutrition 22(1) S59S60
Soulsby C T et al (awaiting publication) Real time measurement of enteral feed tolerance in
critically ill patients: is there a role for electric impedance tomographic spectroscopy?
Proc. Nutrition Society
Vantrappen G 1994 (Supplement) Methods to study gastric emptying Dig. Dis. Sci. 39(12)
91S94S
Wright J W 1995 The eect of intraluminal content on gastrointestinal motility in man.
Nottingham, University of Nottingham 98
APPENDIX
Subjects
Test meal
H2 Blockers
Methodology
Results
Avill
(1987)
Eect of acid
inhibition on
repeatability of GE
measured by EIT
8 normals
1 Oxo cube plus

500 ml water
No inhibition
versus 800 mg
cimetidine
GE measured by EIT on four

occasions per subject, two
consecutive days with acid
inhibition or placebo in
randomized order
Good repeatability for t1=2 with acid

suppression (r 0:90), poor
repeatability without (r 0:19)
Mangnall
(1991)
Eect of acid
inhibition on
accuracy of GE
measured by EIT
compared with
scintigraphy
20 normals
160 g beefburger
No inhibition
versus 800 mg
cimetidine
GE measured simultaneously by Good agreement for t1=2

EIT versus scintigraphy with
(r 0:713), lag time (r 0:585)
acid inhibition (n 12) or
with acid inhibition. Poor
without (n 8)
agreement t1=2 (r 0:058), lag time
(r 0:376) without acid inhibition
Wright
(1995)
Eect of dierent
types of acid
inhibitors on
repeatability of GE
measured by EIT
16 normals
1 Oxo cube plus

500 ml water
No inhibition
versus 800 mg
cimetidine versus
40 mg omeprazole
GE measured by EIT on three

occasions per subject, once with
no acid inhibition, once with
cimetidine, once with
omeprazole
No dierences between males and

females. Acid inhibition increased
speed of t1=2 emptying ( p 0:06
cimetidine, p 0:09 omeprazole)
Wright
(1995)
Eect of dierent
types of acid
inhibitors on
repeatability of GE
measured by EIT
16 normals
500 ml of
porridge 4.5 g
salt
No inhibition
versus 800 mg
cimetidine versus
40 mg omeprazole
GE measured by EIT on three

occasions per subject, once with
no acid inhibition, once with
cimetidine, once with
omeprazole
GE t1=2 was quicker in males than

femalescontrol, p 0:01;
cimetidine, p 0:02.
In males GE was quickest:
cimetidine > controls >
omeprazole.
In the females GE was quickest:
cimetidine > omeprazole > controls.
In controls, female lag phase > males
for semi-solids and liquids ( p 0:04,
p 0:04)
205
Aim of study
Appendix
Study
206
APPENDIX (Continued)
Aim of study
Subjects
Test meal
H2 Blockers
Methodology
Avill
(1987)
Comparison of GE
measured by EIT
versus scintigraphy
8 normals
300 ml consomme
300 ml 100 mCi
99m
Tctin colloid
water
GE measured simultaneously by Good agreement for t1=2 between

the two methods (r 0:801,
EIT versus scintigraphy
p < 0:05)
Avill
(1987)
Comparison of GE
measured by EIT
versus dye dilution
10 normals
750 ml 5%
aqueous sucrose

EIT versus dye dilution
p < 0:01)
Wright
(1995)
Comparison of GE
measured by EIT
versus scintigraphy,
and eect of acid
inhibition
11 normals
1 Oxo cube plus

500 ml water
labelled with
2 MBq 99m Tc
DTPA
400 mg versus no
acid inhibition
GE measured simultaneously by
EIT versus scintigraphy on two
occasions in each subject, once
with acid inhibition, once
without
Nour
(1995)
Investigation of the
feasibility of using
EIT in infants
47 infants
Formula milk
(25 ml/kg) or
dioralyte
GE measured by EIT and gastric Good agreement at 90 min between

residuals
GE and gastric residuals in milk fed
(16/20) or dioralyte fed (24/27)
infants
Avill
(1987)
Comparison of GE
measured by EIT
versus scintigraphy
8 normals
85 g mashed
potato 300 ml
100 mCi 99m Tctin
colloid water
800 mg cimetidine

EIT versus scintigraphy
p < 0:05)
Wright
(1995)
Comparison of GE
measured by EIT
versus scintigraphy
and eect of acid
inhibition
8 normals
500 ml of
porridge 4.5 g
salt labelled with
2 MBq 99m Tc
DTPA
400 mg versus no
acid inhibition
GE measured simultaneously by
EIT versus scintigraphy on two
occasions in each subject, once
with acid inhibition, once
without
Results
One subject failed to complete the

study to give 20 studies.
There was good agreement between
t1=2 for EIT and scintigraphy.
Acid inhibition (r 0:87, p 0:001).
Controls (r 0:77, p 0:006)
Only 10 studies showed good

agreement between t1=2 for EIT and
scintigraphy.
Acid inhibition ( p 0:04).
Controls ( p 0:04)
Study
Chapter 7
Other clinical applications of electrical
David Holder
The principal potential clinical applications for biomedical EIT are imaging of
heart and lung function in the thorax, gastric emptying, screening for breast
cancer and brain function. These are all covered by individual chapters elsewhere in this volume. There are several other possible applications, most of
which are now of historical interestthey were started in the rst ush of
enthusiasm when the Sheeld Mark 1 system became available in the mid
1980s, but then active research was discontinued because of inherent technical
problems, or because other areas within EIT appeared more promising.
However, these ideas may still prove to be practicable and worthwhile if
approached in a dierent light, and are reviewed in this chapter.
7.1.
HYPERTHERMIA
Malignant tumours may be treated by articially increasing temperature by

microwave radiation or lasers. It is essential to monitor tissue temperature so
that normal tissue is not heated, and malignant tissue is heated to the desired
temperature of about 430 8C. At present, this is achieved by inserting thermocouples into the tumour. This is practicable for supercial tumours, but
dicult for deep ones. There is therefore a need for an accurate non-invasive
thermometry method, especially for deep tumours. In principle, EIT might
be suitable for this, because there is a linear relation between temperature
and impedance change in simple aqueous solutionsthe impedance of
ionic solutions varies inversely with temperature by about 2% per 8C
(Griths and Ahmed, 1987). EIT therefore presents a possible non-invasive
means of imaging temperature within a subject.
Unfortunately, the relationship between resistivity and temperature is
complex. Using a laser probe to heat ground calf liver in a cylindrical tank,
208
Other clinical applications of electrical impedance tomography
Moller et al (1993) compared changes within the EIT image with temperature
determined by thermocouples. The tissue was heated to between 35 and 60 8C
as a result in oscillations in a thermoregulatory feedback system. There was a
qualitative correlation between changes in the EIT image and temperature, but
a substantial impedance drift of uncertain origin occurred. A similar study was
performed in a tank lled with conducting agar, into which small pieces of
foam had been inserted in order to simulate inhomogeneous tissue. Heating
was performed with radiofrequency coils (Conway et al, 1992). A linear
relation was observed between EIT image changes and temperature, but the
slopes varied with position in the phantom.
Temperature calibration experiments have also been performed in vivo. In
three volunteers, 200 ml of conducting solutions at various temperatures were
repeatedly introduced into the stomach, whilst EIT images were made from
electrodes around the abdomen (Conway et al, 1992). Acid production was
suppressed by cimetidine. It was found necessary to compensate for baseline
drifts in the images. After compensation, a linear relationship between the
temperature of the infused uid and region of interest integral was observed,
although the slopes varied between subjects.
Unfortunately, reliable clinical use for hyperthermia monitoring
requires a high degree of both spatial and contrast resolution. Single
images in the thigh (Griths and Ahmed, 1987) and over the shoulder
blade (Conway, 1987) of human subjects, with the Sheeld Mark 1
system, during warming, showed substantial artefacts, and it was also
demonstrated in normal volunteers, without warming, that baseline variability would produce impedance changes which were equivalent to temperature changes of several degrees. More recently, some pilot clinical
measurements with planar arrays at 12.5 kHz showed encouraging average
results, but some estimates of tissue temperature were erroneous by 9 8C
(Moskowitz et al, 1995; Paulsen et al, 1996).
Unfortunately, accurate temperature estimation requires not only
accurate imaging, but also an assumed linear relation between temperature
and conductivity. This latter appears to change in a hysteretic fashion
during tissue heating. Given this uncertainty in calibration a priori, and the
baseline variability in vivo, it unfortunately seems that EIT is unlikely to
be an accurate technique unless there are substantial improvements in
system performance (Blad et al, 1992; Paulsen et al, 1996).
7.2.
EIT IMAGING OF INTRA-PELVIC VENOUS CONGESTION
Pooling and congestion of blood in the pelvis is a poorly understood

phenomenon which is thought to be the cause of pelvic discomfort in
women. Thomas et al (1991) investigated the possible use of EIT in its
diagnosis, on the basis that abnormal pooling would produce impedance
Other possible applications
209
changes. EIT images were collected with a ring of electrodes around the
pelvis, as the subject was placed in horizontal and vertical positions using
a tilt table. The rationale was that this should produce uid shifts in the
pelvis. A central area of impedance change was observed in both normals
and subjects, with pelvic congestion diagnosed by venography. A signicant
dierence in the ratio of the areas anterior and posterior to the coronal
midline and greater than 10% of the peak impedance change was observed.
No dierence in mean amplitude of impedance changes was observed
between the two groups. Venography is an invasive procedure, so EIT
would provide a welcome alternative. However, there is no direct evidence
concerning the origin of these changes, although it has been shown that
they are at least plausible by comparison with EIT images made in tanks
with saline-lled tubing (Thomas et al, 1994). This is an intriguing and potentially valuable application, but larger prospective studies will be needed
before its use can be established.
7.3.
OTHER POSSIBLE APPLICATIONS
Using a 16 electrode system operating at 10 kHz and an algorithm similar to

that of the Sheeld system, Kulkarni et al (1989, 1990) were able to produce
EIT images in long bones. Areas of increased resistivity could be identied in
the normal subject and 16 weeks after fracture, whilst a similar region showed
lower resistivity in another subject, four weeks after fracture (Ritchie et al,
1989). It remains to be determined if such results could be used eectively to
monitor fracture healing. However, fractures can at present be assessed with
great accuracy by x-ray. EIT might oer an advantage if repeated measurement was needed for follow-up, but it is unlikely that it could oer appropriate
spatial resolution.
A group in Neurology in Cardi in the UK became interested in the use
of EIT to image swallowing. Disorders of swallowing occur in neurological
conditions like strokes, and are potentially serious as uids may be aspirated
into the lungs. A ring of EIT electrodes was placed around the neck, and
imaging was performed as the subject swallowed a conductive uid
(Hughes et al, 1996a). It was possible to obtain images of uid passing
through the oropharynx, and a method was developed for calculating the
oropharygeal transit time. However, movement of the larynx had a signicant eect on the image, and there was signicant variability between
subjects (Hughes et al, 1996b).
Other proposed applications have included EIT imaging of limb
plethysmography (Vonk et al, 1997), apnoea monitoring (Woo et al, 1992)
and intra-abdominal bleeding or uid (Sadleir and Fox, 2001), but no
direct evidence is yet available to assess the likely clinical accuracy of these
possibilities.
210
Other clinical applications of electrical impedance tomography
REFERENCES
Blad B, Persson B and Lindstrom K 1992 Quantitative assessment of impedance tomography for temperature measurements in hyperthermia Int. J. Hyperthermia 8 3343
Conway J 1987 Electrical impedance tomography for thermal monitoring of hyperthermia
treatment: an assessment using in vitro and in vivo measurements Clin. Phys. Physiol.
Conway J, Hawley M, Mangnall Y, Amasha H and van Rhoon G C 1992 Experimental
assessment of electrical impedance imaging for hyperthermia monitoring Clin. Phys.
Physiol. Meas. 13 Suppl A 185189
Griths H and Ahmed A 1987 A dual-frequency applied tomography technique: computer
simulations Clin. Phys. Physiol. Meas. 8 103107
Hughes T A, Liu P, Griths H, Lawrie B W and Wiles C M 1996a Simultaneous electrical
impedance tomography and videouoroscopy in the assessment of swallowing
Hughes T A, Liu P, Griths H and Wiles C M 1996b Repeatability of indices of swallowing in healthy adults: electrical impedance tomography compared with a simple timed
test of swallowing Med. Biol. Eng. Comput. 34 366368
Kulkarni V, Hutchison J M and Mallard J R 1989 The Aberdeen Impedance Imaging
System. Biomed. Sci. Instrum. 25 4758
Kulkarni V, Hutchison J M, Ritchie I K and Mallard J R 1990 Impedance imaging in
upper arm fractures J. Biomed. Eng. 12 219227
Moller P H, Tranberg K G, Blad B, Henriksson P H, Lindberg L, Weber L and Persson B
R R 1993 Electrical impedance tomography for measurement of temperature distribution in laser thermotherapy (laserthermia), in Clinical and Physiological Applications of Electrical Impedance Tomography, ed D S Holder (London: UCL Press)
Moskowitz M J, Ryan T P, Paulsen K D and Mitchell S E 1995 Clinical implementation of
electrical impedance tomography with hyperthermia Int. J. Hyperthermia 11 141149
Paulsen K D, Moskowitz M J, Ryan T P, Mitchell S E and Hoopes P J 1996 Initial in vivo
experience with EIT as a thermal estimator during hyperthermia Int. J. Hyperthermia
12, 573591
Ritchie I K, Chesney R B, Gibson P, Kulkarni V and Hutchison J M 1989 Impedance
osteography: a technique to study the electrical characteristics of fracture healing
Biomed. Sci. Instrum. 25 5977
Sadleir R J and Fox R A 2001 Detection and quantication of intraperitoneal uid using
electrical impedance tomography. IEEE Trans. Biomed. Eng. 48 484491
Thomas D C, McArdle F J, Rogers V E, Beard R W and Brown B H 1991 Local blood
volume changes in women with pelvic congestion measured by applied potential
tomography Clin. Sci. (Lond.) 81 401404
Thomas D C, Siddall-Allum J N, Sutherland I A and Beard R W 1994 Correction of the
non-uniform spatial sensitivity of electrical impedance tomography images Physiol.
Meas. 15 Suppl 2a A147-A152
Vonk N A, Kunst P W, Janse A, Smulders R A, Heethaar R M, Postmus P E, Faes T J and
de Vries P M 1997 Validity and reproducibility of electrical impedance tomography for
measurement of calf blood ow in healthy subjects Med. Biol. Eng. Comput. 35 107112
Woo E J, Hua P, Webster J G and Tompkins W J 1992 Measuring lung resistivity using
electrical impedance tomography IEEE Trans. Biomed. Eng. 39 756760
PART 4
NEW DIRECTIONS
Chapter 8
Magnetic induction tomography
H Griths
8.1.
INTRODUCTION
The development of tomographic techniques for imaging the low-frequency

(<2 MHz), passive electromagnetic properties of materials non-invasively has
been an active area of research now for almost two decades. Most of this interest
has been in the areas of medical imaging, where cross-sectional images of the
human body are sought (Holder 1993, Bourne 1996), and industrial imaging
for the visualization and control of processes in vessels and pipelines (Williams
and Beck 1995). Electrical imaging has also been used in environmental monitoring for tracking the migration of pollutants underground (Daily and Ramirez
1995) and in archaeology for imaging submerged remains (Noel and Xu 1991).
The oldest of the electrical imaging techniques is electrical impedance
tomography (EIT), which normally involves attaching an array of surface
electrodes around the region to be imaged. Currents are injected and electric
potentials measured via the electrodes, resulting in a set of four-electrode
measurements of transimpedance from which a cross-section of electrical
conductivity and permittivity can be computed. In some EIT systems,
sinusoidal patterns of current are injected, involving all electrodes at once,
as this has been shown theoretically to provide optimal measurement
sensitivity. EIT is sometimes referred to as electrical resistance tomography
(ERT) in applications where the permittivity is negligible.
Another technique, electrical capacitance tomography (ECT), is very
similar to EIT in that it also uses an array of electrodes and applies an electric
eld to the material. It diers only in the way the measurements are made;
instead of a measurement of transimpedance involving four electrodes at a
time, capacitance is measured between dierent pairs of electrodes. ECT is
designed for materials of low permittivity and negligible conductivity
imaged through an insulating boundary.
214
The most recent and least developed technique is magnetic induction

tomography (MIT), the rst reports of which appeared in 19923. Interest
in MIT has increased dramatically in the last few years. MIT applies a
magnetic eld from an excitation coil to induce eddy currents in the material,
and the magnetic eld from these is then detected by sensing coils. This, in
eect, measures the changes in mutual inductance between the coils. Direct
contact with the material is not required. The technique has been variously
named mutual inductance tomography (also MIT), electromagnetic tomography (EMT), electromagnetic inductance tomography (EMIT) and eddy
current tomography. MIT is sensitive to all three passive electromagnetic
properties: conductivity, permittivity and permeability.
A number of hybrid systems have been reported involving either
magnetic excitation with coils and measurement of surface potentials with
electrodes (Freeston and Tozer 1995, Gencer et al 1996, Koksal et al 2002,
Zlochiver et al 2004), or current injection via electrodes and sensing of the
external magnetic eld with coils (Tozer et al 1998). Recently, improvements
have been claimed by injecting current and measuring both surface potentials
and external magnetic eld (Levy et al 2002), or by both injecting and
inducing current and measuring surface potentials (Radai et al 2003). The
terminology has become very confusing, as these methods have been
named magnetic impedance tomography, electromagnetic impedance
tomography (EMIT again) or magnetic EIT, but not being true MIT
they will not be discussed further here.
Adding still more to the confusion, a new European network, formed to
coordinate research into the passive (and altogether dierent) technique for
locating the equivalent electrical sources in the brain from the recorded
electroencephalogram activity, has been named the European Network on
Electromagnetic Tomography. Indeed, the term electromagnetic tomography could equally well be applied to the familiar x-ray CT or to optical or
microwave tomography, all of which employ electromagnetic waves. It is
desirable, therefore, that the term magnetic induction tomography should
now be universally adopted for the class of techniques in which eddy currents
are induced and the external magnetic eld sensed (whether by coils or in
future by other types of magnetic-eld sensors).
8.2.
THE MIT SIGNAL
There are two contributions to the signal detected by the sensing coil. The
rst is directly induced by the eld from the excitation coil (the primary
signal, B). The second is from the eddy currents induced in the material
which in turn produce their own magnetic eld (the secondary signal, B).
For a sinusoidally-time-varying excitation at angular frequency !, the
skin depth of the electromagnetic eld in the material is given by
Coils and screening
215
Figure 8.1. Phasor diagram representing the primary (B) and secondary (B) magnetic
elds detected. The total detected eld (B B) lags the primary eld by an angle .
2=!0 r 1=2 , where and r are the conductivity and relative permeability of the material and 0 is the permeability of free space. If is large
compared with the thickness of the sample, which will normally be so for
biological tissues,
B
P!0 !"0 "r j Qr 1
8:1
B
where "r is the relative permittivity of the material, "0 is the permittivity of
free space and P and Q are geometrical constants (Scharfetter et al 2003).
Thus, the conduction currents induced in the sample give rise to a component
of B, which is proportional to frequency and conductivity and is imaginary
and negative, meaning that it lags the primary signal by 908. Displacement
currents cause a real (in-phase) component proportional to the square of
the frequency. A non-unity relative permeability also gives rise to a real
component, but with a value independent of frequency. The primary and
secondary signals can be represented by the phasor diagram shown in
gure 8.1.
Because for biological tissues B is much smaller in magnitude than B
and is normally dominated by the conductivity term, the phase angle can be
written

B
/ !:

8:2
B
Hence, a higher frequency of excitation will increase the size of the signal.
For a metal sample, where the conductivity is high and the permittivity
negligible, will be much smaller than the thickness of the sample and the
behaviour of B=B departs from the proportionality given in equation
(8.1). Its value will be much larger than for the same volume of biological
tissue, and it will contain not just a negative imaginary part but also a negative real part as the sample tends to act as a screen (Tapp and Peyton 2003).
8.3.
COILS AND SCREENING
A typical practical MIT system consists of an array of coils mounted inside

an outer cylindrical screen (see gure 8.2). Each coil assembly can function as
216
Figure 8.2. A practical MIT system, operating at 10 MHz (after Watson et al 2002b). The
16 coils are mounted inside a cylindrical electromagnetic screen of aluminium. The circuit
boards of the transceivers are enclosed in metal boxes xed to the outside of the screen.
an excitor or a sensor and is switched electronically to either mode. Other coil

congurations such as linear or planar arrays are also being developed.
Because of the small sizes of the signals to be measured in MIT, screening is important for two purposes: to reduce the sensitivity of the system to
objects outside the imaging space and to reduce capacitive coupling between
the coils. The scalar potential dierence required to drive current through the
excitation coil creates an electric eld in the surrounding space that can
induce a signal across the impedance of the sensing coil. This can either be
by direct coupling or by indirect routes via the sample or external bodies
(Peyton et al 2002, Goss et al 2003a). Without careful design of the hardware,
this unwanted capacitive signal can easily be much larger than the signal of
interest from inductive coupling.
The outer screen can be of two types which function in dierent ways. A
cylinder of high-permeability material (e.g. ferrite) acts as a magnetic-connement screen by providing a low-reluctance return path for the eld lines. Thus,
no magnetic ux escapes from the cylinder to interact with external objects.
This type of screen has been used in low-frequency MIT systems (Yu et al
1993a, Peyton et al 1996). A magnetic-connement screen increases the
measurement sensitivity to objects inside the coil array by up to a factor of
2 (Peyton et al 1999).
A second type of outer screen, used in both low- and high-frequency
systems, is a highly-conducting metal cylinder which functions as a so-called
Coils and screening
217
electromagnetic screen (Yu et al 1993a, Korjenevsky et al 2000, Watson et al

2002b). Eddy currents are induced in the screen, creating a magnetic eld in
opposition to the eld from the coil. Provided the thickness of the screen is
large compared with the skin depth of the elds in the metal, no magnetic
ux exists outside the cylinder. In contrast to the magnetic connement
screen, the eddy currents in an electromagnetic screen reduce the imaging
sensitivity to objects inside the array by an amount depending on the
stand-o distance of the coils from the screen (Peyton et al 2003). This
type of screen has a particular advantage, in that it attracts electric eld
lines in a similar manner to a ground plane on a printed circuit board and
signicantly reduces capacitive coupling between the coils.
In addition to the outer screen, screening of the individual coils is often
added. Griths et al (1999) formed the coils as shielded turns, winding them
from coaxial cable and terminating the core on the screen at the feed point.
Korzhenevsky and Sapetsky (2001) also formed coils from coaxial cable, but
used a dierent method of termination. Another way of screening a circular
coil is to enclose it in a metal cylinder having radial cuts in the ends and
longitudinal cuts in the sides (a technique used for inductive applicators in
shortwave diathermy). In this way, the cuts are all perpendicular to the
vector potential eld from the coil and prevent eddy currents from owing
in the screen which would otherwise oppose the magnetic eld from the
coil. Manufacturing coils and screens from printed circuit board is an attractive new method allowing high reproducibility and a low prole of construction. Again the breaks in the screen must be placed so as to prevent the ow
of eddy currents (see gure 8.3).
The use of a receiver with a dierential input can reduce the eect of
capacitive coupling as a large component of this signal will be commonmode (Korjenevsky et al 2000, Watson et al 2002a). Many of the screening
techniques used in MIT are not new and can be found in old texts on
radio engineering (see Peyton et al 2002 and Goss et al 2003a for further
discussion and references). Few data have been published on the size of
the residual signals from capacitive coupling in dierent MIT systems, and
Figure 8.3. Designs of (a) spiral coil and (b) comb screen for printed circuit board
fabrication (after Peyton et al 2002).
218
the best way of quantifying this error needs to be established. The whole
topic of screening in MIT and the determination of what is optimal deserves
much more study.
8.4.
SIGNAL DEMODULATION
In order to exploit the fact that the conduction signal is in quadrature with
the primary signal, phase-sensitive detection is normally used for demodulation (Yu et al 1994, Griths et al 1999, Scharfetter et al 2001). Commercial
lock-in ampliers have provided an o-the-shelf solution incorporating a
vector voltmeter (phase-sensitive detector), analogue-to-digital conversion
and digital ltering (Riedel et al 2002, 2004, Watson et al 2002b, 2004,
00
Ulker and Gencer 2002, Karbeyaz and Gencer 2003). Phase-sensitive detection can discriminate between the conduction signal and any residual signal
due to capacitive coupling (see section 8.3), as the latter is known to aect
predominantly the real part. Customized circuitry for direct digitization of
the high-frequency signal is likely to become a viable, cost-eective option
with the appearance on the market of new, fast, high-resolution, analogueto-digital converters.
An alternative method of demodulation, advocated by Korzhenevskii
and Cherepenin (1997), is to measure the phase angle directly as it will be
proportional to sample conductivity [equation (8.2)]. The method has been
implemented by passing the signal and a reference waveform through zerocrossing detectors and feeding the resulting signals to an exclusive-OR
gate; the output pulse width will then be proportional to the phase dierence
(Korjenevsky et al 2000, Watson et al 2002a).
Watson et al (2001b) identied three indices of error in MIT demodulators: phase noise, phase drift and phase skew (phase skew being an apparent
change in phase caused by a change in signal amplitude). With exclusive-ORbased, direct-phase measurements, the three indices were compared for
dierent limiter amplier circuits (Watson et al 2002a). In a further study,
direct phase measurement was compared with a vector-voltmeter method
in respect of the same three indices (Watson et al 2003); the two methods
had comparable noise and skew values, but the drift was found to be greater
in the direct-phase system.
8.5.
CANCELLATION OF THE PRIMARY SIGNAL
Because the secondary signal has to be detected against the much larger
primary signal, various methods have been tried for backing o the primary
signal, i.e. for subtracting the phasor B in gure 8.1, such that with no sample
present all recorded signals should be zero. This then allows the gain of the
Cancellation of the primary signal
219
electronics to be increased with a consequent improvement in signal-to-noise

ratio. In practice, perfect cancellation is of course never possible, but usefully
large cancellation factors can nevertheless be achieved. Methods for primarysignal backo fall into two categories: those in which it is cancelled at the
sensor, before entering the electronics, and those in which the backo
signal is generated electronically and then subtracted.
In single-channel measurements at 10 MHz, Griths et al (1999) used a
third coil mounted separately, producing an antiphase signal that was then
added to the signal from the sensing coil. Again in a single channel, operating
in the band 40370 kHz, Scharfetter et al (2001) used a planar gradiometer as
the sensor which provided a high rejection of the primary signal (cancellation
factor 102 103 ). The residual signal was reduced further by a phasecompensation circuit (electronic backo). The idea of using a third coil for
backing o the primary signal is not new and was used more than 30 years
ago by Tarjan and McFee (1968). They constructed what they termed a
dierential transformer comprising two sensing coils positioned symmetrically on either side of the excitation coil on a cylindrical former. The sensing
coils were connected such that the signals cancelled, in eect forming an
axial gradiometer. A related technique was used by Crowley and Rabson
(1976) for measuring the resistivity of semiconductor wafers. Also using
00
axial gradiometers, Ulker and Gencer (2002) achieved a cancellation factor
of 103 at 60 kHz and combined it with electronic backo, and Riedel et al
(2002) achieved a similar factor but at a higher frequency, 1 MHz.
Peyton et al (1999) described the overlapping of excitation and sensing
coils so that the net primary ux through, and hence primary signal from, the
two sensing coils immediately adjacent to the excitation coil was close to
zero.
An entirely electronic backo, programmable in amplitude and phase,
was employed by Yu et al (1994) in a 200 kHz industrial MIT system.
The advantage of using a backo coil or gradiometer is that the primary
eld is cancelled at the point of detection and is not dependent on the stability
of the electronics. Any uctuations in the excitation coil current or waveform
will aect the sensing and backo coils (or halves of the gradiometer) alike,
and will not aect the cancellation. The main requirement for the backocoil/gradiometer method is for good mechanical and temperature stability
(see Scharfetter et al 2003 for a discussion). A possible disadvantage of the
method is that whilst it has been shown suitable for single-channel measurements, there is no obvious way of incorporating it into a circular, multichannel, MIT system (e.g. gure 8.2), with the primary signal cancelled for
all excitation coil positions. Rosell et al (2001) have suggested an array of
gradiometers adjusted for a single excitation coil and rotation of the
complete array to obtain the necessary set of projections. Electronic backo,
on the other hand, can be programmed for all excitor/sensor combinations,
and the attractiveness of this arrangement is that a fully electronically
220
scanned system with no moving parts is possible. However, small changes in

the amplitude, phase or waveform of the compensation signal can upset the
cancellation, and great electronic stability is needed.
There is one type of MIT conguration for which the primary signal can
in principle be zero for every sensor in a multi-channel system. This is the
00
planar array. Ulker and Gencer (2002), Karbeyaz and Gencer (2003) and
Riedel et al (2002, 2003) have mechanically scanned a single axial gradiometer
in a plane above conducting objects (see section 8.6.2). From symmetry, a
static, planar array of many such devices would register no primary signal
for any excitor/sensor combination. Watson et al (2004) proposed a dierent
type of planar array with the sensing coils mounted at right angles to the plane
so that they linked with no primary ux from the excitation coils. Again from
symmetry, this would hold true for all excitor/sensor combinations. With a
single channel, they achieved a primary-eld cancellation factor of about
300 over the frequency range 110 MHz. They showed further that the noise
level fell by a factor of over 40 when the primary eld was in eect backed
o, suggesting that a signicant contribution to the noise was from shortterm phase uctuations between the primary and reference signals. Scharfetter
et al (2004) computed sensitivity maps for a single excitation coil, rst with a
planar gradiometer as a sensor and then for Watsons right-angled-coil
method. The maps were found to be very similar in both form and magnitude.
Scharfetter et al then performed practical measurements at 500 kHz and
showed the gradiometer to be much more ecient at rejecting interference
from external sources, resulting in a signal-to-noise ratio higher by 20 dB
than for the right-angled coil.
Multi-channel, planar-array, imaging systems based on these designs
have yet to be constructed, but Riedel et al (2004) have performed preliminary noise and drift measurements on a 2 2 array of four axial gradiometers
operating at 600 kHz.
Although the direct phase measurement method of Korjenevsky et al
(2000) is inherently insensitive to the primary eld, and has been shown
viable in a practical MIT system (see later), the use of backo in future
might still be advantageous as shortening the phasor, B, would increase
the phase angle, (gure 8.1).
8.6.
8.6.1.
WORKING IMAGING SYSTEMS AND PROPOSED

APPLICATIONS
MIT for the process industry
The majority of MIT systems for the process industry have been designed for
detecting metallic or ferromagnetic objects which, having either a high electrical conductivity or a high permeability, can produce large signals with an
excitation frequency of 500 kHz or below.
Working imaging systems and proposed applications
221
Yu et al (1993a) reported a system operating at 500 kHz, employing a

parallel excitation magnetic eld generated by two pairs of large coils.
Twenty-one sensing coils were arranged in a circle around the imaging
volume. The assembly was situated within a magnetic-connement screen
and an electromagnetic screen. Imaging of metallic objects (copper bar and
aluminium foil) was demonstrated. Subsequently, this research group
described a system operating at 200 kHz with a parallel excitation eld and
24 detector coils (Yu et al 1994). Metallic and ferromagnetic objects were
identied from the phase information in the signals. Large signals were
detected, jB=Bj being as much as 0.25.
Williams and Beck (1995) described an array of 12 excitation coils interleaved with 12 sensing coils in a circle. The system operated at 5 kHz and
employed phase-sensitive detection. In a further development of this type
of multi-pole design, Peyton et al (1996) reported a 100 kHz system with
16 coils, each of which could serve either as an exciter or as a sensor. The
coil assembly was housed within a magnetic-connement screen, and again
it was shown possible to distinguish metallic from ferromagnetic objects
from the sign of the signal.
MIT has been proposed for monitoring the ow regime in the pouring
nozzle during the continuous casting of steel (Binns et al 2001). In an experimental system with six coils, dierent ow regimes of Woods metal were
tested. For image reconstruction, the simultaneous increment (SIRT)
method was employed, with a non-negativity constraint. The system has
now received initial trials with molten steel (Higson et al 2002, Ma et al 2003).
Pham et al (1999) have proposed an MIT method for detecting the
extent of solidication of molten metal owing in a pipeline, exploiting the
lower conductivity of the solid phase than the molten. For a parallel primary
eld, 2D imaging of the conductivity distribution was demonstrated by an
analytical method. A frequency of 100 Hz was used for the simulations but
no practical measurements were reported. In examples such as this, when
the material to be imaged is entirely metallic and hence of very high conductivity, MIT has an advantage over EIT. In EIT the transimpedances would
be very small indeed and dicult to measure.
Ramli and Peyton (1999) proposed a 16-coil MIT linear array for detecting the positions and integrity of steel reinforcing bars embedded in concrete.
Images were reconstructed by a SIRT-type method. Subsequently, Bissesseur
and Peyton (2001, 2002) developed an improved algorithm for this application
involving a nonlinear solution, parameterized for discrete conducting bars.
A number of other industrial applications for MIT have been suggested.
These include the tracking of ferrite-labelled powder in separation processes,
foreign-body detection in food, textiles or pharmaceuticals, the detection of
defects in metal components and the monitoring of bulk ionized water in
pipelines for the petrochemical industry (Yu et al 1993b, Williams and
Beck 1995, Yu et al 1995, Peyton et al 1999).
222
Further support for the petrochemical application has appeared in three

papers from a Norwegian research group. A high-frequency, inductive
dipstick was described for sensing levels of sea water, oil and air in a
gravitational separator (Hammer et al 2001), and in a subsequent paper, the
extension of the work to tomography was suggested (Hammer and Fossdal
2002). In such applications, the conductivity of the water is typically
5 S m1 . Recently, nite-element modelling has been used to investigate the
eect of water droplet size and volume fraction on the eddy-current loss in a
resonant coil (Hammer et al 2003).
8.6.2.
Biomedical MIT
Because the conductivities of biological tissues are many orders of magnitude

lower than those of metals, biomedical MIT systems have tended to use
higher frequencies than in industrial MIT in order to obtain larger signals.
Even at a frequency of 10 MHz, the secondary signal is typically only
about 1% of the magnitude of the primary signal, i.e. ImB=B 0:01
(Griths et al 1999).
The rst report of MIT for biomedical use was by Al-Zeibak and
Saunders (1993). An excitation and a sensing coil operating at 2 MHz were
scanned past a tank of tissue-equivalent saline solution, with immersed
metallic objects, in a translaterotate manner. Images were reconstructed
by ltered back-projection and showed the outline of the tank and the
internal features. Despite the fact that these images have been reproduced
in many reviews of MIT since, questions have been raised about the origin
of the signals. Using amplitude detection only, a change in total signal of
about 70% was measured as the saline conductivity was increased from
zero to 1 S m1 . Taking ImB=B 0:01, the proportional change in amplitude will be jB Bj=jBj 12 0:012 1=2 1:00005, i.e. a change of only
0.005%. The reason for the large signals measured was most likely that the
electric-eld screening was inadequate, leaving signicant capacitive
coupling between the coils, and the system was, in eect, largely performing
ECT, not MIT. The paper, however, has had the merit of stimulating a lot of
interest in MIT.
Using a similar, two-coil, translaterotate principle, Griths et al (1999)
measured volumes of tissue-equivalent saline solution at 10 MHz. The
imaginary part of the signal, corresponding to the conductivity of solutions,
agreed well with theoretical predictions and with subsequent more detailed
modelling (Morris et al 2001). An image was reconstructed by ltered
back-projection. The real part of the signal was much larger than predicted
theoretically, and this was attributed to residual capacitive coupling which
had been separated out by the phase-sensitive detection.
Korzhenevskii and Cherapenin (1997) proposed a circular MIT array of
16 coils with direct phase measurement (see section 8.4), and showed images
Working imaging systems and proposed applications
223
reconstructed by weighted back-projection from simulated data. Subsequently,

this research group reported the practical implementation of the method
(Korjenevsky et al 2000). Like the 100 kHz multi-pole system described by
Peyton et al (1996) (section 8.6.1), it employed multiple, electronically-switched
excitation/sensing coil units arranged in a circle and housed within an electromagnetic screen. The excitation frequency of the system was 20 MHz, but this
was mixed down to 20 kHz (a process in which phase information is preserved)
for signal distribution and demodulation. The coils were not individually
screened, but dierential detection was used to minimize interference from
capacitive coupling. Furthermore, any capacitive coupling aecting the real
part of the signal would have had little eect on the measured phase. An
image of a tank of tissue-equivalent saline solution clearly showed two
embedded regions of higher and lower conductivity. The image was referenced
to homogeneous saline, not to empty space. In a later publication, Korjenevsky
et al (2001) showed that reduced spatial distortion could be achieved when
images were reconstructed by an articial neural network for some simple
distributions of conductivity.
Watson et al (2002b) reported a 16-channel, electronically-switched
MIT system similar to the design of Korjenevsky et al (2000), but operating
at 10 MHz and employing phase-sensitive detection for signal demodulation.
An MIT image of a human thigh in vivo was obtained and, from saline calibration images, a mean thigh conductivity calculated; the spatial resolution
was insucient to image internal structure. Details of the transceiver circuit
are given in an earlier report (Watson et al 2001a). Figure 8.4 shows images,
obtained with this system, of a saline bath simulating a brain, with an
immersed block of agar simulating a haemorrhage. The conductivity contrast
between the agar and the saline was a factor of 3.3, being similar to the
contrast between blood and brain measured at 10 MHz (Gabriel et al
1996). The images were reconstructed with a single-step, linear algorithm,
as described by Morris and Griths (2001). The simulated haemorrhage
can be identied in both the absolute (row b) and dierence (row c) images.
The Moscow group has now obtained the rst in vivo MIT images
appearing to show internal anatomical structure (Korjenevsky 2001, Korjenevsky and Sapetsky 2001, see also website: Korjenevsky 2003). Obtaining
these images (gure 8.5) is potentially a major advance in biomedical MIT.
A careful published validation of this MIT system on phantoms with similar
distributions of conductivity to those of the anatomical sites studied would
now be benecial to conrm the interpretation of these images.
A number of workers have identied the imaging of brain conductivity as a
possible clinical application for MIT (Korjenevsky et al 2001, Scharfetter et al
2003). The advantage of MIT is that the magnetic eld easily penetrates the
skull, whereas in EIT the skull acts as a resistive barrier. Tarjan and McFee
(1968) measured an average value for brain conductivity inductively, using
an axial gradiometer (see section 8.5). Netz et al (1993) suggested that brain
224
Figure 8.4. MIT images obtained with the 10 MHz system of Watson et al (2002b) for
4 cm diameter cylinder of agar, conductivity 1 S m1 , in a 20 cm diameter bath of saline,
conductivity 0.3 S m1 . (a) Diagram indicating position of agar; the thickness of the air
gap between the saline bath and the coils (white ring) was 3.5 cm. (b) Absolute images
reconstructed relative to empty space, 40 singular values. (c) Dierence images
reconstructed from the dierence in measurements with and without the agar present,
50 singular values. Only positive image values are displayed.
(a)
(b)
Figure 8.5. Human in vivo images obtained with the Moscow 16-coil 20 MHz MIT system
(after Korjenevsky and Sapetsky 2001). (a) Dierence image of the thorax (inhalation
exhalation) reconstructed by weighted back-projection. The authors interpret features 1
and 2 as the left and right lungs, and 3 as chest movement artefact. (b) Absolute image
of the head (referenced to empty space) reconstructed by articial neural network in
which the two bright (high conductivity) features are interpreted as the lateral ventricles
of the brain.
225
oedema might be detected more promptly from conductivity changes than is

possible from CT or MRI imaging. With a view to brain imaging, Merwa et
al (2003) described a new nite element model for MIT, based on edge elements,
combined with a realistic 3D tissue map of the head. Using the model, the group
has since simulated a region of oedema, set at twice the conductivity of white
matter. Taking a realistic signal-to-noise ratio, based on their practical,
planar-gradiometer system, they calculated that if the region were 40 mm in
diameter and located at the centre of the brain, it would be detectable with
an operating frequency of 100 kHz (Merwa et al 2004).
Gencer and Tek (1999) proposed an MIT system consisting of 49 excitation and 49 separate sensing coils, arranged in two 7 7 planar arrays above
the surface of a slab of conductor. From nite-element simulations, they
reconstructed images in three dimensions. The rst step towards a practical
00
implementation of the technique was reported by Ulker and Gencer (2002), in
which a single axial gradiometer operating at 60 kHz was scanned over a
volume of tissue-equivalent saline solution (see also section 8.5). Maps of
signal strength were given. In a further paper, similar measurements were
performed at 11.6 kHz and 2D images of conductivity of volumes of saline
were reconstructed (Karbeyaz and Gencer 2003). Because only one position
of the sensing coils was available for each position of the excitation coil (all
being wound on the same former), the full data set described in the 1999
paper was not collected. Meaningful images of conductivity were nevertheless obtained, most likely because the subset of measurements collected
were those with high sensitivity values.
Matoorian et al (1995) considered the intriguing idea of a miniature
MIT system, with coils only a few millimetres across, for imaging caries in
teeth. The intended operating frequency was 200 kHz.
Riedel et al (2002) have suggested the inductive measurement of wound
conductivity. Performing impedance measurements of a wound from
electrodes is very dicult as the surrounding skin is often uneven and in
poor condition. A non-contacting inductive method might overcome these
diculties.
Tapp et al (2003b) have described a system combining MIT and bodyshape measurement by structured light for the measurement of body composition, and foresee applications in medicine and sports science. An impressive
optical reconstruction of a head-shaped phantom was given. A status report
on the development of the accompanying MIT hardware can be found in
Goss et al (2003b).
8.7.
IMAGE RECONSTRUCTION
Most image reconstruction in MIT has so far involved linear algorithms.

Weighted back-projection has been used successfully for isolated objects
226
imaged relative to free space (Yu et al 1993a, Korzhenevskii and Cherepenin

1997). The success of this approach has been explained by the fact that the
sensitivity regions approximately correspond with the ux tubes between
excitation and sensing coils. Korjenevsky et al (2000) again successfully
used this method when imaging changes in conductivity relative to a conductive background. This nding appears to be inconsistent with the work of
others (Scharfetter et al 2002a, Hollaus et al 2004, Merwa et al 2004) who
have shown that, with a conductive background, the sensitivity maps for
low-contrast perturbations depart widely from the assumed ux tubes, the
sensitivity increasing outwards towards the edge of the conductive region.
It is not clear how these apparently contradictory ndings can be reconciled,
but it is possible that the success of back-projection was because the perturbations used by Korjenevsky (100% and 200%) were quite large and
outside the range over which the low-contrast maps applied.
A single-step multiplication of the data by the pseudo inverse of the
sensitivity matrix, computed by truncated singular value decomposition,
has been used widely in EIT. In a modelling study using this method,
Morris and Griths (2001) found the MIT images to be of poorer quality
than the corresponding EIT images in a direct comparison with the same
conductivity distributions. However, the use of the method in obtaining the
images shown in gure 8.4 demonstrates that it is capable of identifying a
conductivity perturbation relative to a conductive saline background, despite
the use of a sensitivity matrix computed for changes relative to empty space;
again, this is an apparent inconsistency with the ndings of others, but the
conductivity perturbation (230%) was of a similar contrast to that used
by Korjenevsky (see above). There is much scope for further study of the
sensitivity maps in relation to these image reconstruction algorithms.
Casanova et al (2002) have shown how the truncated-SVD method can
be improved by Tikhonov regularization, and in a further paper (Casanova
et al 2004) demonstrated a dierent form of regularization in which the edges
of features were better preserved, even in the presence of noise.
For process applications in MIT, the simultaneous increment reconstruction technique (SIRT) has been used extensively with good results for highcontrast objects (Peyton et al 1996, Borges et al 1999, Ramli and Peyton
1999, Binns et al 2001). This is a linear, iterative method in which the sensitivity
matrix remains xed. Lionheart (2001) has pointed out that a given number of
iterations of the SIRT (also known as the Landweber method) can be implemented in a single matrix multiplication, if the sensitivity matrix is inverted
by singular value decomposition with the appropriate lter function. However,
if pixel values are to be constrained (e.g. non-negative conductivity), the SIRT
method is often still chosen, with the constraint applied at each iteration (Binns
et al 2001).
A prerequisite of all the above methods is ecient computation of the
sensitivity matrix. This can be computed by assuming an initial conductivity
227
distribution (e.g. uniformity) and solving the forward problem for all excitor/
sensor combinations. Each voxel is then perturbed by a small amount (e.g.
1%) and the whole computation repeated for all such voxels in turn. As
has been pointed out in the context of EIT, such a method is computationally
very time-consuming and several authors have now described more ecient
methods specically for MIT. Gencer and Tek (1999) derived a method for
computing the sensitivity involving the impressed vector potential and a
derivative of the scalar potential. Two papers have described rapid computation of the sensitivity matrix by what is in eect the Gezelowitz sensitivity
formula extended to take account of changes in conductivity, permittivity
and permeability, and the fact that the electric eld contains magneticallyinduced components as well as that arising from the gradient of the scalar
potential (Lionheart et al 2003, Hollaus et al 2004). The methods require
only two solutions of the forward problem for each coil pair, rst exciting
one coil and then the other.
The articial neural network method used by Korjenevsky and Sapetsky
(2001) to produce in vivo images (see section 8.6.2) is sometimes criticized for
not being based on any underlying physical principles and depending for its
accuracy on the training data. However, the method does not assume linearity,
can be implemented with speed and may well prove valuable for practical MIT
applications.
There is a general consensus that, in order for MIT to advance signicantly, the non-linear inverse problem will need to be solved in three dimensions. In contrast to the linear iterative methods, the NewtonRaphson or
GaussNewton method will be used and the Jacobian (sensitivity matrix)
recomputed at each iteration from the most recent estimate of the conductivity
distribution (Lionheart 2004). Soleimani et al (2003) have illustrated such a
method for a simulated, eight-coil, annular, MIT array and produced
images of a simulated copper bar. The Tikhonov-regularized solution was
used at each linear step. Tamburrino et al (2003) described an interesting
non-iterative, nonlinear algorithm using the concept of a resistance matrix
for ERT and showed how it could be modied for MIT, but no illustrations
of imaging were presented.
Because of the ill-posedness of the inverse problem, several workers
have pointed out the likely advantages in introducing a priori information
to constrain the inverse solution, and this can be done in a number of
ways. A non-negativity constraint and regularization are both common
examples of the use of a priori information, the former because it disallows
physically-impossible, negative values of conductivity and the latter because
it restricts the dierences in conductivity between neighbouring voxels in the
image to a physically acceptable level. A priori information can also be
introduced by conning the solution to a certain class of problems or by
introducing shape information determined by some other method. Bissesseur
and Peyton (2001) described nonlinear, iterative, image reconstruction,
228
customized for their particular application in imaging discrete metal bars

(section 8.6.1). Casanova et al (2003) demonstrated nonlinear image reconstruction restricted to cylindrical regions within a larger cylindrical body
and solved for their positions, radii and internal permeabilities. The optical
scanning method of Tapp et al (2003b) allows the boundary shape of the
human body to be determined (section 8.6.2). Knowledge of the outer
boundary is likely to be of particular importance as this is where the large
conductivity contrast between tissue and air occurs. Incorporation of this
shape information into an MIT image reconstruction algorithm has yet to
be demonstrated.
8.8.
SPATIAL RESOLUTION, CONDUCTIVITY RESOLUTION

AND NOISE
The spatial resolution of an MIT system will depend on the number of

independent excitor/sensor combinations. For an array of N transceivers
(coil modules functioning as either exciter or sensor) xed in position,
NN 1 independent measurements will be possible. As these consist of
reciprocal pairs, the number of independent measurements will be
NN 1=2. For the 16-transceiver system of Korjenevsky et al (2000), the
number of independent measurements was 120. As the transceivers were
arranged in a ring, producing a 2D image,
the theoretical maximum spatial
p
resolution possible was approximately 1= 120 9% of the array diameter.
This gure will of course be degraded by noise. Cylindrical objects in a saline
bath, with positive and negative conductivity contrast, each with diameter
29% of the array diameter, were clearly resolved, but the resolution limit
of the system was not given.
For the simulated planar array of Gencer and Tek (1999), low-contrast,
single-voxel conductivity perturbations (10% of the array width) were clearly
reconstructed in the surface layer. The resolution deteriorated to 3040% of
the array width at a depth in the slab of half the array width. A high signalto-noise ratio of 80 dB was assumed.
With industrial MIT systems, Peyton et al (1999) and Borges et al (1999)
report a spatial resolution of 715% of the array diameter for metal bars in
empty space.
It has been pointed out that since MIT is a contactless method, the
array of coils could be shifted by a small amount, for instance by half of
one coil spacing, doubling the number of independent measurements with
a consequent increase in spatial resolution (Gencer and Tek 1999, Rosell
et al 2001).
The resolution in conductivity will depend on the volume over which the
conductivity is being measured and on the level of noise in the system. For
biomedical MIT, equation (8.2) implies that the uncertainty in conductivity
Spatial resolution, conductivity resolution and noise
229
will depend on the phase noise in the system, but that a higher noise level
can be tolerated at higher frequencies. From numerical simulations,
Morris et al (2001) proposed a phase measurement precision of 3 m8 (millidegrees) in order to resolve the internal conductivity features in some
simple models of biological tissues at 10 MHz. This gure reects the very
high measurement precision required of MIT. A phase dierence of this
value amounts to a time dierence of only 1 ps. Light travels less than
1 mm in this time!
In measurements at 10 MHz, Griths et al (1999) reported a maximum
phase shift of 0.02 radian for cylinder of 2 S m1 saline solution. The noise
level was <104 radian <6 m8) for an integrating time of 480 ms. The
random noise gure was not the largest source of phase error as baseline
drifting was sometimes equivalent to 100 m8 over a period of 10 min.
The MIT system with the highest operating frequency yet reported is the
20 MHz system of Korjenevsky et al (2000). The noise level was quoted as
5 103 radian (280 m8), with an integrating time of 4 ms per individual
measurement. The maximum phase shift to be measured was approximately
0.06 radian for a 10 cm diameter cylinder of 3.5 S m1 saline solution in the
centre of the 35 cm diameter coil array. In a more recent publication, an
improvement in the phase noise of the system to 1:5 103 radian (86 m8)
was reported (Korjenevsky and Sapetsky 2001).
Watson et al (2002b) report a gure of 30 m8 combined phase noise and
drift for their 10 MHz multichannel system. The time taken per measurement
was very long, 560 ms, being limited not by the integration time but by the
lock-in time of the amplier.
These noise gures are all signicantly greater than the goal of 3 m8
proposed by Morris et al (2001). In a recent paper, however, Gough (2003)
described a novel method employing two stages of phase-sensitive detection,
and in a single channel operating at 8 MHz, with an integrating time of
100 ms, achieved a noise gure of 1.5 m8 and a drift of only 10 m8 over a
whole day.
Using a planar gradiometer at 150 kHz with an integrating time of
100 ms, Scharfetter et al (2001a) reported a noise level of 8 105 radian
(5 m8) and a typical signal level of 4 103 radian (230 m8). For a single
coil sensor, the signal-to-noise ratio was 20 dB lower than with the gradiometer. When measuring a biological sample, the signal-to-noise ratio was
increased by a further 36 dB by a mechanical chopping of the signal, achieved
by bringing the sample in and out of the eld of view at a frequency of 1 Hz.
Such a technique would not be possible when performing MIT imaging.
It is dicult to judge whether the noise gures achieved by the various
hardware designs so far developed will be adequate for biomedical MIT
imaging. Further detailed modelling studies of the type performed by
Merwa et al (2004) are now needed to determine the required performance
for specic imaging applications.
230
8.9.

PROPAGATION DELAYS
Most theoretical modelling of MIT to date has used the quasi-static

approximation to Maxwells equations, thereby neglecting the eects of
wave propagation. Specically, the instantaneous vector potential has
been used rather than the time-retarded one. Propagation delays are
probably unimportant when metals and ferromagnetic materials are being
imaged because the secondary signals from the eddy currents are large. In
biomedical MIT, with its much smaller signals, propagation delays might
be signicant and will appear at the detecting coil as a phase lag which
could be confused directly with the phase lag, , caused by the eddy current
signal (gure 8.1). Using the formula for dipole radiation, the magnitude
of the propagation delay has been estimated (Gough et al 2001, Griths
2001, Gough 2002). It was concluded that phase changes due to wave
propagation were small compared with the total eddy current signals, but
that in requiring a higher accuracy of MIT for imaging details of internal
structure, these eects will need to be taken into account. Suitable modelling
methods might be the nite-dierence or nite-element time-domain
methods.
8.10.
MULTI-FREQUENCY MEASUREMENTS
No examples of multi-frequency MIT imaging so far seem to have been

reported. In the process application of Binns et al (2001) for the continuous
casting of steel, dierent ow regimes (e.g. bubbly/annular) could be distinguished from changes in the frequency spectrum of the signals measured with
a single channel between 100 and 1000 Hz (see section 8.6.1).
For biomedical applications there is a strong incentive for developing
multi-frequency MIT to match the large body of work in EIT spectroscopy
for tissue characterization, but without the drawback of having to attach
electrodes. In EIT, the frequencies of interest have been below about
2 MHz in the range where the -dispersions of tissues mostly occur, and
changes due to dierent physiology and pathology have been observed.
Scharfetter et al (2001) performed multi-frequency inductive measurements
in the band 40370 kHz (see section 8.5), and were able to obtain the conductivity spectrum of a sample of potato (gure 8.6). Later measurements were
performed for vegetable material within a conducting saline background at
frequencies up to 700 kHz (Scharfetter et al 2002b). Further details of the
hardware are given elsewhere (Rosell et al 2001, Rauchenzauner et al
2002). Although this work has not so far involved imaging, it is a pointer
to an important future eld of MIT development.
There is one obvious pitfall for multi-frequency MIT, particularly at
high frequencies: the self-resonance of the coils can cause large, spurious,
Imaging permittivity and permeability
231
Figure 8.6. Inductively determined conductivity spectrum of potato (circles) (after

Sharfetter et al 2001). The asterisks mark the error limits (SD). For comparison, the
solid line is the spectrum measured with needle electrodes.
phase shifts unless care is taken to keep resonances well away from the
frequency band of operation.
8.11.
IMAGING PERMITTIVITY AND PERMEABILITY
It was demonstrated some time ago that samples of high permeability, such
as ferrite, could readily be visualized by MIT (see section 8.6.1).
For biological tissues, very little work has so far been carried out in
measuring permittivity and permeability as the signals are so small relative
to the already-small conductivity signal. However, phase-sensitive detection
provides a means of separating the conductivity signal, appearing in the
imaginary part, from the permittivity and pearmeability signals in the real
part, provided that system errors such as electric-eld coupling can be
reduced to a suciently low level. Researchers are now beginning to attempt
such measurements. Because the permittivity signal is proportional to the
square of frequency [equation (8.1)], larger signals might be expected at
high excitation frequencies, but this gain will be oset by the fall in relative
permittivity with increasing frequency exhibited by all biological tissues.
Measuring at 10 MHz, Watson et al (2003a) obtained values for the relative
permittivity of a water sample and an average for a human thigh in vivo.
232
Scharfetter et al (2003) evaluated the stability and sensitivity requirements of an inductive sensor for measuring the magnetic susceptibility
(m r 1) of liver with a view to detecting hepatic iron overload. The
susceptibility of liver tissue is very small and ranges from a normal value
of 9 106 to 5 106 in overload. The authors calculated that a very
narrow receiver bandwidth (<1 Hz) would be needed to achieve the necessary
signal-to-noise ratio for such measurements. They furthermore calculated
that for water (m 10 106 , "r 80), the permittivity contribution to
the signal at 50 kHz would be four orders of magnitude lower than that of
magnetic susceptibility, but that for liver tissue the much higher relative
permittivity (104 ) would reduce this dierence. Single-channel practical
measurements at 28 kHz (not imaging) combined with modelling have now
been reported, and showed that whilst the susceptibility of water could be
measured inductively, for human measurements in vivo, the contribution of
the permittivity outweighed that of the magnetic susceptibility and made
the measurement more dicult (Casanas et al 2004). The authors suggested
the use of multiple frequencies to improve the accuracy of the measurement
by exploiting the dierent frequency-dependencies of the permittivity and
permeability terms in equation (8.1).
Imaging permeability might also be applicable, and with somewhat
larger signals than from the bodys natural magnetism, by using magnetic
material as a tracer. Forsman (2000) introduced particles of iron oxide
(Fe2 O3 ) in a meal and was able to observe gastrointestinal mobility with a
magnetometer detection system (again not imaging). This oers the tantalizing possibility of contrast enhancement in biomedical MIT.
8.12.
CONCLUSIONS
There is now considerable interest in MIT worldwide and several new

research groups have appeared in the past few years. Presentations on
MIT now regularly feature at international conferences, and there is increasing collaboration and synergy between the elds of process tomography and
biomedical imaging. Hardware development has been aided greatly by the
advent of new, high-precision, high-frequency electronic devices such as
direct digital waveform synthesizers and the latest generation of digital
lock-in ampliers. The rst in vivo biomedical MIT images, although rudimentary, have now been produced.
To build on these encouraging results, there is a need for much further
work in all areas of MIT development. The required noise performance, optimal coil design, array conguration and screening and the optimal frequency
of operation are all still largely unknown and will be application-dependent.
There is a need for more reliable image reconstruction algorithms. Numerical
modelling studies must now be focused on specic applications in order to
References
233
inuence MIT system design. In biomedical MIT, frequencies of 10 MHz or

higher are being used by some groups, and it needs to be established whether
useful information can be obtained from measurements at these frequencies
or whether the lower frequencies recommended by others and more
commonly used in EIT are more appropriate.
The major advantage of MIT over other electrical imaging modalities
is that it does not require direct contact with the material. This will be of
particular benet in biomedical imaging where the attachment of the many
planes of electrodes necessary for 3D EIT (Metherall et al 1996) is dicult
and inconvenient. In MIT, a large number of coils could be built into the
array and would make no dierence to the ease of application to the patient.
In order to take full advantage of the non-contacting nature of MIT,
however, imaging must be performed relative to empty space, and this will
need further development of nonlinear algorithms in three dimensions.
This type of algorithm will require an accurate knowledge of the coil
positions, but since the coils can be xed rigidly in known positions, it
should not suer to the same extent from the diculties experienced in
biomedical EIT, where electrodes attached to the patient continually move.
However, the diculty in formulating a general solution to the 3D inverse
problem is not underestimated and is likely to be very processor-timeintensive.
There are several emerging areas of MIT development on which
research is just beginning, such as wideband operation for spectroscopy,
imaging permittivity and permeability, low-conductivity industrial imaging
for oil/sea-water mixtures and planar arrays. It will be very interesting to
watch the development of these areas over the next few years.
Other recent reviews of MIT can be found in Griths (2001) and Tapp
and Peyton (2003).
ACKNOWLEDGEMENTS
I am grateful to A Korjenevsky, A J Peyton and H Scharfetter for their
permission to reproduce gures 8.3, 8.5 and 8.6, and to S Watson for providing gures 8.2 and 8.4. I am further indebted to A J Peyton for constructive
criticism of the rst draft.
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Chapter 9
Magnetic resonance electrical impedance
tomography (MREIT)
Eung Je Woo, Jin Keun Seo and Soo Yeol Lee
9.1
INTRODUCTION
When we inject current into an electrically conducting subject through a pair

of electrodes attached on its boundary, the internal current pathway is determined by the resistivity distribution and the shape of the subject. In this
chapter, we use both resistivity and conductivity 1= interchangeably.
Any local change of the resistivity distribution results in a change of the
internal current pathway whose eect is conveyed to boundary voltages. In
EIT, measured boundary voltages due to multiple injection currents are
used to reconstruct an image of the resistivity distribution (Webster 1990,
Boone et al 1997, Saulnier et al 2001). These boundary voltages are insensitive to a local change of the resistivity distribution and the relationships
between them are highly nonlinear. EIT, therefore, suers from the illposed characteristics of the corresponding inverse problem, primarily due
to this nonlinearity and low sensitivity. Many studies have been performed
to appropriately handle or overcome this inherent technical diculty of
EIT as described in other chapters. Even with these techniques, the image
reconstruction problem in EIT still remains ill-posed when we try to produce
an image with high spatial resolution. In order to overcome this technical
diculty, it would be desirable to transform the ill-posed problem into a
well-posed one by incorporating any additional information.
Injected current in an electrically conducting subject produces a magnetic
eld as well as an electric eld. In EIT, the information on the electric eld in a
form of boundary currentvoltage data is used to reconstruct resistivity images.
Therefore, in order to transform the ill-posed problem into a well-posed one, it
is reasonable to consider utilizing the magnetic eld information. This new idea
brings up the following two questions. The rst practical question is how to
actually measure this magnetic eld informationunlike the electric eld,
240
Magnetic resonance electrical impedance tomography (MREIT)
the magnetic eld inside the subject can be measured by a non-contact method.
The second is how to utilize this internal information in resistivity image
reconstructions. This initiated the research area called magnetic resonance
electrical impedance tomography (MREIT).
Since the late 1980s, measurements of the internal magnetic ux density
due to an injection current have been studied by Joy et al (1989) and Scott
et al (1991, 1992). This requires a magnetic resonance imaging (MRI) scanner
as a tool to capture internal magnetic ux density images. Once we obtain the
magnetic ux density B Bx ; By ; Bz due to an injection current I, we can
produce an image of the corresponding internal current density distribution
J from the Ampe`res law J r B=0 , where 0 is the magnetic permeability of the free space. For this reason, this technique has been called
magnetic resonance current density imaging (MRCDI) and suggested as a
technically feasible way to answer the rst question on the measurement
method.
Combining EIT and MRCDI techniques, the basic concept of MREIT
was proposed by Zhang (1992), Woo et al (1994) and Ider and Birgul
(1998). In MREIT, we measure the induced magnetic ux density B inside a
subject due to an injection current I using an MRI scanner. Then, we may
compute the internal current density J as is done in MRCDI. From B and/
or J, we can perceive the internal current pathways due to the resistivity distribution to be imaged. This is the main reason why MREIT could eliminate the
ill-posedness of EIT, as shown in gure 9.1.
However, if we try to use J r B=0 , there occurs a serious technical
problem in measuring all three components of B. Since any currently
available MRI scanner measures only one component of B that is parallel
to the direction of the main magnetic eld of the MRI scanner, measuring
all three orthogonal components of B Bx ; By ; Bz requires subject rotations. In this chapter, we assume that z-axis is the direction of the main
magnetic eld. Since these subject rotations are impractical and also cause
other problems such as misalignments of pixels, it is highly desirable to
reconstruct resistivity images from only Bz instead of B. Therefore, most
recent MREIT techniques focus on analysing the information embedded in
the measured Bz data to extract any constructive relations between Bz and
the current density or resistivity distribution to be imaged.
Though there are still several technical problems to be solved, MREIT
has the potential to provide cross-sectional resistivity images with better
accuracy and spatial resolution. Reconstructed static resistivity images will
allow us to obtain internal current density images for any arbitrary injection
currents and electrode congurations. Potential clinical applications of
MREIT include functional imaging, neuronal source localization and
mapping, optimization of therapeutic treatments using electromagnetic
energy and so on. Images from MREIT may also be used as a priori information in EIT image reconstructions for better results. The disadvantages of
Introduction
241
(a)
(b)
Figure 9.1. (a) EIT using only boundary measurements. (b) MREIT using both internal
and boundary measurements.
MREIT over EIT may include the lack of portability, potentially long
imaging time and requirement of an expensive MRI scanner.
This chapter addresses the image reconstruction problem in MREIT as
a well-posed inverse problem taking advantage of the information on
internal magnetic ux density distributions. Assuming that the magnetic
ux density B Bx ; By ; Bz or only Bz is available, a mathematical formulation for the MREIT problem is presented to explain the fundamental
concept. As a basic tool in experimental design and verication, as well as
development of image reconstruction algorithms, a 3D forward solver for
MREIT is discussed. Measurement methods in MREIT are explained
based on MRCDI techniques, including data collection and processing
methods. Following the discussion on the uniqueness of a reconstructed
resistivity image, several image reconstruction algorithms are described
including the J-substitution, current constrained voltage scaled reconstruction (CCVSR), harmonic Bz algorithm and others. Practical limitations in
terms of the spatial resolution and accuracy of reconstructed images are
discussed based on the noise analysis of the measured magnetic ux density
distribution. At the end of this chapter, possible applications and future
research directions are summarized.
242
9.2.

PROBLEM DEFINITION
Figure 9.2 shows an electrically conducting domain with its boundary @.
We denote two electrodes attached on @ as E 1 and E 2 . Lead wires carrying
an injection current I are denoted as L1 and L2 . Then, we can formulate the
following boundary value problem with the Neumann boundary condition:

8
1
>
>
rVr 0 in
<r
r
9:1
>
1
>
: rV n g on @

where and V are the resistivity and voltage distribution in , respectively, n
is the outward unit normal vector on @ and g is a normal component of the
current density on @ due to the injection current I. A position vector in R3 is
denoted as r. On the current injection electrode E j for j 1 or 2, we have
E j g ds I, where the sign depends on the direction of current and g is
zero on the regions of boundary not contacting with the current injection
electrodes. It is well known that rV 2 L2 is uniquely determined by
and g. Setting a reference voltage Vr0 0 for r0 2 @, we can obtain a
unique solution V of (9.1). Knowing the voltage distribution V, the current
density J is given by
Jr
1
1
rVr
Er
r
r
in
9:2
where E rV is the electric eld intensity.

We now consider the magnetic eld produced by the injection current.
The induced magnetic ux density B in can be decomposed into three
components as
Br B r BE r BL r in
9:3
where B , BE and BL are magnetic ux densities due to J in , J in

E E 1 [ E 2 and I in L L1 [ L2 , respectively. From the BiotSavart law,

r r0
dv0
9:4
B r 0 Jr0
4
jr r0 j3
Figure 9.2. Electrically conducting subject with a pair of electrodes E 1 and E 2 . Lead
wires are denoted as L1 and L2 . Note that more than two electrodes are needed in
MREIT to inject at least two currents, as described in section 9.5.
Problem denition
BE r
0
4
BL r
0 I
4
Jr0
E
243
r r0
dv0
j r r0 j 3
9:5
r r0
dl 0
jr r0 j3
9:6
and
ar0
where ar0 is the unit vector in the direction of the current ow at r0 2 L.

From Ampe`res law, the current density J is also given by
Jr
1
r Br in :
0
9:7
We must have
1
1
rVr
r Br
0
r
and
r Jr 0
in :
9:8
As explained later in this chapter, it is not convenient to measure all

three components of B Bx ; By ; Bz using an MRI scanner. Therefore, in
some cases, we will restrict ourselves to the situation where only one component of B such as Bz is available. Now, the problem of interest is to reconstruct an image of or 1= in from measured B or Bz in and V
on a portion of @ for a given injection current I and electrode conguration.
We may apply multiple injection currents using more than two electrodes for
the uniqueness of the reconstructed image.
When B Bx ; By ; Bz is available, we may use J to reconstruct resistivity
images using image reconstruction algorithms such as the J-substitution
algorithm (Kwon et al 2002a, Khang et al 2002, Lee et al 2003a), current
constrained voltage scaled reconstruction (CCVSR) algorithm (Birgul et al
Figure 9.3. MREIT system block diagram. Resistivity, voltage, current density and
magnetic ux density are denoted as , V, J and B, respectively. Quantities from the
imaging subject are shown with superscripts .
244
2003) and equipotential line methods (Kwon et al 2002b, Ider et al 2003).

There are other type of algorithms utilizing only one component of B such
as Bz to make the MREIT technique easily applicable to clinical situations
(Oh et al 2003, Seo et al 2003a, Seo et al 2003b, Park et al 2004a, Park et al
2004b).
Figure 9.3 shows a diagram of an MREIT system. Given a model of a
subject with an assumed resistivity distribution, injection currents and electrode congurations, a 3D forward solver computes distributions of voltage
V, current density J and magnetic ux density B or only Bz . Measured and
computed data for V, B (or Bz ) and/or J are used to reconstruct crosssectional resistivity images depending on the algorithm used.
9.3.
FORWARD PROBLEM AND NUMERICAL TECHNIQUES
As for the case of EIT, we need a forward solver in MREIT for algorithm
development, experimental design and verication. Since the image reconstruction problem in MREIT is inherently 3D, we describe a 3D forward
solver computing distributions of voltage V, current density J and magnetic
ux density B, all within an electrically conducting domain (Lee et al 2003b).
In real MREIT experiments, it would be desirable to use recessed electrodes
as suggested by Lee et al (2003b) and Oh et al (2003). Therefore, the forward
solver described in this section assumes the use of recessed electrodes.
9.3.1.
Forward problem in MREIT using recessed electrodes
Let R3 be an electrically conducting subject with its boundary @, as

shown in gure 9.4(a). Two electrodes are denoted as E 1 and E 2 , and lead
wires are shown as L1 and L2 . Both electrodes E 1 and E 2 are recessed from
the surface of the subject @ by the plastic containers C1 and C2 , respectively.
We dene regions of containers, electrodes and lead wires as C C1 [ C2 ,
E E 1 [ E 2 and L L1 [ L2 , respectively. Figure 9.4(b) shows the recessed
electrode assembly. We ll the container with a gel of a known resistivity
(a)
Figure 9.4.
(b)
(a) Denition of domains and (b) recessed electrode assembly.
245
value. This kind of electrode assembly is desirable since it helps us in

producing artefact-free MR images of the subject, including its boundary
(Oh et al 2003). Severe artefacts are produced in MR images near the electrode due to the RF shielding eect of the conductive electrode. By recessing
the electrode, we can eectively move these artefacts out of the domain to
be imaged.
Now, we let D be the region including the subject and two plastic
containers, i.e. D [ C with its boundary @D. Assuming that we inject
current I through the pair of electrodes E 1 and E 2 attached on @D, we can
formulate the following boundary value problem with the Neumann boundary condition:

8
1
>
>
rVr 0 in D
<r
r
9:9
>
1
>
: rV n g on @D:

The only dierence in (9.9) from (9.1) is the domain of interest. Once we have
found a numerical solution V of (9.9), we can compute the internal current
density distribution J using (9.2), with D replacing .
We are interested in the magnetic ux density B only in . For the
purpose of numerical computations, we divide B into four components as
Br B r BC r BE r BL r
in
9:10
where B , BC , BE and BL are magnetic ux densities due to J in , C, E and I

in L, respectively.
9.3.2.
Eects of recessed electrodes and lead wires
Before describing numerical methods of solving the forward problem in

MREIT, we discuss the eects
of recessed electrodes and lead wires on B

and J in . We let r; r0 1=4 1=jr r0 j. Since r J 0, we have
1
r B r r r r; r0 Jr0 dv0
0
r2 rr r; r0 Jr0 dv0

Jr rr
Jr r
Jr r

rr0 r; r0 Jr0 dv0
r; r0 Jr0 nr ds0
@
r; r0 Jr0 dv0
9:11
246
for all r in . With (9.7), (9.10) and (9.11), we get
1
r BC r BE r BL r r
r; r0 Jr0 nr ds0 :
0
@
9:12
This means that the current density J within due to BC ; BE and BL is dependent only on the current density or Neumann boundary condition on @.
Therefore, two totally dierent sets of recessed electrodes and lead wires
produce the same current density J in , only if they provide the same
Neumann boundary condition on @. The actual geometrical shape of L
does not aect the computed J, though the shape of C may have some
eect since it can inuence the Neumann boundary condition on @.
Note that the magnetic ux density B in will be dierent depending
on the shape and dimension of recessed electrodes and lead wires. However,
we have
r2 BC r BE r BL r 0
0
for
r2
9:13
since r 1=jr r j 0 when r 6 r . We may utilize (9.13) to remove the

eects of recessed electrodes and lead wires from the measured B in in
some image reconstruction algorithms (Oh et al 2003, Seo et al 2003a, Seo
et al 2003b).
9.3.3.
Computation of voltage V and current density J
We use the nite element method (FEM) to numerically solve (9.9). We rst
construct a 3D model of D and E, assuming that the thickness of each
electrode is negligibly thin. For the discretization of the model into a nite
element mesh, we may use eight-node hexahedral elements with trilinear
interpolation functions i for i 1; . . . ; 8. For the standard hexahedral
element of 1; 13 ,
i
18 1 xxi 1 yyi 1 zzi ;
i 1; . . . ; 8
where xi ; yi and zi are the local coordinates of the ith nodal point of the element.
The current density distribution underneath each electrode is not
uniform in most cases. This means that we only know the amount of injection
current I without knowing the Neumann boundary condition g in (9.9).
Therefore, assuming that each electrode is an equipotential surface due to
its high conductivity, we rst solve the following boundary value problem
with mixed boundary conditions:
8

1
>
~
>
rV r 0 in D
r
>
>
>
r
<
9:14
V~ 1 on E 1 and V~ 0 on E 2
>
>
>
1
>
>
: rV~ n 0 on @DnE 1 [ E 2
247
where E 1 and E 2 are considered as the portions of @D contacting the two

electrodes. Following the standard procedure of FEM (Burnett 1978), we
compute the numerical solution of V~ in (9.14). This solution is a set of
nodal voltages of the corresponding nite element mesh. Expressing the
voltage at a position within an element of the mesh as a linear combination
of eight nodal voltages of the element and interpolation functions, we can
~ from (9.2) with V~ instead of V. We now compute the total current
compute J
~
I passing through E 1 . Then, we multiply the computed voltage V~ and current
~ by I=I~. This gives us the numerical solutions of V and J in D due to
density J
the injection current I.
9.3.4.
Computation of magnetic ux density B using the BiotSavart law
As described before, we are interested in the magnetic ux density only inside

the subject . We now describe how to compute each term in the right hand
side of (9.10) using the BiotSavart law. In the next section, we will introduce
a faster method to compute B in using FEM. However, since the faster
method based on FEM requires the computation of B on @ as a boundary
condition, the method described in this section will also be utilized in the next
section.
9.3.4.1.
Computation of B and BC
Assuming that J does not change much within each element of the mesh for
, we compute B as
NE
X e
r re
c
Jc
ve
9:15
B r 0
e
4 e 1
jr rc j3
where NE is the number of elements, rce the centre point of the eth element,
e
Jce the current density at re
the volume of the element in the nite
c and v
element mesh of . In order to avoid the singularity where r rce , we
compute B at all nodal points of the mesh. Since we have already computed
J in C from the numerical solution of (9.9) and (9.2), we can calculate BC in
the same way as in (9.15).
9.3.4.2.
Computation of BE
The magnetic ux density BE in is due to the surface current in E. We rst

choose the electrode E 1 in gure 9.5(a), which illustrates the current owing
into E 1 from L1 and currents leaving E 1 into C1 . Considering E 1 as a 2D
domain with a high conductivity value, we construct a 2D nite element
mesh for E 1 . From the computed current density J on E 1 in section 9.3.3,
we can compute the sink currents on all nodes of the nite element mesh.
The injection current I from the lead wire becomes a source current at the
centre node of the mesh.
248
(a)
(b)
Figure 9.5. (a) Out-of-plane source and sink currents on the electrode E 1 , and (b) surface
current density within the electrode.
To calculate the surface current density shown in gure 9.5(b), we solve

the following 2D boundary value problem in E 1 :
(
r2 Vr f in E 1
9:16
rV n 0 on @E 1
where f is the source or sink current. From the numerical solution of (9.16)
using FEM, we can easily compute the surface current density on E 1 . After
repeating the computation for E 2 , we can calculate BE in a similar way as
in (9.15).
9.3.4.3.
Computation of BL
We note that the computation of BL requires information on the actual

geometrical shape of lead wires. We consider two cases shown in gure
9.6. In gure 9.6(a), we should include the correct geometry of the portion
of lead wires where they are not twisted together. In gure 9.6(b), the lead
wires run straight in one direction within a certain range. Note that the
current I in a portion of lead wires far away from has a negligible eect
on the magnetic ux density in . In either case, we can numerically compute
(9.6) by discretizing the lead wires into many small line segments. For the
(a)
Figure 9.6.
(b)
Lead wire geometry. (a) Twisted wires and (b) straight wires.
249
lead wire geometry shown in gure 9.6(b), one might use an analytic solution
for BL .
9.3.5.
Computation of magnetic ux density B using FEM
Numerical calculation of the magnetic ux density B using the BiotSavart

law requires a large amount of computation time, since it is in the form of
3D convolution. To introduce a faster method using FEM, we rst note that
r2 Br 0 r Jr in :
9:17
Since J is available from (9.2), we can solve (9.17) for B using FEM if
boundary conditions of B are known on @. We, therefore, compute
B B BC BE BL using the methods described in the previous
section only for r 2 @. Then, we have the Dirichlet boundary condition
on @ and can numerically solve (9.17) for B using FEM. Please note that
it is important to compute all four terms of B on @ to nd the appropriate
Dirichlet boundary condition of B in (9.17). We can also compute (9.17)
in any 3D subdomain of as long as we correctly calculate its boundary
condition.
9.3.6.
Computation of current density J from magnetic ux density
With the computed magnetic ux density B, we can calculate J in (9.7). Since

we have computed the magnetic ux density on all nodal points in , we can
express the magnetic ux density at a position within an element of the mesh
using eight nodal values of B and interpolation functions. Then, the curl
operation in (9.7) can be performed without numerical dierentiations as
in the computation of (9.2).
9.3.7.
Numerical examples of 3D forward solver
Figure 9.7(a) shows a cubic subject of 50 mm 50 mm 50 mm with an

isotropic and piecewise constant resistivity distribution . We set the origin
at the centre of the subject in gure 9.7(a). Figure 9.7(b), (c), (d) and (e)
show four dierent models of the subject with recessed electrodes. We may
assume the lead wire geometry in gure 9.7(b) for simplicity in numerical
computations. The model in gure 9.7(c) includes two full-size recessed electrodes (10 mm 50 mm 50 mm) covering the entire areas of two surfaces.
The other three models in gure 9.7(b), (d) and (e) are equipped with two
narrow recessed electrodes (10 mm 5 mm 50 mm). The amount of the
injection current is 1 mA for models in gure 9.7(b), (c) and (d), and
28 mA for (e). Figure 9.7(f ) shows a typical nite element mesh using
hexahedral elements. For all numerical results, the compatibility conditions
in (9.8) should be checked.
250
(a)
(b)
(c)
(d)
(e)
(f )
Figure 9.7. (a) Cubic subject of 50 mm 50 mm 50 mm with an isotropic and piecewise

constant resistivity distribution. (b) Model with narrow recessed electrodes for the analysis
of numerical accuracy. (c) Homogeneous model with full-size recessed electrodes for the
comparison with analytic solutions. (d) Thorax model and (e) model containing a
cylindrical object with narrow recessed electrodes. (f ) Typical nite element mesh using
hexahedral elements.
Lee et al (2003b) used the model in gure 9.7(b) to determine the nite
element mesh with a desirable numerical accuracy. They assumed that the
error in the measured voltage V is larger than 0.1% (Boone et al 1997).
From the sensitivity analysis by Scott et al (1992), the amount of noise in
the measured magnetic ux density B is greater than 0:1 109 Tesla in
most cases. Dividing this by the average value of the computed jBj due to
the injection current of 1 mA, we could get about 1.88% error in the measured
B. Using a mesh with 120 120 120 elements, Lee et al (2003b) showed that
we may obtain less than 0.1% errors in computed V and B. Compromising the
numerical accuracy and computation time, they suggested using a mesh with
80 80 80 elements (total 512 000 elements and 531 441 nodes) for the
domain .
For the homogeneous model with its resistivity of 100 :cm and full-size
recessed electrodes in gure 9.7(c), the computed voltage changes linearly
only along the x-direction, with its values of 28 mV at x 35 mm (on the
left electrode) and 0 V at x 35 mm (on the right electrode). The current
density J in (9.2) can be computed as J 40; 107 ; 108 mA=cm2 , with
a negligibly small error compared with the theoretical value of
J 40; 0; 0 mA=cm2 . For the compatibility test in (9.8), Lee et al (2003b)
251
dened the following three indices of

"JB
"r J
kJ JB k2
100 [%]
kJk2
kr Jk2 p
100 [%/element]
kJk2
and
"r JB
kr JB k2 p
100 [%/element]
kJB k2
where J 1=rV, JB 1=0 r B and p=0.625 mm is the size of

each element. Their results were "JB 3:23 102 %, "r J 1:0 104
and "r JB 1:18 104 %/element.
The thorax model in gure 9.7(d) is used to present typical numerical
results of the 3D forward solver. Figure 9.8(a) shows the resistivity distribution of the model in gure 9.7(d) within a region of 5 < z < 5 mm. The
average resistivity value in gure 9.8(a) is 536 :cm. Resistivity values in
the upper and lower region of the model are 1072 and 268 :cm, respectively.
Computed voltage V in (9.9) on the xy-plane with z 2:5 mm is shown in
gure 9.8(b). Figure 9.8(c)(h) show the computed current density and
magnetic ux density on the same plane. Compatibility conditions are
satised with "JB =0.971%, "r J =0.725 and "r JB =0.94%/element.
Lee et al (2003b) used the model with narrow recessed electrodes in
gure 9.7(e) to compare the numerical results with experimental ones using
a saline phantom with a cylindrical agar object. For the measurement of
the induced magnetic ux density, they used a 0.3 Tesla experimental MRI
scanner. The measurement technique will be discussed in section 9.4.
Figure 9.9(a) and (b) show the measured and computed Bz at z 0, respectively. Figure 9.9(c) is the dierence between the measured and computed Bz .
Dening the relative L2 -error of the measured Bz as
" Bz
kBz Bm
z k2
100 [%]
kBz k2
where Bz and Bm
z are the computed and measured magnetic ux density,
respectively, they found that "Bz 9:56% for all pixels (or elements) and
"Bz 6:1% excluding the outermost layer of 10 pixels near electrodes.
Comparing the computed and measured magnetic ux density, they observed
mostly random errors and two dierent kinds of systematic error. Random
errors are mainly due to the random noise from the MRI scanner. One of
the systematic errors occurs along the boundary of the cylindrical object.
This is due to the dierence in the resistivity value of the agar object
252
immersed in the saline solution of the phantom, compared with the resistivity
value of the cylindrical object within the model. The other kind of systematic
error occurs near electrodes. This is mainly due to the dierence in lead wire
geometries between the phantom and the model in gure 9.7(e), since it is
dicult to make the lead wires run perfectly straight in real experiments.
To minimize this kind of systematic error, they recommended using a lead
wire guide xed within the MRI scanner. This will be especially important
for image reconstruction algorithms directly using measured B or Bz , without
taking advantage of r2 BL 0 in .
(a)
(b)
Figure 9.8. Typical numerical results for the thorax model in gure 9.7(d) with an injection current of 1 mA. (a) Resistivity distribution of the thorax model. Computed results of
(b) V, (c) Jx , (d) Jy , (e) Jz , (f ) Bx , (g) By and (h) Bz .
(c)
(d)
(e)
Figure 9.8.
(Continued)
253
254
(f)
(g)
(h)
Figure 9.8.
(Continued)
255
(a)
(b)
(c)
Figure 9.9. (a) Measured Bz at z 0 and (b) computed Bz at z 0 from the model in
gure 9.7(e). (c) The dierence between the computed and measured Bz . The amount of
injection current was 28 mA.
256
The forward solver is a basic tool in the development of MREIT image

reconstruction algorithms and their validation. It may also be used for the
study of biomagnetism with a few modications. Since some biological
tissues are anisotropic in resistivity, it should include a way to handle anisotropic material properties in addition to 3D mesh generation techniques
using the structural information of conventional MR images.
9.4.
MEASUREMENT TECHNIQUES IN MREIT
The measurement of internal magnetic ux density due to an injection

current is an essential part of MREIT, since this internal information plays
the most important role in determining the spatial resolution and accuracy
of reconstructed images. This internal magnetic ux density data has been
also used in MRCDI, where images of internal current density distributions
are of primary concern. Since MREIT and MRCDI share the same technique
to obtain images of internal magnetic ux density distributions, we rst
review MRCDI techniques and explain the required data collection and
processing methods to be used in MREIT.
9.4.1.
Review of MRCDI techniques
In attempting to reconstruct a cross-sectional resistivity image, it was quite

natural for us to imagine what we can do if we could obtain the information
on the internal current density distribution J due to an injection current I.
Outside the EIT community, researchers in the MRI eld developed the
MRCDI techniques in the late 1980s. Following the pioneering works of
the Toronto group (Joy et al 1989, Scott et al 1991, Scott et al 1992, Scott
1993), several groups have published experimental results of their MRCDI
research. There are currently three dierent techniques in MRCDI depending on the way we inject currents. In LF(low frequency)-MRCDI, we
inject currents in the form of pulses. Since the pulse width is relatively
wide, this technique basically induces an internal current density at almost
d.c. (Beravs et al 1997, Sersa et al 1997, Eyuboglu et al 1998, Gamba and
Delpy 1998, Bodurka et al 1999).
In VF(variable frequency)-MRCDI, current density images due to an
injection current with a frequency less than a few kHz are reconstructed
(Weinroth 1998, Mikac et al 2001). In RF(radio frequency)-MRCDI,
current density images at radio frequency are reconstructed (Scott 1993,
Carter 1995, Gerkis 1996, Yan 1997, Beravs et al 1999a, Yoon 2000). In
this section, we describe only the LF-MRCDI technique since it is technically more feasible and most widely used in MREIT. However, as VFand RF-MRCDI techniques become more practical, they can easily be
utilized in MREIT.

9.4.2.
257
How to measure one component of B
Let z be the coordinate that is parallel to the direction of the main magnetic
eld B0 of an MRI scanner. Using a constant current source and a pair of
surface electrodes, we sequentially inject two types of current pulse of I
and I synchronized with the standard spinecho pulse sequence shown in
gure 9.10. The application of the injection current during MR imaging
induces a magnetic ux density B Bx ; By ; Bz . Since the magnetic ux
density B produces inhomogeneity of the main magnetic eld changing B0
to B0 B, it causes phase changes that are proportional to the z-component of B, i.e. Bz . Then, the corresponding MRI signals are
1

SI m; n
Mx; y e jx;y e jBz x;yTc e jxmkx ynky dx dy 9:18
1
and
I
S m; n
Mx; y e jx;y ejBz x;yTc e jxmkx ynky dx dy:
9:19
1
Here, M is the transverse magnetization, is any systematic phase error,

26:75 107 rad/Tesla is the gyromagnetic ratio of the hydrogen, and
Tc is the duration of current pulses.

Two-dimensional discrete Fourier transformations of SI m; n and

SI m; n result in two complex images of M
c x; y and Mc x; y, respectively. Dividing the two complex images, we get

Mc x; y
~ z x; y
Arg
Arge j2Bz x;yTc
M
x;
y
c
where Arg! is the principal value of the argument of the complex number
~ z is wrapped in <
~ z , we must unwrap
~ z to obtain z . We
!. Since
may use the Goldsteins branch cut algorithm or others described by Ghiglia
Figure 9.10.
Spinecho pulse sequence for MRCDI and MREIT.
258
(a)
(b)
(c)
Figure 9.11. Subject rotations to measure all three components of B Bx ; By ; Bz . B0 is

the main magnetic eld of the MRI scanner. Measurement of (a) Bz , (b) Bx , and (c) By .
and Pritt (1998). Finally, we get

Bz x; y
1
x; y:
2Tc z
9:20
In summary, the injection current generates the magnetic ux density B

which perturbs the corresponding MR phase image. Given an MR image
with the phase perturbations, we can obtain the image of Bz .
9.4.3.
Measurements of all three components of B by subject rotations
In MRCDI, we try to produce an image of J in the subject by measuring

B Bx ; By ; Bz due to an injection current I. Since the measurement technique in section 9.4.2 provides only one component of B that is parallel to
the direction of the main magnetic eld B0 , we must rotate the subject to
obtain Bx and By as shown in gure 9.11. Figure 9.11(a) is the initial setup
to measure Bz . In gure 9.11(b), we rotate the subject so that the x-direction
becomes parallel to the direction of B0 . This enables us to obtain Bx by repeating the procedure described in section 9.4.2 with the same injection currents I
and I . With one more rotation shown in gure 9.11(c), we can get By .
9.4.4.
Computation of current density image J in MRCDI
Once we have measured all three components of B Bx ; By ; Bz , we can

obtain a current density image J in the subject . From J r B=0 , we
compute J Jx ; Jy ; Jz as

1 @Bz @By
1 @Bx @Bz

Jx
; Jy
0 @y
0 @z
@z
@x
9:21

1 @By @Bx

Jz
:
0 @x
@y
259
Since we should dierentiate Bz with respect to x and y, it is enough to

acquire one phase image for Bz from the centre slice Sc in gure 9.11(a).
We must dierentiate Bx and By with respect to z, as well as y and x. This
requires us to obtain three magnetic ux density images from three slices
of Su , Sc and Sl for each of Bx and By in gure 9.11(b) and (c), respectively.
Therefore, we need to acquire seven magnetic ux density images from three
slices to compute J Jx ; Jy ; Jz in (9.21).
9.4.5.
Data processing
Due to the main magnetic eld inhomogeneity and the gradient eld nonlinearity, MR images from transversal, sagittal and coronal slices in gure
9.11(a), (b) and (c), respectively, may contain dierent amounts of geometrical distortions. Inhomogeneous susceptibility distribution inside the subject
may also cause geometrical distortions, especially in a high eld MRI
scanner. Since we must compute the internal current density at every pixel
using magnetic ux density images of Bx , By and Bz from the corresponding
imaging slices, we need a geometrical error correction method. This is usually
done by using a grid phantom (Khang et al 2002, Lee et al 2003a).
As described in the next section, MR phase images contain Gaussian
random noise and numerical dierentiations tend to amplify the noise. Therefore, it would be desirable to use a denoising technique before computing (9.21).
Khang et al (2002) suggested a total variation-based denoising technique (Chan
et al 2000). This method eectively removes random noise while preserving
both slow and abrupt changes in magnetic ux density images.
There are two major technical problems in obtaining J. One is the low
signal-to-noise ratio (SNR) in measured magnetic ux density images and
the other is the requirement of subject rotations to obtain B Bx ; By ; Bz .
In the next section, we discuss the SNR problem. The problem of subject
rotations will be treated in section 9.5 on reconstruction algorithms by introducing new techniques based on Bz only.
9.4.6.
Signal-to-noise ratio (SNR) in magnetic ux and current

density image
Scott et al (1992, 1993) described the sensitivity analysis in MRCDI. In this

section, indicates the standard deviation of a Gaussian random noise
instead of the conductivity. The noise standard deviation in a measured
magnetic ux density image can be estimated as
B
1
2Tc SNR
9:22
where SNR is the signal-to-noise ratio of the corresponding MR magnitude

image Mx; y in (9.18) or (9.19). The noise standard deviation is inversely
260
proportional to the size of each pixel, since SNR in (9.22) is proportional to

the size. With Tc 50 ms, we obtain B 1:43 109 and 5:68 109 Tesla
when SNR 50 and 25, respectively.
The noise standard deviations in Jx , Jy and Jz were also given by Scott
et al (1992). These are aected by factors such as B in (9.22), numerical
dierentiation methods, amounts of pixel misalignments among dierent
slices and others. The noise in the current density is inversely proportional
to the volume of each voxel. This means that the voxel size is one of the
major factors to determine the image quality in MRCDI. Scott et al (1992)
suggested that the noise standard deviation of 10 mA/cm2 on a
1:5 mm 1:5 mm 5 mm voxel could be achieved in the current density
image using a 2.0 Tesla MRI scanner for a subject with T2 values between
40 and 100 ms.
In MREIT, we are mostly interested in the SNR of measured magnetic
ux density images, and it is mainly determined by the noise standard deviation B in (9.22), amount of injection current, size of the subject and electrode
conguration. To reduce B , we must increase the SNR of the MR magnitude
image. This can be done by increasing the voxel size, number of averaging,
strength of the main magnetic eld and so on. In doing so, it is inevitable to
sacrice the spatial and/or temporal resolution to some extent.
Regarding the amount of injection currents, it should be lower than the
level that can stimulate muscle or nerve tissues. Although the amount
depends on several factors such as the size and shape of electrodes,
anatomical structure and type of tissues, it is desirable to conform to the
safety guideline of IEC 601. According to the guideline, the current should
be limited below 0.1 mA at the frequency range of LF-MRCDI (usually
below 20 Hz). The safety limit increases as frequency goes up and a current
up to 1 mA is allowed at 10 kHz and beyond.
From the BiotSavart law in (9.4), we can see that the magnitude of
magnetic ux density at one point is strongly dependent on the current
density near the point. The current density distribution inside the subject
could be quite inhomogeneous and very low current density could appear
at some local regions depending on the dimension of the subject and
electrode conguration. If we use small electrodes compared with the
subject size, the current density at the vicinity of the electrodes will
be much higher than that in the far region. To alleviate the spatial
dependency of the SNR, it may be desirable to use electrodes with an
appropriate size.
9.5.
IMAGE RECONSTRUCTION ALGORITHMS
Image reconstruction algorithms in MREIT utilize the measured internal

magnetic ux density to produce cross-sectional resistivity or conductivity
261
images. In order to recover the absolute values in reconstructed resistivity

values, measured boundary voltage data are usually needed. After describing
the requirements in data collection methods for the uniqueness of a reconstructed resistivity image, this section briey summarizes early algorithms
and then describes recent techniques in detail.
Currently, there are two dierent types of reconstruction algorithm. The
rst type uses the internal current density J that is computed from the
measured magnetic ux density B as J r B=0 . The second type is
based on only one component of the measured magnetic ux density, e.g.
Bz . Algorithms belonging to the rst type have the disadvantage of the
subject rotation procedure, as described in section 9.4.
9.5.1.
Requirements in data collection methods for uniqueness
Before we describe image reconstruction algorithms, it is necessary to deal

with the issue on the uniqueness of a reconstructed resistivity image in
MREIT. Since the proof of the uniqueness requires quite rigorous mathematical analysis, we briey summarize the results by Kim et al (2002), Ider et al
(2003) and Kim et al (2003).
First, we must inject at least two currents I1 and I2 into a subject , so
that the corresponding two internal current densities J1 and J2 satisfy
J1 r J2 r 6 0
in :
9:23
The requirement in (9.23) means that the two current densities are not
collinear in . Kim et al (2002) provided a mathematical proof for the 2D
domain, and later Kim et al (2003) proved it for the general 3D domain.
Even with at least two injection currents satisfying (9.23), Kwon et al
(2002a) noted that we can only reconstruct a resistivity image apart from a
multiplicative constant. Therefore, as the second requirement for the uniqueness, they suggested using one boundary voltage measurement to determine
the constant or scaling factor. If we know the true resistivity value at one
point, this scaling factor can also be determined without measuring any
boundary voltage.
In summary, the requirements in data collection methods for the
uniqueness of a reconstructed resistivity image include the following:
1. At least two injection currents satisfying (9.23) almost everywhere in the
imaging slice and the corresponding magnetic ux density images.
2. At least one nonzero boundary voltage measurement or predetermined
resistivity value at least at one point in the imaging slice.
In order to inject two dierent currents, Kwon et al (2002a) suggested using
four electrodes. It is also advantageous to use at least four electrodes since we
can avoid measuring boundary voltage data on current injection electrodes.
262
With four electrodes, we may sequentially inject six dierent currents and
measure the corresponding magnetic ux densities and boundary voltages.
Increasing the amount of measurements beyond the minimal requirement
may be benecial since we can eectively improve the SNR by using all of
them in an appropriate way. Especially, in real experiments, multiple
injection currents with carefully chosen electrode congurations (possibly
more than four electrodes) will be important to minimize the regions
where the induced magnetic ux densities are smaller than a noise level.
Birgul et al (2003) and Oh et al (2003) suggested dierent ways of utilizing
multiple measurements beyond the minimal requirement, and these techniques are described in sections 9.5.4 and 9.5.6.
9.5.2.
Early algorithms
The rst resistivity image reconstruction algorithm in MREIT is based on the

line integral technique. Zhang (1992) proposed a resistivity image reconstruction algorithm, utilizing the measurement of internal J and
many boundary
voltages. His method is based on the relationship V1;2 C J dl, where V1;2
is the voltage dierence between two locations 1 and 2 at the boundary, C is
an interior line integral path connecting 1 and 2, and is the resistivity. After
discretization of an imaging slice into M pixels, we can construct a linear
system of equation VN 1 GN M RM 1 NN 1 , where V is a vector of
N boundary voltage measurements, R is a vector of resistivity values from
M pixels, and N is a noise vector in measured voltages. Assuming that we
have obtained current density at every pixel, the matrix G contains internal
current density data and we can reconstruct the resistivity image R by solving
the linear system of equations. A drawback of this method is the requirement
of many boundary voltage measurements to improve the accuracy and
spatial resolution of the resistivity image.
Woo et al (1994) proposed a dierent method where the error between
the measured and computed current density is minimized as a function of the
resistivity distribution of a nite element model of the imaging subject. They
used a sensitivity matrix relating the measured current density to changes in
resistivity values. Ider and Birgul (1998) suggested a method based on a sensitivity matrix between the magnetic ux density and resistivity. They used the
singular value decomposition to reconstruct resistivity images. Eyuboglu et al
(2001) used a nite element model with measured boundary voltages and
injection current as boundary conditions. Their method is iterative assuming
an initial guess on the resistivity distribution. For a given resistivity distribution of the model, they computed internal current density using FEM and
updated the resistivity distribution to minimize the error between this current
density and the measured one. These early algorithms initiated the MREIT
research to develop more eective and practically applicable new algorithms
described in this section.

9.5.3.
263
J-substitution algorithm
Assuming that measured data of J are available, Kwon et al (2002a)

proposed a new way of viewing the image reconstruction problem in
MREIT. Since J rV, we try to reconstruct J=jrVj, where
J jJj. For the uniqueness of a reconstructed conductivity image, they
suggested using two injection currents I1 and I2 with the corresponding
Neumann boundary conditions g1 and g2 . Assume that J1 and J2 are measured internal current densities due to I1 and I2 , respectively. Then, we can
construct the following coupled system:

Ji r
r
rVi r 0 in ; i 1; 2
jrVi rj
J1 r
J2 r
jrV1 rj jrV2 rj
9:24
in
Ji
rVi n gi
jrVi j
Vi r0 0 and Vi r1 Vi
on @;
where V1 and V2 are non-zero voltage dierences between two points r0
and r1 on @. The second coupling identity connecting V1 and V2 stems
from the fact that the change of due to dierent injection currents is
negligible.
The J-substitution algorithm is a natural iterative scheme of the
coupled system (9.24). Since the conductivity should be given by
J1 =jrV1 j J2 =jrV2 j, we can easily design the following iterative
scheme updating V1 ; V2 and .
1. Initial guess 0 1.
2. For each n 0; 1; . . . ; solve

r n rV1n 0 in
n rV1n n g1
on @;
V1n r0 0:
3. Update the conductivity using

n 1=2
J1 V1n r1
:
jrV1n j V1
4. Solve
(
n 1=2
r n 1=2 rV2
n 1=2
n 1=2
rV2
0 in
n g2
on @;
n 1=2
5. Stop the process if kJ2 n 1=2 jrV2

ance.
n 1=2
V2
r0 0:
jk < ", where " is a given toler-
264
6. Update the conductivity using

n 1
n 1=2
V2
J2
n 1=2
jrV2
j
V2
r1
The J-substitution algorithm uses the magnitude J jJj instead of J.

As proved by Kim et al (2003), using J is not only equivalent but also
advantageous to using J, since J is less sensitive to measurement noise.
After Kwon et al (2002a) rst introduced the J-substitution algorithm and
provided its numerical simulations, Khang et al (2002) and Lee et al
(2003a) applied it to reconstruct conductivity images of saline phantoms.
These experimental results will be reviewed later. Variations of the above
iterative scheme are possible depending on the way we utilize the measured
current density data.
The J-substitution algorithm can also be derived following the procedure by Kwon et al (2002a). Assuming that the measured internal current
density J due to an injection current is available from a subject with a
true conductivity , we construct a model of with an arbitrary initial
guess of its conductivity . Then, we introduce the following cost functional
:
: jJ r rE rj2 dr
9:25
where J jJ j and E : jrV j is the magnitude of the calculated electric

eld intensity obtained
by solving (9.1) with 1=. After discretization
1
SN
of the model
k 0 k with the same area for all k , we get the following squared residual sum R:
R0 ; . . . ; N 1 :
N
1
X
k0
k
jJ r k E rj2 dr
9:26
where k is the kth element or pixel of the model and k is the conductivity in
k that is assumed to be a constant on each element. P
Note that, in this case,
the conductivity distribution is expressed by r kN01 k k r, where
k r denotes the indicator function of k . In (9.26), E r is also a function
of 0 ; . . . ; N 1 . To update the conductivity from the zero gradient argument for the minimization of the squared residual sum, we dierentiate
(9.26) with respect to k for k 0; . . . ; N 1 to get

@R
2
E r k E r J r dr
@k
k
N
1
X

@E r
2
m
9:27
m E r J r dr:
@k
m 0 m
265
Letting @R=@k 0 leads to the following approximate identity:

0 E rk k E rk J rk
N
1
X
m
m0
@E rk
m E rk J rk
@k
9:28
for k 0; . . . ; N 1, where rk is the centre point of the element k and we

used the simplest quadrature rule. Hence, the updating strategy to minimize
the residual sum in (9.26) is
k
J rk
E rk
for k 0; . . . ; N 1
9:29
where k is a new conductivity value on k and E rk is the calculated value

of the magnitude of the electric eld intensity
centre point of k from
Patthe
1
the old conductivity distribution r N
k 0 k k r. The updating
strategy in (9.29) is exactly the same one used in the iterative scheme of the
J-substitution algorithm.
9.5.4.
Current constrained voltage scaled reconstruction

(CCVSR) algorithm
The CCVSR algorithm proposed by Birgul et al (2003) shares the basic idea
with the J-substitution algorithm. They suggested using more than four
electrodes, e.g. 16, uniformly spaced on the boundary of a subject with
its conductivity distribution . Current is injected between a pair of
electrodes facing each other. This current injection method is called the
opposite-drive strategy. Using 16 electrodes, there could be eight injection
currents. For each injection current Ij for j 1; . . . ; 8, they assume that the
corresponding internal current density Jj is available from the measurement
of internal magnetic ux density Bj . They also assume that a set of boundary
voltage data V j@ from electrodes not injecting current are available.
The CCVSR algorithm is iterative, starting with an initial guess n with
n 0 of the true conductivity image . It numerically solves (9.1) for each
injection current Ij with n in place of 1=. From the computed voltage
Vjn , the electric eld intensity is obtained as Enj rVjn . The conductivity
nk of the kth pixel is updated as
P8
n

j 1 Ej r Jj r ds
n1
for k 0; . . . ; N 1:
9:30
k P8 k
n
n
j 1 k Ej Ej ds
The scaling factor is found by minimizing the function
F k1=V n j@ V j@ k with respect to , where V n j@ indicates a set of
computed boundary voltages from (9.1) with n . Then, each kn 1 is multiplied by .
266
9.5.5.

Direct algorithms based on equipotential lines
Kwon et al (2002b) noted that we can nd equipotential lines (or surfaces)

inside a subject from a known distribution of J in , if values of boundary
voltages on the whole surface of the subject are available. This is based on
the fact that each equipotential surface has its normal direction J=jJj at every
point on its surface, and is connected to the boundary of . Once we have
found equipotential surfaces, the conductivity can be determined by
r
jJrj
jrVrj
for r 2 :
9:31
However, this direct method requires accurate voltage data on the entire
boundary of the subject, which is technically quite dicult in real applications.
Ider et al (2003) also developed a direct method for reconstructing
conductivity images carefully utilizing the vector eld J. They started from
rln J r J in a subject under static conditions. They rewrite
the vector identity as
~j rln r Jj ; j 1; 2; 3
J
~1 0; Jz ; Jy ; J
~2 Jz ; 0; Jx ; J
~3 Jy ; Jx ; 0. We can conwhere J
0
~
struct a characteristic curve with r1 s J1 r1 s passing through a point
r1 s0 at which is assigned. Then,
d
~1 rln r J1
ln r1 s J
ds
and therefore we can determine ln along the characteristic curve r1 s. Next,
~2 r2 s,
we construct a family of characteristic curves r2 s satisfying r02 s J
passing any point on the curve r1 s. We repeat this process until the curves
cover all of and determine in . Here, two injection currents will be
enough to determine in with a known value of at only one point. At
least one boundary voltage measurement can replace the role of the known
conductivity value at one point.
9.5.6.
Harmonic Bz algorithm
All of the previous algorithms utilize the measured data of B and computed
J r B=0 . This means that we must measure all three components of
B Bx ; By ; Bz , and it requires mechanical rotations of the subject within
an MRI scanner as described in section 9.4. In order to eliminate this
impractical subject rotation procedure, Seo et al (2003b) developed a new
algorithm utilizing only one component of the measured magnetic ux
density, such as Bz .
We place a subject inside an MRI scanner and attach surface
electrodes. We assume that the conductivity distribution of the subject is
267
isotropic with 0 < < 1. When the number of electrodes is E, we can

sequentially select one of N EE 1=2 dierent pairs of electrodes to
inject currents into the subject. Let the injection current between the jth
pair of electrodes be Ij for j 1; . . . ; N. The current Ij produces a current
density Jj Jxj ; Jyj ; Jzj inside the subject. The presence of the internal
current density Jj and the current Ij in external lead wires generates a
magnetic ux density Bj Bjx ; Bjy ; Bjz , and Jj r Bj =0 holds inside
the electrically conducting subject. We now assume that we have measured
Bjz for j 1; . . . ; N.
Let Vj be the voltage due to the injection current Ij for j 1; . . . ; N.
Since is approximately independent of injection currents, each Vj is a
solution of the following classical boundary value problem:
(

r rrVj r 0 in
9:32
rVj n gj on @
where gj is the normal component of current density on the boundary of the
subject for the injection current Ij . If , Ij and electrode conguration are
given, we can solve (9.32) for Vj using a numerical method such as FEM,
as described in section 9.3.
Based on the relation of r2 B 0 rV r observed by Scott et al
(1991), Seo et al (2003b) derived the following expression that holds for
each position in :

@Vj
@Vj
1 2 j
@ @
;
;
r Bz

; j 1; . . . ; N:
9:33
0
@x @y
@y
@x
Note that the magnetic ux density due to the injection current Ij along
external lead wires becomes irrelevant by using r2 Bjz . Using a matrix
form, (9.33) becomes
Us b
9:34
where
2 @V
6 @y
6 .
.
U6
6 .
4 @V
@y
@V1
@x
..
.
7
7
7;
7
@VN 5

@x
2 @ 3
6 @x 7
7
s6
4 @ 5;
@y
3
r2 B1z
1 6 . 7
b 4 .. 5:
0
r2 BN
z
For the case where two injection currents are used (N 2), we can
obtain s provided that two voltages V1 and V2 corresponding to two injection
currents I1 and I2 satisfy
@V1 @V2 @V1 @V2
6 0:
@y @x
@x @y
9:35
268
We can argue that (9.35) holds for almost all positions within the subject, since
two current densities J1 and J2 due to appropriately chosen I1 and I2 will not
have the same direction (Kim et al 2002, Ider et al 2003, Kim et al 2003).
We use N injection currents to better handle measurement noise in Bz
and improve the condition number of UT U, where UT is the transpose of
U. Using the weighted regularized least square method suggested by Oh
et al (2003), we can get s as
~ TU
~ I1 U
~ T ~b
s U
9:36
where is a positive regularization parameter, I is the 2 2 identity matrix,

~ WU, ~
U
b Wb and W diagw1 ; . . . ; wN is an N N diagonal weight
matrix.
There could be dierent ways of determining the value of and the weight
wj . One way of setting the value of is to make it inversely proportional to the
~ TU
~ . This means that we use a bigger ,
absolute value of the determinant of U
where all of rVj for j 1; . . . ; N have almost the same directions and/or all of
jrVj j are small. For the weighting factor wj , we may set
wj
SNRj
N
X
9:37
SNRj
j1
where SNRj is the signal-to-noise ratio of the measured Bjz . Note that SNRj
should be determined for each position or pixel. In practice, however, it is
dicult to know SNRj for each position. Oh et al (2003) discuss how to
estimate SNRj from measured Bjz data. Computing (9.36) for each position
or pixel, we obtain a distribution of

@ @ T
s
@x @y
inside the subject.
We now tentatively assume that the imaging slice S is lying in the plane
fz 0g and the conductivity value at a xed position r0 x0 ; y0 ; 0 on its
boundary @S is 1. For a moment, we denote r x; y, r0 x 0 ; y0 and
x; y; 0 r. In order to compute from r @=@x; @=@y, Seo
et al (2003b) suggested a method using line integrals. However, since the
line integral technique tends to accumulate errors, it is not suitable for
noisy Bz data. Oh et al (2003), therefore, employed a layer potential technique in two dimension. Then,
r r2 r r0 r0 dr0
S
rr0 r r0 rr0 dr0
@S
nr0 rr0 r r0 r0 dlr0
9:38
269
where
r r0 1=2 log jr r0 j and rr0 r r0 1=2r r0 =jr r0 j2 :
It is well known (Folland 1976) that for r 2 @S,
lim
nr0 rr0 r tnr r0 r0 dlr0
t ! 0 @S
r
@S
nr0 rr0 r r0 r0 dlr0 :
Hence, as r 2 S approaches the boundary @S in (9.38), we have
@S r 1
r r0 nr0
1
r r0 rr0 0
0
0

r
dl
dr
@S
r
2
2 @S jr r0 j2
2 S
jr r0 j2
9:39
where @S denotes the conductivity restricted at the boundary @S. It is also
well known that the solvability of the integral equation (9.39) for @S is
guaranteed for a given right-hand side of (9.39) (Folland 1976). Since r
is known in S, so does the right-hand side of (9.39). This enables us to
obtain the value @S by solving the integral equation (9.39). Now, we can
compute the conductivity in S by substituting the boundary conductivity
@S into (9.38) as
0
0
0
r rr0 r r rr dr
nr0 rr0 r r0 @S r0 dlr0 :
S
@S
9:40
The process of solving (9.36) for each pixel and (9.39) and (9.40) for each
imaging slice can be repeated for all imaging slices of interest within the
subject, as long as the measured data Bz are available for the slices. Furthermore, we can apply the method described in this section to any imaging slice
of axial, coronal and sagittal direction.
As expressed in (9.32), voltages Vj depend on the unknown true
conductivity and, therefore, we do not know the matrix U corresponding
to . This requires us to use the iterative algorithm described below. For
j 1; . . . ; N, we sequentially inject current Ij through a chosen pair of electrodes and measure the z-component of the induced magnetic ux density
Bjz . For each injection current Ij , we also measure boundary voltages Vj j@S
on electrodes not injecting the current Ij . Then, the r2 Bz algorithm is as
follows:
1. Let n 0 and assume an initial conductivity distribution 0 .
2. Compute Vjn by solving the following Neumann boundary value
problems for j 1; . . . ; N:

r n rVjn 0 in
9:41
n rVjn n gj on @:
270
3. Compute n 1 using (9.36), (9.39) and (9.40). Scale n 1 using the

measured boundary voltages Vj j@S and the corresponding computed
ones Vjn j@S .
4. If kn 1 n k2 < ", go to Step 5. Here, " is a given tolerance. Otherwise,
set n
n 1 and go to Step 2.
5. If needed, compute current density images as Jj
n 1 rVjM , where VjM
is a solution of the boundary value problem in (9.32) with n 1 replacing .
9.5.7.
Partial Bz algorithm
Although the harmonic Bz algorithm solves the problem of subject rotations

inside an MRI scanner, it requires the computation of r2 Bz , and twice
dierentiations of noisy Bz data could deteriorate the accuracy of reconstructed images. The purpose of the partial Bz algorithm is to avoid this
noise amplication, assuming that we could inject a transversally dominating
current in an imaging slice (Seo et al 2003a).
Instead of handling more general cases, we assume a transversal current
density J having Jz 0 within a thin transversal slice s to be imaged. It
must be noticed that this transversal current density J Jx ; Jy ; 0
cannot be computed directly from Bz , i.e. Jx 6 1=0 @y Bz and
Jy 6 1=0 @x Bz . When we inject current I into the subject through a
pair of surface electrodes and lead wires, it produces an internal current
density distribution J satisfying
r Jr 0
Jn g
in
on @:
9:42
9:43
Now we assume that the conductivity distribution of the subject does

not change much in the z-direction. With an appropriate choice of the
injection current and electrodes, the resulting current density J in s could
be approximately a transversal current, i.e. Jz 0 in s , although it does
not hold in the entire subject . In this special case, we can obtain J in s
from only Bz .
The presence of the internal current density J in gives rise to a
magnetic ux density BJ via the BiotSavart Law:
0
r r0
J
B r
Jr0
dr0 :
4
jr r0 j3
Similarly, the injection current I along lead wires produces a magnetic ux
density BI . Hence, the total magnetic ux density due to the internal current
density J and external current I is B BJ BI : Using an MRI scanner in
which the subject is located, we can measure the z-component Bz of B.
Let Dt denote a cut of the subject
by the xy-plane fz tg. A thin slice
S
s to be imaged could be s < t < Dt for a small > 0. Since a human
271
body is locally cylindrical in its shape, Dt D0 for < t < and therefore
s D0 ; . If the conductivity of the subject does not change much
in the z-direction, we could produce approximately a transversal internal
current density J, i.e. J Jx ; Jy ; 0 in the cylindrical chop s using
longitudinal electrodes. Note that J could have nonzero z-components in
the exterior ns of the thin chop s . The transversal current density
J Jx ; Jy ; 0 in s satises the following mixed boundary value problem:
8
@
@
>
>
J J 0 in s
>
> @x x @y y
>
<
9:44
J n g on @D0 ;
>
>
>
>
>
: @ J 0 @ J on D [ D :

@z x
@z y
Here, D and D indicate the top and bottom surface of s , respectively. We
assume that the current density g under the electrodes is independent of z
along the lateral boundary @D0 ; of s .
From the BiotSavart law,
Bz r BJz r BIz r
y y0 Jx r0 x x0 Jy r0 0

0
dr BIz r;
4
jr r0 j3
r 2 s
9:45
where BIz is the z-component of the magnetic ux density BI . It must be

noticed that Bz changes along the z-direction in s even if J is independent
of z in s . We divide BJz into two parts: one is the magnetic ux density
due to J in s , and the other is due to J in ns : Then, we can rewrite
(9.45) as
0
dr
Bz r
4 s
jr r0 j3
Gr BIz r;
r 2 s :
9:46
Here, G is the z-component of the magnetic ux density due to J in ns and

dr ; r 2 s :
Gr : 0
4 ns
jr r0 j3
Since the lead wires are located outside of , we have r2 BIz 0 in s .
Similarly, G also satises r2 G 0 in s . These can be proved using
r2 1=jr r0 j 0 when r 6 r0 .
Since r Jy ; Jx ; 0 0 in s , there is a function w in s such that
rwr Jy r; Jx r; 0
in s :
272
Using rw, we can rewrite (9.46) as

r r0 rwr0 0
Bz r 0
dr Gr BIz r;
4 s
jr r0 j3
r 2 s :
9:47
Integrating by parts yields

Bz r 0 wr
0
4
r r0
r0
wr0 dSr0
@s
jr r0 j3
Gr BIz r;
r 2 s :
9:48
Since the integral in the right hand side of (9.48) satises the Laplace equation, we obtain
r2 Bz r 0 r2 wr;
r 2 s :
Now we dene H as
Hr : wr
1
B r;
0 z
r 2 s :
Then, r2 H 0 in s and we can explicitly compute H from its boundary

condition. This requires us to know the boundary condition for w. Since
@w=@z 0,
@
1 @
Hx; y;
B x; y; ;
@z
0 @z z
x; y 2 D0 :
9:49
From the boundary condition J n g in (9.44), we get

@w
@w
;
; 0 n J n g on @D0 :
@y
@x
The above boundary condition can be understood as the tangential derivative of w along the curve @D0 . Let r0 2 @D0 be xed. For r 2 @D0 , let Cr
denote the arc of the boundary @D0 joining from r0 to r in the counterclockwise direction, then
wr wr0
g dl; r 2 @D0
Cr
where dl is a line element. Since w is independent of z for < z < , H also

has the boundary condition
H
where
r
1
B
0 z
g dl;
Cx;y;0
in @D0 ;
r x; y; z 2 @D0 ; :
9:50
9:51
273
We can now compute H by solving the Laplace equation r2 H 0 with the

boundary conditions (9.49) and (9.50). Then, we obtain J Jx ; Jy ; 0 as
Jx
@
1 @
H
B;
@y
0 @y z
Jy
@
1 @
H
B:
@x
0 @x z
9:52
Once we have obtained current density images, we can reconstruct

conductivity images using the J-substitution algorithm or others. The
current form of the algorithm could be useful only for the imaging of a
subject such as human limbs. As discussed in Seo et al (2003a), further
investigation is needed to derive dierent ways to compensate the eects of
nonzero out-of-plane current densities in order to apply the method to
subjects with more general shapes and conductivity distributions.
9.5.8.
Other algorithms
Each one of currently available image reconstruction algorithms has pros

and cons. The harmonic Bz algorithm is promising when the noise level in
measured magnetic ux density images is small. The partial Bz algorithm
should be improved to better handle the eects of the out-of-plane current
density. Lately, two new algorithms were suggested. One is the variational
gradient Bz algorithm (Park et al 2004a) and the other is the gradient Bz
decomposition algorithm (Park et al 2004b). Both of them are based on
the Bz -based MREIT model and applicable to more general cases without
any severe restriction on the amount of the out-of-plane current density.
Since the MREIT technique is still at the early stage of its development,
there should be more research eorts to develop better algorithms including
dierent kinds of hybrid algorithms.
An injection current produces a current density distribution within the
entire 3D domain of a subject. However, in practice, we may not be able
to measure the induced magnetic ux density at every point in the domain.
Usually, we acquire images of B or Bz only from several selected imaging
slices. Therefore, there should be a way to appropriately handle the eects
of the current density in other parts of the domain. Oh et al (2003) suggested
a method based on the observation that the magnetic ux density at a eld
point is inversely proportional to the square of the distance from a source
point of the current density. The gradient Bz decomposition algorithm by
Park et al (2004b) also utilizes this property of insensitivity.
An eective denoising method such as the total variation-based technique by Chan et al (2000) could be useful for preprocessing noisy measured
data of Bz . In MREIT, conventional MR magnitude images are always
available providing excellent structural information. It would be desirable
to utilize these images as a priori information in conductivity image reconstructions.
274
9.6.

MREIT IMAGES
All MREIT images published until now were obtained from computer simulations or saline phantom experiments. This section presents some of these
results.
9.6.1. Images using the J-substitution algorithm
Lee et al (2003a) reconstructed current density and resistivity images of a
saline phantom using a 0.3 Tesla experimental MRI scanner and the J-substitution algorithm. The main magnet of the MRI scanner was a permanent
magnet with gap size of 500 mm and the main magnetic eld pointed to
the z-direction. They used a cubic phantom (50 mm 50 mm 50 mm,
acrylic plastic) shown in gure 9.12(a). It was lled with a solution containing
12.5 g/l NaCl and 2 g/l CuSO4 :5H2 O. Inside the phantom, a cylindrical
sausage object is located around its centre. The diameter and height of the
sausage object were 30 and 50 mm, respectively. The resistivity values of
the solution and sausage were 50.5 and 123.7 :cm, respectively.
They installed four copper electrodes (5 mm 50 mm) to inject two
dierent currents I1 and I2 . Using a constant current source, the injection
current I1 was applied between the vertical pair of electrodes. After collecting
all image data for I1 , they switched it to the other electrode pair in the
horizontal direction for the injection current I2 . Injection current pulses of
I 28 mA with Tc =2 24 ms were synchronized with the pulse sequence
in gure 9.10. The pulse repetition time was 300 ms and the echo time was
60 ms. The slice thickness was 10 mm and the eld of view was 77 mm. In
obtaining 128 128 MR images, the number of averaging was 16 and the
phase encoding step was 128. The voxel size was 0:6 mm 0:6 mm 10 mm.
They rotated the phantom twice, as shown in gure 9.11, to obtain phase
images for Bx ; By and Bz from three slices of Su ; Sc and Sl , shown in
gure 9.12(b). Since Bz should be dierentiated with respect to x and y in
(a)
(b)
(c)
Figure 9.12. (a) Saline phantom including a cylindrical sausage object, (b) three imaging
slices of Su , Sc and Sl , and (c) MR magnitude image at the centre slice Sc .
MREIT images
(a)
275
(b)
Figure 9.13. Phase image for Bz at the centre slice Sc of the phantom for the vertical injection current I1 : (a) before and (b) after phase unwrapping.
computing the current density J r B=0 , they acquired one phase image
for Bz from the centre slice Sc . We must dierentiate Bx and By with respect
to z, as well as y and x, respectively. Therefore, they obtained three phase
images from three slices of Su ; Sc and Sl for each of Bx and By . For each
injection current of I1 and I2 , they acquired seven phase images from the
three slices.
Figure 9.12(c) shows the MR magnitude image of the phantom at the
centre slice Sc . The artefacts near electrodes are due to the RF shielding
eect of copper electrodes. The SNR of the magnitude image was 27.2 in
the solution and 6.86 in the sausage, assuming that both solution and sausage
are homogeneous. As shown in gure 9.12(c), the phantom occupies a region
of 83 83 pixels in the 128 128 MR image. Since there are artefacts near
electrodes, they extracted magnetic ux density images of 66 66 pixels
from the region of 83 83 pixels. They applied the total variation-based
denoising method by Chan et al (2000) to images of Bx ; By and Bz .
Figure 9.13 shows the wrapped and unwrapped phase image for Bz at
the centre slice Sc . Figure 9.14(a), (b) and (c) are images of Bx , By and Bz ,
respectively, at the same slice of Sc before denoising for the vertical injection
current I1 . Figure 9.14(d), (e) and (f ) are the corresponding images after
denoising. The noise standard deviations in the magnetic ux density
image were estimated using (9.22) as B 1:43 109 Tesla in the solution
and 5:68 109 Tesla in the sausage. Figure 9.15(a) shows horizontal
proles at the centre of two Bz images in gure 9.14(c) and (f ). Figure
9.15(b) is the dierence between these two horizontal proles.
Figure 9.16(a) shows the magnitude of the current density jJj for the
vertical injection current I1 , computed from the nite element model of the
saline phantom with the true resistivity distribution using the 3D forward
276
(a)
(b)
(c)
(d)
(e)
(f )
Figure 9.14. Magnetic ux density images at the centre slice Sc for the vertical injection
current I1 : (a) Bx , (b) By , (c) Bz , (d) Bx after denoising, (e) By after denoising, and (f ) Bz
after denoising.
MREIT images
277
(a)
(b)
Figure 9.15. (a) Horizontal proles at the centre of two Bz images in gure 9.14(c) and (f ).
(b) Dierence between two proles in (a).
solver by Lee et al (2003b). Figure 9.16(b) is the corresponding image

obtained from the measured magnetic ux densities without denoising.
Figure 9.16(c) is the same image using the measured magnetic ux densities
with denoising. Using the method by Scott et al (1992, 1993), the noise
278
(a)
(b)
(c)
Figure 9.16. Images of the magnitude of the current density jJj for the vertical injection
current I1 from (a) the 3D forward solver, (b) measured magnetic ux densities without
denoising, and (c) with denoising.
MREIT images
279
(a)
(b)
Figure 9.17. (a) Horizontal proles at the centre of two jJj images in gure 9.16(b) and (c).
(b) Dierence between two proles in (a).
standard deviations in the image shown in gure 9.16(b) were estimated as

about 54 and 215 mA/cm2 within the solution and sausage, respectively.
Figure 9.17(a) shows horizontal proles at the centre of two jJj images in
gure 9.16(b) and (c). Figure 9.17(b) is the dierence between these two proles.
280
Figure 9.18(a) shows the true resistivity image of the phantom. Here, the
resistivity distribution within the solution and sausage are assumed to be
homogeneous in each region. Using the J-substitution algorithm, gure
9.18(b) and (c) show reconstructed resistivity images without denoising
and with denoising, respectively. Figure 9.19 shows horizontal proles
around the centre of three resistivity images in gure 9.18. For the resistivity
image in gure 9.18(b) without denoising, the reconstructed average
resistivity values were 60.8 and 115.4 :cm in the solution and sausage,
respectively, compared to the true values of 50.5 and 123.7 :cm. For the
image in gure 9.18(c) with denoising, the average values were 60.9 and
117.7 :cm in the solution and sausage, respectively. The relative L2 -error
of the resistivity image is dened as
"
k k2
100 [%]
k k2
where and are the true and reconstructed resistivity image, respectively.
The computed relative L2 -errors were 32.3 and 25.5% for the images in gure
9.18(b) and (c), respectively.
Lee et al (2003a) discussed that the errors in reconstructed current
density and resistivity images were primarily due to the low SNR of the
0.3 Tesla experimental MRI scanner. Since they rotated the phantom to
get images of Bx and By in addition to Bz , misalignments of pixels among
dierent slices should have also caused a signicant amount of errors.
Their results suggest that we should use only one component of B such as
Bz to eliminate the troublesome subject rotation procedure. Furthermore,
recessed electrodes are desirable to avoid severe artefacts near copper
electrodes.
9.6.2. Images using the harmonic Bz algorithm
This section summarizes experimental results using the harmonic Bz
algorithm by Oh et al (2003). They used the same 0.3 Tesla experimental
MRI scanner described in the previous section. They constructed a cubic
saline phantom of 50 mm 50 mm 50 mm shown in gure 9.20(a). On
the four sides of the phantom, recessed electrode assemblies of
20 mm 20 mm 10 mm were positioned symmetrically. The phantom
was lled with a solution of 2 S/m conductivity (12.5 g/l NaCl and 2 g/l
CuSO4 ). Two cylindrical objects (5 ml of 20% polyacrylamide, 4.9 ml of
6% sodium-styrenesulfonate with molecular weight of 70 000, 15 mg of
CuSO4 , 0.1 ml of 10% ammonium persulfate and 4 ml of tetramethylethylenediamine) were located inside the phantom, and these objects are denoted
as A1 and A2 in gure 9.20. The conductivity value of A1 and A2 was
0.56 S/m. Their diameter was 14 mm and heights were 20 and 50 mm, respectively. Figure 9.20(b) and (c) show the diagrams of the phantom.
MREIT images
281
(a)
(b)
(c)
Figure 9.18. (a) True resistivity image assuming the sausage is homogeneous, (b) reconstructed resistivity image without denoising, and (c) with denoising.
282
Figure 9.19. Horizontal proles around the centre of three resistivity images in gure
9.18.
With four recessed electrodes, it is possible to inject six dierent currents

as shown in gure 9.21. Placing the phantom in the 0.3 Tesla experimental
MRI scanner, they selected the rst pair of electrodes to inject current I1 .
The injection current pulses of I 26 mA with Tc =2 24 ms were synchronized with the standard spin echo pulse sequence shown in gure 9.10. After
acquiring image data for the injection current I1 , they sequentially selected
other pairs of electrodes and repeated the same data collection process for
all six injection currents. When they injected current through a pair of electrodes, they also measured the voltage dierence between the other pair of
electrodes into which no current was applied.
They used a 3D spinecho volume imaging sequence to obtain 16 axial
images (xy-plane). The image matrix size was 128 128, phase encoding step
in the z-direction was 16, number of averaging was 4, TR was 200 ms, TE was
60 ms, eld-of-view (FOV) in the x- and y-directions was 77 mm and FOV in
the z-direction was 50 mm. The slice thickness was 3.1 mm and pixel size was
0:6 mm 0:6 mm. Average SNRs of magnitude images in the solution A1
and A2 regions were 30.2, 13.6 and 13.6, respectively. We denote each
imaging slice as S i for i 1; . . . ; 16 from the bottom to the top of the
phantom. Figure 9.22(a) shows a typical MR magnitude image of the
phantom at S 9 (25 z 28:1 mm). We can see only the object A2 because
S 9 is above the object A1, as shown in gure 9.20(c). Central 82 82
pixels corresponding to the 50 mm 50 mm region of the phantom were
extracted from all images for the subsequent data processing.
MREIT images
283
(a)
(b)
(c)
Figure 9.20. (a) Cubic saline phantom with four recessed electrodes. Diagrams of the
phantom: (b) top view and (c) front view (the recessed electrode on the frontal surface is
hidden). The conductivity values of the solutions A1 and A2 were 2, 0.56 and 0.56 S/m,
respectively.
Figure 9.21.
Six dierent injection currents (top view).
284
(a)
(b)
(c)
Figure 9.22. (a) MR magnitude image of the phantom with four recessed electrodes at
the axial imaging slice of S 9 (25 z 28:1 mm). Since the imaging slice is above the
object A1, as shown in gure 9.20(c), we can see only the object A2. (b) 82 82 image
of B1z at S 12 . (c) 82 82 image of B1z at S 6 .
MREIT images
(a)
(b)
(c)
(d)
(e)
(f )
285
Figure 9.23. (a) Positions of ve slices. Reconstructed conductivity images of the saline
phantom at slices of (b) #1, (c) #2, (d) #3, (e) #4 and (f ) #5. The relative L2 -errors are
in the range of 13.8 to 21.5%.
286
After geometrical error corrections and phase unwrappings, phase

images were converted to magnetic ux density images of Bjz as in (9.20).
Figure 9.22(b) and (c) show 82 82 images of B1z for the injection current
I1 at the imaging slices of S 12 and S 6 , respectively.
For the computation of the weight matrix W in (9.36), Oh et al (2003)
rst applied the total variation-based denoising technique by Chan et al
(2000) to all Bjz images. Then, they considered these denoised images as
noise-free images. For each Bjz image, the amount of noise was estimated
as the dierence between the corresponding noise-free image and the original
noisy image. This enabled them to compute the weight in (9.37) for each pixel
in Bjz images.
Using the measured Bjz for j 1; . . . ; 6, they applied the r2 Bz algorithm
to reconstruct conductivity images shown in gure 9.23. The relative L2 errors of these images were between 13.8 and 21.5%. Figure 9.24 shows
a
Figure 9.24. Typical horizontal proles of the conductivity images in gure 9.23. Solid
and dotted lines are the true and reconstructed proles, respectively.
MREIT images
(a)
287
(b)
Figure 9.25. Typical reconstructed images of the magnitude of current density distributions. (a) Imaging slice S 9 including only the object A1, and (b) dierent slice S 7 including
both A1 and A2.
typical conductivity proles of the reconstructed images in gure 9.23. They

solved (9.32) with , replaced by the reconstructed values and computed
current density distributions inside the phantom. Figure 9.25 shows two
images of the magnitude of current density distributions. Figure 9.25(a)
and (b) are current density images at two dierent slices, including only
the object A1 and both A1 and A2, respectively.
MREIT images shown in this section need much more improvements.
Since the progress in MREIT research is quite fast, we may expect images
of animal and human subjects in the near future. Especially, it is worthwhile
trying experimental studies using a high Tesla (e.g. 3 Tesla) MRI scanner
with much better SNR. One of the most recent results using a 3 Tesla
system is described by Oh et al (2004).
Lately, Woo et al (2004) also used the same 3 Tesla system and
produced conductivity images of a biological tissue phantom shown in
gure 9.26. They injected current pulses with 48 mA amplitude and 10 ms
width. Figure 9.27(a) and (b) are the MR magnitude image at the middle
imaging slice and the corresponding reconstructed conductivity image,
respectively. The pixel size is 1:56 mm 1:56 mm and there are 90 90
pixels in the reconstructed conductivity image. They found that the
reconstructed conductivity values of the image in gure 9.27(b) are very
close to the measured ones using an impedance analyser after the experiment. This result demonstrates the feasibility of the MREIT technique in
producing conductivity images of dierent biological tissues with a high
spatial resolution and accuracy when we use a sucient amount of injection
current.
288
Figure 9.26.
Biological tissue phantom.
(a)
(b)
Figure 9.27. (a) MR magnitude image of the tissue phantom in gure 9.26 at the middle
imaging slice, and (b) reconstructed conductivity image at the same slice.
9.7.
POSSIBLE APPLICATIONS OF MREIT
MRCDI techniques have been tried in various biomedical applications.

These include current density imaging of bone (Beravs et al 1997) and
tumour (Sersa et al 1997). Joy et al (1989) imaged current pathways in
Current status and future of MREIT research
289
rabbit brain during transcranial electrostimulation. Gamba et al (1999)

utilized measured current density distributions in a head phantom to better
understand the eect of the human skull on the current distribution within
the brain tissue. Beravs et al (1999b) also applied the MRCDI technique to
measure conductivity changes during a chemical process.
Clinical applications of MREIT have not been tried yet since it is still in its
early stages of development. Once we can reconstruct cross-sectional conductivity and current density images with improved spatial resolution and
accuracy, MREIT will nd numerous clinical applications. These include all
clinical application areas of EIT and MRCDI, where static or absolute
values of conductivity and current density are needed. However, the temporal
resolution of MREIT is expected to be much worse than that of EIT and
MREIT lacks the portability. Therefore, MREIT will never replace EIT in
application areas where monitoring of fast physiological events is requested.
For this kind of application, MREIT may provide conductivity images to
be utilized as a priori information in EIT image reconstructions.
Bodurka et al (2002) tried a direct mapping of neural activity by
measuring very weak transient magnetic eld changes using a 3.0 Tesla
MRI scanner. Providing static images of conductivity and current density
distributions, MREIT could nd important contributions in the areas of
neuronal source localization and mapping. There are numerous methods of
applying electromagnetic energy to the human body, mostly for therapeutic
purposes. Conductivity information from MREIT will be valuable for the
optimization of these therapeutic treatments and current density images
could be used to visualize how therapeutic electric currents are actually
distributed within the subject. Based on the temperature dependency of
tissue conductivity, MREIT could also be used for internal temperature
mappings.
9.8.
CURRENT STATUS AND FUTURE OF MREIT RESEARCH
We rst summarize several technical problems of MREIT to be discussed in

this section. Some of them are already solved and others are not.
1. Subject rotation within an MRI scanner to measure all three components
of B Bx ; By ; Bz .
2. Artefacts near electrodes.
3. Low SNR in measured magnetic ux density images.
4. Amount of injection currents.
5. Electrode conguration and data collection method.
6. Image reconstruction algorithm.
7. Multi-frequency MREIT technique.
8. Anisotropic conductivity image reconstruction.
290
The rst problem has been the major technical limitation of MREIT and also
MRCDI. Now, the harmonic Bz algorithm provides a solution even though
this algorithm has a weak point in terms of noise tolerance. As we make
progress in better understanding the information embedded in the induced
magnetic ux density, we expect other algorithms with an improved stability
against measurement noise to appear soon. The second problem of artefacts
near electrodes can be eectively handled by using recessed electrodes. We
may also look for new electrode materials generating a negligible amount
of artefacts.
The third and fourth problems are interrelated. If the SNR of an MRI
scanner is large enough, we could easily reduce the amount of injection
current down to 0.1 or 1 mA. There are many factors determining the
amount of random noise in measured magnetic ux density images. First
of all, we should use an MRI scanner with a high main magnetic eld
and excellent eld homogeneity. Then, we may gradually increase the
voxel size until we obtain the amount of random noise that could be
tolerated by image reconstruction algorithms. Ecient denoising techniques based on the underlying physical principles should be developed
to enhance the SNR without sacricing the edge information in reconstructed images.
Reducing the amount of injection currents down to 0.1 or 1 mA is the
most challenging task in MREIT. With such a small injection current, the
induced magnetic ux density could easily be lower than the noise level.
Once we have minimized the amount of random noise in measured magnetic
ux density images, we have to rely on the signal averaging technique to
improve the SNR further. However, this will increase the imaging time
and may limit the practical applicability of MREIT.
From the BiotSavart law, the induced magnetic ux density (signal) is
determined by the current density distribution due to an injection current.
Though the relation between them is given in the form of a 3D convolution,
we can roughly expect a bigger signal where the current density is large.
Therefore, we should further investigate the optimal electrode conguration
including size, shape and location to minimize the regions where the current
density becomes small. It is desirable to sequentially inject multiple currents
through dierent pairs of electrodes so that each injection current will
produce bigger signals in dierent regions. Then, we could get an averaging
eect by using all of them in an appropriate way. Injecting a pattern of
currents with multiple current sources may also be helpful to generate
more or less uniform current density distribution. When multiple electrodes
are used, it will be benecial to measure all independent boundary voltage
data to provide extra compatibility conditions.
In terms of image reconstruction algorithms, a hybrid form combining
the advantages of dierent algorithms may turn out to be optimal as long
as it requires only one component of B such as Bz . Since conventional MR
References
291
images are available providing excellent structural information, it would be

helpful to use those images as a priori information. As we make more
progress in VF- and RF-MRCDI techniques, we may expect a multifrequency MREIT system to appear for applications where spectroscopy is
desired.
Biological tissues are known to have anisotropic conductivity values.
The ratio of anisotropy depends on the type of tissue. For example, the
human skeletal muscle shows the anisotropy of up to 110 between the
longitudinal and transversal direction. However, all of the previous works
in MREIT are limited to the isotropic conductivity imaging problem. In
order to apply the technique to more realistic situations, we need to develop
anisotropic conductivity image reconstruction algorithms. This requires
thorough analysis of how anisotropic conductivities aect the internal
current density and thereby the magnetic ux density. Since anisotropy
exists in various biological tissues, future studies should include this
practically important issue.
Currently we speculate that conductivity and current density images
with 3 mm 3 mm 3 mm voxels in a eld of view of about 200 mm
could be possible using an injection current of about 1 mA. In other
words, 64 64 whole body imaging or 32 32 localized imaging is
considered to be feasible using a high eld MRI scanner, while conforming
to the safety guideline of 0.1 to 1 mA current injection. However, it is too
early to conrm that this is the ultimate limit in the spatial resolution of
MREIT images.
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Chapter 10
Electrical tomography for industrial
applications
Trevor York
10.1.
INTRODUCTION
The mathematical concept of tomography was rst suggested early in the 19th
century. About 100 years later an Austrian mathematician, Radon, extended
the ideas to objects with arbitrary shapes [1]. During the rst half of the 20th
century several independent workers, notably Bocage, Ziedses des Plantes,
Grossman and Watson, suggested methods for imaging a plane using x-rays.
In 1979 Godfrey Hounseld and Allen Cormack were jointly awarded the
Nobel prize for their pioneering work on computed x-ray tomography, a
concept that was, perhaps, anticipated by Gabriel Frank in 1940 [2]. The
basic aim of modern tomography is to determine the distribution of materials
in some region of interest by obtaining a set of measurements using sensors
that are distributed around the periphery. For instance, in medical applications the contrasting materials may be normal and cancerous tissue, and
for industrial applications the materials could be oil or gas in a pipeline. Tomographic measurements are non-intrusive, perhaps penetrating the wall of the
vessel but not entering into the medium, and also, ideally, non-invasive such
that the sensors are located on the outside of the wall. Each measurement
is aected, to a greater or lesser degree, by the location of materials in the
region of interest. Typically a source of energy is imposed on the vessel from
one orientation and a number of measurements are taken by distributed
sensors to create a projection of data. The source is then moved to provide
another projection and so on around the vessel until a frame of data is accumulated. Usually the frame of data is translated, in software, into a crosssectional image representing the distribution of materials. Tomography has
enjoyed considerable success in medical applications, for instance identication of tumours, particularly using x-rays as a source of energy, to identify
contrasting material density from the attenuation of the transmitted signal.
296
Electrical tomography for industrial applications
More recently magnetic resonance and electrical excitation [3], among others,
have emerged as alternative modalities oering particular features that might
be usefully exploited. Tomography, therefore, is inherently complex, involving
energization of a target region, multiple sensor electronics, data acquisition
and data inversion.
Fuelled by developments in personal computing and sensor design,
research into applications of tomography to industrial processes began to
gain popularity in the early 1990s. Techniques have been inuenced by
successes in medicine; however, in many cases, the demands of industrial
applications are signicantly dierent. It is not uncommon to require
many cross-sectional images per second, at low cost, using mobile equipment that is easy to operate and introduces no risk to the user. For these
reasons nucleonic techniques are often inappropriate and alternatives have
emerged. For instance, the literature includes descriptions of instruments
that are based on acoustic propagation, optical, infra-red and microwave
sources of energy [4, 5]. A particularly successful approach for industrial
applications involves electrical tomography. Three, relatively low frequency,
measurement modalities are used to determine distributions of conductivity
(resistance), permittivity (capacitance) and permeability (inductance), and
these are the subject of the present survey. Impedance tomography oers
the ability to measure both the resistive and reactive components. It
should be noted that microwave tomography is excluded from the present
discussion, operating at signicantly higher excitation frequencies, of the
order of GHz, where eects due to molecular structure start to become
signicant. The characteristics of the electrical modalities are summarized
in table 10.1.
Prediction of the electric elds that arise, and consequently the boundary
values, due to electrical excitation of specic distributions of materials, is
referred to as the forward problem. This is usually realized using nite element
modelling tools. The opposite process, to determine the distribution of
materials from the boundary values, is called the inverse problem. For x-ray
tomography the path of the signal is known to follow a straight line and the
only eect on the detected signal strength is due to material along that path.
This is a so-called hard eld problem. In contrast, for soft eld modalities
such as electrical tomography, material throughout the subject aects the
signal strength and presents a much more demanding challenge. Consequently
it is not yet possible to match the spatial resolution of the images that are
produced by hard-eld systems, although this is also, in part, due to the
increased number of measurements that are often taken in hard-eld systems.
An important decision when selecting an appropriate modality is whether the
reduced resolution is an acceptable price to pay in order to enjoy the accompanying benets.
Electrical tomography has motivated applications for process design
and validation, on-line monitoring and control. This can, for instance, lead
Introduction
Table 10.1.
Method
297
Comparison of electrical tomography techniques (courtesy A Peyton,

University of Lancaster).
Arrangement
ECT
Measurand
Material properties
Typical material
Capacitance
C
"r ; 100 102

< 101 S/m
Oil
De-ionized water
Non-metallic powders
Polymers
Burning gases
Resistance
(impedance)
RZ
; 101 107 S/m

"r ; 100 102
Water/saline
Biological tissue
Geological materials
Semiconductors
Self/mutual
inductance
L=M
; 102 107 S/m

r ; 100 104
Metals
Some minerals
Magnetic materials
Ionized water
Capacitive
plates
ERT
Electrode
array
EMT
Coil array
to improved product quality and process eciency, with accompanying

improved prots through reduced time and waste. There are also important
consequences for environmental issues and the reduction of exposure
hazards for plant operators. Typical elds of application in the early years
of development included two-phase ow, uidized beds, mixing and environmental monitoring [69].
Progress in industrial process tomography is recorded in the proceedings
from a number of international meetings. From 1992 to 1995 European
activity was coordinated through the European Concerted Action on Process
Tomography [69]. This was followed by two international conferences,
Frontiers in Industrial Process Tomography, that were organized by the
Engineering Foundation in 1995 and 1997 [10, 11]. The World Congress
on Industrial Process Tomography was rst held in Buxton, UK, in 1999,
and there have been subsequent meetings in Germany (2001) and Canada
(2003) [5]. The fourth meeting is planned for Japan in 2005. In addition
there have been a number of special issues of journals which catalogue developments in the eld [4, 12, 13, 92, 93]. There have been previous reviews of
tomography for industrial applications, notably Process Tomography
The State of the Art by Beck, Dyakowski and Williams in 1998 [14], and
Electrical Tomography Techniques for Process Engineering Applications
by Xie et al [15]. In addition, Boone et al presented an excellent review of
EIT for medical applications [16]. The present discourse is based on an earlier
review Status of Electrical Tomography in Industrial Applications [94], and
the Institute of Physics would like to thank SPIE for allowing reproduction
298
of signicant sections. The intention is not to attempt to present an exhaustive introduction to industrial tomography, which can be readily found in
earlier publications such as Process Tomography: Principles, Techniques
and Applications by Williams and Beck [17], but to present a technical
audit for 2004.
Section 10.2 presents a summary of hardware for data acquisition that
has been reported for electrical tomography. The hardware is primarily
sourced from academic institutions, but includes two established commercial
instruments plus emerging systems. Section 10.3 addresses data processing
issues of image reconstruction and interpretation. Section 10.4 considers
contrasting applications of tomography that have made signicant progress
towards industrial benet.
10.2.
DATA ACQUISITION
Instrumentation for industrial electrical tomography systems has been

reviewed previously, for instance by Dickin et al [18]. Almost all of the
instruments that have been described to date are uni-modal; in other
words they measure just one parameter, for instance capacitance. In many
applications it is benecial to obtain measurements of more than one parameter. For instance, in an oil pipeline the ow may be oil continuous, in
which case capacitance tomography would be appropriate; or water continuous, in which case resistance tomography would be appropriate. To take
full advantage of such an approach it is necessary that the signals from the
various sensors are synchronized, and for this reason recent eorts have
been applied to a multi-modal instrument [19]. It is too early to draw
conclusions about the success of this specic approach.
Electrical tomography systems comprise sensors, measurement electronics, switching electronics, signal conditioning, analogue-to-digital
conversion, communications and a computer hosting control and data
processing, including inversion, analysis and display algorithms. A schematic
representation of a typical system is shown in gure 10.1.
Figure 10.1.
Electrical tomography system.
Data acquisition
299
Typically, electrodes are located in rings around regions that are to be

interrogated. For capacitance and inductance systems the electrodes are
frequently non-invasive, lying outside the vessel wall, as well as nonintrusivetouching but not penetrating the materials in the vessel. For
resistance measurements the electrodes are usually invasive but not intrusive.
However, for vessels with conducting walls it is necessary in all cases for the
electrodes to be located inside the vessel. This has presented a signicant challenge to the tomography community and working solutions are beginning to
appear, some of which are outlined in section 10.4. It is becoming apparent
that there are a number of applications, notably for batch processes, which
allow electrodes to be placed above and below the vessel as well as around
the circumference. This allows a richer variety of electrode congurations to
be considered which should, in turn, lead to higher quality results.
Signals from the sensors are routed to the measuring electronics by
a multiplexer, which is usually implemented using solid state switches.
Parasitics that are associated with these switches are particularly important,
aecting switching speed and noise, and selection of appropriate devices is an
important decision. When the initial signals have been amplied and buered
programmable gain and oset are usually employed, to accommodate a wide
range of signals, with demultiplexing and ltering in analogue hardware.
Most systems implement the conditioning electronics in a self-contained
unit. In order to reduce unwanted stray signals, some groups have employed
active sensors in which the electronics is distributed and located on the electrodes [20]. The emergence of powerful signal processing chips provides
increased exibility and it is likely that digital conditioning of signals will
become dominant in future systems. Analogue measurements are converted
to digital format and transferred to the host, usually via a high speed, robust,
serial communications link. Typically, data rates of about 10 Mbits/s are
desirable. It is also becoming increasingly common for systems to include
embedded microcontrollers, which relieve the host processor of some of
the supervisory tasks in order to focus on data processing.
Some of the basic characteristics of electrical tomography systems are
outlined below, but the reader is referred to more specic documents for a
fuller description.
10.2.1.
Electrical resistance tomography
A general introduction to electrical resistance tomography (ERT) was

published by Wang [21]. The basic aim is to determine the distribution of
electrical conductivity from measurements of voltage around the periphery
of a vessel. Early systems were strongly inuenced by developments in the
medical eld, notably the Sheeld Applied Potential Tomography system
[22]. Electrodes are relatively small and placed in contact with the conducting
materials. Some systems have separate electrodes for excitation and detection
300
[23], while others combine the functionality. The most popular approach for
industrial applications is to apply a sinusoidal current source to a pair of
electrodes, at a frequency of some tens of kilohertz, and to measure the
resulting electric potentials between other pairs of electrodes. This arrangement reduces eects due to contact impedance, although this is less important in many industrial applications compared with the medical eld in
which the interface is human tissue. This adjacent strategy provides high
sensitivity near the vessel walls, but is poor in the centre of the region.
Alternatively, other strategies can be adopted, for instance to inject current
between opposite electrodes. An adaptive current strategy, in which signals
of varying amplitude are injected concurrently on all electrodes in order to
optimize the eld distribution, is popular in the medical tomography community [23]. Measurements are taken concurrently on all electrodes and the need
for multiplexing the electrodes is removed. The required instrumentation is
considerably more complex for this approach and the resulting benets
have not yet proved suciently attractive to generate widespread interest
for industrial applications. Much eort is directed at providing a high quality
current source with high output impedance. However, a practical solution,
that has some merit, monitors a modest current source [24]. For industrial
applications metal walls pose a signicant problem as current leaks away
through the wall. A strategy to accommodate this uses common ground
return for transmitted and detected signals. An ERT system that resulted
from work done at UMIST has been developed into a commercial instrument
by Industrial Tomography Systems Ltd. (http://www.itoms.com).
Three recent projects have explored the design of ERT instruments that
specically aim to yield low-cost solutions [79, 80, 83]. The rst two use a bidirectional current pulse to excite the region, and this is related to the original
technique that was used for electrical capacitance tomographyas described
in section 10.2.2. Dierential voltages are measured around the vessel on the
positive and negative cycles. These values are subtracted to yield d.c. levels
representing resistance. Electrochemical eects are minimized by the use of
bipolar excitation. At the University of Cape Town [79] a commercial
DAQ card is used to transfer results into the host PC. The original version
employed a single multiplexed measurement channel and was tested at low
excitation frequencies of a few kilohertz. A modied version takes advantage
of parallel input ampliers and is synchronized by an embedded microcontroller. The authors claim a measurement rate of 500 frames per second.
Image reconstruction is performed o-line using the NewtonRaphson algorithm. The system that has been developed at the University of Aberdeen [80]
is intended for considering uid distribution in porous rock. It employs eight
planes of 24 electrodes and can acquire a frame of data, comprising
192 192 measurements, in 19 s. It is suggested that the system might oer
capture rates of a few hundred frames/s for a 16-electrode sensor. At
Tampere University of Technology [83], a 16-electrode ERT system is
Data acquisition
301
(a)
(b)
(c)
Figure 10.2. Prototype conducting ring sensor. (a) Complete sensor, (b) inner view of the
conductive ceramic ring, (c) electrical contacts on the outside wall of the conducting ring [82].
described for monitoring the air bubbles in pulp ow. The system that can
inject either sinusoidal waves or square pulses with some advantage
suggested the latter in terms of a sampling period.
A novel approach to the implementation of ERT sensors is described by
Wang et al [82]. Conventional ERT sensors use discrete electrodes that are
mounted on the inside wall of the vessel, and this can give problems when
the medium is discontinuous. For instance, consider a conducting aqeous
medium that is either stratied or contains gas bubbles. If a large gas
bubble is adjacent to a pair of electrodes then there is, essentially, no conduction between them. Wang et al have proposed a novel sensor in which the
discrete electrodes are replaced by a conductive ring that is inserted into
the wall. Contact can be made at any point and discontinuities are accommodated by the ring such that current can still be applied. This arrangement has
been modelled using 3D FEM, and results suggest a more uniform eld
within the vessel but with reduced eld strength and consequently sensitivity.
A value of 5 : 1 is suggested for the ratio of the conductivity of the ring
compared with the material in the vessel. A prototype sensor comprising a
38 mm ring with 16 electrical contacts has been manufactured from conducting ceramic having conductivity of 0.5 ms cm1 , as shown in gure 10.2.
Initial results of images of stratied ow in water are shown in gure 10.3.
302
Figure 10.3.
10.2.2.
Reconstructed images of stratied waterair ow [82].
Electrical capacitance tomography (ECT)
Introductions to ECT have been presented previously by, for instance, Yang
[25]. Distributions of electrical permittivity are determined from measurements of current around the boundary of a vessel. For capacitance measurements, electrodes must have a large surface area in order to provide sucient
signal. Electrodes are often located outside the vessel, such that the technique
is non-invasive as well as non-intrusive. In contrast to ERT, an a.c. voltage
signal is usually applied to a drive electrode and the resulting current on the
remaining electrodes is measured. Typical excitation frequencies, to provide
sucient sensitivity, are about 1 MHz. The main dierence between the
various systems that have been described is the use of either sinusoidal or
Data acquisition
303
square pulse excitation, often referred to as chargedischarge. The latter

was developed rst and is described in Williams and Beck [17]. Derivatives
of the chargedischarge approach have appeared from other groups, for
instance the system reported by Warsaw University of Technology [84].
The sinusoidal approach provides a readily analysed measurement in
which the phase as well as the magnitude can be exploited, but this is at
the cost of increased complexity to generate and demodulate the signals.
The biggest challenge is to detect sub-femtofarad (1015 F) changes in
the presence of standing capacitances that may be hundreds of femtofarad
and stray capacitances that are of the order of 100 pF. Electrodes and
cables must be well screened and careful attention must be given to the
layout of printed circuit boards. In addition it is important to employ
stray immune circuits. Capacitance changes between adjacent electrodes
may be 100 times greater than those between opposite electrodes and therefore the conditioning electronics must include programmable gain and oset
to provide optimum sensitivity. The use of driven guards, in an attempt to
conne the excitation signal to a single plane, has enjoyed some success.
Process Tomography Ltd. (PTL) manufactures capacitance tomography
systems based on the so-called chargedischarge system developed at
UMIST (http://www.tomography.com), and in 2002 they entered a collaboration with Tomoow (http://www.tomoow.com), which oers a
completely new category of owmeter based on the use of tomographic
imaging and correlation techniques. A recent report [81] describes improvements to the PTL instrument. This now employs an embedded PC, ethernet
interface to the host and Linux operating system. PTL aim to deliver 100
images per second for twin-planes each having 12 electrodes.
Finally, a recent paper [90] describes a new ECT system which employs
pairs of rotating electrodes, in order to increase the number of measurements in a frame. Four electrodes are mounted around a 17 cm diameter
plastic vessel. Each pair is connected in turn to a measuring circuit, leading
to six measurements for each position of the rotor. The measurement
circuit uses two switched capacitor ampliers which feed a dierential
amplier. A sensitivity of 2 mV/fF and measurement rate of 1 MHz are
reported. Measurements are communicated to the host computer via a
wireless link.
10.2.3.
Electromagnetic tomography (EMT)
For an introduction to EMT, also referred to as magnetic inductance

tomography or eddy current tomography, see Peyton et al [26, 86] or Griths
[87]. EMT seeks to determine the distribution of electrical permeability or
conductivity from boundary measurements of mutual inductance. The
region of interest is interrogated with a time varying magnetic eld. Nonconducting, magnetic materials, such as ferrite, increase the measured
304
signal. High conductivity, non-magnetic materials, for instance non-ferrous

metals, decrease the signal, and low conductivity materials, such as saline,
produce a small change in the quadrature component. For low conductivity
materials there is an increase in the measured signal for increases in excitation
frequency, and consequently values of 120 MHz are popular. Due to the
skin eect excitation frequencies are limited to a maximum of about
100 kHz for high conductivity materials. All reported EMT systems to date
have used single frequency sinusoidal excitation, and therefore the major
system blocks have been sine generator, programmable gain amplier, background subtraction, demodulation and analogue-to-digital conversion.
Various possibilities exist for conguring these blocks, e.g. background
subtraction can be achieved magnetically, electronically or digitally (in software). In common with the other electrical modalities small object signals on
a large background present a signicant challenge. No multi-frequency EMT
systems have been reported, although the use of pulse transient methods is
well established for some non-destructive testing (NDT) applications [27].
There is clearly scope for future work here combining spectroscopy with
tomography. D.C. systems could be considered using Hall devices, magneto
resistors etc., but no work has been published to date on these.
A major dierence between EMT and the other electrical methods is in
the operation of the sensor array. There are two key issues:
1. Use of coils. Coils can give enormous exibility in the design of arrays.
For example, coils can be superimposed allowing excitation and detection
elements in virtually the same positions, and measurements combined to
cancel the background signal. For some systems a parallel eld is established using two orthogonal excitation coils, in which varying magnitudes
are used to generate a rotating eld. A number of detector coils are
distributed around the boundary as shown in gure 10.4(a). The imaging
capability of parallel eld systems is, however, severely limited by the lack
of high spatial frequencies in the eld excitation patterns. A system that
potentially avoids this has recently been reported [90]. It comprises a
circular array of eight detector coils, an array of 32 longitudinal independently supplied current-carrying strips and an outer screen, as shown in
gure 10.4(b). Non-parallel elds can be generated by alternating sources
and detectors.
2. Screening. Magnetic screening is generally accepted as being dicult
compared with electrical screening. If the external environment is dened,
the screening is not required, as external conductive or magnetic objects
will have a constant eect, which can usually be subtracted during
calibration. Otherwise magnetic shielding is required, typically a high
permeability material to provide a low reluctance return path for the
interrogating eld. Recently, bonded ferritepolymer composites have
become available for sensor applications.
Data acquisition
Figure 10.4.
305
(a) Parallel-eld system, (b) current-strip source system [86].
Peyton et al [59] report the study of paramagnetic to ferromagnetic phase

transitions in strip steel as it is cooled below the Curie point. Section
10.4.2 describes a project to image the ow prole of molten steel. Ramli
[88] and Miller [89] have used EMT to explore the corrosion of steel bars
in reinforced concrete.
10.2.4.
Electrical impedance tomography
As suggested above, most electrical tomography systems that have been

described for industrial applications are only single modality, and measure
resistance, capacitance or inductance to yield information on resistivity,
permittivity or permeability distributions. This somewhat undesirable situation has arisen due to the contrasting requirements of circuitry to optimize
the measurement of each component. However, commercial instruments to
determine complex impedance from four-point measurements of amplitude
and phase are readily available for other application areas, and this approach
should be considered for electrical tomography. UMIST and Syngenta have
recently described a new impedance tomography system based on this principle [109]. The LCT system employs rapid sampling of sinusoidal signals to
yield amplitude and phase using digital signal processing techniques in a
manner similar to that described by the Dartmouth group for medical EIT
[24, 110]. The signal conditioning board supplies a known current on two
output terminals and measures the resulting potential dierence between
two input terminals. A strong motivator for this system has been the requirement for low cost manufacture. To acquire tomographic measurements the
signal conditioning board controls a multiplexer which allows connection
of the terminals to any electrode. The basic system can deliver a 16-electrode
frame rate of about one per second via a USB2 interface to the host PC and
is, therefore, targeted at slowly changing processes. The hardware has been
coupled with the EIDORS 3D software tools, described in section 10.3
below, to deliver images from the in-phase and quadrature components of
the measurements.
306
10.2.5.

Intrinsically safe systems
Many industrial processes operate in hazardous environments. For instance,

the use of solvents presents a potentially explosive atmosphere. In order to
exploit the benets of electrical tomography in such cases, it is essential to
provide certied safe equipment. York et al [85] describe the design of the
worlds rst, certied, Intrinsically Safe (I.S.) electrical tomography
system. This has been designed for a research project that is seeking to monitor progress during pressure ltration of agrochemical products, as described
in section 10.4.3 below, but could be readily applied in other application
areas which may or may not involve tomographic processing.
Across the process sector many organic solvents and products are
common, which are ammable in air or other gas mixtures. To allow electrical
apparatus to be applied within such an environment, a branch of engineering
has been developed to classify the risk and reduce the probability of an ignition
source being present. This methodology is a legal requirement in Europe and
industrial nations elsewhere. There are a number of ways of ensuring that a
ammable atmosphere is isolated from any signicant energy source, but by
its very nature electrical tomography requires energy to be injected into a
potentially ammable atmosphere, and therefore only one approach, intrinsic
safety, is appropriate. Conveniently, of all the protection methods I.S.
certication has the greatest degree of integrity and is, therefore, the most
appropriate for Zone 0, which is the most stringent classication of hazardous
environment. Zone 0 suggests an area in which an explosive gas/air mixture is
continually present or is present for long periods.
I.S. certication relies on constructing apparatus in such a manner that
the maximum electrical energy that can be provided to the ammable atmosphere during normal operation or in the case of worst case failure will be less
than the minimum ignition energy of the ammable gas mixture into which it
is placed. In realizing an I.S. version of the tomography system it is necessary
to acknowledge the demands of certication, not only in terms of cost but
also the time delay between concept and approval. For both of these reasons
it was decided to simplify the problem by locating only passive electrical
components in the hazardous, Zone 0, environment found within the
pressure lter. In other words, only the electrodes and connecting wires are
located in the hazardous area. All active, electronic, components and
power supplies are located on the safe side of the barrier. By limiting the
dimensions of the electrodes and the maximum capacitance and inductance
of the interconnecting wires, it has been possible to dene the equipment
within the hazardous area as simple apparatus and allow up to 50 m of
co-axial cable to be connected to each of the electrodes. For an intrinsically
safe system it is necessary to dene a boundary between the hazardous and
non-hazardous areas. In the system described by York et al, all of the interface electronics and the control computer are mounted remotely in the plant
Data processing
307
switch room, which is a safe area some 50 m from the lter. The philosophy
behind the design of the I.S. system has been to utilize, wherever possible,
existing certied components. This is achieved by taking an existing system
certication for a typical Zener barrier in a strain gauge conguration
and expanding on this using a series of certied I.S. relay modules.
The intrinsically safe EIT system is built on an earlier system that incorporates a commercial LCR instrument with a custom switch matrix [28].
Although the acquisition rate is slow, taking about 40 s for a 16 electrode
frame of ERT data, it is adequate for many applications that have modest
dynamics. The instrument is capable of measuring both the resistive and
reactive parts of the impedance. Industrial Tomography Systems Ltd. have
recently succeeded in obtaining certication for an intrinsically safe option
for their ERT system.
10.2.6.
Summary of data acquisition systems
Some systems oer the possibility of determining electrical impedance, to

include both the resistive and reactive components, from the magnitude
and phase of the signal. Some medical systems have been based on bespoke
impedance measurement circuitry [24]. An alternative approach is to
synchronize the measurements from individual modalities, as reported by
Hoyle et al [19].
Table 10.2 summarizes electrical tomography systems that have been
reported for industrial applications and also includes some systems that
have been used for medical applications. In their review, Imaging with
Electricity, Boone et al [16] tabulated EIT systems, primarily for medical
applications. Not all of the systems cited there are included in this report,
which focuses on industrial applications, but the interested reader should
consult their paper for further details.
10.3.
DATA PROCESSING
One of the main goals for a tomographic system is to produce cross-sectional

images of the distribution of materials. Ideally this will yield real time images
with high spatial resolution. Reconstruction of images for industrial applications was initially based on algorithms that were inherited from medical, xray, tomography. For electrical tomography the eld lines are inuenced
by the distribution of materials resulting in a soft eld environment,
which presents a more challenging data processing task. Finite element
modelling is used to determine a sensitivity map which denes the sensitivity
of each measurement to changes in the contents of each picture element,
commonly referred to as a pixel. Historically, generation of such maps has
been a slow and laborious process involving the systematic placement of
Mode
Comments
Aberdeen [80]
Barcelona [29]
Bergen [30]
ERT
ERT
ECT
Cape Town [79]

Dartmouth [24, 110]
ERT
ERT
Delft [31]
De Montfort [32]
ECT
EIT
ITS 2000 [33]
ERT
Keele [20]
ERT
Kuopio [34]
EIT
Lancaster [26]
EMT
Manchester Metropolitan [35]
ECT
Morgan Town [36]
ECT
Oxford Brookes [37]

PTL [81]
EIT
ECT
Industrial: Bipolar pulse excitation, eight planes of 24 electrodes.

Industrial: Commercial function generator with custom measurement and switching circuitry.
Industrial: Eight electrodes, ratio arm bridge. Used in conjunction with gamma ray system. Five
frames per second.
Industrial: 500 measurement frames per second, bipolar pulse excitation.
Medical: Spectroscopy, 1 kHz10 MHz, 32356 channels, monitor modest current source,
computed magnitude and phase.
Industrial: New fast active dierentiator circuit, promises high data rates. Awaiting test results.
Medical: 32 electrodes, 10-bit sinewave generation, current source, gain 1400, analogue
conditioning, real and imaginary, 10 kHz5 MHz.
Industrial: Derived from UMIST Mk 1b, 12 programmable frequencies, 256 levels of current, 128
electrodes, up to 25 frames/s at 38.4 kHz. Recent medical application
(http://www.itoms.com).
Medical: 10 kHz3 MHz, distributed electronics on 16 electrodes, multifrequency, acquisition 5
frames/s.
Industrial: External sinusoidal generator, 100 Hz50 kHz, current excitation, 16 channels, digital
conditioning.
Industrial: Inductive and conductive components, analogue conditioning, capture rate up to 100
frames/s.
Industrial: 12 electrodes, driven guards, modied a.c. bridge, 100 kHz DDS sinusoidal source,
hardware conditioning, 1.9 V/pF.
Industrial: 400 kHz sinusoidal excitation at up to 250 V, 4 planes of 16 electrodes, 30 images per
second.
Medical: OXBACT 14, adaptive currents, 32 32 electrodes, 60 kHz, analogue conditioning.
Industrial: Derived from UMIST chargedischarge system, twin 12 electrode planes, driven
guards (http://www.tomography.com).
Organization
308
Table 10.2. Summary of reported electrical tomography systems.
EIT
Moscow [38]
EMT
UMIST/Syngenta
LCT [109]
Sheeld [22]
EIT
ERT
Tabriz [91]
Tampere [83]
Thrace [39]
UCL [99]
UMIST [25]
UMIST Mk 1b [21]
ECT
EIT
EIT
EIT
ECT
ERT
UMIST Mk 2a [40]
UMIST [28]
UMIST [85]
VCIPT [19]
ERT
EIT
EIT
Multimodal
ECT
Warsaw [84]
Medical: Adaptive currents up to 500 mA, 30 kHz, 32 source 32 measurement, parallel

acquisition, digital conditioning, up to 480 data frames/s, 18 images/s.
Medical: 16 electrodes, 20 MHz excitation, use phase shifts to nd conductivity, imaging at 1
frame/s.
Industrial: Amplitude and phase from rapid sampling. About 1 frame/s.
Medical: Mk 1Mk 4, up to 16 electrodes, up to 1.6 MHz, current injection, originally analogue
conditioning now digital. Later versions multi-frequency.
Industrial: Four rotating electrodes.
Industrial: Sinusoidal or pulse excitation.
Medical: 32 electrodes, current source, potential for 20 frames/s.
Medical: 64 channel, current source, single multiplexed measurement circuit, 3 images/s.
Industrial: Chargedischarge circuit, 1 MHz, 12 electrodes, commercialized (PTL).
Industrial: 030 mA VCCS, 12-bit digital synthesis, LUT, lter, gain X1, 10, 100, 1000, analogue
or digital demodulation, 25 frames/s, 75 Hz75 kHz, up to 64 electrodes, commercialized (ITS).
Industrial: Based on plug-in card for a PC. 100 frames/s, twin plane for correlation.
Industrial: Multiplexed impedance analyser. About 1 frame/min.
Industrial: Intrinsically safe EIT system based on above.
Industrial: Sinusoidal excitation using DDS, analogue conditioning, embedded ADSP2181. Can
accommodate other modalities, e.g. ultrasonic.
Industrial: Derivative of chargedischarge technique.
Data processing
Rensselaer [23]
309
310
an object at pixel locations in an otherwise uniform permittivity distribution.

More recently, techniques have evolved to utilize a direct mathematical
approach that has been inherited from the medical tomography community
[41]. Once the homogeneous case is known the map can be calculated by
integrating the vector dot products of two basic electric eld distributions
across the area of each pixel in turn. This method requires considerably less
computational eort. Image reconstruction algorithms are computationally
intensive and almost universally implemented in software. Coarse-grained
parallelism, utilizing a small number of powerful microprocessors [42, 43],
has been used to exploit the inherent parallelism in the processing but, to
realize signicant speed-up, ne-grained architectures must be developed.
The most popular reconstruction algorithm for industrial applications
of electrical tomography that require a high imaging rate is still linear
back-projection (LBP) [44]. From the sensitivity map and the frame of
measurements, a qualitative image, representing the distribution of
materials, can be reconstructed using a simple matrix multiplication. To
achieve this the matrix containing the sensitivity map is transposed in
order to solve the inverse problem. This technique is mathematically nonrigorous and system calibration with representative materials is essential.
LBP is simple and fast, but produces blobby images with low spatial resolution. It is, however, important to note that for many industrial applications
this level of spatial resolution is often adequate and, importantly, it provides
perhaps the best opportunity, to date, for fast real-time imaging. Rates up
to about 100 reconstructed images/s have been reported.
More recently, eort has been directed at iterative algorithms. Starting
with an initial guess or estimate of the distribution, that could for instance
have been generated from the measurements using LBP, a forward solver,
typically nite element modelling, predicts the measured boundary values.
For ECT this would be inter-electrode capacitances and for ERT the
voltages. The predicted and measured values are compared and the resulting
errors are fed back, via the inverse algorithm, to give an improved estimate of
material distribution. This is repeated until the magnitude of the error vector
is below some dened threshold of tolerance. Iterative approaches typically
provide more accurate images, but the process is time consuming and there
may be problems with convergence. Perhaps the most well known iterative
approach is based on the NewtonRaphson method that has gained some
popularity for ERT [45]. The Landweber technique has been implemented
for ECT, with promising results [46], due in part to the explicit eld calculations that are used in the forward problem. For many ECT applications this
approach works well without the need for recalculation of either the forward
or inverse transforms. This is partly because the eld distortion is normally
relatively small, but also because it is possible to use additional information
about the known limits on the possible values of the image pixels. If the
recalculated permittivity values are truncated between iterations so that
Data processing
311
they lie within the known physical limits of calibration, this seems to get rid
of any spurious artefacts and speeds up convergence to the true image. Without such truncation the image accuracy is signicantly degraded.
It is well known that pixel-based image reconstruction is an ill-posed
problem due to the limited number of measurements that are available in
each frame of data. Driven by the desire for interpretation of images,
parametric approaches have been suggested for void fraction in oilgas
ows [47] and determination of the size of the air core in a hydrocyclone
[48]. The latter case will be considered to illustrate the approach. A hydrocyclone was equipped with eight planes of 16 electrodes each for ERT. Xray photographs suggest the stability of a centrally located air core in a
correctly operating hydrocyclone. This information can be used to direct
the parameterization of the process such that the conductivity (s) is
modelled as
r a b3r 2 c10r2 12r 3
where r is distance of the air core from the boundary, and a, b and c are
parameters to be determined. The expected voltages can be calculated
numerically, using the four parameters, and the results compared with the
measurements. Optimization routines are then used to nd the best values
for the parameters and, hence, determine the most likely distribution of
materials in the hydrocyclone. A parametric approach can be very attractive
for the ecient reconstruction of high quality images for processes that have
well understood behaviour. Clearly, care should be taken to ensure that the
starting assumptions about the process, in this case the location and stability
of the air core, are valid under all conditions.
Motivated by the possibility of learning good solutions and an anity
for improved speed via parallel computation, a number of neurally inspired
approaches have been considered for processing tomographic data. Most of
these, for instance [4951], are based on derivatives of conventional multilayer perceptrons and have been implemented in software and tested o-line.
Results are interesting, for limited data sets, but have not yet revealed significant benet over conventional techniques. In addition, the multi-layer
perceptron networks suer from extensive learning cycles, which often
yield rigid network congurations, in terms of connectivity, that are not
readily updated when conditions change. One approach [52], using a socalled weightless neural network which is eectively an exotic look-up
table, has been implemented in hardware and tested on-line using an ECT
system. Although this approach oers some potential improvement in
speed, the quality of the resulting images to date are no better than those
from simple linear back projection, and more eort is needed if signicant
advantage is to be realized.
A signicant development is the EIDORS (Electrical Impedance and
Diuse Optical Tomography Reconstruction Software) project [53]. This
312
aims to develop dedicated, open source, software for electrical impedance

and diuse optical tomography. Existing approaches tend to use commercial
tools for the forward problem, e.g. the Maxwell 3D package from Ansoft.
Naturally, such tools are general purpose and not necessarily optimized for
the specic demands of electrical tomography. Using EIDORS solutions can
be rapidly prototyped using a MATLAB environment and faster solutions
are facilitated using C coding. The main engines comprise object-oriented
libraries for linear algebra and nite element modelling. This environment is
being used to consider non-symmetrical arrangements of electrodes in three
dimensions to satisfy the requirements of many real industrial processes [77],
as described in section 10.4.3 below.
The area of reconstruction and analysis algorithms oers great promise
for the enhancement of electrical tomography and its applications, after a
long period in which hardware development has dominated. This work
will vary between incorporation of the complete physics of the problem
[54] and the engineering approach which exploits detailed knowledge of
the industrial process being measured.
10.4.
INDUSTRIAL APPLICATIONS OF ELECTRICAL

TOMOGRAPHY
Previous reviews have summarized early applications of electrical tomography [14]. Table 10.3 directs the reader to some interesting recent reports.
The following sections summarize developments in a number of contrasting
application areas. Much of the material has been extracted, with approval,
from earlier papers by the researchers involved. Rather than presenting
exhaustive lists, it is intended that reference to recent publications will
direct the reader to related earlier work. Criteria for selection of the applications presented here include progress towards industrial benet, contrasting
modalities, sensing challenge and on-going eort.
10.4.1.
Application of electrical resistance tomography technology to

pharmaceutical processes [95]
Ricard et al describe a collaborative project between GlaxoSmithKline

(GSK) and Imperial College London to evaluate the applicability of electrical resistance tomography (ERT) to pharmaceutical process development. A
3.5 litre, 150 mm diameter, glass reactor, located at GSK, has been tted with
64 electrodes arranged in four planes, as shown in gure 10.5.
The platinum electrodes were deposited in liquid layers and have high
chemical resistance with a thermal expansion coecient that matches the
walls of the reactor. A P2000 ERT system from Industrial Tomography
Systems Ltd. was used to acquire measurements and reconstruct images. The
313
Table 10.3. Recent reported applications of electrical tomography.

Process
Modality
Status
Bead milling [55]

Hydrocyclone monitoring [56]
Monitoring pressure ltration [57, 77]
Pneumatic conveying [58]
Density owmeter [35]
Nylon polymerization [28]
Onset of crystallization in steel production [59]
Nuclear waste site characterization [60]
Waste storage ponds [61]
Subsurface resistivity [62]
Leaks in buried pipes [29]
Flame monitoring [63]
Fluidized beds [64, 105]
Multi-phase ow [40, 107]
Bubble column dynamics [65, 103]
Pneumatic conveying [66, 100]
Mixing in a stirred vessel [67, 104]
Foam density distribution [68, 106]
Powder ow in a dipleg [69]
Belt conveyor [70]
Blast furnacehearth wall thickness [71]
Dust explosions [72]
Solid rocket propellant [73]
Metal solidication [74]
Paste extrusion [102]
Flow of molten steel [97]
Pneumatic conveying [100]
Imaging wet gas [101]
Slurry transport [108]
ECT
ERT
ERT
ECT
ECT
ERT
EMT
ERT
ERT
ERT
ERT
ECT
ECT
ERT
ECT, ERT
ECT
ERT
ERT, ECT
ECT
ECT
ERT
ECT
ECT
EMT
ERT
EMT
ECT
ECT
ERT
Industrial tests
Industrial tests
Industrial tests
Industrial tests
Industrial tests
Industrial tests
Industrial tests
Field tests
Field tests
Field tests
Field tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Laboratory tests
Theoretical
Laboratory tests
Industrials
Laboratory tests
Laboratory tests
Laboratory tests
reactor vessel and stirrer arrangements were designed to mimic those that might
typically be encountered in the pharmaceuticals industry. For instance, a
retreat curve impeller (RCI), similar to those tted in 50% of pilot plant
stirred tanks in GSK Chemical Development, has been studied. A schematic
of the impeller is shown in gure 10.6. All impellers were coated with PTFE
to prevent interference of the impeller with the electrical eld.
Mixing time is often used to assess quantitatively the blending performance of stirred tanks. It was decided to study t99 , which is the time required
to reach 99% of homogeneity. Using conductivity probes it is possible to
detect as many dierent values of the mixing time as there are probes in
the reactor. All those values are equally valid and represent the mixing
time at a particular location in the tank. A value of t99 over the whole
314
Figure 10.5.
Overall design of the ERT reactor.
tank can be obtained by combining all these local measurements. Its value
will vary with the increase in the number of probes until it reaches a plateau
where an increase in the number of probes has only a marginal eect.
Using the adjacent current strategy for the 64 electrode ERT sensor
described above, there are eectively 1264 non-intrusive electrical conductivity probes so that a much higher data density is obtained when recording the
distribution of a tracer compared with the traditional method of inserting
conductivity probes.
The tracer distribution images obtained from the mixing time experiments were compared with computational uid dynamics (CFD) results, as
Figure 10.6.
Overview of a glass lined steel vessel with a retreat curve impeller.
Figure 10.7.
315
Comparison between ERT and CFD tracer plots at selected timesteps.
shown in gure 10.7. The tracer is seen to cover a large proportion of the
surface before being ingested into the bulk. After it reaches the impeller a
well mixed zone emerges. The nal layer to be mixed lies between the well
mixed impeller zone and the surface. The results suggest that there is some
advantage to adding material close to the bae and working with a liquid
height equal to the impeller diameter. Although there is reasonable agreement a shift in time steps is observed between the images from ERT and
CFD. Two possible reasons are suggested to account for this discrepancy.
First, CFD evaluates mixing time over the whole bulk. Second, the CFD
software may be unable to model large eddy structures which are known
to have an impact on mixing time.
Observation of the oscillations of the electrical conductivity over 20
pixels after tracer addition allow t99 to be deduced. The stirrer speed was
varied over a range so that measurements took place in the turbulent ow
regime (Re > 1000 for the RCI). In general, the mixing time measurements
showed good reproducibility and followed the expected trend, i.e. mixing
time decreased when increasing stirrer speed. The data obtained were
compared with correlations available from the literature for liquid height
equal to tank diameter. Figure 10.8 shows good agreement with the correlation described by Nienow [96].
Conclusions from this work suggest that ERT shows promise for online control of process mixing performance, as well as eciency evaluation
and optimization of reactor geometries. Results show successful modelling
and analysis of pharmaceutical mixing processes. ERT is capable of oering
superior mixing time information for vessel characterization purposes
compared with existing techniques, and can also provide valuable data for
316
Figure 10.8.
Comparison of experimental data for mixing time with results of Nienow.
CFD validations. The authors plan for the work to evolve to an increased
level of process complexity with the study of multiphase, solid/liquid
systems.
10.4.2.
Imaging the ow prole of molten steel through a submerged

pouring nozzle [97]
Continuous casting, shown schematically in gure 10.9, is a process by which

molten steel is formed into semi-nished billets, blooms and slabs. Liquid
steel from the basic oxygen steelmaking (BOS) or electric arc furnace
(EAF) process, and subsequent secondary steelmaking, is transferred from
a ladle, via a refractory shroud, into the tundish. The tundish acts as a
reservoir, both for liquid steel delivery and removal of oxide inclusions. A
stopper rod or sliding gate is used to control the steel ow-rate into the
mould through a submerged entry nozzle (SEN). The SEN distributes the
steel within the mould, shrouds the liquid steel from the surrounding
environment and reduces air entrainment, thus preventing re-oxidation
and maintaining steel cleanliness. Primary solidication takes place in the
water-cooled copper mould, and casting powder is used on the surface to
protect against re-oxidation and serve as a lubricant in the passage of the
strand through the mould. Exiting the mould, the strand consists of a solid
outer shell surrounding a liquid core. This is continuously withdrawn
through a series of supporting rolls and banks of water sprays, where further
uniform cooling and solidication take place. The resulting cooled and
solidied strand is nally divided by cutting torches into pieces as required
for removal and further processing.
Figure 10.9.
317
Schematic of a continuous casting process.
In continuous casting, control of molten steel delivery through the

pouring nozzle is critical to ensure the stability of the meniscus and to
create the optimum ow patterns within the mould. These factors inuence
the surface quality and also the cleanliness of the cast steel product. Steel
ow through the nozzle can also be adversely aected by clogging within
the nozzle, which aects the internal geometry. This results in unstable asymmetric ow, which leads to entrainment of casting powder and inclusions and
inhomogeneous heat transfer within the casting mould. Nozzle clogging is a
particular problem when casting low-carbon aluminium-killed steels due to
the deposition of aluminium oxide non-metallic particles on the inside of
the nozzle wall and exit ports, and can be predicted by monitoring nozzleclogging factors including casting speed and mould level, or using sophisticated methods such as neural network models. There are a number of
methods that can be used to reduce and avoid nozzle clogging, but neither
the prediction of clogging nor the proposed remedial actions are totally
eective. At present, the metal level in the mould, which is maintained by
automatic ow control, is usually measured using electromagnetic or radioisotope metal level sensors in the mould.
Several possible ow regimes could exist within an SEN, examples of
which are annular ow (a stream with a central air gap), central stream
and bubbly ow (argon bubbles with the stream), with the possible transition
from one ow mode to the other during casting depending on the ow rate of
steel and gas for the given casting conditions. Therefore, an on-line ow
visualization approach, based on a rugged and inherently safe sensor,
would be highly desirable. Knowledge of the ow regime in the SEN
would enable improved control of conditions in this area of the caster.
318
The authors describe the application of electromagnetic tomography

(EMT) to the imaging of the ow prole of molten steel through a submerged
pouring nozzle, as shown schematically in gure 10.10. The hot casting trials
were undertaken at Corus Teesside Technology Centre.
The waveform generator outputs a 5 kHz sinusoidal current with variable magnitude, which is conditioned to produce both in-phase and phaseshifted d.c. components. The data acquisition unit allows each coil to be
selected for excitation and controls the gain selection for the induced voltage
amplication. The d.c. component of the induced voltage is selected from the
detection coils after demodulation. Sensitivity maps were created by direct
measurements using a 12.5 mm diameter copper rod in 37 locations to represent pixel perturbation. The SIRT (Simultaneous Increment Reconstruction
Technique) reconstruction algorithm was used to solve the inverse problem
and constraining is used to limit extreme values.
There are eight wound wire coils in the sensor, each of 50 turns and
50 mm diameter. The coils are spaced at 458 intervals around the periphery
of the SEN. The coils are air-cooled and the internal temperature is monitored. The sensor array was placed around a transparent quartz glass tube,
which was positioned o centre within a standard slab caster SEN and
connected to the EMT instrument through long thermal shielded cables.
Molten steel was supplied from a 4 tonne nominal capacity electric arc
furnace via a stoppered ladle to a tundish, and then passed to a pseudo casting mould via the glass tube to enable steel pouring to be simulated.
A selection of results is shown in gure 10.11. The images are shown in
sequence from left to right and then top to bottom with a common grey scale.
Two breaks in the pour, at approximately 60 and 140 s, are clearly visible, as
is a partially throttled ow at 59.18 s. These results were consistent with video
recording of an exposed section of the steel ow. The hot trial results
demonstrate that EMT images can reveal the changes of steel ow proles
through the SEN.
Tomography is important in this application because it demonstrates the
ability to measure real ows, but the steel producers are not really interested in
images. Full scale industrial implementation would require a simpler system,
with fewer coils and a GO/NO-GO output. An important practical point is
that the sensor cannot totally enclose the nozzle, as it must be possible to withdraw it quickly if something goes wrong.
10.4.3.
The application of electrical resistance tomography to a large

volume production pressure lter [57, 77]
Pressure ltration is a generic process operation applied across the chemical

industry for rapid, cost-eective separation and drying of a solid phase from
a liquid slurry. Existing instrumental techniques are inadequate for providing
both diagnostic information and measured variables on which to apply
Block diagram of the experimental system.
Figure 10.10.
319
320
Figure 10.11.
Images of molten steel ow proles through the SEN.
closed-loop control. This results in sub-optimal process settings, which are

designed to accommodate the worst-case conditions. The eect of this is
pervasive; at the very least there will be an extended pressure ltration
cycle time, which implies an inecient use of the asset. In addition, there
may be yield loss when processing an unstable intermediate product, poor
energy usage during elevated temperature drying, or additional environmental impact through excessive use of wash solvents.
To address these issues, Electrical Resistance Tomography (ERT) is
being developed to provide real-time information on:
end point of ltration and drying;
imperfections in the lter cake; and
. solvent displacement of the mother liquor.
.
.
As the lters operate in potentially explosive environments, it is necessary to

employ intrinsically safe equipment as described in section 10.2.5.
To gain credibility for ERT within manufacturing it was accepted, by
the project team, that a large-scale demonstrator would need to be
established. Economically this could only be achieved by retrotting to an
Figure 10.12.
321
36 m3 subject pressure lter.
existing production unit. A suitable 36 m3 asset was identied on the

Syngenta Hudderseld site (gure 10.12).
The scale of the unit is readily appreciated from consideration of the
doors on the left-hand side of the photograph. This unit is of metallic
construction, with a non-conductive lter cloth. As the vessel was not originally designed to accept ERT electrodes, an additional series of challenges
soon became apparent:
Electrode geometry: It was agreed with the plant management that the
pressure rating of the vessel could not be jeopardized by attempting to
machine into the wall of the unit. This led to the alternative option of
mounting the 24 electrodes in a planar arrangement above the lter
cloth. A photograph of the inside of the lter, tted with electrodes, is
shown in gure 10.13.
. Electrode design: To locate the electrodes above the lter cloth, it was
necessary to design an assembly that could be easily removed during
routine cloth replacement and which would be small enough to not aect
.
322
Figure 10.13.
Inside the 36 m3 lter.
the normal operation of the lter. The design has evolved to the mark IV
version, 50 mm diameter, as shown in gure 10.14.
. Materials of construction: In common with the majority of processes
operated within the chemical industry, the materials of construction of
the subject process unit were carefully selected to prevent erosion and
corrosion. The demonstration lter is predominantly hastelloy-C276, an
alloy of nickel, with a mesh fabricated from polypropylene. These
materials, together with PTFE, PVDF and viton, for the O-ring elastomer,
were used exclusively in the electrode assembly.
. Cable routing: The pressure vessel had no provision for additional anges
through which the 24 electrode cables could exit. Surprisingly, for such a
large vessel, the best solution involved routing the 24 cables through two
1 cm diameter air balance ports.
Figure 10.14.
Mark IV electrode detail for 36 m3 lter vessel.

.
323
Operational constraints: As the demonstration unit was also a manufacturing asset, access to get into the lter to t the electrodes was severely
restricted to an existing time window during the planned annual maintenance period. The eect of this was to limit the electrode installation
time to a four-day period each year. The usable resource was further
constrained as safety procedures dictated that to ensure a breathable
atmosphere within the vessel only two people could enter the unit at any
one time.
10.4.3.1.
Results
Figure 10.15 shows representative results that compare the level measurements of the ltrate in the vessel with the mean signal from the tomography
system. The eect of the slurry, acetic acid and water washes can be seen and
the tomographic measurements clearly track the process. The tomography
measurements lag behind the level measurements and it is reasonable to
assume that this is due to the time for the liquid to pass through the cake.
A simple algorithm, that assumes that the conductivity in regions of the
cake is reected by local measurements, has been used to provide a crude
estimation of the conductivity distribution. The cross-section is divided
into six regions and a representative image is shown in gure 10.16(a),
where the darker colour corresponds to a wetter region of the cake. The
time evolution of the wetness during a batch is also recorded, as shown in
gure 10.16(b). This and other information is available on a dedicated
web-site that is available on the Syngenta intranet. The information is
updated every 15 min and can be readily accessed by the plant operators.
The EIDORS 3D software toolsuite is being used to explore possibilities
for 3D image reconstruction. The model incorporates the vessel furniture,
such as hold-down bars and central metal pillar, and results using simulated
data are shown in gure 10.17. In this simulation two inhomogeneities
are introduced, representing above average and below average conductivity.
The reconstructed inhomogeneites are clearly visible in gure 10.17.
Unfortunately, eects due to the Zener barrier diodes in the intrinsically
safe instrument lead to diculties in reconstructing images from real
measurements and this aspect is currently under consideration.
The instrument has been operating on a continuous basis for about three
years. Results are repeatable and the electrodes are transparent to the
process. The main challenge is to deliver 3D images and this is being impeded
by the proliferation of metal current sinks in the vessel. Work is on-going to
produce an accurate forward model under these circumstances which will, in
turn, allow good images to be reconstructed. Subsequently, if the cost of
instruments can be signicantly reduced, then it is likely that the use of
the technology in related applications will spread and generate tangible
benets.
324
Figure 10.15.
Level and mean tomographic measurement during a batch.
(a) Cross-sectional image
(b) Batch chronology
Figure 10.16.
Cake wetness during a batch.
325
326
Figure 10.17.
10.4.4.
Reconstructions of simulated data using EIDORS 3D.
A novel tomographic ow analysis system [98]
Hunt et al describe a novel ow analysis system, Tomoow R100 ECT, which

uses twin-plane tomographic data to derive detailed pictures of the velocity
and concentration structure within complex two-phase ows. Initial results
have been obtained using electrical capacitance tomography (ECT), but
other modalities may also be used. By dening a set of contiguous zones
over the ow cross-section the full integration of owrate may be undertaken
and a mass owmeter created for two-phase systems. The system comprises
pipe-mounted sensor, data acquisition module, and control computer with
real-time and o-line ow imaging and analysis software for investigating
multiphase ows. The capacitance measurement unit is a high-speed design
from Process Tomography Ltd. with embedded PC, as described by Byars
and Pendleton [81].
Twin-plane sensors are used in conjunction with guard electrodes to
create two image planes that are separated axially along the ow. Each
Figure 10.18.
327
Gravity drop ow-rig schematic with detail of sensor on right.
plane is in fact a cylinder of nite length made up of 812 pixels on a 32 32

square. For eight-electrode systems, the cross-sectional ow is divided into
13 zones each containing approximately 62 pixels. The size of the zones is
consistent with the linear spatial resolution of ECT which is sometimes
quoted as D=ne , where ne is the number of electrodes circumferentially
around the pipe of diameter D. Within each zone the pixel values are averaged to give one concentration value per zone for each frame of data.
A simple gravity-drop ow is used to illustrate the level of detail that can
be obtained from ECT-based ow measurement. A funnel and cylindrical pipe
of 4.95 cm diameter were part-lled with a measured volume of plastic beads,
as shown in gure 10.18. The beads are retained by a ball valve above an ECT
sensor. The ECT system had been calibrated by lling successively with air and
then beads to give a concentration range from 0 to 1. When the valve is
opened the beads pass under gravity from the funnel through the sensor and
outlet.
Figure 10.19 shows the cross-sectional images for the two image planes
at times 3.126, 3.171 and 4.389 s. After the valve is opened a dense plug
of beads falls down the centre of the pipe between about 2.5 and 3.2 s.
The transit time of the last spike of concentration in the upper plane at
3.126 s can clearly be seen to arrive at the lower plane at 3.171 sa delay
328
Figure 10.19. Images at various times from the gravity-drop ow test. White represents
solids, black is air.
corresponding to the correlogram peak at 0.04 s within the frame rate

resolution of 0.005 s. Following this a trickle of beads continues for another
4 s or so until the funnel is empty.
The resulting correlogram, shown in gure 10.20, has a clearly discernible
peak if the ow structures are coherent over the sensor length and contains
information about the time domain statistics of the owprimarily convection and dispersion. The simplest assumption is that the time delay at the
peak of the correlogram corresponds to the transit time of ow structures
between the two planes. The peak may be found by the greatest single value,
centroid of area or polynomial tting. For these types of gravity particle
ow the authors found that polynomial tting gave the most consistent results,
though all the other techniques are available in the software. The time window
used for the correlation process needs to be shaped in some way to minimize
Figure 10.20.
Normalized correlogram.
329
Figure 10.21. Concentration (left-hand scale) and velocity (right-hand scale) against time
in centre zone.
artefacts caused by sharp-edged windows. This shaping is known as apodization and various apodization functions are programmed into the Tomoow
R100 ECT. The results presented here use the common Hanning window,
which is a smooth bell shape.
Figure 10.21 shows the concentration and velocity against time for the
central zone of a 13-zone map for a typical test with data acquisition of
200 frames per second. The dashed line shows the concentration in the rst
plane, light grey shows the concentration in the second plane and the
black line shows velocity.
The velocity of the plug starts at about 2.80 m/s, rising to about 3.70 m/s.
This speed increase is consistent with the fact that the lowest beads fall about
0.4 m before arriving at the upper plane of the sensor, while the upper beads
fall about 0.7 m. The beads falling from the funnel after the rst plug show a
steady velocity of about 3.70 m/s and though barely discernible in gure
10.19 the signals correlate well between the two planes, as shown in gure
10.21.
Integrating the whole ow period between 2 and 8 s gives an estimate of
volume of 2335 cm3 , compared with the actual value of 2379 cm3 within
2%. The plug between 2.5 and 3.2 s can be separately integrated and
shows a volume of 591 cm3 . This plug volume corresponds to a cylinder of
330
4.95 cm diameter and 30.7 cm length, which is the cylinder of beads from
the top of the valve to the top of the beads within the part-lled funnel, as
shown in lighter grey in gure 10.18. It appears then that as the valve is
opened the entire volume of the cylinder of beads supported by the valve,
both in the cylindrical section and within the funnel, drops as one accelerating mass down through the centre of the sensor. The remaining beads
within the funnel then trickle out in the manner of an egg-timer at a much
lower rate. An understanding of this type of behaviour will assist in the
design of industrial hoppers or silos, where many types of solids may be
dicult to discharge.
This work demonstrates the feasibility of making a owmeter for blown
and gravity-fed solids. A few technical challenges remain, for instance
calibration and varying moisture content of materials, but these are likely
to be solved in the near future. The main obstacle to implementing a full
scale commercial integrated owmeter is availability of capital on the 35
years scale to fund the large engineering programme to launch the product.
This would involve engineering design, integration of electronics, manufacturing route, marketing, distribution and servicing. The technical risk is
small, but the commercial risk is dicult to evaluate as there is not a current
market because such owmeters do not exist.
10.4.5.
Application of electrical capacitance tomography for measurement of

gas/solids ow characteristics in a pneumatic conveying system [100]
Applications of pneumatic conveying (i.e. the use of air for transporting

granular materials, such as our, coal, lime, plastic pellets, granular chemicals etc.) along pipelines date back as early as the mid-19th century. In
dilute (or lean) phase conveying, the particles are usually transported in
the form of a suspension with the solids concentrations typically below
10%. For dense-phase transport the pipe is lled with particles at one or
more cross-sections, and this mode has become increasingly popular since
1960s. It oers reduced air consumption, energy requirements and pipeline
attrition due to a low solids velocity. Previous studies show that the predominant mechanism for solids transport is due to ow instabilities referred
to as slugs and plugs. Jaworski and Dyakowski report the study of pneumatic conveying using twin-plane ECT, supported by high-speed video and
pressure measurements.
Figure 10.22 shows a schematic of the pneumatic conveying ow rig at
the Department of Chemical Engineering, UMIST. The rig measures about
7 m horizontally by 3 m vertically and the internal diameter of the stainless
steel pipe is 57 mm. Each tank has a capacity of 100 litres. On-line weighing
of the solids allows independent measurement of the mass ow rate of
solids for validation. The granules used are polyamide chips measuring
approximately 3 mm 3 mm 1 mm.
Schematic of UMIST dense-phase pneumatic conveying ow rig.
331
Figure 10.22.
332
Figure 10.23.
Design of the twin-plane ECT sensor.
Tomographic images were obtained using a twin-plane ECT system

from Process Tomography Ltd., capable of collecting up to 100 images/s
from both planes simultaneously. The twin-plane sensor shown
schematically in gure 10.23 is inserted in either a vertical or horizontal
section of the ow rig. High-speed video images, at 500 frames/s, were
recorded using an NAC 500 camera.
The experiments focused on relatively low gas velocities between 1.5 and
2.0 m s1 for an empty pipe. This was mainly dictated by the speed of data
acquisition of the ECT system and the spacing between the planes for the
existing sensor. The solids feed was between 700 and 900 kg h1 in order to
obtain well dened plug ow. Figure 10.24 shows a series of six photographs
illustrating the passage of two consecutive slugs in the horizontal pipe. These
images clearly illustrate some of the parameters of interest that are associated
with such slugs, such as height and density of slug and slope of leading and
trailing edges.
Figure 10.25 shows a time series of cross-sectional tomographic images
corresponding to the slug ow shown in gure 10.24. The rst seven images
show the transition between a half-lled and fully-lled pipe that corresponds
Figure 10.24.
Video images of slug ow in a horizontal pipe.
Figure 10.25.
333
ECT images of slug ow in a horizontal pipe.
to the passage of the slug front. Similarly, the last four images show the
passage of the slugs tail through the measurement plane.
The use of a twin plane system allows the shape of the slugs to be reconstructed, as shown in gure 10.25. The pixels lying along a vertical line
passing through the centre are selected from each frame. These are combined
to give a longitudinal cross-section of the slug, as shown in gure 10.26. Diculties associated with such images include limited spatial resolution in the
cross-sectional images, averaging of the concentration of solids along the
length of the electrodes and smearing of boundaries between phases.
If a model relating the dielectric permittivity to the bulk density is
known, it is possible to extract an average solids distribution from the
cross-sectional image. Using a simple linear relationship, the average
solids distribution is plotted in gure 10.27 as a function of frame number
Figure 10.26.
Axial reconstruction of horizontal slug ow.
334
Average solids concentration obtained from the tomograms.
Figure 10.27.
Figure 10.28.
vertical pipe.
335
Correlation results for upward and downward transport of solids in the
over a period of 40 s. It can be seen that the occurrence of plugs is

quasi-periodic.
In order to calculate solids mass ow rates, two interrelated points must
be addressed. First, the direction of the solids ow must be determined.
Second, the conveying velocity must be calculated. To achieve this, spectral
and correlation analysis of the signal obtained from the two planes of the
sensor was performed. Figure 10.28 shows that correlation can be used to
distinguish the direction of movement.
The solids mass ow rates that are calculated from the tomographic data
underestimate those obtained by weighing of the material by about 2030%.
Several issues for further research were identied by the authors:
The electrodes are of nite length and therefore it is not obvious which electrode distance should be taken for calculating the velocity of ow structures.
. For improved accuracy, cross-correlation analysis should be performed on
the pixel-by-pixel basis rather than for the whole cross section.
. The technique may be inappropriate for ow regimes which are close to
blocking the system. In this case, long plugs of almost stationary material
ll the sensor and render the cross-correlation techniques ineective.
. A more accurate estimate of the solids mass ow will use an improved model
of the relationship between material density and dielectric permittivity.
.
10.4.6.
Imaging wet gas separation process by capacitance tomography [101]
Natural gas from a well contains condensable materials, such as water and
hydrocarbons, which must be separated from the gas stream. Traditional
336
Figure 10.29.
wet gas.
Twister supersonic separator used to separate liquid components from
separation systems utilize glycol injection, JouleThompson valve and low

temperature operation. The problems with those systems are: the rotating
or moving parts require routine maintenance and possibly replacement;
such separation facilities are large, requiring signicant space, which may
be at a premium in some industrial locations, e.g. an oshore platform; the
operating cost can be high.
Twister is a revolutionary gas-conditioning processing unit that is
based on the combination of aero-dynamics, thermo-dynamics and uid
dynamics. A schematic is shown in gure 10.29. A Laval nozzle is used to
expand a gas stream to supersonic velocity, between 350 and 400 m/s, resulting in low temperature and low pressure. This causes nucleation and condensation of water and hydrocarbon droplets. An airfoil inside the tube causes
the ow to swirl, centrifuging the liquid droplets towards the tube wall,
which are then separated by a catcher system. The ow is then decelerated
and the pressure is recovered to about 70% of the initial pressure. The
process can be very ecient in energy usage.
Compared with the traditional gas-conditioning facilities, Twister has
several advantages: no chemical additions and hence no handling and
emission issues, no mechanical rotating parts, minimum space required
and low operating cost. An ECT system based on a commercial impedance
meter that is selectively connected to the electrodes has been designed to
investigate the performance of Twister and to validate CFD models. This
system is particularly sensitive to changes in permittivity. The measurement
frame rate is low, but is adequate for this application, in which the distribution of water droplets does not change rapidly for a given arrangement of the
experimental conditions.
A twin-plane ECT sensor that is compatible with the industrial environment has been constructed, as shown in gure 10.30. Each plane is 35 mm in
Figure 10.30.
337
Twin-plane ECT sensor.
diameter and has eight electrodes. The sensor is able to operate from 20 to
60 8C and pressure up to 150 bar. Ideally the sensor should be in direct
contact with the gas stream, but because of electrical insulation requirements
a very thin insulating layer has to be applied to the electrodes. In the present
design, a 0.5 mm PEEK inner sheath is used, to maintain high sensitivity.
Sensor 1 is located immediately down-stream of the airfoil. Sensor 2 is
located immediately up-stream of the vortex nder.
The sensor is calibrated using two materials having dierent, known,
permittivities to determine the wall capacitance and standing capacitance.
In this way the permittivity of a third material can be estimated. Experiments were conducted using an air/water ow Twister. Humidity was
varied from 20 to 95% and the temperature from 35 to 50 8C to obtain
dierent concentrations of water droplets. The linear back-projection
algorithm was used for rapid on-line monitoring and the Landweber iterative algorithm was used for more accurate o-line image reconstruction.
Figure 10.31 shows representative images using the iterative algorithm.
Without the airfoil water droplets are distributed almost uniformly over
the cross section of sensor. When the airfoil is in place, water is accumulated
on the walls of both sensors. Hollow cores of the vortex are suggested by the
dark regions.
338
(a) Without airfoil
(b) With airfoil
Figure 10.31.
10.5.
Images of water droplet distribution.
SUMMARY
Recent years have seen the beginning of a migration of the application of

electrical tomography systems from the University laboratory into industrial
environments. Simple sensors and compact electronic hardware are
particularly well suited to on-site measurements for on-line process monitoring and control. Both resistance and capacitance modalities are now
available commercially and true impedance tomography systems are beginning to emerge. Cost is low compared, for example, with x-ray tomography
or magnetic resonance imaging, and would reduce considerably in mass
Summary
339
production, especially with shrewd use of custom silicon. Many challenges

have been addressed successfully by prototype solutions that accommodate
metal walls, elevated temperature and pressure, reactive chemicals and
restricted access. Image resolution is still disappointing to those familiar
with nucleonic hard-eld systems, but new programmes of work are delivering mathematically driven solutions that promise signicant improvements.
However, the limited number of measurements means that without dramatic
technological developments the problem will remain severely underdetermined. Multi-modal systems are beginning to emerge which will provide
synchronized measurements from a variety of sensors, not necessarily
electrical, and these will benet from research into appropriate methods of
data fusion. Miniaturized tomography systems have not been considered
here, but progress is being made with the development of sensors that may
eventually prove invaluable for process intensication [78].
As the technology is in its second decade of evolution, it is incumbent to
oer reasons for the slow uptake by industry. Although reconstructed images
are relatively coarse, compared for instance with those from x-ray or
magnetic resonance, this is not perceived to be a limiting factor. In many
cases the low resolution is more than adequate to provide invaluable
information in a wide variety of processes. In fact it is not uncommon for
the images to be superuous to process operators as suggested by some of
the case studies above. Single parameters (e.g. void fraction, mass ow
rate, mixing time) that are better determined from knowledge of the physical
distribution of materials provided by tomographic measurements are often
the only requirement. Similarly, although extreme applications would
benet from imaging rates of thousands of frames/s, for instance monitoring
ame propagation in an internal combustion engine, there are many applications with much more modest requirements that can be easily satised with
current technology. An important factor discouraging the uptake of the
technology for production plant is the potential disruption to normal
operation. The continuous application to production pressure ltration
plant described above is, perhaps, the most advanced in this respect and
has successfully overcome many challenges, but this has only been possible
following a signicant and mutually sympathetic programme of collaboration.
Received wisdom suggests the predominant factor that is seriously
impeding uptake of the technology is the unavailability of attractively
priced instruments. It is frequently argued that both the potential benets
to be enjoyed from the use of tomography and the cost of the assets to
which they are applied are often considerable, and therefore a commensurate
cost for the instruments is justied. However, this naively overlooks the
mechanism that is frequently encountered when rst engaging industrialists
about the virtues of the technology. Typically, the company contact might
be a scientist, engineer or plant manager who can readily sanction modest
340
investment in exploratory studies. Crucially, it is suggested here that the

present cost of commercial electrical tomography instruments is above the
typical sanction limit for such investment. Larger amounts demand more
formal proposals to internal funding panels which consume time in both
preparation and evaluation of the case for support, and are frequently
unsuccessful due to the inevitable competition from other areas. This mitigates against the type of speculative industrial programmes that are essential
in order to verify the claimed benets for the technology. With the emergence
of lower cost instruments the uptake of the technology will be accelerated
dramatically. The resulting positive feedback will have the eect of reducing
production costs due to economies of scale, and this will be reected in
increased functionality to meet the diverse needs of a wider user base.
Market forces will prevent the instrument costs increasing again once the
applications base has been established. A related and very important issue
is open access to software such that users can readily explore new ways of
using the information-rich data that are available. Commercial instruments
have tended to deliver a xed functionality which doesnt encourage
imaginative exploration. Consequently, opportunities have been missed to
nurture the creativity of the tomographic community.
From the foregoing the case for provision of lower-priced instruments
with accessible software should be clear.
ACKNOWLEDGEMENTS
Many thanks to the following for approving the inclusion of their work and
for facilitating appropriate materials: Tom Dyakowski, Bruce Grieve, Andy
Hunt, Tony Peyton, Francois Ricard, Mi Wang and Wu Qiang Yang.
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Chapter 11
EIT: The view from Shefeld
D C Barber
11.1.
BEGINNINGS
This chapter is about how Sheeld came to be involved in electrical

impedance tomography and what we learnt as we went along. It is a personal
view of the development of EIT which has taken place in Sheeld over the
past two decades. Several people, especially Brian Brown, have contributed
to it and helped me to remember how the various stages in our understanding
of EIT evolved. However, the views expressed here are mine, especially those
concerning the viability of EIT, and are not necessarily shared by the many
colleagues who have worked on EIT in Sheeld and who have made so many
useful contributions to the subject. It has been a real pleasure to work with
them.
EIT in Sheeld started on a train journey from London to Sheeld that
Brian Brown and I took in 1980. Brian had been interested in using electrical
measurements of conductivity to determine fat to lean ratios in patients. For
all the usual reasons (electrode contact impedance etc.), it was clear that fourelectrode measurements would be needed. A single measurement would be
aected not only by the fat to lean ratio, but also the relative volume of
bone to soft tissue and the geometry of the patient, so it seemed that measurements of voltage at several sites would be useful. Since at that time Brian was
thinking about measuring the upper arm he argued that a useful solution
would be to place electrodes all around the arm and make a prole of
measurements using adjacent electrodes. Brian asked whether an image
could be formed. At the time I was interested in tomographic image reconstruction, and it seemed that an image might be formed using a modied
version of the back-projection algorithm used in other imaging modalities.
We agreed to try this out when we got back to Sheeld. As this was in the
days before widespread computer simulation (at least as far as we were
349
concerned), Brian immediately started to build a data collection device.

Things went quiet for a little while and then he came to see me to say the
data collection device was ready, and what about image reconstruction?
After a little panic I put something together based on back-projection, the
image reconstruction technique used in computed tomography (CT), and
we tried it out. The data were collected from a simple phantom made up
of an array of resistors. For simplicity this had been given a high degree of
symmetry, but when the image was reconstructed it was clear that the
image was not completely symmetric. When we went back to look at the
resistor network it was discovered that a wiring error had been made and
that the image had picked this up. This result convinced us that there was
something worth investigating.
11.2.
MAKING IMAGES: APPLIED POTENTIAL TOMOGRAPHY
Looking back on the very early days it was clear that there were many things
we did not know about. We did not know about ill-posed problems and
regularization. We did know about reciprocity, but initially did not appreciate
the fact that there were only a limited number of independent current patterns.
It is of course obvious that if you have N electrodes there are only N 1
independent current patterns, but it wasnt obvious to us (or at least to me)
then. So the rst system Brian built generated data using all current bipolar
patterns, from adjacent to 1808 apart. We did see the sense in back-projecting
along equipotentials, so these were constructed for all current patterns (in 2D
with a circular boundary and point electrodes) and everything was backprojected. With 16 electrodes there were 1920 measurements and all of them
were used [1, 2]. We continued to do this until Andrew Seagar contacted us
from New Zealand and pointed out that we only had 104 independent
measurements. The logic was impeccable and Andrew came to join us.
Andrews thesis [3] was a model of rigour and claried many things for us.
It also used distributed current patterns! It was also realistically pessimistic
about the likely image quality we could expect. This was an early introduction
to the idea of ill-posed problems. I still think it took some time before it really
settled in. I certainly remained optimistic about how much image quality might
be improved for a long time after Andrew left us (perhaps because he was not
there).
At the time we did not call the technique EIT but applied potential
tomography (APT) [4]. This was because our experience to date with electrophysiological measurements had been with internally generated signals
(EMG, ECG etc.), and in the case of APT the currents were applied from
outside. Once other groups had taken up EIT it became clear that this was
the favoured name for the technique and we converted to it, but it was
hard to drop the name APT locally.
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11.2.1.

Back-projection
We continued with back-projection. It seemed obvious that the appropriate

thing to do was to back-project the voltage measured between two electrodes
into the space between the equipotentials ending on those electrodes. The
analogy seemed straightforward. An x-ray beam integrates the attenuation
along the beam. The value obtained is that which would be obtained if the
attenuation was the same average value all the way along the beam. For
EIT, if the resistivity between the equipotentials uniformly changed, the
voltage measured would change by the same proportion. CT image reconstruction projects this data, or a ltered version of it, back along the beam.
We knew that in CT the boundary data was ltered before back-projection,
but, theoretically, ltering could also be done after back-projection of the
raw data, so we did not need to know the correct lter to start using backprojection. We knew that back-projection was not quite correct because
the equipotentials do not physically act as an x-ray beam. Nevertheless, if
we made appropriate conformal transformations on the data (this was in
2D of course) then the equipotentials became straight lines. In addition, if
we looked at the prole generated by a small point object in this transformed
space the peak of the prole was on a line normal to the boundary running
through the centre of the point, and the prole was symmetric about this
point. When the Fourier transform of this prole was taken it was clear
that what we were looking at was a bell-shaped boundary prole ltered
with a ramp lter, the lter used in CT reconstruction [5]. So nature was
doing the ltering in ltered-back-projection for us. We knew that the
width of the bell-shaped prole increased the deeper the point object was
placed, so resolution was clearly going to be depth dependent, but the
same was true of other tomographic imaging systems (e.g. gamma camera
systems), admittedly not quite so dramatically as with EIT, so this did not
worry us too much. This was exciting stu.
Figure 11.1 shows the equipotentials for a circular object with a dipole
current drive. A dipole drive is obtained theoretically by driving current
Figure 11.1.
Back-projection along equipotentials.
351
between a pair of adjacent electrodes and then moving these electrodes closer
and closer together, increasing the current as this is done to maintain the
voltage levels on the surface of the object. In the limit current input and
output (source and sink) are at the same point, which is dicult to realize
practically, but mathematically this is acceptable, just like any other
dipole. The equipotentials for a dipole drive were easy to compute and
formed the basis of our back-projection algorithm.
11.2.2.
Normalizing the data
We knew that simply back-projecting the voltage dierence was not correct.
We wanted to back-project a resistance value, and although the voltage
dierence between a pair of electrodes was dependent on the resistance
between the equipotentials, it was also dependent on the area between the
equipotentials. We knew we would have to normalize the data in some
way. The obvious way was to calculate the voltage between the two
electrodes when the resistance was some standard uniform value, measure
the equivalent voltage dierence on the object being imaged and then take
the ratio of these two values. Provided the current did not change, the
ratio of these values was the same as the ratio of the two resistances, the
standard value and the unknown value (assuming that the resistance changed
uniformly between the equipotentials), and so this value could be safely backprojected. Thus was born dierential imaging. A more subtle argument
convinced us that we should be back-projecting the logarithm of the ratio.
This could then be approximated by the ratio of the dierence in voltage
values divided by the reference value (or possibly the average of the
values). Since we were only equipped to deal with small changes in conductance (because the algorithm was linear), the dierence between log of ratios
or normalized dierences was of no real signicance.
There was one other feature which we added to the back-projection.
Simple back-projection clearly did not work very well near the edges of the
image being reconstructed. This was most obvious when reconstructing
point objects. Circular objects became elongated in a direction normal to
the boundary. The reason was not dicult to see if the equipotentials passing
through the object were inspected. At the boundary, all equipotentials are
normal to the boundary. Close to the boundary, the majority run in a direction close to the normal. But if we are going to be able to reconstruct the
point object accurately we need back-projections going through the object
in all directions. This is what happens in the CT algorithm. To make it
happen in EIT we need to give a larger weighting to those data projecting
along equipotentials at large angles to the normal to the boundary, and
smaller weights (because there are more of them) to those data backprojecting along equipotentials more parallel to the normal to the boundary.
We need isotropic back-projection. After some struggles with trigonometry
352
the appropriate weights were calculated and applied [5]. It was gratifying that
subsequently a much more rigorous analysis came up with the same result [6],
and in fact a subsequent analysis by us based on conformal transformations
(again this was all in 2D) provided a much simpler route to the weights [7].
With our initial approach to calculating the weights, it was only possible
to calculate weights for the case when the drive electrodes were adjacent,
and it was this fact that, from a reconstruction standpoint, dictated the use
of the adjacent drive conguration. Later it became possible to calculate
the weights for other bipolar drive congurations [7], but by then we had
moved on to other approaches to reconstruction. Fan-beam CT also uses a
weighted back-projection for similar reasons.
We knew that, by itself, the back-projection algorithm could not give
uniform resolution across the image. Resolution was always worst at the
centre, but improved as the point object being imaged moved towards the
boundary. Further analysis (again using conformal transforms based on
the work in Andrew Seagars thesis) produced a measure of the resolution
as a function of the distance of the point object from the centre. Clearly, if
the resolution was to be improved further we needed to perform some
image processing. Two approaches were tried. We found a radial transform
which (approximately) transformed the image into one with uniform resolution (the boundary went o to innity) and applied standard position
independent image lters, using fast Fourier transform (FFT) methods, to
improve resolution [5, 8]. The other approach constructed a simple
position-dependent enhancing lter and applied it to the image. This lter
was combined with the matrix used for back-projection to create a set of
reconstruction weights, and these weights went out with the rst APT
systems we produced. The decision to use this approach, rather than the
FFT method, was made largely on the basis of simplicity and speed. The
computer systems we were using were not very powerful. I am not sure I
would do the same today.
All the above was based on a linear model of reconstruction. We knew
that the problem was not linear, we knew that objects were 3D rather than
2D and did not have circular boundaries, and we knew that the equipotentials did not run through the object as though its resistance was uniform.
However, there was one overriding consideration which dictated our
choice of reconstruction methods and that was that we wanted to reconstruct
images using data taken from human subjects.
11.3.
DIFFERENTIAL IMAGING
In order to make the reconstruction method work for a general object, we

needed to have data from an object of uniform resistivity but with the
same shape and electrode placing. For simple phantoms (circular 2D
Dierential imaging
Figure 11.2.
353
First EIT image of an arm.
dishes of saline) we could possibly calculate this, but we did not have access
to and experience of nite element techniques then. If we had had such
methods, within the limits of our reconstruction algorithm, we could have,
in principle, produced images of the absolute distribution of resistivity. As
we had a Radiotherapy section within the department, we did have access
to techniques for making plastic moulds of parts of the body. In Radiotherapy these moulds are for patient immobilization, but in our case we
were looking for a copy of the body surface that we could ll with saline
to measure the reference data. We made a model of Rod Smallwoods arm
and inserted a ring of electrodes inside (drawing pins, points outwards!).
We then made a set of measurements on his arm, took his arm out, blanked
o the ends of the mould, lled it with saline and made a second set of
measurements. An image was reconstructed and turned out quite well, showing all the basic structures [2]. Figure 11.2 shows an example of the sort of
images we were able to obtain. These actually represented the rst absolute
images of human subjects, although the forearm was not an area of major
clinical interest! The bones could easily be seen (high resistivity is represented
by black) and possibly a layer of surface fat. We convinced ourselves we
could see other structures [2].
Although we considered this approach as a possible way of getting
images, it was obvious that it was not really practical. Attempts to directly
compute reference data were not very successful, but in the course of looking
at data from the head we did discover that images could be produced if we
concentrated on changes in resistivity. More importantly, we could also do
the same using data from the chest. So although static imaging was proving
dicult, it was possible to produce dynamic images from data which changed
over time and from then on, for many years, we focused on such imaging. We
354
eventually changed the name to dierential imaging, but the principles were
the same.
Dierential imaging was more than a convenience. The measured
voltages on the surface of an object are determined by the shape of the
object, the placing of the electrodes on the surface of the object and the
internal resistivity distribution. The rst two of these are usually dominant
and for successful reconstruction of resistivity distributions must be
accounted for in some way. As an example, the voltage dierence between
electrodes can be measured to 0.1% accuracy, and this sort of accuracy is
required if useful images are to be obtained. If electrodes are spaced
100 mm apart around a thorax, then a variation in positioning of 0.1 mm
will produce errors of 0.1%. So random electrode placement errors of
1 mm will produce measurement errors 10 times that due to noise [9]. We
felt that it was going to be dicult to determine electrode positions with
this accuracy. However, with dierential imaging this sort of error would
cancel out. This is discussed further in the Appendix.
The reconstruction algorithm also assumed that the electrode pairs were
equally spaced around a circular boundary. Now, in 2D, it can be shown that
all non-circular boundaries can be mapped to a circular boundary using a
conformal transformation. So any boundary with any electrode spacing
can be mapped on to the circle. The electrodes would no longer be placed
uniformly along this equivalent circular boundary, but provided we knew
where they were we could interpolate our data to that produced by electrodes
of uniform spacing. We developed an algorithm which would determine the
boundary shape (and electrode positions) from the measurements (to within
5% accuracy) [10] and an algorithm which would map the non-circular
boundary on to a circle [11], so we had the tools to convert all problems to
the ideal 2D case. Coupled with the use of dierential imaging to deal with
variations in electrode spacing, this went some way towards dealing with
the uncertainties in real data. Oddly enough we never followed this up. It
is dicult to recall the reasoning process which led us to put these results
to one side, but in part it was due to the realization that solving a 2D problem
was not the correct way to tackle 3D problems and partly because we thought
that we should be using a more principled approach to reconstruction,
namely the sensitivity matrix. When we had solved these problems it might
be appropriate to return to the ne details of shape correction. We knew
that, even if the above problems were solved, the assumption of uniform
resistivity for building the sensitivity matrix, or determining equipotentials
for back-projection, was going to run into diculties for situations (such
as the head) where there were signicant deviations from uniform resistivity,
so there were always going to be reconstruction artefacts. Putting in some
a priori information might help, but using this to determine the correct equipotentials and back-projecting along these equipotentials did not seem to
produce spatially correct images [12, 13], so a proper sensitivity matrix was
Collecting data
355
required. We were also being told, correctly, that our approach was only an
approximation, in the case of back-projection with little theoretical support,
and that better algorithms were available, based on sound principles, which
oered the prospect of accurate images of good resolution and that better
current patterns were available. Nevertheless, the dierential algorithm
was the only one to provide images of any quality from in vivo data. In
particular, it allowed us to collect data from 3D objects (humans) but
reconstruct images using a 2D algorithm. The images were not accurate
but looked sensible, and this was very encouraging.
Although there is only one physical property being measured, we can
talk about either resistivity or its reciprocal conductivity. When we moved
to the use of the sensitivity matrix rather than back-projection, the mathematics suggested that we should talk about conductibility, and from this
point on we produced images of changes in conductivity rather than changes
in resistivity.
We had started o by taking the ratio of the data before and after a
change of conductivity, and then the logarithm of the ratio (to get logarithms
of conductivity changes) and then the normalized dierence of the data. In
the limit of small changes in conductivity the last two data transforms
were equivalent. However, whereas our earlier analysis had supported the
view that we were imaging log changes in conductivity, the later sensitivity
matrix approach did not obviously support this view. This was not an
important issue in practice, but nevertheless continued to niggle away in
the background. Huw Griths continued to use ratios of logarithms [14]
and I now believe he was correct to do so. In fact the dierences between
these two approaches can be resolved quite easily. A reworking of the
Sheeld algorithm, including extension to complex data, is given in the
Appendix.
11.4.
COLLECTING DATA
From the beginning of our work we had put signicant eort into the
development of data collection equipment. The developmental approach
we took was heavily inuenced by the desire to collect data from patients,
which meant careful attention to the issues of safety and the problems
associated with electrode impedance, and the need to collect data quickly.
Although there have subsequently been several attempts to develop methods
of determining electrode impedance in vivo, we took the view that this was
not practically possible and that therefore all measurements would be
four-electrode, with current being driven between a pair of electrodes with
measurement of voltage between another pair. The need to collect data at
high speed, because we were looking at dynamic imaging, meant that the
data collection system had to be kept simple and robust.
356
11.4.1.

The mark 1
Following the prompting of the reconstruction algorithm, we opted for an

adjacent current drive conguration with voltage measurements between
adjacent electrodes. The same electrode pairs were used for driving current
and measuring voltages, though not at the same time, but arranging the
switching between driving and receiving without contaminating the received
voltage signals with contamination from the drive system was not trivial. It
was also important to ensure that the drive current was the same for all drive
congurations, or at least that its value could be measured and used to
correct the measured voltage values to those from a constant current. Even
small uctuations if uncorrected could produce artefacts. The mark 1 APT
system was the outcome of this eort. It supported 16 electrodes and could
collect a full set of 208 data measurements in 0.1 s, allowing 10 sets of data
to be collected each second. We knew from reciprocity that there were
only 104 independent measurements, but the fact that we were using adjacent
drive electrodes meant that we were able to compare sets of measurements
using reciprocity (driving between pair A and measuring the voltage between
pair B should be the same as driving the same current between pair B and
measuring the voltage between pair A) to check for data quality and
system stability. This was important for reliable collection of data from
human subjects. Later we added an option which dropped the reciprocal
set of data. This enabled the data collection rate to be increased to 24 data
sets/s, which allowed cardiac-related changes to be collected. In principle
the data collection conguration could be changed in this system. Selection
of drive and receive pairs was made though a lookup table of values stored
on a ROM. Changing this could alter, for example, the drive conguration
used, but we were committed to adjacent drive and so this was always
used. For well known reasons we used a.c. rather than d.c. current, and in
this device the current was at 50 kHz. The mark 1 machine, seen in gure
11.3, gave long and faithful service and found its way to many other institutions. It even appeared on Tomorrows World. We also produced a body
worn version of this system for the monitoring of uid shifts in astronauts
[15]. This was tested on parabolic ights over France. There is a long and
fascinating story behind the space EIT system, but it did y and brought
back results from the Russian space station MIR.
11.4.2.
The mark 2
The mark 1 machine was completely serial. A current pattern was applied
and the voltages between adjacent electrodes measured one after the other.
One clear improvement we could make was to collect the data in parallel.
We could only apply the current patterns one at a time, but there was no
reason why we could not collect the voltage data from each current pattern
Collecting data
Figure 11.3.
357
The mark 1 systemeven the student is now a professor!
in parallel. This was an important step forward. We could collect data much
faster. More importantly, we could spend more time collecting each data
value with improved signal to noise. The machine which did this for us
was the mark 2. Having decided to go parallel, we also decided to go digital.
Demodulation and processing of the signals was made completely digital,
which further improved the signal-to-noise ratio. Given that we could collect
a complete set of high quality data 25 times a second, we decided we needed
to reconstruct and display data at this rate, in other words to go for a realtime system. This could only be done with a simple matrix-based reconstruction algorithm, which of course we had. The reconstruction time on the mark
1 system, using by todays standards a very modest PC, was about 1 s, so
although we could collect data at much faster frame rates the data had to
be processed o-line. In the mark 2 system (gure 11.4) we decided to use
Figure 11.4.
Mark 2: our lowest noise and fastest system.
358
a recently developed processor called the transputer, which was fast enough
to implement the reconstruction within the time for data collection. The
novel feature of the transputer was that it was specically designed to be
linked together with other transputers to form an array of processors,
across which computations could be distributed. There was even a parallel
language, OCCAM, developed for it. We linked together four transputers:
one to acquire data, one to reconstruct the images, one to display the
images and one to manage the others. This was a cutting edge approach at
the time and worked remarkably well. Images of an insulating rod moving
in a tank of saline were a common demonstration. Perhaps one of the
most impressive and evocative sequences was the visualization of a stream
of water or concentrated saline poured into a tank of isotonic saline. Used
in dierential mode, the system allowed us to visualize in real time the
changes in conductivity in the heart as it moved through the cardiac cycle.
We still used a.c. current, but this time at 20 kHz. We used the mark 2 to
try to simultaneously identify ventilation defects in the lung by gating data
analysis to breathing, and perfusion defects by gating data analysis to the
cardiac cycle [16]. The aim was to try to detect pulmonary embolism. The
principle was sound, but technically it was very dicult.
11.4.3.
Limitations
For all the reasons given previously, the images were not very reliable. If we
took the electrodes o and replaced them on the patient we would not reliably
get the same images. If the patient moved signicantly between collecting the
reference data set and the second data set there would be artefacts in the
images. Unlike other imaging systems, images of nominally the same part of
the anatomy on two dierent subjects often looked very dierent from each
other. We could produce images of the lungs during respiration, and of the
heart, and obtain gastric emptying curves, but only the latter experiments
seemed to have any practical applications [17]. No one else was faring any
better. The problem was not one of reconstruction algorithms as such. By
this time we had moved on to reconstruction using sensitivity matrices. We
felt that the ad hoc nature of the back-projection algorithm precluded the
possibility of being able to signicantly improve the resolution using this technique. In addition, it was not obvious how this approach could be extended to
3D, which we were beginning to think about. We also wanted to try to improve
resolution by adding more electrodes104 measurements give an eective
pixel size of just under 10% of the image diameter and on a good day we
could obtain a resolution (in a phantom) with our 16-electrode system consistent with this result. With 64 electrodes we could expect to obtain an eective
pixel size of 3% of the image diameter, and if our object was a thorax we would
be talking about a resolution of the order of 1 cm, comparable with a gamma
camera. The problems around our assumptions of circularity were still there,
359
but resolution seemed a more pressing problem, and once we had dealt with
resolution we could return to the other issues.
11.5.
MULTIFREQUENCY IMAGES
We still had the problem of artefacts caused by movement between reference

and data, and there seemed no obvious way of dealing with this using a single
frequency of current. Things looked dierent if we added the dimension of
frequency to the data collection. It was well known that tissues were complex
conductors, the behaviour with frequency being fairly well described by the
ColeCole equation. If, instead of imaging changes of conductivity with
time, we imaged changes in conductivity with frequency, we could in principle
collect data without signicant patient movement and hence avoid movement
artefacts. In general we expected the changes of conductivity with frequency to
be smaller than those with time, although there might be situations where this
did not hold. We still did not know the underlying gross conductivity distribution so our sensitivity matrix would not be correct, but this issue had not been
an obvious problem in the past and did not worry us unduly. One additional
attraction of the multi-frequency approach was that it was possible, again in
principle, to construct an absolute image. One of the parameters of the
ColeCole equation is a characteristic frequency. By analysing the changes
with frequency of each pixel it is possible to extract the characteristic
frequency, and this had absolute units (s1 ). Other dimensionless parameters
could also be extracted. The negative side of using changes of conductivity
with frequency was that if they were small the measurements of these changes
would be sensitive to noise. In addition, the characteristic frequency could
have values up to 500 kHz, and to make measurements of it and the other
parameters it was necessary to collect data at frequencies up to and beyond
1 MHz. This proved technically challenging.
11.5.1.
The mark 3
We decided to build a third data acquisition system, the mark 3. This had 16
electrodes and could collect data at eight frequencies. Previous experience with
the marks 1 and 2 had identied the diculty of making measurements using
the same electrodes through which, at a dierent part of the data collection
cycle, current was owing. The electrodes had to be switched between a current
source and a high impedance voltage measurement system. We knew that this
would cause problems at higher frequencies because of capacitive eects in the
electronics. We therefore decided to separate the 16 electrodes into two
interleaved sets of eight electrodes each, one set for current drive (in adjacent
pairs) and the other set for voltage measurement, an approach used for
other reasons by other groups elsewhere. This simplied the electronics
360
considerably. For reasons largely of cost we reverted back to analogue signal

measurement. Making accurate measurements as the frequency increases
becomes increasingly dicult because of capacitive eects within the cables
connecting the electrodes to the equipment. We used coaxial cables in the
marks 1 and 2, with the outer conductor being actively driven to the same
voltage as the core conductor, i.e. the conductor connected to the electrode.
This minimized capacitive eects by shielding the core from the environment,
eliminating capacitive current leaks to the environment and allowing the
voltage on the core to nd its correct value. However, this was not perfect
and some leakage between cables was still possible, especially at high frequencies. We decided to deal with this by having some coaxial cable made with two
coaxial outer conductors, which we somewhat incorrectly called tri-axial
cable. The core was connected to the electrode, the next layer of conductor
was driven as before and the outer layer was grounded to earth. This extra
layer provided the shielding we needed to reduce capacitive eects to a low
level. As current was passed through a drive pair, data was collected in parallel
over all eight receive pairs and at eight frequencies, and we produced some
sensible images [18]. We only had 49 independent measurements from this
conguration, which actually made the image reconstruction problem quite
well-conditioned. Although we used a sensitivity matrix approach, for reasons
which are still not clear to me the reliability of the image data was not as good
as we had hoped it would be. The images from the interleaved conguration
seemed to contain more artefacts than from the original adjacent drive receive
conguration. We were never able to resolve this problem. Figure 11.5 shows
images collected from this system. Brian Brown did subsequently manage to
use the mark 3 to obtain static images without using multi-frequency data
[19]. He collected thorax data from normal subjects and subjects suering
from emphysema. He was able to produce an average reference image from
the normal subjects and reconstruct the data from abnormal subjects using
the mean normal as a reference. This produced good results and demonstrated
Figure 11.5. Multi-frequency images. Each of these is a dierential (inspiration, expiration) image at the named frequency.
361
that the diculties of constructing static images from in vivo data might not be
as dicult as I had always supposed, at least for well-conditioned systems.
11.5.2.
Marks 3a and 3b
This machine became the mark 3a because we were still interested in the
possibility of high resolution and so, having used the 3a as a test bed for
the electronics, we built a 64-electrode system, the mark 3b. This gave us,
in principle, 961 independent measurements which should have delivered
three times the resolution of the marks 1 and 2. This, of course, turned out
to be wishful thinking, but this system did enable us to explore 3D imaging
(more on this below), although it had not been explicitly designed for this and
was not completely optimal for the purpose.
Finally, we developed the mark 3.5 (gure 11.6). In this minimalist
system we reduced the number of electrodes to eight (largely because we
were planning to work with neonates), returned to the idea of using the
same electrodes for current drive and voltage measurement, and expanded
the number of frequencies to 30 in order to determine the ColeCole
Figure 11.6. Mark 3.5 eight-electrode multi-frequency system applied to a neonate. A

functional lung imageshowing only the regions that are ventilatedobtained from a
one-day-old child using the mark 3.5 system.
362
Figure 11.7. Data collected of absolute lung resistivity from 155 normal infants over the
rst three years of life.
parameters more accurately. We stayed with the triaxial cables from the
mark 3 because they improved accuracy at high frequencies. The number
of independent measurements is 20, which removed all worries about conditioning, and we have used this system to obtain some interesting results on
Figure 11.8.
Adult dynamic lung image obtained from eight electrodes.
The third dimension
363
neonatal lung development. In particular we have been able to use these data
to determine the absolute conductivity of lung tissue. This was done using a
model of the thorax. By treating the lung conductivity as a free parameter it is
possible to determine the absolute conductivity of the lung as a function of
frequency. This allowed us to follow the way the impedance spectra of the
lungs changes with age (gure 11.7), and hence quantify the relation between
lung composition and impedance spectra. This approach brings us back to
the original idea which stimulated our interest in EIT, the determination of
body composition (the fat to lean ratio). The system could collect data
from adults as well as neonates (gure 11.8).
I suspect the eight-electrode multi-frequency conguration is probably
close to the optimum for practical 2D EIT.
11.6.
THE THIRD DIMENSION
All our work so far had been concerned with 2D imaging, or treating dierential image data as though it was from 2D objects. We knew that this was
not strictly justied. The mark 3b had sucient electrodes to allow us to
collect data over the surface of an object. We concentrated on a 3D conguration consisting of four layers of 16 electrodes, again with an interleaved
pattern on each layer (gure 11.9). This conguration worked well, even
Figure 11.9. Three-dimensional data collection. The images are dierential ventilation
images at eight levels through the chest.
364
though, because the mark 3b had been designed for 2D use, we were not able
to take full advantage of the benets of driving and collecting between layers.
Peter Metherall developed a 3D version of the reconstruction algorithm, and
demonstrated 3D dierential images and images at dierent frequencies.
This work resulted in a paper in Nature [20]. We collected data from the
chest and were able to reconstruct reasonable 3D images of respiration
and cardiac activity, but did not go on to explore other truly 3D geometries,
for example those that might be associated with the breast. Connecting many
electrodes to a patient was not a fast or reliable thing to do, and only a
limited amount of 3D in vivo data was collected. In addition, the dierential
algorithm can run into a problem in 3D which is not found in 2D. The data
used for reconstruction are based on the ratio of two data sets. For 2D data,
at least theoretically, all data have a non-zero value. However, in the case of
3D data it is possible for some data to be truly zero. This can arise, for
example, when the drive electrode pair and the receive electrode pair are
orthogonal to each other. Taking ratios of such zero or near-zero data can
produce large reconstruction errors. With absolute imaging this should not
be a problem, but with dierential imaging it could be quite serious. In practice we identied drive/receive combinations which suered from this
problem, and did not use the data from these when we reconstructed the
images.
11.7.
CLINICAL STUDIES
We have performed various clinical studies using EIT. Perhaps the most
successful were gastric emptying studies, since it did seem possible that
EIT could be used clinically for measuring the rate of gastric emptying without the need for ionizing radiation, especially for paediatric subjects [21]. We
also investigated the use of EIT for lung disease [22], including PE. However,
the technique has not proved robust or reliable enough to be useful for
routine clinical investigation. The multi-frequency work and the measurement of absolute lung conductivity oers some insights into the development
of the neonatal lung [2325]. Absolute conductivity can be used to determine
lung density and air volume. The major use of this appears to be in measuring
lung water and in controlling levels of lung positive pressure when ventilators
are in use. This work has pointed the way to tissue characterization via multifrequency measurements, and Brian Brown has shown how such measurements may be used to dierentiate between normal and diseased cervical
tissue [26]. This may represent the best opportunity so far for impedance
measurements to make a clinical impact, although imaging has not been
used in this work to date. Other groups are also investigating clinical applications and the epilepsy work of the UCL group is particularly interesting,
but formidable technical challenges still remain.

11.8.
365
WHAT WE HAVE LEARNED
I would like to take stock of what I see as the present state of EIT. Medical
EIT as an imaging procedure still represents a signicant technical challenge.
Progress seems slow. The success of EIT depends on the quality of image
reconstruction and it seems to me that no really signicantly new improvements in reconstruction have been published since the mid 1990s. I think it
is possible to draw some general conclusions about the state of EIT at present
and oer them here.
11.8.1.
High resolution imaging is not possible
The reasons are well understood. Reconstruction of images from boundary

voltage data is a very ill-posed problem. This means that, for any set of
measurements, no matter what current patterns are used, there are many
conductivity distributions diering signicantly from each other which can
generate these measurement, within the limits set by noise. If we could
measure the voltages with perfect precision then there would only be one
conductivity distribution which could generate these voltages (provided
there are no anisotropic regions), but the moment noise is introduced this
uniqueness breaks down dramatically. If we try to solve the inverse problem
in order to reconstruct the conductivity, then we will end up with a distribution which is likely to be signicantly (catastrophically) dierent from the
true one.
How can we improve this situation? The standard approach, and as far
as we are aware the only approach, is to try to select from all the possible
solutions the one which satises some reasonable constraintsalso known
as regularization. A common constraint is that the conductivity distribution
is smooth (apart from some sharp changes at conductivity boundaries).
Another constraint applicable to EIT is that the conductivity values are
non-zero.
These constraints can improve performance beyond that obtainable by
simple unconstrained methods, but largely by making the image appear
smooth. There has been little evidence of signicant improvements in
resolution using these methods. Another potentially useful constraint is
prior anatomical information. In the limiting case, if we know that the
conductivity in dened anatomical regions is uniform, and we have sucient
anatomical information to dene these regions and there are only a limited
number of them, then the reconstruction problem can become quite well
posed. In this case we might usefully obtain quantitative information
about bulk organ conductivity properties, as is the case for lung conductivity
described above. In general, however ingenious the constraint or constraints
(apart from using the correct answer as the constraint!), the EIT problem is
suciently ill-posed to prohibit high resolution solutions. In particular,
366
high resolution at the centre of an object cannot be achieved. This is not

because of failure to understand the mathematics of reconstruction, or
insucient ingenuity or computing power, but because nature has made it
that way.
11.8.2.
Making reliable in vivo measurements is dicult
The second thing we have learnt is that making reliable measurements on

human subjects is dicult. If reconstruction is to be possible we not only
need to know the value of a voltage measurement, but exactly where on
the surface of the object it was made. We can measure the voltages with
good accuracy, but we generally do not know with sucient accuracy
where the electrodes are or the shape of the skin boundary. This lack of
knowledge is a form of noise which can easily swamp electronic noise in
magnitude. Even with dierential methods these eects make images unreliable in that nominally similar images collected from the same subject at
dierent times can look very dierent. This may not be such a problem in
applications where the geometry and electrode positions are xed, for
example imaging the contents of pipes or process vessels. We spent some
eort devising methods of placing electrodes reliably on human subjects
and some of them worked quite well, but even with the spacing between
electrodes reasonably well controlled there were still sucient uncertainties
present to compromise image quality. Without detailed information about
the boundary shape and electrode positions, iterative absolute reconstructions do not really stand a chance of doing anything useful. Recently spatial
positioning devices have been used to determine electrode positions and
generic (and ultimately patient specic) FE models can be used to provide
a more accurate sensitivity matrix, but accuracy of prediction of voltage
values still remains a key issue. The best hope is probably dierential
imaging, based on a sensitivity matrix derived from a good model of the
expected underlying conductivity distribution. Absolute imaging is probably
going to remain dicult to achieve with clinical data, although measurement
of the mean conductivity of the larger organs looks possible.
11.8.3.
Humans are 3D
Most reconstruction algorithms which have appeared in the literature are

2D. We produced a 3D imaging system and a 3D (dierential) reconstruction
algorithm, and produced images from in vivo data, but most images from
human subjects (including our own) are from 2D data collection and reconstruction. If the sensitivity matrix is based on a 2D model, these cannot be
correct. If putting 2D sets of electrodes on a human subject is tedious, putting
3D sets on is even worse.

11.8.4.
367
What do we need to do?
So where does this leave medical EIT? We believe it leaves us with the need
to clearly formulate what problems can be solved. We have to nd clinical
problems which we can solve with robust methods, and then apply those
methods properly. To achieve robust reconstructions in the presence of
random noise and positioning uncertainties, we have to work within the
constraints of a well-posed problem, and the simplest way to do this is
to reduce the number of electrodes. To illustrate this point consider the
case of a 16-electrode 2D system. With an adjacent drive conguration
the condition number is >105 , which is far too large for reliable reconstruction. If we restrict ourselves to condition numbers of 100 then we
can only use 50 of the singular values, i.e. reconstruct images with 50
independent pixels. A 12-electrode adjacent drive system has 54 degrees
of freedom, which would bring it close to the margin. An eight-electrode
system has only 20 degrees of freedom but a condition number of 30.
Data collection and reconstruction with such a system, whilst of poor
resolution, should be relatively robust, and this has been conrmed with
the mark 3.5.
11.8.5.
Some suggestions
(a) If possible, use a sensitivity matrix derived from an actual 3D model.

Whether this is an appropriate thing to do requires some work, but
FE systems are fast enough to make this feasible on a patient-by-patient
basis. Know where your electrodes are.
(b) Concentrate on multi-frequency imaging. This removes some of the
problems of patient movement provided data collection is fast enough
and keeps the reconstruction problem fairly linear. Collect a reasonable
number of frequencies.
(c) Choose a signicant but possibly solvable clinical problem. The best
candidates to date in my opinion are probably the breast and the
lungs. Breast cancer presents a signicant diagnostic problem, especially
in younger women; the geometry can be xed, xed electrode position
applicators can be designed, and 3D hemispheric placement of electrodes can be used. Making full use of 3D imaging and multi-frequency
methods may help to distinguish normal from abnormal tissue, even if
resolution is compromised. This simple and interesting 3D geometry
does not appear to have been analysed in any detail. If I were going
back into EIT this is the clinical application I would concentrate on.
The lungs have the advantage of being large and of having an impedance
spectrum which is clearly determined by composition. The staging of
lung development in neonates and the distribution of lung water in
adults are areas of clinical need.
368
(d) Test out EIT with anatomically realistic models. There are plenty of
image data around to build such models and many have been built.
There are sucient data on the electrical properties of tissue to allow
physically realistic models to be built and good 3D FE software to
solve them. Demonstration of images derived from such models
would have far greater impact than yet another set of images derived
from a 2D circular mesh!
11.9.
THE FUTURE OF MEDICAL EIT
In the form that it has taken so far, it seems unlikely that EIT will be a major
routine clinical tool. Having said that, there are at least two commercial EIT
systems: Transcan (Siemens) for breast imaging and our own eight-electrode
system (Maltron). The most likely applications, in my view, are the breast
and lungs, and if signicant progress could be made in these areas then
EIT might have a future. EIT has been a rich source of funding and research
projects, it has certainly improved greatly our understanding of what determines the impedance of tissue and has furthered many an academic career.
These are valuable aims in themselves, but EIT shows no evidence of
achieving its other goal, which is to provide support for routine health
care. Credibility is wearing thin and it is time to realize some of the promises
made over the past 20 years, or close the shop.
APPENDIX. THE SHEFFIELD ALGORITHM REVISITED

Approximations and the dierential algorithm
A simplied model of EIT used by us assumed that current is applied through
a drive dipole with strength md . Similarly, measurements are made using
receive dipoles of strength mr . The measured signal is given by
gpr ; pd md mr A pr ; pd ; :
A1
The equation separates dipole positions from dipole strength (related to

electrode spacing). In principle, we can solve this equation provided we
know the dipole positions and strengths, and can compute A. However, if
a small change in conductivity occurs, we can write
gpr ; pd md mr
@Apr ; pd ;
@
A2
and by forming
gpr ; pd
@Apr ; pd ; =@

g pr ; pd
A pr ; pd ;
A3
Appendix. The Sheeld algorithm revisited
369
we have eliminated the dipole strengths. In practice, we drive current and

measure voltage gradients using pairs of electrodes which approximate
dipoles. The dipole strength mr will depend at least on the spacing of the
electrode pair and shape of the electrodes, and any small (random) variations
in spacing between the electrodes will produce errors in g larger than the
noise on this signal. A direct use of this model (equation (A1)) to compute
will be compromised by the uncertainties in md and mr , especially the
latter. The dierential approach eliminates the eects of the dipole magnitudes since these are the same (at least we assume they are) for data collected
before and after a conductivity change occurs. This approach assumes that
we can calculate A reasonably accurately with an appropriate model, and
any other eects dicult to model accurately (such as electrode shape) will
be absorbed into the dipole strengths. A dierential algorithm is still
needed, but reliable images of changes, given A, should be possible.
We took the process further than this. We knew that the magnitude of
the signal is dominated by the shape of the object and where the dipoles
are placed, and is only relatively weakly aected by the conductivity distribution. We assumed
gpr ; pd md mr A pr ; pd ; md mr B pr ; pd h p_ r ; p_ d ;
A4
where B is a function which is only dependent on the shape of the object and
the position of the electrodes, and h is a function which, although dependent
on the position of the dipoles and the conductivity distribution, is (hopefully)
less dependent on shape than A. The dipole position parameters in h are
dotted to reect the fact that they are the true positions mapped in some
way to t h. Then as before
g pr ; pd
@h p_ r ; p_ d ; =@

gpr ; pd
h p_ r ; p_ d ;
A5
@h p_ r ; p_ d ; =@=h pr ; pd ; is still dependent on the position of the dipoles,

but we hoped that if we constructed this function using a simple 2D circular
model with equally spaced dipoles, the eect on the image would be at worst
a smooth distortion of the image. For 2D objects, conformal transform
theory gave us some justication for this approach. Of course we had no
theoretical justication for using this approach to reconstruct 2D images
from 3D data. However, experimentally we know this approximation
worked as it was possible to construct useful images from 3D data.
The Sheeld algorithm, by which I mean an adjacent drive/receive dierential reconstruction algorithm, has been the only algorithm to reliably (or
fairly reliably) obtain images from in vivo data. In our hands it has gone
370
through several variations, as outlined previously, but theoretically has

settled down. I want to give in this section an outline of how I would
derive the algorithm if I were starting from what I know now, and show
why Griths et al [14] were right in continuing to use the logarithm of the
voltage ratios rather than the normalized dierences that we used when we
moved to a sensitivity matrix approach. There will be an assumption in
what follows that an adjacent drive conguration is being used. This is not
critical, but the analysis is restricted to bipolar drive congurations with
voltage measurements being made between adjacent electrodes. The voltage
vector g is a vector of such adjacent voltage dierences. Then changes in
conductivity c are related to changes in measured boundary voltages g by
g Sc
A6
where the elements of S are obtained from the Gezelowitz reciprocity

theorem. An element of the sensitivity matrix is @gj =@ci Sij . S is in principle
computed for the distribution cref about which changes are occurring, the
reference distribution. As c changes S changes. The linearity assumption is
that changes in S can be ignored provided the changes in conductivity are
suciently small.
g is still sensitive to electrode spacing errors, but logg is not since
the subtraction is replaced by a division. A relationship which should avoid
electrode spacing errors (dipole magnitude), but not electrode position errors
(dipole position), is
log g F log c:
A7
We obtain an element of the new sensitivity matrix F by writing

@ loggj @ loggj @gj
@ci
1
Sij ci Fij :
@ logci
@gj
@ci @ logci gj
A8
Equation (A7) relates changes in the logarithm of the boundary values as the
conductivity changes from some reference value to changes in the logarithm
of conductivity values. In previous work we approximated logg by
g=gref , and this approach also ignored the contribution of c in the construction of F. In all our work we had constructed F for uniform reference distribution, so in practice the F we used was the same as the F above, apart from a
scaling factor. Equation (A7) represents a generalization of the Sheeld
algorithm to nonlinear reference distributions.
Complex data
In general, S will be complex. Dehghani has shown that S, for the case of
uniform but complex conductivity, can be written as
S S
A9
References
371
where S is the sensitivity for the real uniform case and is a complex
constant. If we multiply S by the uniform c c, where c is real and
is also a complex constant, then
g Sc g:
1=gj Sij ci
A10
Fij . When g , c and S are substiNow for the complex case

tuted into this equation the complex terms cancel out, producing an F
which is real even though the underlying (uniform) reference distribution is
complex. Thus, if the reference distribution is uniform, we can use a real
matrix F, the matrix derived for a real uniform conductivity distribution.
We can compare the above algorithm with that described by Griths
et al [14] for reconstructing images from complex data. They take the log
ratio of the two sets of data and back-project this, stating that the result is
the ratio of two complex conductivity values. The back-projection operator
they use is, eectively, an approximation to an inverse sensitivity matrix. It is
a real rather than a complex operator, but our result above gives some
legitimacy to this operation. In addition, inspection of the columns of F
shows that they bear many similarities to a back-projection operator,
albeit with some additional ltering eects.
REFERENCES
[1] Barber D C, Brown B H and Freestone I L 1983 Imaging spatial distributions of resistivity using applied potential tomography (APT), in Proceedings of 8th Conference
Information Processing in Medical Imaging ed F Deconinck (Dordrecht: Martinus
Nijho ) 446462
[2] Barber D C, Brown B H and Freestone I F 1983 Experimental results of electrical
impedance tomography, in Proceedings of the 6th International Conference on Electical
Bio-impedance, Zadar, Yugoslavia, Medical Jadertina XV: Supplementary Issue 15
[3] Seagar A D 1983 Probing with low frequency electric currents, PhD thesis, University
of Canterbury, Christchurch, NZ
[4] Barber D C and Brown B H 1984 Applied potential tomography J. Phys. E: Sci.
Instrum. 17 723733
[5] Barber D C and Brown B H 1986 Recent developments in applied potential tomography, in Proceedings of 9th Conference on Information Processing in Medical Imaging
ed S Bacharach (Dordrecht: Martinus Nijho) 106121
[6] Santosa F and Vogelius M 1988 A back-projection algorithm for electrical impedance
imaging. Technical note BN-1081, Department of Mathematics, University of
Maryland, College Park, MD 20742, USA
[7] Barber D C Image Reconstruction in Applied Potential TomographyElectrical
Impedance Tomography INSERM, Unite 305, Toulouse, France.
[8] Barber D C and Seagar A D 1987 Fast reconstruction of resistance images Clin. Phys.
Physiol. Meas. 8 Suppl. 2A 4754
[9] Barber D C and Brown B H 1988 Errors in reconstruction using linear reconstruction
techniques Clin. Phys. Physiol. Meas. 9 Suppl A 101104
372
[10] Kiber M A and Barber D C 1991 Estimation of boundary shape from the voltage
gradient measurements, in Proc. Electrical Impedance Tomography, Copenhagen,
University of Sheeld, 5259
[11] Barber D C and Brown B H 1991 Shape correction in APT image reconstruction, in
Proc. Electrical Impedance Tomography, Copenhagen, University of Sheeld 4451
[12] Avis N J, Barber D C, Brown B H and Kiber M A 1992 Back-projection distortions in
applied potential tomography images due to non-uniform reference conductivity
distributions Clin. Phys. Physiol. Meas. 13 Suppl A 113117
[13] Avis N J, Barber D C, Brown B H and Kiber M A 1991 Distortions in applied potential tomographic images due to non-uniform reference distributions Proc. IEEE
EMBS 13 2021
[14] Griths H, Leung H T and Williams R 1992 Imaging the complex impedance of the
thorax Clin. Phys. Physiol. Meas. 13 Suppl. A 7781
[15] Brown B H, Lindley E, Knowles R and Wilson A J 1990 A body-worn APT system
for space use, in Proc. Electrical Impedance Tomography, Copenhagen, University of
Sheeld 162167
[16] Brown B H, Sinton A M, Barber D C, Leathard A D and McArdle F J 1992 Simultaneous display of lung ventilation and perfusion on a real-time EIT system, in Proc.
14th Ann. Conf. IEEE EMBS, Paris 17101711
[17] Avill R, Mangnall Y F, Bird N C, Brown B H, Barber D C, Seagar A D, Johnson A G
and Read N W 1987 Applied potential tomography: A new non-invasive technique
for measuring gastric emptying Gastroenterology 92 10191026
[18] Brown B H, Barber D C, Wang W, Lu L, Leathard A D, Smallwood R H, Hampshire
A R, Mackay R and Hatzigalanis K 1994 Multi-frequency imaging and modelling of
respiratory related impedance changes Physiol. Meas. 15 Suppl. 2A 111
[19] Noble T J, Morice A H, Channer K S, Milnes P, Harris N and Brown B H 1999 Monitoring patients with left ventricular failure by electrical impedance tomography Eur.
J. Heart Failure 1 379384
[20] Metherall P, Barber D C, Smallwood R H and Brown B H 1996 Three-dimensional
electrical impedance tomography Nature 380(6574) 509512
[21] Lamont G L, Wright J W, Evans D F and Kapila L 1988 An evaluation of applied
potential tomography in the diagnosis of infantile hypertrophic pyloric stenosis
Clin. Phys. and Physiol. Meas. 9 Suppl. A 6569
[22] Campbell J H, Harris N D, Zhang F, Brown B H and Morice A H 1994 Clinical applications of electrical impedance tomography in the monitoring of changes in intrathoracic uid volumes Physiol. Meas. 15 Suppl. 2A 217222
[23] Hampshire A R, Smallwood R H, Brown B H and Primhak R A 1995 Multifrequency
and parametric EIT images of neonatal lungs Physiol. Meas. 16 Suppl. 3A 175189
[24] Brown B H, Primhak R A, Smallwood R H, Milnes P, Narracott A J and Jackson M J
2002 Neonatal lungscan absolute lung resistivity be determined non-invasively?
Med. Biol. Eng. 40 388394
[25] Brown B H, Primhak R A, Smallwood R H, Milnes P, Narracott A J and Jackson M J
2002 Neonatal lungsmaturational changes in lung resistivity spectra Med. Biol.
Eng. 40 506511
[26] Brown B H, Tidy J, Boston K, Blackett A D, Smallwood R H and Sharp F 2000 The
relationship between tissue structure and imposed electrical current ow in cervical
neoplasia The Lancet 355 892895
Chapter 12
EIT for medical applications at Oxford
Brookes 19852003
C McLeod
The origins of the developments in EIT at Oxford Brookes University are in

the shared interests of Lionel Tarassenko and Mike Pidcock around 1984.
Lionela bioengineer in the Department of Paediatrics at Oxford Universitywas studying methods of detecting intraventricular haemorrhage in
neonates in special care and attempting to use the pulsatile component of
the transcephalic impedance measured using a single channel. The neonatal
skull is much thinner than the adult and was also thought to be more conductive. Lionel had started to look at the sensitivity of surface measurements to
internal changes using a fairly simple nite element mesh with square
elements [1]. His D.Phil thesis therefore included the rst attempt at EIT
in Oxford. He moved to Oxford Polytechnic (which became Oxford Brookes
University in 1991) as a lecturer and consulted Mikean applied mathematician. Lionel eventually moved away from impedance methods, but Mike
took on the inverse problem, and a postgraduate, Bill Breckon, returning
from a Harkness Fellowship in Berkeley, joined him.
Bill, who later changed his name to Bill Lionheart, developed the nite
element methods which are still the basis of the reconstruction method in
current use [2, 3]. The method is developed from work by Gisser, Isaacson
and Cheney, at RPI, who showed that it was possible to determine the
optimal current to provide the best possible data [4, 5]. One of the attributes
of this method is that it allows absolute values of impedance or conductivity
to be estimated across the region if a 3D model is used. There is always
experimental noise arising from the electrodes, background electrical signals
and the equipment itself; the optimal current method calculates a set of
orthogonal current patterns which maximize the voltage dierences to be
measuredin engineering parlance, those which give the best signal-tonoise ratio. A set of trigonometrical current patterns could also be used;
they would be optimal for a radially-symmetric conductivity distribution.
374
EIT for medical applications at Oxford Brookes 19852003
A signicant dierence between our approach and that of RPI is in our use of
independent current-application and voltage-measurement electrodes.
As the theoretical and mathematical modelling work progressed, curiosity
demanded some real experimental work. Mike and Bill had successfully
simulated conductivity distributions, applied current patterns to them and
calculated the resulting voltage patterns; the voltage patterns and current
patterns and added noise could be given to the reconstruction algorithm
which reproduced a recognizable version of the conductivity pattern. Dale
Murphy, another bio-engineer who had been working with Lionel in
Paediatrics, and Chris McLeod, another bio-engineer who had moved from
Paediatrics to Engineering at Oxford Polytechnic, adapted some of the
circuitry which had been used in the single-channel impedance work and
added programmable current sources to produce OXPACT-1, the Oxford
Polytechnic adaptive current Tomograph, in 1987. The performance was
very poor and no images were ever obtained. A great deal was learnt about
the precision needed in the hardware, particularly if the current sources were
to perform correctly when connected together on a conductive object. John
Lidgey, an Engineering lecturer specializing in analogue circuit design,
contributed many ideas for improving the sources [6].
For perspective, an alternative method had been developed by the
Sheeld group, amongst others, involving the use of only a single current
source; the current output could be measured continuously and it did not
have other sources to react with. The current source was applied in turn to
each adjacent pair of electrodes and voltage measured on the remaining
electrodes. From these, equipotential regions were calculated and a weighted
back-projection algorithm applied to produce a conductivity image. The
method works best when applied in a dierence modefrom some reference
physiological state, the dierences in conductivity during a cycle of heart or
breathing activity are imaged.
Any multiple-source system had to have identical sources, or sources
which could be programmed precisely, which would maintain the
programmed current during large impedance changes. Impedance changes
within the body are small, but the electrode contact impedance varies rapidly
due to movement. In the mid-1980s the extra complexity of the instrumentation for multiple-source systems and the success of the adjacent-drive systems
pioneered by Barber and Brown in Sheeld prompted many groups to avoid
the multiple-source method.
The computational task in reconstructing images from the measurements from 32 electrodes for a complete set of current patterns was very
time-consuming for the available computers. A second applied mathematics
post-graduate, Kevin Paulson, joined the group to work on, amongst other
things, reducing the computation time. These were the days of 16 MHz
clock speed PCs and 1 Mbyte memory size. Data les were transferred
from the acquisition system PC to the reconstruction PC on a 514 inch
375
oppy disk. Kevin experimented with Inmos Transputers and the Intel i860
vector co-processor, and achieved some improvement, but not much more
than could be achieved by waiting for the next generation of faster PC chipsets. The extra complexity introduced by having programs written in Occam
for the Transputers and C on the host PC, and the cost of using non-PC
boards and the diculty in maintaining such software, taught us many
lessons. It became clear that faster computers were never going to make
EIT practical and that more sophisticated inversion algorithms were
required. The time required to calculate an EIT image is limited by the
complexity of solving the matrix equation of the form Ax b. Given the
matrix A, with N rows and columns, and data vector b, ON 3 calculations
are required to nd the EIT image vector x. For an EIT system with M electrodes the matrix A has M 2 rows and columns, and so calculating the EIT
image requires OM 6 calculations. If the number of electrodes in an EIT
system are doubled, the time required to calculate the image increases by a
factor of 64. Kevin introduced the concept of optimal measurement patterns
that parallels optimal current patterns. When both sets of optimal patterns
are used, only M of the M 2 possible measurements are non-zero. The
POMPUS algorithm calculates the EIT image using only these non-zero
measurements and so scales as OM 6 . For a 32-electrode system the
POMPUS algorithm is over 32 000 times faster than the standard algorithm.
This development has made possible 3D and high resolution EIT systems
[7, 8].
By 1989 the EIT Group, as we named ourselves, consisted of Mike, Bill
and Kevin, who were primarily working on reconstructionthough no
distinction was drawn between system software and algorithm workand
Chris working on hardware and the low-level hardware drivers with help
from John Lidgey on the current sources. Various undergraduates helped
build some parts, but it was clear that a larger eort was required for building
a more suitable system. The rst electronics postgraduate, Ching (QS) Zhu,
joined the group for the development of the OXPACT-2 system.
Amongst the design changes introduced was the use of voltage sources
for delivering current. This was achieved by measuring the transfer admittance matrix and then calculating the voltage settings required to generate
the required current pattern. The transfer admittances are measured by
applying voltages to the electrodes and measuring the resulting currents.
Errors in the measurements and calculations are iteratively reduced by
using Landwebers algorithm to rene the voltage pattern until the desired
currents are set. Making high-accuracy current sources at high frequencies
(in our case, the design specication for the system was to operate at 10,
40, 160 and 640 kHz) was extremely dicult, so the voltage source idea
was attractive. It also prompted the realization that it does not matter
whether voltages are applied and currents measured or currents applied
and voltages measured, as long as a reasonable basis could be applied. The
376
other major development was to change from analogue signal demodulation

to digital. This was certainly prompted by what the Sheeld and RPI groups
were reporting, and had become more feasible as very high speed analogueto-digital converters became readily available [9].
A brief digressionthe relationships with the EIT research groups in the
other centres in Europe and with RPI in the USA have been unfailingly
friendly. The EIT eld has been peopled by a particularly supportive
community. There has been a strong sense of co-operation in tackling the
problems of the research, and the feeling that it was in everyones interests
that there should be successful development of systems and successful studies
to show the value of this novel imaging modality. This may be because none
of us were close to commercializing our work.
The OXBACT-2 system was built with 32 current sources and 32 voltage
measurement channels. This choice had both a practical and a theoretical
basisthe more the better for increased resolution, the fewer the better for
ease of attaching to a patient. For reconstruction, a nite element model in
the computer was generated with a constant conductivity within each
element. The boundary datacurrents and voltagesis used to force these
conductivities to change until the laws relating to current, voltage and
conductivity are obeyed for each element of the mesh. There are numerous
papers on the constraints which have to be applied in order to make this
method converge to an acceptable solution and numerous others on the ecient implementation of the methods. The point to bring out here is that the
geometry of the boundary is fundamental to the reconstruction of the
internal conductivity imageif there isnt a true solution to converge to.
The group was having diculty distinguishing the unknown errors in
phantom measurements from artefacts and errors in the reconstructions.
We decided to build a phantom that could be accurately modelled, which
led to several radical design decisions. The rst was to separate current
driving from voltage measuring electrodes. It is dicult to model the voltage
on current carrying electrodes as the contact impedance and distribution of
current density under the electrode are unknown. Even passive electrodes can
shunt current parallel to the boundary. It was decided to make voltage
measurements on electrodes as close to points as possible. Choosing the
size of current driving electrodes faced conicting constraints; RPI had
shown that these electrodes should be as large as possible. However, voltage
measurements near current driving electrodes are sensitive to the unknown
current density distribution under the electrode. Some modelling showed
us that evenly spaced current driving electrodes that covered 30% of the
boundary, with voltage measurement half way between, was the optimal
compromise. A precisely milled cylindrical phantom was constructed
(30 cm internal diameter, 5 cm depth), with gold-plated electrodes ush
with the surface. The current electrodes are the same height as the tank
wall, so the tank is essentially 2D. If the tank is described in cylindrical
377
Figure 12.1.
polar (r; ; z) co-ordinates, all currents, voltages and conductivities should be

constant in z.
In 1991, some six years after the mathematicians became interested and
about four years after the engineers got involved, we produced our rst
experimental images from the tank. The tank was very carefully levelled,
then lled with normal saline. This was an easy test for the system as the
conductivity was completely dened and stable, and the transfer admittance
could be checked and the resulting image veried. A set of trigonometric
voltage patterns was applied and current measurements made during each
voltage pattern. The transfer admittance matrix was calculated, and then a
set of trigonometric current patterns was applied and voltage measurements
made during each current pattern. The result was a noisy image. A highly
conductive steel cylinder with a diameter of 3.5 cm was then placed in the
saline and the whole process repeated. The applied currents were a.c., at
10 kHz, and less than 1.5 mA peak. The resulting image is shown in gure
12.1 and should be admired, if only for the eort and expense involved in
its generation!
The reality of turning an idea into an image marked the beginning of the
process of acquiring medical images. We could assess what impedance
contrast could be imaged at dierent points within the region, and what
eect dierent EIT strategies would have on the distinguishability of objects.
These are image acquisition features. It also marked the beginning of our
work on turning impedance values into images, which would have to be
acceptable to those outside the EIT community who were used to a very
378
Figure 12.2.
2D 30 cm diameter tank.
dierent presentation. These image processing features include the choice of

a better colour scale, the smoothing of at least some of the jagged nite
element boundaries and the inclusion of whatever a priori information was
availablewhich could all be expected to improve the image quality.
The mathematicians, Mike, Bill and Kevin, had developed the algorithms for generating optimal current patterns, i.e. patterns which would
result in the largest voltage measurements and which would thereby have
the largest signal-to-noise ratio. For the time being, however, we continued
to use trigonometric current patterns, as these were regular, well-behaved
and seemed to work.
We conducted a series of tank studies using high-contrast metal cylinders
and wooden cubes (completely unscientic choice) of varying sizes, placed
singly or in combinations at various radii within the tank (gure 12.2).
What in retrospect seem like obvious points were new and interesting or
bothersomethe tank had to be levelled very carefully; the images were
very susceptible to the cleanliness of even gold-plated electrodes; the currents
should have been applied through d.c. blocking capacitors to prevent the
migration of the gold plating. With practise, we got better at making images
and soon progressed to imaging low-contrast salty Agar jelly cylinders, and
found that we could detect objects with a contrast of 1.2 and size 3% of the
tank area or objects, with a contrast of 1.5 and a size of 1% throughout
most of the tank. Such objects at the centre of the tank were still unobservable.
Impatience soon got the better of us so a willing volunteer donned 64
ECG electrodes one dayequally spaced around the chest, alternately for
379
applying current or measuring voltage. The system was started up and a

measurement set acquired. It quickly became clear that the conditions had
to be very carefully controlledthe slightest movement upset the transfer
impedance measurements and the desired current patterns could not be
applied. The stable electrode impedances of the tank could not be replicated.
This had serious implications for the system design, as it inferred that using
voltage sources to apply the correct currents via the transfer impedance
matrix would not be viable.
Some of the data sets did provide data which could be reconstructed,
and gure 12.3 shows one result. The reconstruction was based on a circular
FE mesh and the breath-holding subject (the acquisition time for a full data
set was about 30 s) was delighted to see a pair of high-impedance regions
appear towards the front, one on the left and one on the right. There was
doubt for some time about this image as it might have been an artefact
caused by currents actually being applied and voltages measured on a boundary which was wider than it was deep, the ratio being about 1.5 : 1. However,
since no-one was able to do the reconstruction in their head, we had to wait
until Bill and Kevin had generated an elliptical mesh and reconstructed the
data again; and there were the two high-impedance regions, still towards
the front and with slightly higher impedance than before.
At about this time it had become apparent that there were a number of
major changes (developments) needed for a clinical system:
.
.
.
.
Current sourcesbecause the transfer impedance calculations could not

keep up with the rapid contact impedance changes of electrodes on skin.
Boundary shape required, as the convergence of the computer model of
conductivity with the boundary data measurements would be unreliable
if the model shape was signicantly in error.
Rapid data acquisitionbecause the 30-s period of breath-holding would
not be acceptable for patients. In fact, a period much shorter than a cardiac
cycle would be more appropriate.
The system should comply fully with the safety standards required of all
medical electronic equipment.
The 2D versus 3D issue had to be properly considered.
The meetings organized by the Concerted Action on Impedance Tomography

had helped bring the community of EIT researchers together; we were able to
share best practice for multiple-source systems through frequent contact with
the RPI group. As a perspective, Sheeld systems with a single current source
were regularly producing dierence images for groups around the world. EIT
was making an impact as a potentially important new medical imaging modality and was attracting research funding. We were pleased to get our rst
substantial funding from the Wellcome Trust and are extremely grateful to
them for their support. This support enabled us to go ahead with a new
system which would attempt to meet the needs we had uncovered.
380
Posterior
Anterior
Figure 12.3(a).
Figure 12.3(b).
Rotated with respect to gure 12.3(a).
OXBACT-3 [10] was designed to acquire data for images at 25 frames/s,

a standard video speed in Europe at least. That is fast enough to allow 10
samples per cardiac cycle even at a heart rate of 150, which is typical in
neonates. Chris Denyer, a new postgraduate, and John Lidgey carried out
some good developments for new current sources, intended to allow the
381
Tomograph to use excitation at up to 640 kHz (the design allows 10, 40, 160
and 640 kHz). The system included much more digital circuitry, taking
samples at up to 10 million/s. This allowed greater exibility in using the
acquisition section, and greater accuracy through using digital signal generation, ltering and signal demodulation. The number of electrodes remained
the same: 32 for current sources and 32 for voltage measurements. A multiplexer selected the electrode for voltage measurement and measurements
were made sequentially during each applied current pattern. In this respect
the system diered from the contemporary RPI ACT3 system [9], which
has a dedicated processor for each electrode and which measures voltage
on the electrodes through which current is being delivered.
A 3D systemOXBACT-4was built with very limited funding for
tank studies. It was designed for static imaging and to test 3D reconstruction
algorithms. It could therefore be slow and be based on commercially available PC analogue input and digital output cards. The current sources (192)
and the voltage measurement multiplexer (816 channels) were custom-built
to match the eight-layer, 24 current electrodes/layer design. The current
electrodes occupied 30% of the cylindrical surface area and each current
electrode had four voltage electrodes associated with it, one in the centre
of the electrode and one mid-way to the adjacent current electrodes. The
arithmetically-adept need to know that the other 48 voltage electrodes
formed another layer beyond the last current layer. The electrode arrays
and connections were made accurately on exible printed circuit boards
and the tank cast around them in bre-glass. The tank is 30 cm diameter
and 120 cm high, with the electrode region occupying the middle third, as
seen in gure 12.4.
Ching Zhu left to join a medical electronics company in North America
and Dr Yu Shi joined us from the Toulouse group. Yu Shi wrote a wonderful
user interface on the host PC, and mastered the intricacies of the DSP which
drove the acquisition system. A pair of bre optics joined the two parts,
providing a fast, electrically isolated link. That left body shape and the
2D3D issue outstanding. As it happened, all the volunteers for the trial
studies with the new system had very similar chest shape, and a one-sizets-all FE mesh was created whose boundary was well described by only
four Fourier components. FE meshing programmes were appearing in Shareware schemes by this stage, so we nally produced images which had some
chance of convincing non-believers that there was truth in the resultssee
gure 12.5. Of course there was, and still is, no way to verify the truth of
the conductivity values, as there is little data on warm, blood-lled, living
tissue.
Kevin, Mike and Chris initiated a small parallel project on impedance
spectroscopy (EIS), to try to get conductivity data from living human
tissue from a small probe placed on exposed tissue [11, 12]. That work
progresses when funding allows. What it did show was that the quality of
382
Figure 12.4.
3D tank.
impedance or conductivity data required for showing signicant dierences

was high, and that the EIT data only reached that quality very close
indeed to the electrodes. It convinced us that trying to perform spectral
analysis on EIT images at dierent excitation frequencies was most unlikely
Figure 12.5.
mesh.
One frame of a set recorded at 15 frames/s, reconstructed on a body-shaped
383
to be valuable. The EIT imaging was therefore only carried out at 40 kHz,
which allowed reasonable currents to be applied and good measurements
to be made.
The new fast system allowed sets of images to be made and hence timeseries analysis could be applied to these (gure 12.6). Nacer Kerrouche
replaced Yu Shi who had left for Australia, and his main work became the
time-series analysis which Bill had started. We applied Principal Component
and Fourier Analysis to the image sets and found that Fourier generated
much clearer and more helpful data. In retrospect, it is quite obvious that
it should, as there are no signicant or non-cyclical movements of tissue
around the chest. The obvious rhythms appeared at respiratory and cardiac
frequencies and there is often a small component at a much longer period
(c. 25 s), which we have speculated may be caused by the autonomic
system. More data is needed to investigate this feature.
Signicant stang changes forced changes in the emphasis of the
Groups work. Bill moved to a very good post at UMIST and added his
own brand of EIT to the existing expertise there. Kevin moved to the RutherfordAppleton laboratory; not far away, but concentrating on other scientic problems. Although we maintain links with both of them, their drive in the
project is greatly missed. This was partly oset by the arrival of Andrea
Borsic from Turin, who came to work on developments of the reconstruction
technique such as anisotropic smoothing and the Total Variation method. In
addition, he was also responsible for a short paper at a medical imaging
summer school on the localization of the sense of humour using a modied
evoked response method.
After many studies on those still-willing volunteers (gure 12.7) in the
laboratory, we felt ready to impose on patients and got ethical approval
for studies on a group of patients in Intensive Care, who had severe
cardio-respiratory problems. The patients were on articial ventilators and
had problems with uid accumulating in their lungs. This ought to be the
cue for some interesting abnormal lung images, but unfortunately the data
from these patients was too poor to reconstruct at all. The outcome will be
perhaps the biggest step change of the whole development, incorporating
advances in:
.
.
.
.
.
the reconstruction method based on Andreas work on the inclusion of

a priori information on anatomy;
sizethe nursing sta were not impressed by the amount of space we
needed for the equipment close to the patient;
electrode arraysagain, neither we nor the nursing sta thought that the
electrode attachment arrangements were suitable for these patients;
3Dwe had stayed with 2D data acquisition and reconstruction for too
long, knowing that it was a poor approximation to reality;
software implementationthe user interface will be in MATLAB.
384
Figure 12.6. Fourier analysis of an image set: magnitude and phase at the respiratory and
cardiac frequencies. From [13].
Figure 12.7.
385
Laboratory study on a willing volunteer, Mark Bode.
The importance of the software environment was brought home when Yu Shi
left; his (excellent) coding of the Texas Instruments TMS320C40 digital
signal processor as the data acquisition controller in the C language and
assembler is dicult for his successors to maintain. This is mainly due to
the intricacy of the assembly language for this processor. It is more generally
true for the environment in which university research takes placea succession of bright young researchers come and then go. Over the years, the starting point for new work becomes more sophisticated and the learning curve
correspondingly longer. For the new system we are attempting to separate
the system developer functions, written in a low-level language, from the
EIT researcher functions, written in MATLAB. Fortunately, the boundary
can be dened very simply as the Tomograph applies a current pattern (a
vector) and measures all the voltages (another vector). The EIT researcher
can dene the current vectors and send them, and wait for the returning
measurements. Functionally, whether it is a calibration function or an
imaging session is immaterial.
OXBACT-5 is the name of the new system. In it there are technological
developments whose plans were presented at the Colorado meeting, whose
implementation has taken longer than expected and some of whose results
should be ready for the Gdansk meeting (June 2004). The last year has
been spent on hardware development, so no truly EIT results have been
coming out in that period. The eort will be more justiable if these systems
are used by other groups; we hope that such inter-group co-operation will
help the whole EIT eld to establish the benets of the method, and see it
contribute to patient monitoring and diagnosis in the way we imagined
when we were all motivated to work on its development.
386
The long view of the project is that we believe that technically the
optimal methods are the right ones to pursue; it is more dicult to obtain
absolute conductivity values, but these data should be more valuable than
dierence data for dening the state of tissues. The spatial resolution of
any EIT method with a nite electrode set is limited by the number of
independent data, so more electrodes will give more resolution. In practice,
the limit on number is set by what is possible in an acceptable clinical
technique. In this respect the non-contacting magnetic or inductive methods
have an advantage, but at the expense of providing less precise data.
Electrode technology is improving independently with the development of
micro-needle arrays and non-contacting physiological signal sensors.
The recent interest shown by Microsoft [14] in using the resistance and
conductivity of the body for data entry and signalling, respectively, will
stimulate an orders-of-magnitude increase in EIT, though probably under
another name.
Today the inaccuracy in knowing the 3D spatial co-ordinates of the
electrodes on the surface of a human body remains the biggest error. The
electronics continue to improve and get cheaper, following Moores law
for computing. The software techniqueswhile they remain publicallow
new developers to build on the growing knowledge bases of incorporating
a priori data, and of solving large and complex ill-posed inverse problems.
The following have contributed to the project in chronological order of
start-date:
Lionel Tarassenko
Bill Lionheart
QS (Ching) Zhu
Matthew Rose
Jean-Louis Lottiaux
Andrea Borsic
Mike Pidcock
Kevin Paulson
Tieying Duan
Evelyn Morrison
Nacer Kerrouche
Alex Yue
Dale Murphy
Chris McLeod
Chris Denyer
Annabelle Le Hyaric
Svetlana Jouravleva
Dimitar Kavalov
Peter Furner
John Lidgey
Yu Shi
Mark Bode
REFERENCES
[1] Tarassenko L, Murphy D, Pidcock M and Rolfe P 1985 The development of imaging
techniques for use in the newborn at risk of intraventricular haemorrhage, in Proceedings of the International Conference on Electric and Magnetic Fields in Medicine and
Biology, London
[2] Breckon W and Pidcock M 1988 Some mathematical aspects of electrical impedance
tomography, in Mathematics and Computer Science in Medical Imaging ed M A
Viergever and Todd-Poporek, 204215, Springer
[3] Breckon W and Pidcock M 1988 Ill-posedness and non-linearity in electrical
impedance tomography, in Information Processing in Medical Imaging ed C N de
Graaf and M A Viergever, 235244, Plenum
[4] Isaacson D 1986 Distinguishabilities of conductivities by electric current computed
tomography IEEE-TMI MI-5(6) 9195
References
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[5] Cheney M and Isaacson D 1992 Distinguishability in impedance imaging IEEE-BME

39 852860
[6] Murphy D, Lidgey F J, Breckon W R, McLeod C N and Davey-Winter T 1989 A
multiple programmable current source impedance tomography, in Proceedings of
2nd IFMBE Pan Pacic Symposium, Melbourne
[7] Paulson K S, Lionheart W R and Pidcock M K 1995 POMPUS: an optimised EIT
reconstruction algorithm Inverse Problems 11 425437
[8] Paulson K S, Lionheart W R B and Pidcock M K 1993 Optimal experiments in EIT
IEEE-TMI 12(4) 681686
[9] Zhu Q S, Lionheart W R B, Lidgey F J, McLeod C N, Paulson K P and Pidcock M K
1993 An adaptive current tomograph using voltage sources IEEE-BME 40(2) 163
168
[10] Zhu Q S, McLeod C N, Denyer C W, Lidgey F J and Lionheart W R B 1994 A DSPbased multiple drive EIT data acquisition system for real-time impedance imaging, in
Proceedings ECAPT94, Oporto
[11] Paulson K S, Jouravleva S and McLeod C N 2000 Dielectric relaxation time
spectroscopy IEEE-BME 47(9) 15101517
[12] Paulson K S, Pidcock M K and McLeod C N 2004 A probe for organ impedance
measurement IEEE-BME (accepted for publication)
[13] Kerrouche N, McLeod C N and Lionheart W R B 2001 Time series of EIT chest
images using singular value decomposition and Fourier transform Phys. Meas.
22(1) 147158
[14] US Patent 6,754,472. Method and apparatus for transmitting power and data using
the human body. Filed: 27 April 2000. Granted: 22 June 2004
Chapter 13
The Rensselaer experience
J Newell
Electrical impedance imaging research began at Rensselaer in 1985. Since

that time, we have designed several instruments with multiple current
sources, and used them to make static and dierence images of phantoms,
animals, normal humans and patients. A goal we have tried to pursue
throughout is to build the highest quality instrument that our funds and
the technology could support, in the belief that we could thereby draw
more general conclusions about the limits of the technology itself, rather
than just on our particular choices. This seems to have resulted in some relatively complicated instruments, compared to those built by other groups.
Whether in the long run such complexity will be needed remains to be seen.
13.1.
EARLY DEVELOPMENTS
The work began at Rensselaer by David Isaacson, who wanted to contribute to

the diagnosis of cardiac disease, in particular to solve the inverse problem in
electrocardiology. Solving that problem requires knowledge of the electrical
properties of the tissues in the chest that the EKG signal passes through on
its way from the heart to the skin. Dave thought about the design of a
system to measure these electrical properties. He recognized that resolving
tissue properties on a ne scale would require a large number of electrodes,
and he was able to formulate a theory to relate the number of electrodes that
a system could usefully employ to the noise level in that system. In general, a
noise-free system could use an innite number of electrodes, but a particular
noise level limits the useful number of electrodes. If the measurements have a
lot of noise, it makes no sense to have too many electrodes, since all they can
resolve is the noise. The relation between noise level and resolution is given
in [1]. The rst collaboration at Rensselaer grew out of this result. Dave
Early developments
389
Figure 13.1. This is ACT 0. It is a coil of copper wire wound around a wooden stick. At
intervals along the coil, wires are connected, which can be connected using clip leads to
electrodes around the inside edge of a circular saline tank. The intervals are irregular,
proportional to a sinusoid. The ends of the coil are connected to the output of a Radio
Shack audio amplier, driven by a signal generator. The result is a set of voltages in a
spatial sinusoid around a circular tank. Data are obtained from a hand-held multimeter,
and recorded by pencil and paper. (The student who spent a summer collecting and analysing this data has since earned a PhD.)
Isaacson wanted some realistic estimates of the noise levels that could be
achieved in a multi-channel instrument. Jon Newell had a laboratory where
electronic experiments in water baths could be done. We did the rst experiments to demonstrate the feasibility of detecting targets in water baths when
the targets were not near the electrodes (see gure 13.1). A sinusoidal pattern
of a.c. voltages was applied to 32 copper electrodes installed at the periphery
of a plastic pie transport dish. There were detectable changes when conducting
targets were placed in the bath, even near the centre of the bath.
This was enough encouragement to interest David Gisser in designing a
computer-controlled set of current sources, and a multiplexed voltmeter [3, 4].
This rst instrument, called an Adaptive Current Tomograph (ACT 1), was
built on a single perforated circuit board with wire-wrap technology (gure
13.2). Its multiplexed voltmeter converted the 12 kHz working signal to a DC
level that was passed to the computer through a commercial I/O board with
an A/D converter. Currents were specied digitally through the same board,
under the control of a language called ASYST. The result was a slow, imprecise
system with 32 current sources. Images were reconstructed from these data
using a non-iterative algorithm, which takes the rst step toward minimizing
the least-squares error between the measured voltages and the voltages
predicted from a uniform conductivity estimate. In the single-step algorithm
used, that rst step is just a constant conductivity. Dave designed this
390
Figure 13.2. This is ACT 1. Arrayed from left to right are 16 dual D/A converters at the
middle of the board, and current sources above and below each, to give a total of 32 current
sources. There are four multiplexers adjacent to the electrode connectors at the bottom
edge. The real and quadrature voltmeters are at the left end. The 50-pin cable to the
data acquisition card in the computer would connect at the upper left. Construction is
wire wrap.
algorithm, and it was written by Steve Simske as a Masters thesis [12]. It has
been the mainstay of our imaging eorts since 1988.
One of the rst results of this instrument was the discovery that in a real
saline phantom tank with real electrodes, the reconstruction algorithm overestimated the conductivity of the saline by as much as 15%. This was because
of the metal electrodes at the periphery, which were not modelled, but which
lowered the voltages by providing alternate current paths. In response, Dave
and his student, Kuo-Sheng Cheng, developed the complete electrode
model [5], which accounted for the conductivity of the electrodes, the gap
between them, and the interface impedance between the electrolyte and the
metallic conductor. This model agreed with the experimental results to
within the accuracy of the data.
The original ACT 1 instrument was designed with a synchronous detectorsensitive only to the real part of the target conductivity. Almost as an
afterthought, we added a quadrature voltmeter, and made a few images of
the reactive component of conductivity. We were pleased to see that aluminium
targets could be distinguished from bright copper targets by the permittivity of
the aluminium oxide layer on the former, although both had similar high
conductivity.
When it became clear that both conductivity and permittivity contained
valuable information, we developed a display and analysis system [38] that
accounted for the interaction between them, rather than simply reconstructing and displaying the results from the real and quadrature voltmeters [14].
In those early years of EIT, guring out what to do was almost as much
of a challenge as actually doing it. Everyones choices were strongly inuenced by their starting assumptions, and it has been interesting to see how
our systems have evolved along with those of the other groups in the eld.
13.2.
391
RECONSTRUCTION ALGORITHMS (see table 13.1)
The rst images made by ACT 1 were reconstructed by the NOSER algorithm, mentioned above. This algorithm has a number of properties that
allow it to take advantage of the data obtained by the ACT hardware. In
order to be able to invert the matrix relating voltage to current, the matrix
must be regularized, which has the eect of smoothing the image. This
adds stability and suppresses noise, but at the cost of blurring sharp boundaries in the image. Selection of the appropriate degree of regularization
required an empirical study of typical geometric and electronic noise sources,
and the reconstruction of several images with dierent regularization levels,
to reach a workable compromise. This algorithm in its general form was also
fairly slow, and required a few minutes to reconstruct each image on the SUN
workstation available at that time. The original slow algorithm for circular,
2D geometry has since been extended to incorporate non-circular shapes in
two and three dimensions, and to work in real time.
In 1997, NOSER was expanded to include out-of-round geometries for
the 2D case. Hemant Jain made manual measurements of a subjects chest
and made a reconstruction mesh by hand that ts that geometry. He also
made phantom tanks in elliptical shapes, and reconstructed their images
with various targets in elliptical meshes [38] (gure 13.3).
Another geometrical adaptation was made by Cathy Caldwell, who
wrote a reconstruction algorithm for the case of an array of 16 electrodes,
arranged in a circle within the volume to be imaged and 16 others at the
periphery [A35]. This geometry can be achieved by introducing a catheter
with electrodes into the esophagus to improve the image quality near the
heart. Other applications, for example in urology, may also treat the
unknown volume as an annulus with interior and exterior electrodes.
Table 13.1.
This table summarizes the dierent reconstruction algorithms this group has
developed.
Author
Year
Speed
Dim.
Geometry
Iterations
Approach
Ref.
Simske
Cheney
Goble
Caldwell
Edic
Jain
Edic
Mueller
Blue
Mueller
Choi
1990
1991
1992
1993
1995
1997
1998
1999
2000
2003
2004
slow
slow
slow
slow
fast
slow
fast
slow
fast
slow
slow
2
2
3
2
2
2
2
3
3
2
3
round
round
round
annulus
round
any
round
planar
round
round
two planes
1
NA
1
1
1
1
many
1
1
none
1
indirect,
direct
indirect,
indirect,
indirect,
indirect,
indirect,
indirect,
indirect,
direct
indirect,
12
16
24
A35
32
38
40
42, 43
44
49
A57
linearize
linearize
linearize
linearize
linearize
linearize
linearize
linearize
linearize
392
Figure 13.3. This gure shows the eects of using a reconstruction mesh that closely
approximates the actual shape of the body being studied. On the left is a non-circular
simulated phantom with two inhomogeneities. When the resulting voltage data are used
to reconstruct an image on a circular mesh, the middle gures are obtained. Important
artefacts are observed. On the right are the results of reconstructing the image on a
mesh that approximates the original. The artefacts are not present.
Steve Simske, who wrote the code for the original reconstruction
algorithm, called it NOSER, an acronym for Newtons One-Step Error
Reconstructor. In 1998, Peter Edic wrote and incorporated a forwardsolver algorithm that enabled NOSER to become a multi-step algorithm.
We were pleased and somewhat surprised to learn that allowing more
iterations did not markedly improve the resulting images [40] (gure 13.4).
Margaret Cheney introduced a novel reconstruction algorithm that
makes use of a layer stripping approach to solve the nonlinear inverse
problem directly, rather than forming a small-perturbation linearization as
NOSER and other algorithms do [16, 23]. This algorithm worked well with
simulated data, but was too sensitive to error to be practical with
experimental data.
393
Figure 13.4. This is a static image of a saline lled tank with agar phantoms of the heart
and lungs. The actual resistivity values are shown in the bottom-left drawing, and the static
resistivity image is on the right.
Figure 13.5. On the left is a phantom like that in gure 13.4. On the right is a conductivity
image of that phantom, reconstructed using the d-bar algorithm. The conductivity range is
from 185 to 662 mS/m.
394
More recently, Jennifer Mueller and David Isaacson have used scattering theory to develop a direct inversion algorithm called the d-bar method.
This algorithm uses deep ideas from inverse scattering and boundary value
theory, proposed by A. Nachman [45, 47]. An example of its application
to a test phantom is given in gure 13.5. The absolute conductivities reported
Figure 13.6. At the upper left is an empty tank phantom, in which a cubical metal
inhomogeneity (not shown) was suspended at precisely known locations. At the upper
right, the 3D volume in which the conductivity is reconstructed is shown. Below are
images of reconstructed conductivity in slices through each of eight layers below the top
electrode plane. Results are shown for four dierent target depths below the top electrode
layer: (a) 3 mm, (b) 6 mm, (c) 9 mm, and (d) 12 mm. Conductivity scales are dierent
among cases (a)(d).
Hardware
395
by the d-bar algorithm are generally closer to the truth than the NOSER
results.
Our immediate plans are to study breast cancer in a conguration
similar to an x-ray mammogram. Rectangular arrays of electrodes will be
placed on opposite sides of the breastthis requires a reconstruction
algorithm for this geometry. Tzu-Jen Kao and Myoung Hwan Choi have
developed such an algorithm, presently using just 32 electrodes. A test
tank or phantom suitable for this geometry is shown in gure 13.6, along
with one example of the result from the reconstruction algorithm working
from real conductivity data obtained with ACT 3.
13.3.
HARDWARE
We expanded the hardware capability of our system in 1988 with the introduction of ACT 2 (gure 13.7), a 64-electrode system built with considerable
help from the Corporate Research and Development Center of GE [4]. This
system was built on eight double-sided circuit boards with eight channels
each. It could obtain the data for a 32-electrode image in a few seconds, a
signicant improvement over ACT 1 (see table 13.2). Its other characteristics
were similar.
Shortly thereafter, we began the design of ACT 3, a signicantly faster
and more accurate instrument (gure 13.8). It is a property of impedance
imaging systems that if any region of the eld changes during the acquisition
Figure 13.7. This is ACT 2. It contains eight boards with eight current sources on each.
The real and quadrature voltmeters are upper right, above the power supply. The ribbon
cable connects to the data acquisition card in the supporting computer. Construction is
two-sided printed circuit boards.
396
Table 13.2. A summary of the technical characteristics of the hardware systems we have
developed.
System
Architecture
Construction
Frequency
(kHz)
Imax ma,
peak
Frame rate
(frames/s)
In service
ACT I
ACT II
ACT III
32 ch/bd 1 bd
8 ch/bd 8 bd
1 ch/bd 32 bd
Wire wrap
2-sided boards
2-sided boards
12
15
28.8
5.0
5.0
0.85
1/30
1/5
20
ACT IV
8 ch/bd 8 bd
12-layer boards
0.51000
various
20
1987
1988
Slow, 1991
Fast, 1993
2004
of the data, all parts of the image are degraded. This was the motive for
designing ACT 3 to acquire data in a much shorter time, for use in imaging
the chest. We wanted the aperture time for an image to be a small fraction of
a cardiac cycle [30]. This was achieved by the rst version of the instrument,
but it was not able to reconstruct or display these data rapidly. Another
major change was to reconstruct and display data in real time [32]. ACT 3
also incorporated a high speed A/D converter, operating in an oversampling/undersampling mode to achieve high accuracy and high speed
Figure 13.8. This is ACT 3. Each of 32 electrodes is connected to a circuit board. There
are 32 such boards in two rows of 16. Only the front edge of each board is visible. The
instrument is controlled from the keyboard and rear monitorthe monitor displays the
images in real time. Construction is two-sided printed circuit boards.
Hardware
397
with high rejection of noise outside its narrow frequency bandwidth. The
current sources were also designed to have very high output impedance.
This is necessary because the load impedances for dierent electrodes can
be very dierent, and if the output impedance of a current source is not
high, some of the current it produces does not go to the load as desired. A
high output impedance is obtained in ACT 3 by adjusting a negative capacitance circuit and an output resistance circuit using digitally controlled potentiometers. Each channel can be connected to a calibrating circuit which
measures its output impedance. The digital potentiometers are then adjusted
iteratively to attain an output impedance above 10 M
, with an output
capacitance below 0.5 pF.
In 1998, we began the design of an instrument for breast cancer detection, based on a commercial data acquisition board. The manufacturer of
this board made some assertions about its capabilities that turned out not
to be true, and we wasted a lot of eort on a system that ultimately failed.
We then began the design of ACT 4, a faster, multi-frequency, 64-electrode system designed for breast imaging [50] (gure 13.9). This machine is
being built at the time of writing, having been simulated in software and
partly prototyped. Its technical characteristics are summarized with those
of its predecessors. Its major technical characteristic is its exibility; by
using programmable digital signal processors and eld programmable gate
Figure 13.9. This is ACT 4 at the time of writing. Modular design and construction uses
eight and 12 layer circuit boards in surface mount technology.
398
arrays, this instrument can be tailored to many data acquisition and image
display schemes. This single instrument contains a current source and a
separate voltage source for each electrode. The current sources are adjustable
using digital potentiometers, so as to have very high output impedance at
each of 610 operating frequencies over a wide spectrum. The intent is to
compare the quality of the data achievable with these sources, with the
signal-to-noise ratio achievable with voltage sources adjusted in software
to provide desired current levels. A complicated automatic calibration
scheme is used for the voltage sources, and their high precision may allow
a comparable overall system signal-to-noise ratio for the current and voltage
sources.
13.4.
APPLIED CURRENTS
Dave Isaacson made an important discovery about the choice of current

patterns applying in 1987 [2, 3, 10]. He recognized that the eigenvalues of
the matrix that converts current to voltage on the electrode array have a
special signicance. These current or voltage patterns are the most sensitive
to distinguish one state from another in the target. One set of patterns, called
the optimal static pattern, consists of the eigenvalues of the current-tovoltage transform for the homogeneous eld. Other sets of patterns can be
found that distinguish one condition from another. For example, the dierence between inspiration and expiration can be optimally distinguished for
an electrode array around the chest. Alternatively, systole can be optimally
distinguished from diastole. The process for identifying optimal currents is
iterative, starting with the application of an arbitrary pattern and using its
result to generate the next pattern to apply. After 34 such iterations, the
patterns converge to the optimal pattern. This concept can be applied to
nd the individual current to distinguish an object from a homogeneous
eld. It can also nd the full set of currents to form a dierence image.
One of the rst questions confronting the designers of an EIT system is
what patterns of current or voltage to apply. The high impedance of the skin,
and the presence of electrode impedance combine to present a barrier to
current, or a substantial voltage drop at or near a current-carrying electrode.
These phenomena are intrinsic to any system. We have approached them
dierently from many other investigators. Our approach has been to try to
image everything in the body within the electrode array. If there is a high
impedance zone at the periphery, we will image it, and if it contains information irrelevant to the application, we will ignore that part of the picture.
Other investigators have dealt with this high-impedance zone by not using
voltage data on current-carrying electrodes. This means that (most of) the
voltage drop across the skin is not measured, the reconstruction algorithm
receives data with a smaller dynamic range, and with no representation (or
Optimal currents
399
noise) from the skin. For these reasons, the eects of the skin are eliminated
or greatly reduced.
There is a rationale for the approach we have adopted. Spatial noise
introduced by, for example, errors in electrode placement or dierences in
electrode impedance, occurs at high spatial frequency. In systems which
apply currents, these artefacts are minimized by applying patterns with low
spatial frequency. They are exaggerated by patterns with high spatial
frequency. Patterns applying current between pairs of electrodes contain
high energy at high spatial frequency, and less energy at low frequencies.
There is, therefore, a noise-reducing eect of applying low-frequency current
patterns.
13.5.
OPTIMAL CURRENTS
An example of the benet of using optimal currents is shown here [38]. We

obtained a cross-sectional MRI image of one of us, and traced its outline,
along with the outlines of the lungs and heart. We then made a numerical
phantom, assigning realistic resistivity values to these structures. The
algorithm to nd optimal current patterns was then applied, starting with
the canonical trigonometric patterns. The phantom is shown at the top of
gure 13.10, and the resistivity image using the trigonometric current
Figure 13.10. This is a static image of a simulated thorax with realistic geometry and electrical properties. The top image is the phantom simulated. The middle image shows an
FEM reconstruction of the resistivities, using the canonical trigonometric current patterns.
The bottom image shows the increased contrast obtained when the current patterns have
been optimized by eight iterations of the optimizing algorithm.
400
patterns is just below it. We then applied the iterative optimal current
algorithm for eight iterations, with the result shown at the bottom of
gure 13.10. Clearly, the contrast and dynamic range of the reconstructed
resistivities are closer to the simulated values when optimal currents are used.
13.6.
STATIC IN VIVO IMAGES WITH NON-CIRCULAR

BOUNDARY AND OPTIMAL CURRENTS
When optimal currents are used in vivo, the number of iterations should be
limited to 24 because of the variations in the actual data due to cardiac
and ventilatory events. Figure 13.11 shows the rst four iterations of the
current optimizing algorithm, producing static images of a non-circular
chest. The contrast of the high-resistivity skin at the periphery and the central
lungs improves with each iteration.
Figure 13.11. These images are reconstructed from data obtained from a subject whose
chest had the shape shown. The reconstruction algorithm used a mesh adapted to this
shape. The four images show the result of using current patterns that approach the optimal
patterns. Note the range of conductivities displayed with each image, indicated by the
numbers above the grey scale. The original image with the canonical trigonometric
patterns has a range from 242 to 608 mS/m. After three iterations of the current-optimizing
algorithm, the image reconstructed from the data obtained with the new currents has a
range from 121 to 1477 mS/m.
13.7.
3D
Impedance imaging has most frequently been done using 2D reconstruction

algorithms and data from structures in three dimensions, or 2D phantoms.
Between 1990 and 1992, John Goble reported his work on a 3D reconstruction algorithm [13, 24]. These were slow reconstructions made using data
from 32 electrodes arranged in four layers of eight electrodes each. They
provided the ground work for Russell Blue, who used the ACT 3 system
to write a real-time 3D reconstruction and display system [44, 48] (gure
13.12).
In vivo applications
401
Figure 13.12. Four rows of eight electrodes each were applied to a subjects chest. A 3D
reconstruction algorithm was used to form a static image of the relatively conductive heart
(light grey) and less conductive lungs (dark grey). Two views of the reconstructed image are
shown, from above and in front of the subject (bottom left), and from above but behind the
subjects right side (bottom right).
13.8.
IN VIVO APPLICATIONS
We have conducted and published several studies in living subjects [20, 35,
43, 44, 48]. In a 1996 investigation of acute pulmonary edema in dogs, we
demonstrated the ability of the ACT 3 system to monitor the development
of acute pulmonary edema, induced by intravenous infusion of oleic acid
[35]. Changes in impedance images were correlated with post-mortem assessment of lung water. We also studied several acutely ill patients in a surgical
intensive care unit in 1993. These were early studies using ACT 3, which
conrmed our ability to use it in the ICU with minimal interference to clinical
routines. We detected a case of tension pneumothorax in one patient, which
was conrmed a few hours later by x-ray. These studies were of an exploratory nature, and they taught us a lot about how to use the system, but did not
yield publishable results. Three years later we studied a few more patients in a
coronary care unit, and related impedance changes to x-ray appearance of
pulmonary edema. A general correlation was found, and valuable experience
402
Figure 13.13.
See text for explanation.
was gained, but no denitive ndings could be published. We were able to

show real-time variations in thoracic images at the CAIT meeting in
Barcelona in 1993 [A34], and at the World Congress in Rio in 1994 [A38].
This work was extended to the third dimension by Russell Blue and reported
at the EPSRC Conference in London in 2001 [A48].
An important feature of the ACT 3 system is illustrated next, and its
ability to acquire accurate data in real time with no need for averaging
over many cardiac cycles. Figure 13.13 shows an array of 32 copper foil electrodes applied with hydrogel to a subjects chest. The images below show the
dierence in the magnitude of the admittivity of the chest from a reference
frame taken in mid-diastole. In these images, the top is dorsal, the bottom
ventral, and the subjects left is on the right. Changes in admittivity are
shown, on the scale from 2.5 to 1.0 mS/m. The original images were
Paying for it
403
obtained and displayed at 20 frames/s. We have shown here every other

image, so the interval between the frames shown is 100 msec, and 700 msec
elapses in the time period shown. The cardiac period at the time was
1100 msec (55 bpm). At the onset of systole, admittivity decreases in two
regions in the anterior left chest, as the conductive heart decreases in size.
This is accompanied or slightly followed by an increase in conductivity in
two larger regions bilaterally, as blood enters and lls the pulmonary vasculature. This increased admittivity persists somewhat longer than the initial
decrease at the heart, since the heart rells more rapidly than the lungs drain.
The real-time ACT 3 system came on line in the late spring of 1993. Even
before it was thoroughly tested, we moved it to the Albany Medical Center
Hospital, in order to complete some patient studies during the summer
when we had more time. The rst patient we approached granted permission,
and we applied a band of electrodes around her chest. She had been in a car
accident about a week previously, and was being treated aggressively with
mechanical ventilation and surfactant replacement for Adult Respiratory
Distress Syndrome. We studied her chest on the morning of the rst day,
and returned to repeat the study the next morning. At that time, we remarked
that there seemed to be no ventilation on the right side, but we drew no
conclusion from the observation. A few hours later, we returned to get a
second data point and encountered about four of her physicians standing
around the bedside looking grim. Whats wrong? Tension pneumothorax.
Right side? Yes. Howd you know? Saw it this morning with our instrument, but didnt know what we were seeing. Oh. That is not the sort of
thing you can report to the scientic literature, but it sure did make us
think we were on the right track.
Another piece of encouragement also came in 1993, when we won the
ComputerWorld Smithsonian Award in Medicine. This got us an invitation
to a gala dinner in Washington, a handsome trophy, and our work was on
display in the Smithsonian Institutions National Museum of American
History for a year. It is still there in the attic somewhere.
13.9.
PAYING FOR IT
This work has been funded by the US taxpayers, and a few private sources.
Dave Isaacson got the rst National Science Foundation grant in 1987 for
two years support, and we got a follow-up grant from the National Institutes
of Health in 1988 for three years.
What happened next involved my guardian angel. In the mid-1980s,
when this work was getting started, I had been involved for many years
with a large-scale projectfunded by the National Institutes of Healthto
study trauma. When that project was competitively renewed in 1988, we
included an EIT proposal which was very favourably reviewed, but the
404
overall trauma project was disapproved. I was holding a winning hand in a

poker game on the Titanic. I was lamenting this state of aairs with the
NIH administrator, Lee Van Lenten, who said Let me try to work something
out. Lee went out of his way to get the EIT project assigned a new, independent project number, and it was funded independently for ve years with its
budget intact. When that grant expired, another NIH administrator, Yvonne
Maddox, extended our grant and funding for another two years, but we
could not convince the peer reviewers of the merits of our work, and continued funding was not approved.
The New York Health Department carried us through with a small
grant for two years to keep Alex Ross supported for his work on ACT 4.
As this was winding down, we were able to join an Engineering Research
Centerfunded by the National Science Foundationthat involves four
Universities collaborating in a Center for Subsurface Sensing and Imaging.
Our work ts into that centre like a hand in a glove, and it has been our
main support for three years. We have just received a substantial research
grant from NIH after two revisions of the proposal, so the next three
years, at least, will be well supported.
We have been approached by well over a dozen parties interested in
commercializing our system. A combination of factors including their
impatience, the long delays needed to obtain regulatory (FDA) approval,
the relatively new nature of the technology, and the long development
time, has stopped most of these enquiries. We were funded for a preliminary
investigation of lung water by a clinical monitoring instrument company,
and we have licenced the system to a second company for one clinical
application that remains a viable prospect.
13.10.
PEOPLE
This project started with David Isaacsons work in 1985. When his rst paper
was nearly completed, he asked me to do some simple measurements of noise
levels, to illustrate what might be achievable in the real world. We recruited
an undergraduate student, Denise Angwin, who spent a summer getting data
from a saline-lled tank with copper electrodes driven by a Radio Shack
audio amplier (see gure 13.1). This gave some useful results, but took
too long. David Gisser, a senior Professor in Electrical Engineering was
well known to me from a couple of decades of collaboration in the trauma
research project. He joined us in 1986, and designed ACT 1, a system with
32 computer-controlled current sources and a multiplexed voltmeter. Results
from this system were encouraging, we decided we needed a faster system,
and began the design of ACT 2. By early 1988 that machine was in service,
and producing encouraging results. As we started the design of ACT 3,
around 1989, Gary Saulnierof the Electrical, Computer and Systems
Meetings
405
Engineering Dept.became interested in the project. We soon had a serious

collaboration under way, with Dave Gisser and Gary working closely on the
new machine. Garys experience in signal processing was put to good advantage, and tted in well with Daves knowledge of analogue circuit design. The
result was a true collaboration, and in retrospect there are only a few places
where one can say who did what part of the design. We suered a painful loss
in 2000, when Dave Gisser died before we could complete the design of ACT
4. That machine contains many of his ideas.
In one of our rst conversations about the design of EIT systems, Dave
Gisser asked if a particular multiplexing scheme might work. I immediately
thought thats impossible, but before I could say so, Dave Isaacson chimed
in with sure, you could . . ., and went on to explain some details of that idea.
I nally spoke up and raised my original objection. Isaacson responded
Well, yes, youd have to run the multiplexer faster than the speed of light,
but if you did that, it would work ne. We all agreed.
In 1988, Margaret Cheney joined the Rensselaer faculty, and soon
became a close collaborator with Dave Isaacson in the theoretical and mathematical aspects of the project. She rened and documented much of what
had been done so far, and invented a layer-stripping approach for direct solution of the inverse problem in reconstruction. Margarets collaboration
continued through to about 1998, when her interests turned to radar and
other high-frequency phenomena.
One of the themes that runs through much of our work is that of
communications across unexpected barriers. We know that our disciplines
are dierent, and we know to allow for that in our meetings. It was not so
easy to gure out what was happening in our early discussions with Felipe
Fuks, a new graduate student. We would make some point, and he would
respond with No, no, no, its actually like this. And then hed repeat exactly
the point wed just made, verbatim. Months later we learned that it is a
Brazilian cultural style, and Felipe was just following his upbringing in
prefacing his response with no when he was agreeing with a point. Another
glitch occurred during the London meeting in 2001, when A. P. Bagshaw, in
David Holders group, began presenting a paper on the use of the peel of a
marrow as the model for skin in a phantom of the head. I and most of the
Americans present only knew marrow as the interior of bones. There
followed widespread confusion because nobody could gure out why the
others were confused. Turns out marrow is the plant the Americans call
zucchini.
13.11.
MEETINGS
Most of the work done in the early years of impedance imaging was in
Europe, with major support from the European Community through a
406
Concerted Action in Impedance Tomography. Thanks to a liberal interpretation of the term Europe by Brian Brown who ran that programme,
we have participated in all the major meetings of that group. David
Holder also obtained EPSRC support for meetings in London, which we
have also joined with pleasure. Since 1995, there has been closer collaboration between those working in impedance imaging and the International
Conference on Electrical Bio-Impedance. These ties were greatly strengthened by Dr Eberhard Gersing, who organized a joint meeting of CAIT
and ICEBI in Heidelberg in 1995. Subsequent meetings in Barcelona and
Oslo have further developed these collaborations.
In working closely together, dierences in personality and style can
present challenges to everyone. In 1987, Dave and I travelled together to
Lyon for the CAIT Conference. But we almost didnt get there. We planned
to take the train to New York one morning, and y to Paris that evening. We
were to meet at the station. The train arrived on time, and several dozen other
passengers and I boarded. No sign of David. I hurried through the whole
train, searching. No David. As the scheduled departure time approached,
the platform was deserted, and the train doors were closed except for one,
just behind the engine. There I stood with the conductor, waiting. With a
minute to go, David appeared, and, seeing no activity on the platform, set
his suitcase down against a wall and sat on it to wait. I shouted, he walked
over, boarded the train, the conductor waved to the engineer, and we were
o to Lyon.
13.12.
CONCLUDING REMARKS
We have been working with this technology for around 18 years, as of June
2004, and perhaps it is appropriate to look back and look ahead with a longer
term view. In retrospect, I think we have been well served by the use of
multiple current sources, and the use of all available voltage measurements.
Our progress has been slowed by the technical challenges of the analogue
circuits required, but the basic EIT problem is dicult and ill-posed, and
requires the highest quality data that can be obtained if one is to draw
rm conclusions about its use.
At the time of writing, I can see some areas where I wish we had made
dierent decisions about the latest system, ACT 4. It is designed to have
many desirable features in a single instrument. It has both current and
voltage sources, available over a wide frequency range on 64 electrodes in
a small package operating at high speed. The development of this system
has been slowed, and made more expensive by our decision to use very
small circuit boards with high component density. A lot could be learned
without using as many as 64 electrodes. If tissue spectroscopy of the breast
is useful, we could improve spatial resolution by expanding a smaller
407
system to 64 or more at a later stage. It is possible that the high speeds of

computation now available will make it possible to synthesize desired current
patterns using programmable voltage sources. ACT 4 is designed to answer
this question by making side-by-side comparison of synthesized and generated current patterns. If synthesized patterns work as well as generated
ones, the next version of the hardware will be vastly simpler than ACT 4.
That comparison could probably have been done with fewer than 64
electrodes.
I remain optimistic that EIT will nd a long-term clinical application. It
may be that this will be as an enhancement of an existing imaging modality,
like mammography or ultrasound. The high resolution of these systems may
complement the low-resolution but useful tissue spectroscopy data available
by EIT. Several existing clinical applications use the high-resolution systems
for diagnosis, but with less than ideal specicity and sensitivity. We will be
testing ACT 4 in a mode combining EIT and mammography to make simultaneous, in-register images. Stay tuned.
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SELECTED ABSTRACTS
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1887
[A38] Newell J C, Isaacson D, Saulnier G J, Cheney M, Gisser D G, Edic P M, Ren X and
Larson-Wiseman J L 1994 Electrical impedance imaging of thoracic admittivity in
normal man, in Proc. World Congress on Medical Physics and Biomedical Engineering, Rio de Janiero, Brazil, August, p 604, OS22-2.1
[A48] Newell J C, Blue R S, Isaacson D, Saulnier G J and Ross A S 2001 Phasic threedimensional impedance imaging of cardiac activity, in Proc 3rd EPSRC Conf.,
London, April
[A57] Choi M H, Kao T-J, Isaacson D, Saulnier G J and Newell J C 2004 A simplied
model of a mammography geometry for breast cancer imaging with electrical
impedance tomography, in Proc. IEEE-EMBS Conf. 26, in press, #592, 2.4.2
Appendix A
Brief introduction to bioimpedance
David Holder
Bioimpedance refers to the electrical properties of a biological tissue, measured

when current ows through it. This impedance varies with frequency and
dierent tissue types, and varies sensitively with the underlying histology.
This appendix is a brief summary of its principles; I hope it will be useful
for any non-technical readers new to EIT. The section is unreferenced; a
suggested reading list is attached at the end.
A.1.
RESISTANCE AND CAPACITANCE
The resistance and the capacitance of tissue are the two basic properties in
bioimpedance.
Resistance is a measure of the extent to which an element opposes the
ow of electrons or, in aqueous solution as in living tissue, the ow of ions
among its cells. The three fundamental properties governing the ow of electricity are voltage, current and resistance. The voltage may be thought of as
the pressure exerted on a stream of charged particles to move down a wire or
migrate through an ionized salt solution. This is analogous to the pressure in
water owing along a pipe. The current is the amount of charge owing per
unit time, and is analogous to water ow in a pipe. Resistance is the ease or
diculty with which the charged particles can ow, and is analogous to the
width of a pipe through which water owsthe resistance is higher if the pipe
is narrower (gure A.1).
They are related by Ohms law:
V (voltage, Volts) I (current, Amps) R (resistance, Ohms
:
The above applies to steadily owing, or d.c. current (direct current).
Current may also ow backwards and forwardsa.c. (alternating current).
412
Figure A.1.
Basic conceptscurrent, voltage and resistance. Analogy to water ow.
Resistance has the same eect on a.c. current as d.c. current. Capacitance (C)
is an expression of the extent to which an electronic component, circuit or
system, stores and releases energy as the current and voltage uctuate with
each a.c. cycle. The capacitance physically corresponds to the ability of
plates in a capacitor to store charge. With each cycle, charges accumulate
and then discharge. Direct current cannot pass through a capacitor. A.c.
can pass because of the rapidly reversing ux of charge. The capacitance is
an unvarying property of a capacitive or more complex circuit. However,
the eect in terms of the ease of current passage depends on the frequency
of the applied currentcharges pass backwards and forwards more rapidly
if the applied frequency is higher.
For the purposes of bioimpedance, a useful concept for current travelling through a capacitance is reactance (X). The reactance is analogous to
resistancea higher reactance has a higher eective resistance to alternating
current. Like resistance, its value is in Ohms, but it depends on the applied
frequency, which should be specied (gure A.2).
The relationship is
Reactance (Ohms) 1=2 Frequency Hz Capacitance Farads:
When a current is passing through a purely resistive circuit, the voltage
recorded across the resistor will coincide exactly with the timing, or phase,
of the applied alternating current, as one would expect. In the water ow
analogy, an increase in pressure across a narrowing will be instantly followed
by an increase in ow. When current ows across a capacitor, the voltage
recorded across it lags behind the applied current. This is because the back
and forth ow of current depends on repeated charging and discharging of
the plates of the capacitor. This takes a little time to develop. To pursue the
water analogy, a capacitor would be equivalent to a taut membrane stretched
Figure A.2.
413
Capacitance, reactance and eect of frequency.
across the pipe. No continuous ow could pass. However, if the ow is

constantly reversed, then for each new direction, a little water will ow as
the membrane bulges, and then ow back the other way when the ow
reverses. The development of pressure on the membrane will only build up
after some water has owed into the membrane to stretch it. In terms of a
sine wave which has 3608 in a full cycle, the lag is one quarter of a cycle, or 908.
In practice, this is seen if an oscilloscope is set up as in gure A.3. An
ideal constant alternating current source passes current across a resistor or
capacitor. The current delivered by the source is displayed on the upper
trace. The voltage measured over the components is displayed on the lower
trace. When this is across a resistor, it is in phasewhen across a capacitor,
it lags by 908 and is said to be out-of-phase. When the circuit contains a
mixture of resistance and capacitance, the phase is intermediate between 0
and 908, and depends on the relative contributions from resistance and
capacitance. As a constant current is applied, the total combination of
resistance or reactance, the impedance, can be calculated by Ohms law
from the amplitude of the voltage at the peak of the sine wave.
414
Figure A.3. The voltage that results from an applied current is in phase for a resistor (A)
and 908 out of phase for a capacitor.
Impedance is made of these two components, resistance or the real part

of the data, and reactance, the out-of-phase data. These are usually displayed
on a graph in which resistance is the x axis and reactance is the y axis. This is
termed the complex impedance, and the graph is the complex plane. For
mathematical reasons to do with solutions of the equations for the sine
waves of the a.c. voltages, the in-phase resistive component is considered
to be a real or normal number. The out-of-phase, capacitative, component
is considered to be imaginary. This means that the amplitude of the
capacitative voltage, a real number such as 3.2 V, is multiplied by j, which
is the square root of minus 1. Thus, a typical complex impedance might be
written as
450 370j
:
This would mean that the resistance is 450
and the reactance is 370
, and
would be displayed on the complex plane as in gure A.4, with the resistance
on the x axis and reactance on the y axis. Another equivalent way is to
calculate the length of the impedance line, which passes from the origin of
the graph to the complex impedance point. This is termed the modulus of
the impedance (Z), and means its total amplitude, irrespective of whether
Figure A.4.
415
416
it is resistance or reactance. In practice, this is identical to the amplitude of

the sine wave of measured voltage, seen on an oscilloscope, as in gure
A.3, irrespective of the phase angle. The phase angle is calculated from
the graph, and is given along with the modulus. The phase angle on the
graph is exactly the same as the lag in phase of the measured voltage
(gure A.4). For the above example,
450 370j
R jX converts to 583
at 398Z :
A.2. IMPEDANCE IN BIOLOGICAL TISSUE

Cells may be modelled as a group of electronic components. One of the
simplest employs just three components (gure A.5). The extracellular
space is represented as a resistor (Re), and the intracellular space and the
membrane is modelled as a resistor (Ri) and a capacitor (Cm) (gure
A.5(a)). Both the extracellular space and intracellular space are highly
conductive, because they contain salt ions. The lipid membrane of cells
is an insulator, which prevents current at low frequencies from entering the
cells. At lower frequencies, almost all the current ows through the
extracellular space only, so the total impedance is largely resistive and is
equivalent to that of the extracellular space. As this is usually about 20%
or less of the total tissue, the resulting impedance is relatively high. At
higher frequencies, the current can cross the capacitance of the cell
membrane and so enter the intracellular space as well. It then has access to
the conductive ions in both the extra- and intra-cellular spaces, so the overall
impedance is lower (gure A.6(a)).
Figure A.5. (a) The cell modelled as basic electronic circuit. Ri and Re are the resistances
of the intracellular- and extracellular-space, and Cm is the membrane capacitance. (b)
ColeCole plot of this circuit.
Impedance in biological tissue
417
Figure A.6. (a) The movement of current through cells at both low and high frequencies.
(b) Idealized ColeCole plot for tissue.
The movement of the current in the dierent compartments of the cellular

spaces at dierent frequencies, and the related resistance and reactance values
measured, is usefully displayed as a ColeCole plot. This is an extension of the
resistance/reactance plot in the complex plane. Instead of the single point for a
measurement at one frequency, as in gure A.4, the values for a range of
frequencies are all superimposed. For simple electronic components, the arc
will be a semicircle (gure A.5(b)). At low frequencies, the measurement is
only resistive, and corresponds to the extracellular resistanceno current
passes through the intracellular path because it cannot cross the cell membrane
capacitance. As the applied frequency increases, the phase angle gradually
increases as more current is diverted away from the extracellular resistance,
and passes through the capacitance of the intracellular route. At high frequencies, the intracellular capacitance becomes negligible, so current enters the
parallel resistances of the intracellular and extracellular compartments. The
cell membrane reactance is now nil, so the entire impedance again is just
resistive and so returns to the X axis. Between these, the current passing
through the capacitative path reaches a peak. The frequency at which this
418
occurs is known as the centre frequency (Fc), and is a useful measure of the
properties of an impedance. In real tissue, the ColeCole plot is not exactly
semicircular, because the detailed situation is clearly much more complex;
the plot is usually approximately semicircular, but the centre of the circle
lies below the x-axis. Inspection of the ColeCole plot yields the high- and
low-frequency resistances, as the intercept with the x-axis, and the centre
frequency is the point at which the phase angle is greatest. The angle of depression of the centre of the semicircle is another means of characterizing the tissue
(gure A.6(b)).
Over the frequency ranges used for EIT and MIT, about 100 Hz to
100 MHz, the resistance and reactance of tissue gradually decreases. This is
due to the simple eect of increased frequency passing more easily across capacitance, but also because cellular and biochemical mechanisms begin to operate, which increases the ease of passage of the electrical current. A
remarkable feature of live tissue is an extraordinarily high capacitance, which
is up to 1000 times greater than inorganic materials, such as plastics used in
capacitors. This is because capacitance is provided by the numerous and closely
opposed cell membranes of cells, each of which behaves as a tiny capacitor.
Over this frequency range, there are certain frequency bands where the phase
angle increases, because mechanisms come into play which provide more capacitance. They may be seen as regions of an increased decrease of resistance in a
plot of resistance against frequency, and are termed dispersions. At the low
end of the frequency spectrum, the outer cell membrane of most cells is able
to charge and discharge fully. This region is known as the alpha dispersion
and is usually centred at about 100 Hz.
As the frequency increases, from 10 kHz10 MHz, the membrane only
partially charges and the current charges the small intracellular space structures, which behave largely as capacitances. At these higher frequencies the
current can ow through the lipid cell membranes, introducing a capacitive
component. This makes the higher frequencies sensitive to intracellular
changes due to structural relaxation. This eect is largest around 100 kHz,
and is termed the beta dispersion. At the highest frequencies, dipolar
reorientation of proteins and organelles can occur, and aect the impedance
measurements of extra- and intracellular environments. This is the gamma
dispersion, and is due to the relaxation of water molecules and is centred
at 10 GHz. Most changes between normal and pathological tissues occur
in the alpha and beta dispersion spectra.
A.3. OTHER RELATED MEASURES OF IMPEDANCE
A.3.1.
Unit values of impedance
Resistance and reactance, as described above, are xed measures of individual components or samples. It is useful to be able to describe the general
Other related measures of impedance
Figure A.7.
measured.
419
The eect of changing the length or cross-sectional area of the tissue sample
properties of a material. The impedance of a sample increases, as one would

expect, with increasing length of the sample between the measuring electrodes. Somewhat counter-intuitively, it decreases if the area contacting the
measuring electrodes increasesthis is because there is more conductive
material to carry the current. The individual values for resistance or
reactance can be converted to the general propertytermed resistivity or
reactivity by adjusting for these. Resistivity is given in
:m and is the
ability of a material to resist the passage of electrical current for a dened
unit of tissue (gure A.7). It is calculated as

:m Resistance
Area=Length:
The capacitative element of a material can be considered in the same way
the reactivity is also measured in
:m and is the general resistance property
of a material, at a specied frequency.
A.3.2.
Other indices of impedance
The resistance and reactance fully describe the impedance of tissue, but there
are several other related measures which are, sometimes confusingly, used in
the EIT and Bioimpedance literature. These arise because dierent, reciprocal, terms may be used to describe the ease, as opposed to the diculty, of
passage of current. Secondly, with respect to capacitance, one can choose
to use the eective resistance at a given frequencythe reactance, or the
intrinsic property of the material, the capacitance, which is independent of
frequency. Each of the dierent measures may be suxed with -ivity to
yield its general property. Finally, the measure given may refer to the
complex impedance rather than the in- or out-of-phase component.
Not all permutations, fortunately, are widely used. These are the most
common: the conductivity is the inverse of resistivity and is given in
Siemens/m or, more usually, S/m. The admittance is the inverse of
impedance, and so is a combined measure of in- and out-of-phase ease of
420
passage of current through a tissue. The capacitance of the tissue is the

capacity to store charge, and is given in Farads. The permittivity of a
tissue is the property of a dielectric material that determines how much
electrostatic energy can be stored per unit of volume when unit voltage is
applied, and is given in F/m. The dielectric constant " is the permittivity
relative to a vacuum, and indicates how much greater the capacitance of a
capacitor would be if the sample was placed between the plates compared
to a vacuum.
A.4. IMPEDANCE MEASUREMENT

The impedance of samples is usually recorded with silver electrodes. The
simplest arrangement is to place electrodes at either end of a cylindrical or
cuboidal sample of the tissue. A constant current is passed and the
impedance is calculated from the measured voltage (gure A.8). The drawback of this method is that the impedance measured includes not only the
tissue sample, but also that of the electrodes. The method can be reliable,
but requires that a calibration procedure is performed rst to establish the
electrode impedance. These then need to be subtracted from the overall
impedance recorded, and it should be a fair assumption that the electrode
impedances do not change between the calibration and test procedures (see
gure A.8).
Impedance is best measured using four electrodes, as this circumvents
the error of inadvertent inclusion of the electrode impedance with two
terminal recordings (gure A.9). The principle is that constant current is
Figure A.8. (a) The two-electrode measurement as a block diagram, and (b) modelled as a
simple electrical circuit. The two overlapping rings represent a constant current electrical
source.
Relevance to electrical impedance tomography
421
Figure A.9. The four-electrode measurement as (a) a block diagram, and (b) modelled as
a simple electrical circuit.
delivered to the electrodes through the two current electrodes; as it is

constant, the correct current is independent of the electrode impedance.
The voltage is recorded by high performance modern ampliers, which are
not signicantly aected by the series electrodes impedance between the
sample and amplier (gure A.7). As a result, the impedance is ideally
unaected by electrode impedance, although non-idealities in the electronics
may cause inaccuracies in practice. The main drawback of this method is that
the geometry of the sample is no longer clear cut, so that conversion to
resistivity needs careful modelling of the path of current ow through the
tissue.
A.5.
RELEVANCE TO ELECTRICAL IMPEDANCE

TOMOGRAPHY
The Sheeld mark 1, and the several similar systems which have been used to
make clinical and human EIT measurements, only record the in-phase,
resistive, component of the impedance. This is because unwanted capacitance
in the leads and electronics introduce errors. Fortunately, these are all out-ofphase and so can be largely discounted by throwing away the out-of-phase
data. For the same reason, images are generated of dierences over time,
as subtraction like this minimizes errors. As a result, the great majority of
clinical EIT images are a unitless ratio between the reference and test
image data at a single frequency. More recently, systems have been
constructed and tested which can measure at multiple frequencies, and
provide absolute impedance data. As these are validated, and come into
wider clinical use, then we may expect to see more absolute bioimpedance
parameters, such as resistivity, admittivity, centre frequency, or ratio of
extra- to intracellular resistivity, in EIT image data.
422
FURTHER READING
Duck F A 1990 Physical properties of tissue: a comprehensive reference book. London:
Academic Press
Gabriel C, Gabriel S and Corthout E 1996a The dielectric properties of biological tissues: I.
Literature survey Physics in Medicine and Biology 41 22312249
Gabriel S, Lau R and Gabriel C 1996b The dielectric properties of biological tissues: II.
Measurements in the frequency range 10 Hz to 20 GHz Physics in Medicine and Biology 41 22512269
Geddes L B L E 1967 The specic resistance of biological materiala compendium of data
for the biomedical engineer and physiologist Med. Biol. Eng. 5 271293
Grimnes S and Martinsen G 2000 Bioimpedance and bioelectricity basics. London:
Academic Press
Appendix B
Introduction to biomedical electrical
David Holder
One of the attractions but also diculties of biomedical EIT is that it is interdisciplinary. Topics which are second nature to one discipline may be incomprehensible to those with other backgrounds. Not all readers will be able to
follow all the chapters in this book, but I hope that the majority will be
comprehensible to most, especially those with a medical physics or bioengineering background. Nevertheless, the reconstruction algorithm or
instrumentation chapters may be dicult to follow for clinical readers, and
some of the clinical terminology and concepts in application chapters may
be unfamiliar to readers with Maths or Physics backgrounds. This chapter
is intended as a brief and non-technical introduction to biomedical electrical
impedance tomography. It is didactic and explanatory, so that the more
detailed chapters in the book which follow may be easier to follow for the
general reader. It is intended to be comprehensible to readers with clinical
or life sciences backgrounds, but with the equivalent of high school physics.
A non-technical introduction to the basics of bioimpedance is presented in
Appendix A, and may be helpful for any reader wishing to refresh their
understanding of the basics of electricity and its ow through biological
tissues. As it is intended to be explanatory, key references and suggestions
for further reading are included, but the reader is recommended to the
detailed chapters in the main body of the book for detailed citations.
B.1.
HISTORICAL PERSPECTIVE
The rst published impedance images appear to have been those of Henderson
and Webster in 1976 and 1978 (Henderson and Webster 1978). Using a rectangular array of 100 electrodes on one side of the chest earthed with a single large
electrode on the other side, they were able to produce a transmission image of
424
Introduction to biomedical electrical impedance tomography
the tissues. Low conductivity areas in the image were claimed to correspond to
the lungs. Shortly after, an impedance tomography system for imaging brain
tumours was proposed by Benabid et al (1978). They reported a prototype
impedance scanner which had two parallel arrays of electrodes immersed in
a saline lled tank, and which was able to detect an impedance change inserted
between the electrode arrays.
The rst clinical impedance tomography system, then called applied
potential tomography (APT), was developed by Brian Brown and David
Barber and colleagues in the Department of Medical Physics in Sheeld.
They produced a celebrated commercially available prototype, the Sheeld
Mark 1 system (Brown and Seagar 1987), which has been widely used for
performing clinical studies, and is still in use in many centres today. This
system made multiple impedance measurements of an object by a ring of
16 electrodes placed around the surface of the object.
The rst published tomographic images were from this group in 1982 and
1983. They showed images of the arm in which areas of increased resistance
roughly corresponded to the bones and fat. As EIT was developed, images
of gastric emptying, the cardiac cycle and the lung ventilation cycle in the
thorax were obtained and published. The Sheeld EIT system had the advantage that 10 images/s could be obtained, the system was portable, and the
system was relatively inexpensive compared to ultrasound, CT and MRI
scanners. However, since the EIT images obtained were of low resolution
compared to other clinical techniques such as cardiac ultrasound and x-ray
contrast studies of the gut, EIT did not gain widespread clinical acceptance
(see Holder 1993, Boone et al 1997, Brown, 2003, for reviews).
Around the same time, a group in Oxford proposed that EIT could be
used to image the neonatal brain (Murphy et al 1987). They developed a
clinical EIT system and obtained preliminary EIT images in two neonates.
Their system used 16 electrodes placed in a ring around the head, but in
contrast to the Sheeld system, the current was applied to the head by
pairs of electrodes which opposed each other in the ring in a polar drive
conguration. This maximized the amount of current which entered the
brain and therefore maximized the sensitivity of the EIT system to impedance
changes in the brain.
Since the rst ush of interest in the mid to late 1980s, about a dozen
groups have developed their own EIT systems and reconstruction software,
and publications on development and clinical applications have been produced
by perhaps another twenty or so. Initial interest in a wide range of applications
at rst has now settled into the main areas of imaging lung ventilation, cardiac
function, gastric emptying, brain function and pathology, and screening for
breast cancer. Convincing pilot and proof of principle studies have been
performed in these areas. In 1999, FDA approval was given to a method of
impedance scanning to detect breast cancer, and the system has been marketed
commercially (http://imaginis.com/t-scan/eectiveness.asp), but it is not yet
EIT instrumentation
425
clear how widely it is being used. In other areas, EIT has not yet broken into
routine clinical use.
B.2.
EIT INSTRUMENTATION
EIT systems are generally about the size of a video recorder, but some may be
larger. They usually comprise a box of electronics and a PC. Connection to
the subject is usually made by coaxial cables a metre or two long, and ECG
type electrodes are placed in a ring or rings on the body part of interest. All
will sit on a movable trolley, so that recording can be made in a clinic or outpatient department. A typical system is shown in gure B.1.
B.2.1.
Individual impedance measurements
A single impedance measurement forms the basis of the data set which is used
to reconstruct an image. Most systems use a four-electrode method, in which
constant current is applied to two electrodes, and the resulting voltage is
recorded at two others. This minimizes the errors due to electrode
impedance. The transfer impedance of the subject with this recording geometry is calculated using Ohms law (gure B.2). The current applied is
approximately one tenth of the threshold for causing sensation on the
skin. It is insensible and has no known ill eects. Most single frequency
systems apply a current at about 50 kHz. At this frequency, the properties
of tissue are similar to those at d.c., in that the great majority of current
travels in the extracellular space, but electrode impedance is much lower
than at d.c., so there are less instrumentation errors. At 50 kHz, a single
measurement usually takes less than 1 msec.
Figure B.1.
The Sheeld Mark 2 EIT system (Sinton et al 1992).
426
Figure B.2.
Typical single impedance measurement with EIT.
The electronics for this four-electrode arrangement comprises a current

source, a voltage recording circuit, and a means to extract the phase sensitive
information from the acquired voltage. The latter usually employs a circuit
called a phase-sensitive demodulator. The phase of the injected current is
known; the circuit retrieves the value of the received waveform both inphase with the applied current and with a phase delay of 908. In this way,
the resistance and reactance may be calculated (gure B.3). Many systems
discard the out-of-phase component, as it may be inaccurate due to eects
of stray capacitance. Early systems, such as the Sheeld Mark 1, used a
single such impedance measuring circuit, which was then linked to the electrodes by a multiplexer. More recent systems use multiple circuits for drive
and receive, which increases the speed of acquisition but also expense and
bulk.
It will be seen below that EIT images in human subjects suer from low
resolution. One of the causes is errors in individual measurements. The principal of these is a high skin-electrode impedance. In principle, measurement
should be accurate with a four-electrode system. Unfortunately, in practice,
this is not the case. It is generally necessary to abrade the skin of subjects to
lower the impedance, and this can easily vary from site to site. Although leads
are coaxial, and usually have driven screens to minimize stray capacitance,
this is signicant, especially at higher frequencies. The combination of
variable skin impedance and stray capacitance conjoin to cause signicant
errors in recorded impedance values, especially in electrode combinations
which are recording small voltages. Signicant factors include uctuations
in current delivered, if skin impedances vary at dierent electrodes, and
EIT instrumentation
427
Figure B.3. Essential components of an EIT system. The system shown is for a single impedance measuring circuit with connection to electrodes
using a multiplexer. More complex systems may have multiple circuits attached directly to electrode pairs. The demodulator converts the a.c.
recorded signal into a steady d.c. voltage for both resistance and reactance, although the reactance signal is discarded in many systems as the
stray capacitance renders it inaccurate. The subject and electrode impedances (R(e)) are represented as resistances.
428
Figure B.4. Sources of error in impedance measurements. There are two main sources of
error. (1) A voltage divider exists, formed by the series impedance of the skin and input
impedance of the recording instrumentation amplier. Under ideal circumstances, the
skin impedance is negligible compared to the input impedance of the amplier, so that
the voltage is very accurately recorded (upper example). In this example, skin impedance
is 100 kOhms and input impedance is 100 MOhms, so the loss of signal is negligible. In
practice, the stray capacitance in the leads, coupled to high skin impedances, may cause
a signicant attenuation of the voltage recordede.g. to 90%, if the input impedance
reduces to 1 MOhm (lower example). In this diagram, only one side of a dierential amplier is shown, for clarity. This attenuating eect may be dierent for the two sides of the
amplier. This leads to a loss of common mode rejection ability, as well as absolute
errors in the amplitude recorded. (2) The ideal current source is perfectly balanced, so
that all current injected leaves by the sink of the circuit. The eect of stray capacitance
and skin impedance may act to unbalance the current source. Some current then nds
its way to ground, either by the ground, or by the high input impedance of the recording
circuit. This causes a large common mode error. The common mode rejection ratio may be
poor because of the eects in (1), so that the recorded voltage is inaccurate.
common mode errors on the recording side due to impaired common mode
rejection as a result of stray capacitance (see Boone and Holder 1996 for a
review) (gure B.4).
B.2.2.
Data collection
EIT systems employ from eight to 64 electrodes. Earlier systems used 16

electrodes applied in a ring, but current systems may use several rings on
the thorax or evenly distributed, for example, over the head. The following
describes the procedure employed by a standard early prototype, the
Sheeld Mark 1 system (Brown and Seagar 1987). Sixteen electrodes are
applied in a ring. A single measurement is made with four electrodes. A
current of up to 5 mA at 50 kHz is applied between an adjacent pair of
electrodes, and the voltage dierence is recorded from two other adjacent
electrodes. This yields a single transfer impedance measurement. Only the
EIT instrumentation
429
Figure B.5. Data acquisition with the Sheeld Mark 1 system. A constant current is
injected into the region between two adjacent electrodes, and the potential dierences
between all other pairs of adjacent electrodes are measured. The current drive is then
moved to the next pair of adjacent electrodes, and the measurements repeated and so on
for all possible current drive pairs. It is not possible to measure potential dierences accurately at the pair of electrodes injecting current, so there are 208 (13 16) measurements in
a data set.
in-phase component of the voltage is recorded, so this is a recording of

resistance, rather than impedance. Voltage signals are measured on all
other electrodes in turn (gure B.5). Sequential pairs are then successively
used for injecting current until all possible combinations have been measured. Each individual measurement takes less than a millisecond, so a
complete data set of 208 combinations is collected in 80 ms, and 10
images/s can be acquired. This can be increased to 25 frames/s if reciprocal
electrode combinations are not used, and each data set comprises 104
measurements.
About 20 dierent designs have been constructed and reported since the
Sheeld Mark 1 system in 1984. Many were very similar, but had variations
such as a variable software selectable variable frequency, miniaturization
(gure B.6) (Baisch 1993), or a design with a separate headbox on a long
lead to enable recording over days in ambulatory patients (gure B.7)
(Yerworth et al 2002).
In theory, greater resolution within the image can be obtained if current
is injected from many electrodes at once. This may be injected in dierent
combinations to give xed patterns of increasing spatial frequency, as in
designs from groups at the Rensellaer Polytechnic (RPI), New York, USA
430
Figure B.6. Miniature Sheeld Mark 1 APT system designed for the Juno space mission
(courtesy of Prof. B. Brown).
(Cook et al 1994), Oxford Brookes University, Oxford, UK (Zhu et al 1993),

or Dartmouth, USA (Halter et al 2004). It has also been proposed that the
patterns may be automatically adjusted to give the best image accuracy
(Zhu et al 1994). Although these approaches are better in theory, this requires
Figure B.7. UCLH Mark 1 EIT system, intended for ambulatory recording in subjects
being monitored on a ward for epileptic seizures. A small headbox is on a lead 10 m
long, so that the subject may walk around near their bed during recording.
EIT instrumentation
431
much greater precision as all the current sources have to be controlled

accurately at once; it is not yet clear if, in practice, this confers an improvement in image quality over the simpler method of applying current only
to two electrodes at a time. Other variations in hardware design include
applying voltage and measuring current, using only two rather than four
electrodes for individual measurements as in the RPI system, or recording
many frequencies simultaneouslymultifrequency EIT or EIT spectroscopy
(EITS).
B.2.3.
Electrodes
The great majority of clinical measurements have been made with ECG type
adhesive electrodes attached to the chest or abdomen (gure B.1). Although
the four-electrode recording system should in theory be immune to electrodeskin impedance, in practice it is usually necessary to rst reduce the skin
impedance by abrasion. Similar EEG cup electrodes have been used for
head recording.
In the mid 1980s convenient exible electrode arrays were designed and
reported for chest imaging, but did not become commercially available, so
now most groups use ECG or EEG electrodes (McAdams et al 1994).
Some specialized designs have been developed for the special case of imaging
the breastprecise positioning may be achieved by radially movable motorized rods arranged in a circle (gure B.8).
B.2.4.
Setting up and calibrating measurements
Data collection in human subjects in EIT is sensitive to movement artefact

and the skin-electrode impedance. It is usually necessary, therefore, to
check signal quality before embarking on recordings. A simple widely used
method is to check electrode impedance. Another method, pioneered by
the Sheeld Mark 1 system, is to measure reciprocity. This principle is
that the recorded transfer impedance should be the same, under ideal
circumstances, if the recording and drive pair are reversed. A low reciprocity
ratiousually below 80%generally indicates poor skin contact, which can
be corrected by further skin abrasion or repositioning of the electrodes.
Other systems, especially those using two, rather than four, electrodes may
require special trimming before recording. Another potential problem lies
in determining the correct zero phase setting for the impedance measuring
circuit. The phase of the current produced by the electronics is, of course,
accurately known, but stray capacitance and skin impedance may interact
to alter the zero phase of the current delivered to the subject, and similar
eects on the recording side may also alter the phase of the signal delivered
to the demodulator. Dierent approaches have been employed. One method
is to calibrate the system on a saline lled tank. Others are to optimize the
432
Figure B.8.
USA.)
A system for EIT of the breast. (Courtesy of Prof. A. Hartov, Dartmouth,
reciprocity, or to assume that the subject is primarily resistive at low frequencies, and adjust the phase detection accordingly (Fitzgerald et al 2002).
As many EIT systems are prototypes, it is helpful to calibrate them on
known test objects. Some employ agar test objects, impregnated with a
saline solution, in a larger tank which contains saline of a dierent concentration. These can be accurate if images are made quickly, but the saline
will diuse into the bathing solution, so that the boundaries can become
uncertain (Cook et al 1994). Others have employed a porous test object
such as a sponge, immersed in the bathing solution in a tank, so that the
impedance contrast is produced by the presence of the insulator in the test
object (Holder et al 1996a). Many tanks have been cylindrical; more realistic
ones have simulated anatomy, such as the head (Tidswell et al 2003), or used
biological materials to produce multifrequency test objects. Typically, the
spatial resolution of test objects in tanks is about 15% of the image diameter
(gure B.9).
B.2.5.
Data collection strategies
Most EIT work has used EIT as a dynamic imaging method, in which images
of the impedance change compared to a baseline condition are obtained. An
EIT instrumentation
433
Figure B.9. Example of image quality with a modern multifrequency EIT system from
Dartmouth, USA. (Courtesy of Prof. A. Hartov.)
example is EIT of gastric emptying. A reference baseline image is obtained at

the start of the study when the stomach is empty. The stomach is then lled
when the subject drinks a conductive saline solution (gure B.10). Subsequent EIT images are reconstructed with reference to the baseline image,
and demonstrate the impedance change as the stomach lls and then empties
the conductive solution. A second example is of cardiac imaging: images are
gated to the electrocardiogram (ECG) to demonstrate the change in
impedance during systole, when the heart is full of blood in the cardiac
cycle, compared to a reference baseline image when the heart is emptied of
blood in diastole (gure B.11). To image ventilation, a reference image is
obtained when the lungs are partially emptied of air at the end of expiration
and EIT images of the changes during normal ventilation are reconstructed
with reference to the baseline image.
The main reason for imaging dynamic impedance changes is to eliminate or reduce errors that occur due to the instrumentation or dierences
Figure B.10. Example of EIT of gastric emptying, collected with the Sheeld Mark 1 EIT
system, and 16 electrodes placed around the abdomen.
434
Figure B.11. Example of cardiac imaging, collected with the Sheeld Mark 1 EIT system,
and a ring of 16 electrodes placed around the chest.
between the model of the body part used in the reconstruction software and
the actual object imaged. To reduce these, impedance changes are reconstructed with reference to a baseline condition; if the electrode placement
errors in the baseline images and the impedance change images are the
same, then these errors largely cancel if only impedance change is
imaged. Although the dynamic imaging approach minimizes reconstruction
errors, it limits the application of EIT to experiments in which an
impedance change occurs over a short experimental time course; otherwise,
electrode impedance drift may introduce artefacts in the data which cannot
be predicted from the baseline condition. As dynamic imaging cannot be
used to image objects present at the start of imaging and therefore in the
baseline images, dynamic EIT cannot be used to obtain images of tumours
or cysts. This contrasts with images obtained with CT, which can obtain
static images of contrasting tissues such as tumours. Dynamic imaging
has been used for almost all clinical studies to date in all areas of the
body.
In principle, it should be possible to produce images of the absolute
impedance. Unfortunately, image production is sensitive to errors in instrumentation and between the model used in reconstruction and the object
imaged. Pilot data has been obtained in tanks (Cook et al 1994) and some
preliminary images in human subjects (Cherepenin et al 2002, Soni et al
2004).
Dynamic EIT images typically use one measurement frequency, usually
between 10 and 50 kHz, to make impedance measurements. An alternative
approach is to compare the dierence between impedance images measured
at dierent measurement frequencies, termed EITS (EIT spectroscopy).
This technique exploits the dierent impedance characteristics of tissues
435
at dierent measurement frequencies. An example of such a contrast would

be the dierence between cerebro-spinal uid (CSF) and the grey matter of
the brain. As the CSF is an acellular, ionic solution, it can be considered a
pure resistance, so that its impedance is identical and equal to the resistance
for all frequencies of applied current. However, the grey matter, which has
a cellular structure, has a higher impedance at low frequencies than at
high frequencies This frequency dierence can theoretically be exploited
to provide a contrast in the impedance images obtained at dierent
frequencies, and provides a means of identifying dierent tissues in a
multifrequency EIT image. The Sheeld mark 3.5 is an example
(Hampshire et al 1995, Yerworth et al 2003). Eight electrodes are used in
an adjacent drive/receive protocol to deliver sine waves at frequencies
between 2 kHz and 1.6 MHz; Cole parameters such as the centre frequency
and ratio of intra- to extra-cellular space can be extracted to create
images.
B.3.
B.3.1.
EIT IMAGE RECONSTRUCTION

Back-projection
The hardware described above produces a series of measurements of the

transfer impedance of the subject. These may be transformed into a tomographic image using similar methods to x-ray CT. The earliest method,
employed in the Sheeld Mark 1 system, is most clear intuitively. Each
measurement may be conceived as similar to an x-ray beamit indicates
the impedance of a volume between the recording and drive electrodes.
Unfortunately, unlike x-rays, this is not a neat dened beam, but a diuse
volume which has graded edges. Nevertheless, a volume of maximum sensitivity may be dened. The change in impedance recorded with each electrode
combination is then back-projected into a computer simulation of the
subjecta 2D circle for the Sheeld Mark 1. The back-projected sets will
overlap to produce a blurred reconstructed image, which can then be
sharpened by the use of lters (gure B.12).
B.3.2.
Sensitivity matrix approaches
Back-projection has been very successful for the simple case of 16 electrodes
in a plane, but suered from the need for two assumptionsthat the problem
was 2D, and that the initial resistivity was uniform. Most systems now
employ a more powerful method, based on a sensitivity matrix (gure
B.13). This is based on a matrix, or table, which relates the resistivity of
each voxel in the subject, and hence, images, to the recorded voltage
measurements.
436
Figure B.12.
Principles of EIT image reconstruction by back-projection.
The method requires a mathematical model of the body part of interest.

These may be modelled using mathematical formulae alonethese are
termed analytical solutions. In general, these are only practical for simple
shapes, such as a cylinder or sphere. More realistic shapes, such as the
thorax or head containing layers representing the internal anatomy, are
achieved using imaginary meshes in the model, whose boundaries are determined by segmenting MRI or CT images. The equations of current ow are
solved for each cell in the mesh; each cells calculation is therefore simple, but
solutions for the whole mesh, which may contain tens of thousands of cells,
may be time consuming on even powerful computers, and may suer from
instability or hidden quantitative errors. These are termed numerical
methods and common mesh types are FEM (nite element mesh) or BEM
(boundary element mesh).
Using one of these models, the expected voltages at each electrode
combination can be calculated. The principle is that the applied current
actually ows everywhere in the subject, but, clearly, ows more in certain
regions than others. Each voxel in the subject contributes to the voltage
measured at a specied recording pair, but this depends on the resistance
in the voxel, the amount of current which reaches it, and its distance from
the recording electrodes. The total voltage at the recording pair is a sum of
all these contributions from every voxel. Many of these, from voxels far
away, may be negligible. This is illustrated in gure B.13(a), for the case of
a disc with just four voxels. In practice, for 16 or 32 electrode systems, several
hundred electrode combinations are recorded, so the matrix will have several
hundred rows. In principle, an image can only be accurately reconstructed if
there is one independent measurement for each voxel. In practice, accurate
437
(a)
(b)
Figure B.13. Explanation of sensitivity matrix. (a) The sensitivity matrix. This is shown
guratively for a subject with four voxels and four electrode combinations. Each
column represents the resistivity of one voxel in the subject. Each row represents the
voltage measured for one electrode combination. The current from one current source
ows throughout the subject, but the voltage electrodes are most sensitive to a particular
volume, shown in grey. The resulting voltage is a sum of the resistivity in each of the voxels
weighted by the factor S for each voxel, which indicates how much eect that voxel has on
the total voltage. (b) The forward case. In a computer program, all the sensitivity factors
are calculated in advance. Given all the resistivities for each voxel, the voltages from each
electrode combination are easy to calculate. (c) The inverse. For EIT imaging, the reverse is
the casethe voltages are known; the goal is to calculate all the voxel resistivities. This can
be achieved by inverting the matrix. This is straightforward for the simple case of four
unknowns shown here, but is not in a real imaging problem, where the voltages are
noisy, and there may be many more unknown voxels than voltages measured.
438
(c)
Figure B.13.
(Continued)
anatomical meshes need to contain many more cells than a few hundred,
especially if in 3D, so the matrix may contain tens of thousands of
columnsone for each voxeland a few hundred rows. If the resistivities
of each voxel are given, then the expected voltages for each electrode combination may be easily calculated. This is termed the forward solution and is
simply a simulation of the situation in reality (gure B.13(b)). Its use is to
generate a sensitivity matrix. This is produced by, in a computer simulation,
varying resistivity in each voxel, and recording the eect on dierent voltage
recordings. This enables calculation of the sensitivity of a particular voltage
recording to resistance change in a voxelthe s factor in gure B.13.
To produce an image, it is necessary to reverse the forward solution. On
collecting an image data set, the voltages for each electrode combination are
known, and, by generating the sensitivity matrix, so is the factor relating
each resistance to these. The unknown is the resistivity in each voxel. This is
achieved by mathematically inverting the matrixwhich yields all the
resistivities (gure B.13(c)). In principle, this can give a completely accurate
answer, but this is only the case if the data is innitely accurate, and that
there are the same number of unknownsi.e. voxels requiring resistance
estimates, as electrode combinations. In general, none of these is true. In
particular, in many of the voxels, very little current passes through, so the
sensitivity factor for that cell in the table is near to zero. Just as dividing by
zero is impossible, dividing by such very small numbers causes instabilities
in the image. This is termed an ill-posed matrix inversion. There is a well
established branch of mathematics which deals with these inverse problems,
and matrix inversion is made possible by regularizing the matrix. In principle,
this is performed by undertaking a noise analysis of the datanoisy channels
with little signal-to-noise are suppressed, so that the image production by
439
inversion relies on electrode combinations with good quality data and so

proceeds smoothly. Commonly used methods for this include truncated
singular value decomposition (Bagshaw et al 2003a) or Tikhonov regularization (Vauhkonen et al 1998).
B.3.3.
Other developments in algorithms
Initially, reconstruction was always performed with the assumption that

the subject was a 2D circle. Although this actually worked quite well in practice, changes in impedance away from the plane of electrodes could be seen in
the image, sometimes in an unpredictable way. 3D recording requires far more
electrodesusually four rings of 16 per ring around the chest. For simplicity,
many continuing clinical studies still use a 2D approach. The rst 3D images
were of the chest in 1996 (Metherall et al 1996), and an algorithm for imaging
in the head has been developed more recently (Bagshaw et al 2003a).
The sensitivity matrix approach described above requires an assumption
that there is a direct unvarying, or linear relationship, between the resistance of a voxel and its eect on recorded voltage. In practice, this is
almost true for small changes in impedance below about 20%. However, it
is not true for larger changes. This can be overcome by using more accurate
non-linear approaches. This can be achieved by using a logical loop in the
algorithm. A guess is made for the initial resistivities in the voxels. The
forward solution is calculated to estimate the resulting electrode combination
voltages. These are then compared with the original recorded voltage data.
The resistances in the model are then adjusted, and the procedure is repeated
continuously until the error between the calculated and recorded voltages is
minimized to an acceptable level. In theory, this should give more accurate
images, but it is time consuming in reconstruction and instabilities may
creep in as the process is more sensitive to minor errors, such as anatomical
dierences between the mesh used and the subjects true anatomy, or the
position of electrodes (see Lionheart 2004, Morucci and Marsili 1996, for
reviews). Although there is interest in the development of non-linear
approaches, the author is not aware of any clinical studies at the time of
writing in which they are currently employed.
B.4.
CLINICAL APPLICATIONS
B.4.1.
B.4.1.1.
Performance of EIT systems

Spatial resolution
The great majority of clinical studies have been performed with the Sheeld
Mark 1 system, so that most published studies of accuracy have mainly been
440
(a)
(b)
Figure B.14. (a) Calibration studies with the Sheeld Mark 1 system in a saline lled
tank. The tank was lled with saline, which was varied to give dierent contrasts with
the test object of a cucumber. The cucumber may be seen in the correct location for all
contrasts, but with more accuracy and greater change near the edge (Holder et al 1996).
(b) Images taken with 3D linear algorithm in a latex head-shaped tank, with or without
the skull in place. The algorithm employed a geometrically accurate nite element mesh
of the skull and tank (Bagshaw et al 2003).
with this prototype system. In saline lled tanks, the Sheeld Mark 1, with
its 16 electrodes and back-projection algorithm, produces somewhat blurred
but reproducible images (gure B.14(a)). In general, the spatial accuracy is
about 15% of the image diameter, being 12% at the edge and 20% in the
centre (see Holder 1993 for a review). More recent studies with more
441
advanced systems, including those in 3D in the thorax and head, are roughly
similar (Metherall et al 1996, Bagshaw et al 2003b) (gures B.9, B.14(b)). In
general, in human images where the underlying physiological change is well
described, such as gastric emptying (Mangall et al 1987), lung ventilation
(Barbas et al 2003), lung blood ow (Smit et al 2003), or cardiac output
(Vonk et al 1996), images have a similar resolution with mild blurring, but
the anatomical structures can be identied with reasonable condence. In
the more challenging areas such as imaging breast cancer (Soni et al 2004),
or evoked activity or epileptic seizures in the brain (Tidswell et al 2001,
Bagshaw et al 2003a), some individual images appear to correspond to the
known anatomy, but these are not suciently consistent across subjects to
be used condently in a clinical environment.
B.4.1.2.
Variability
In all dynamic EIT measurements, it is necessary to distinguish the required

impedance change from baseline variability. This may be partly due to
electronic noise, which may be reduced by averaging as it is random. There
may also be systematic changes due to processes such as changes in electrode
impedance, temperature or blood volume in body tissues. They may be
present as a slowly varying drift, or as irregular variations of shorter
duration. In EIT recordings made on exposed cerebral cortex or scalp, a
drift of about 0.5% over 10 min was shown to be linear, and was compensated for in images taken over 50 min (Holder 1992a). Murphy et al (1987)
recorded EIT images from the scalp of infants, and noted that pulse-related
impedance changes were about 0.1% in amplitude. Larger irregular changes
of about 1% were attributed to movement artefact and respiration. Liu and
Griths (in Holder 1993) examined baseline variability in EIT images
collected from electrodes around the upper abdomen, using their own EIT
system which was similar to the Sheeld Mark 1 system. Images were
collected over 40 min in ve subjects. The variations in impedance change
were typically 5%, but ranged up to over 20%. Wright et al (in Holder
1993) conducted a large study of gastric emptying, in which six dierent
test meals were given to each of 17 subjects; 27% of the tests (28 of 102)
were considered uninterpretable and were excluded from the analysis. In
all tests in one subject, the region of integral interest was of opposite direction
to all the other subjects, so these measurements were discarded. In measurements of gastric emptying following a drink of conducting uid after acid
suppression with cimetidine, baseline variability was usually less than 10%
(Avill et al 1987).
In general, in dynamic imaging over time, the baseline uctuates by
several per cent over 10 min or so. If the recording takes place over a few
minutes or less, or if averaging over time is possible, such as for ventilation
or cardiac changes, then images may usually be reliably made.
442
Variability over time has also been investigated in serial recordings.

Gastric emptying times were measured by EIT in eight volunteers after drinking a liquid meal on two successive days (Avill et al 1987). Acid production
was suppressed by cimetidine. The half emptying times on the two days
correlated well (r 0:9). There is a high degree of correlation in cardiacrelated lung perfusion changes over both subjects and successive recordings
over days (Killingbeck et al (in Holder 1993), Smit et al 2003).
Variability across subjects is clearly of paramount interest, as it is this
which determines how condently changes seen in an individual patient
can be interpreted. In general, there is signicant variability, and it is this
that has limited the clinical use of EIT. There do not appear to have been
quantitative evaluations of this. However, qualitative evaluation, using the
Sheeld Mark 1 or similar systems, has indicated considerable variability,
which may in part be due to variations in electrode position in imaging
cardiac output (Patterson et al 2001), ventilation (Frerichs 2000) and gastric
emptying (Avill et al 1987). The most reliable approach has been to extract
parameters, such as gastric emptying time, or ventilation ratios, in which
the subject acts as their own normalization. Variability in EIT spectroscopy
has been investigated in images of neonatal lungs. Changes across frequency
were reproducible to within 13% of the highest frequency, 1.2 MHz, but Cole
parameters, such as centre frequency, were excessively variable across
subjects (Marven et al 1996).
B.4.2.
B.4.2.1.
Potential clinical applications

Gastrointestinal function
Measurement of gastric emptying can be useful clinically in disorders of

gastrointestinal motility. Imaging gastric emptying was one of the earliest
proposed applications of EIT and has been validated as a reliable method
(Mangall et al 1987, Ravelli et al 2001). It is now used in clinical research,
but still at a few specialist centres with EIT expertise. Although it appears
to have the potential for widespread use, this has not yet happened, largely
because good, although invasive, alternative methods are available, such as
radioisotope scintigraphy. Good pilot studies have also demonstrated its
utility in imaging in pyloric stenosis (Nour et al 1993) and acid reux (Ravelli
and Milla 1994), but this early interest does not appear to developed into
clinical use.
B.4.2.2.
Thoracic imaging of lung and cardiac function
The clinical application which has received the greatest interest has been
imaging of lung ventilation and cardiac output (Frerichs 2000). Large
impedance changes occur during ventilation, as air enters and leaves the
443
lungs. Although the images have a relatively low resolution, several pilot
studies have conrmed that reasonably accurate data concerning ventilation
can be continuously obtained at the bedside (Harris et al 1988, Kunst et al
1998). EIT therefore has the potential to image ventilation. Although the
feasibility of imaging this with the Sheeld Mark 1 system was established
in the 1980s, the method has not yet been taken up into clinical use. This is
presumably because good imaging methods already exist for assessing lung
function and pathology, and the portability of EIT was not considered
sucient to outweigh relatively poor spatial resolution. However, recently,
there has been fresh interest in this application, led by Amato and colleagues
(Kunst et al 1998, Barbas et al 2003, Hinz et al 2003, Victorino et al 2004). In
operating theatres or Intensive Care Units, there is a growing body of thought
that, in ventilated patients, the outcome is improved if ventilation is adjusted
so that no regions of lung stay collapsed; EIT is suciently small and rapid to
enable continuous monitoring at the bedside to achieve this.
Pilot studies have also shown that EIT has reasonable accuracy in
imaging in emphysema (Eyuboglu et al 1995), pulmonary oedoema (Noble
et al 1999), lung perfusion with gating of recording to the ECG (Smit et al
2003), and perfusion during pulmonary hypertension (Smit et al 2002).
However, although of physiological interest, these applications have not
yet been taken up as being suciently accurate for clinical use.
All the above studies have employed the Sheeld Mark 1 or similar 2D
systems with a single ring of electrodes; it appears that this gives sucient
resolution to enable optimization of ventilator settings when compared to
concurrent CT scanning (Victorino et al 2004). Studies have also been
performed in the thorax with more advanced methods. A method for 3D
imaging of lung ventilation created great interest on publication in 1996
(Metherall et al 1996), but this requires the use of four rings of 16 electrodes
each and has not been taken up for further clinical studies, presumably
because of practical diculties in applying this number of electrodes in
critically ill subjects. The above studies have used EIT at a single frequency
and relied on its anatomical imaging capability for the proposed clinical use.
An alternative philosophy, developed in the Sheeld group, has been to go
to lower spatial resolution and extract EITS parameters of the lung function
in conditions such as respiratory distress or pulmonary oedoema, on the
principle that such conditions diusely aect the lung and the method will
be more reliable. The characteristics of adult (Brown et al 1995) and neonatal
(Brown et al 2002) lungs have been obtained in normal subjects, but this has
yet to be taken up in further studies in pathological conditions.
B.4.2.3.
Breast tumours
Early diagnosis by screening of the common condition of breast cancer is

another area where the portability of EIT could lead to benets. The
444
electrical properties of breast tumours may dier signicantly from the

surrounding tissue and could enable EIT to be eective in screening. At
present, women are screened for breast cancer using x-ray mammography,
though some cancers of the breast cannot be seen using this technique.
During this procedure, their breast is compressed at in order to visualize
all the tissue and minimize the required radiation dosethis can be
uncomfortable and sometimes painful for the patient. There is also a high
false-positive rate of 40% and the false-negative rate is 26%. Preliminary
clinical images have been collected by groups in Dartmouth, USA (Soni et
al 2004), and Moscow (Cherepenin et al 2002), but whether it will prove
suciently sensitive and spatially accurate is not yet clear.
B.4.2.4.
Brain function
There are already excellent methods for imaging brain anatomy and
functionx-ray CT, MRI and functional MRI. EIT has the potential,
however, to oer a low-cost portable system for imaging brain abnormalities like epileptic activity or stroke, where it is not practicable to undertake
serial or rapid imaging in a large scanner. For example, it could enable takeup of a new treatment for stroke. New thrombolytic (clot-busting) drugs
have been shown to improve outcome in acute stroke, but must be administered within three hours of the onset. Neuroimaging must be performed
rst, in order to determine the cause of the stroke; about 15% of strokes
are due to a haemorrhage, and thrombolysis must not be given in these
patients, as it may make the haemorrhage extend. In practice, it is not possible to obtain and report a CT scan in the recommended 30 min. EITS could
be available in casualty departments and used to provide images which
would enable distinction of haemorrhagic from ischaemic stroke, and so
enable the rapid use of thrombolytic drugs. It also has the potential for
imaging the small impedance changes associated with opening of ion
channels during activity in the brain, which is not presently possible by
any other method and would be substantial advance. Unfortunately, EIT
of the brain has to overcome the diculty of injecting current through the
resistive skull.
Systems optimized for brain imaging have been developed at University
College London. Imaging through the skull with reasonably good resolution
has been shown to be possible, mainly by using widely spaced electrodes
for current injection (Bagshaw et al 2003a). A series of pilot studies in anaesthetized animals with electrodes placed directly on the brain, and the
Sheeld Mark 1 system, conrmed that suitable changes could be imaged
in stroke (Holder 1992b), epilepsy (Rao et al 1997) and evoked activity
(Holder et al 1996b). In humans, with recording in 3D using scalp electrodes,
reproducible impedance changes have been recorded during physiologically
evoked activity (Tidswell et al 1999) and epilepsy (Fabrizi et al 2004), but
Current developments
445
the reconstructed images were noisy and did not reveal consistent changes.
At the time of writing, trials are in progress to assess the utility of EIT in
acute stroke and epilepsy with improved multifrequency hardware and
reconstruction algorithms.
B.5.
CURRENT DEVELOPMENTS
This review has covered applications with conventional EIT. There are two
new methods, with considerable potential, which are still in technical
development, and have not yet been used for clinical studies. Magnetic
induction tomography (MIT) is similar in principle to EIT, but injects
and records magnetic elds from coils. It has the advantages that the position of the coils is accurately known and there is no skin-electrode
impedance, but the systems are bulkier and heavier than EIT. In general,
higher frequencies have to be injected in order to gain a sucient signalto-noise ratio. Until now, spatial resolution has been the same or worse
than EIT. The method could oer advantages in imaging brain pathology,
as magnetic elds pass through the skull, and may in the thorax or abdomen
if the method can be developed to demonstrate improved sensitivity over
EIT. MR-EIT (magnetic resonance-EIT) requires the use of an MRI scanner. Current is injected into the subject and generates a small magnetic
eld that alters the MRI signal. The pattern of resistivity in three dimensions
may be extracted from the resulting changes in the MRI images. This therefore loses the advantage of portability in EIT, but has the great advantage
of high spatial resolution of MRI. It could be used to generate accurate
resistivity maps for use in models for reconstruction algorithms in EIT,
especially for brain function, where prior knowledge of anisotropy is
important.
Biomedical EIT is, at the time of writing, in a phase of consolidation,
where optimized EIT systems are still being assessed in new clinical situations. Almost all clinical studies have been undertaken with variants of
the 2D Sheeld Mark 1 system. Several groups are near completion of
more powerful systems with improved instrumentation and reconstruction
algorithms, with realistic anatomical models and non-linear methods. The
most promising applications appear to be in breast cancer screening,
optimization of ventilator settings in ventilated patients, brain pathology
in acute stroke and epilepsy, and gastric emptying. Although there is a
commercial application in breast cancer screening with an impedance scanning device, EIT has yet to full its promise in delivering a robust and
widely accepted clinical application. Well funded clinical trials are in
progress in the above applications, and there seems to be a reasonable
chance that one or more, especially if using improved technology, may
prove to be the breakthrough.
446
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Series in Medical Physics and Biomedical Engineering

Institute of Physics Publishing

# IOP Publishing Ltd 2005

Copyright 2005 IOP Publishing Ltd.

Copyright 2005 IOP Publishing Ltd.

IFMBE publishes the series of IFMBE Proceedings. The Federation has 2

Copyright 2005 IOP Publishing Ltd.

This volume is dedicated to

Copyright 2005 IOP Publishing Ltd.

1. THE RECONSTRUCTION PROBLEM

Why is EIT so hard?

Copyright 2005 IOP Publishing Ltd.

1.8.1. Basic FEM formulation

Copyright 2005 IOP Publishing Ltd.

3. IMAGING OF THE THORAX BY EIT

4. ELECTRICAL IMPEDANCE TOMOGRAPHY OF

Copyright 2005 IOP Publishing Ltd.

EIT of slow evoked physiological activity in the brain

5. BREAST CANCER SCREENING WITH ELECTRICAL

Rationale for using impedance measurements for breast

6. APPLICATIONS OF ELECTRICAL IMPEDANCE

Rationale for EIT within the gastrointestinal tract

Copyright 2005 IOP Publishing Ltd.

Electrical impedance tomography to measure gastric

7. OTHER CLINICAL APPLICATIONS OF ELECTRICAL

8. MAGNETIC INDUCTION TOMOGRAPHY

Copyright 2005 IOP Publishing Ltd.

Working imaging systems and proposed

9. MAGNETIC RESONANCE ELECTRICAL IMPEDANCE

Copyright 2005 IOP Publishing Ltd.

9.5.2. Early algorithms

10. ELECTRICAL TOMOGRAPHY FOR INDUSTRIAL

Copyright 2005 IOP Publishing Ltd.

11. EIT: THE VIEW FROM SHEFFIELD

12. EIT FOR MEDICAL APPLICATIONS AT OXFORD

Copyright 2005 IOP Publishing Ltd.

Appendix A BRIEF INTRODUCTION TO BIOIMPEDANCE

Resistance and capacitance

Appendix B INTRODUCTION TO BIOMEDICAL ELECTRICAL

Copyright 2005 IOP Publishing Ltd.

Copyright 2005 IOP Publishing Ltd.

Copyright 2005 IOP Publishing Ltd.

Electrical impedance tomography (EIT) is a relatively new medical imaging

Copyright 2005 IOP Publishing Ltd.

Copyright 2005 IOP Publishing Ltd.

and to see if the developments in hardware and reconstruction algorithms

Copyright 2005 IOP Publishing Ltd.

Copyright 2005 IOP Publishing Ltd.

WHY IS EIT SO HARD?

Copyright 2005 IOP Publishing Ltd.

The reconstruction problem

Our starting point for consideration of EIT should be Maxwells equations

Copyright 2005 IOP Publishing Ltd.

and Coulombs law

where J is the electric current density. We dene the charge density by

Copyright 2005 IOP Publishing Ltd.

The reconstruction problem

The current density on the boundary is

density must satisfy the consistency condition @ j 0. The ideal complete

Copyright 2005 IOP Publishing Ltd.

data, but knowing the Dirichlet to Neumann mapping on an open subset of

Copyright 2005 IOP Publishing Ltd.

The reconstruction problem

and similarly for sin, where 1 2 =1 2 . We can now express

This can be calculated as the square root of the largest eigenvalue of A A.

i are the eigenvalues of A A, which for

where T is T with the nonzero i replaced by i =2i 2 . As only T

matrix P 2 Cn n and the norm kxk2P x Px. A common choice is to use an