title: Initial evaluation of prospective cardiac triggering using photoplethysmography signals recorded with a video camera compared to pulse oximetry and electrocardiography at 7T MRI.
abstract: BACKGROUND
  Accurate synchronization between magnetic resonance imaging data acquisition and a subject's cardiac activity ("triggering") is essential for reducing image artifacts but conventional, contact-based methods for this task are limited by several factors, including preparation time, patient inconvenience, and susceptibility to signal degradation. The purpose of this work is to evaluate the performance of a new contact-free triggering method developed with the aim to eventually replace conventional methods in non-cardiac imaging applications. In this study, the method's performance is evaluated in the context of 7 Tesla non-enhanced angiography of the lower extremities.
  
  
  METHODS
  Our main contribution is a basic algorithm capable of estimating in real-time the phase of the cardiac cycle from reflection photoplethysmography signals obtained from skin color variations of the forehead recorded with a video camera. Instead of finding the algorithm's parameters heuristically, they were optimized using videos of the forehead as well as electrocardiography and pulse oximetry signals that were recorded from eight healthy volunteers in and outside the scanner, with and without active radio frequency and gradient coils. Based on the video characteristics, synthetic signals were generated and the "best available" values of an objective function were determined using mathematical optimization. The performance of the proposed method with optimized algorithm parameters was evaluated by applying it to the recorded videos and comparing the computed triggers to those of contact-based methods. Additionally, the method was evaluated by using its triggers for acquiring images from a healthy volunteer and comparing the result to images obtained using pulse oximetry triggering.
  
  
  RESULTS
  During evaluation of the videos recorded inside the bore with active radio frequency and gradient coils, the pulse oximeter triggers were labeled in 62.5% as "potentially usable" for cardiac triggering, the electrocardiography triggers in 12.5%, and the proposed method's triggers in 62.5%. Evaluation of the angiography images demonstrated that under appropriate conditions the method is feasible to produce an image quality comparable to pulse oximetry.
  
  
  CONCLUSIONS
  We conclude that cardiac triggering using the proposed method is technically feasible. However, for improved reliability the signal-to-noise ratio of the videos will have to be addressed by either replacing the camera sensor, improving the illumination, or by use of additional signal filtering techniques.
authors.affiliation: Department of Computer Science, University of Applied Sciences and Arts Dortmund, Emil-Figge-Str. 42, 44227, Dortmund, Germany. nicolai.spicher@fh-dortmund.de.
authors.forename: Nicolai
authors.identifier: http://orcid.org/0000-0002-2879-9948
authors.initials: N
authors.lastname: Spicher
authors.affiliation: Department of Computer Science, University of Applied Sciences and Arts Dortmund, Emil-Figge-Str. 42, 44227, Dortmund, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kukuk
authors.affiliation: Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, 45141, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Maderwald
authors.affiliation: Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, 45141, Essen, Germany.|Division of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ladd
mesh_terms: D000328:Adult; D000465:Algorithms; D000792:Angiography; D016477:Artifacts; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008279:Magnetic Resonance Imaging; D008297:Male; D010092:Oximetry; D017156:Photoplethysmography; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D014741:Video Recording
keywords: Cardiac triggering; Contact-free methods; Electrocardiography; In-bore cameras; MRI; Pulse oximetry; Remote vital sign measurement