This invention relates to a flow rate sensor system and method for measuring the flow rate of a bodily fluid.
A computer program listing appendix is filed herewith on compact disk. The material on the compact disk is hereby incorporated by reference. Two identical compact disks have been submitted. Each compact disk contains two files entitled source implant.txt and source external.txt. The two disks were created on Mar. 21, 2014.
Drainage of cerebrospinal fluid (CSF) is one major life-sustaining therapy which may be used for patients with congenital or acquired hydrocephalus or patients with serious head injuries. Ventriculo-peritoneal (VP) shunt placement for CSF drainage is a common procedure in neurosurgery. However, shunt failure is common and shunt revision surgery is even more common than initial placement. One study of shunt-related deaths from January 1990 to July 1996 found that children are dying of shunt failure and that early detection could prevent many of these deaths. Another study of all shunt procedures performed between January 1996 and December 2005, excluding temporary shunts such as external ventricular drains (EVDs), found that the median shunt survival life span was 398 days. These results are in good agreement yet another study that suggests failure rates of 25 to 40 percent in the first year and failure of seventy percent of shunts by five years. These findings point to the importance of the need for a non-invasive and convenient system and method for monitoring shunt function.
Invasive surgery allows direct observation of the shunt and its flow behavior when it is allowed to drain into a collection vessel. This is different than measuring the flow rate when the shunt is draining into the peritoneum, but it does allow the surgeon to check patency of the shunt and provide an indication of current flow.
The ShuntCheck by NeuroDX Development (Bensalem, Pa. 19020) has been shown in clinical studies to provide a means for assessing CSF flow through a VP Shunt. The ShuntCheck uses thermal techniques for determining that CSF flow is present in the shunt. The ShuntCheck relies on a disposable temperature sensor placed over the skin proximate the shunt tubing. An ice cube is placed over the shunt and the effect on the temperature of the skin close to the shunt downstream of the ice cube is monitored. The ShuntCheck has the advantage that it is not implanted, but it has the disadvantage that it is unable to provide a quantitative measure of flow rate.
Another conventional quantitative flow measuring device for measuring the flow of CSF in VP shunt tubing uses an implantable device that produces a bubble in the shunt tubing by electrolysis. The bubble is then detected by an electrode arrangement using electric impedance or ultrasonically with a Doppler probe. Extracorporeal high-frequency transmission supplies the energy for electrolysis and flow may be calculated based on the velocity of bubble flow in the tubing.
Another conventional VP shunt pressure sensor determines pressure from deflection of a capacitive membrane. The shunt flow sensor membrane has a vacuum on the side of the membrane that is not in contact with fluid. Thus, the device is measuring pressure relative to vacuum.
Yet another conventional implanted intracranial pressure (ICP) sensor relies on the deflection of a membrane and the resultant change in the resonance of an LC-circuit.
However, none of the devices discussed above have yet to be demonstrated in humans to provide sufficiently reliable and accurate quantitative information on shunt function to be adopted for clinical use.
Current techniques to evaluate implanted shunts may include cranial imaging techniques, such as ultrasonography, computer assisted tomography (CAT), magnetic resonance imaging (MRI), and the like. Such techniques require relatively expensive equipment typically only available in hospitals. Intracranial pressure monitoring is currently available through implanted catheters and transducers, typically in an intensive care unit. Thus, clinicians rely on reports of symptoms from the patient, imaging of the ventricles, or the use of invasive devices to treat diseases related to CSF flow through VP shunts. Additionally, the progression of disease and injuries cannot be studied extensively because of the lack of shunt flow data.
Therefore, there is a need for an implanted sensor system capable of determining and reporting flow rate of a bodily fluid, such as CSF, that can be queried transcutaneously to allow the clinician to noninvasively assess shunt function.
This invention features a flow rate sensor system for non-invasively measuring the flow rate of a bodily fluid. The system includes an encapsulated implant having a flow tube having an inlet and an outlet configured to receive a flow of a bodily fluid. A heating element externally coupled to the flow tube is configured to dissipate heat at a predetermined rate over a predetermined amount of time. A temperature sensor externally coupled to the heating element is configured to measure a temperature rise of the heating element over the predetermined amount of time. An implant microcontroller coupled to the temperature sensor is configured to determine the flow rate of the bodily fluid in the flow tube from the measured temperature rise of the heating element over the predetermined amount of time and a curve fit to a stored set of previously obtained calibration measurements. An implant power and communication subsystem coupled to the implant microcontroller is configured to wirelessly receive power and wirelessly transmit and receive data.
The system also includes an external device having an external microcontroller and an external power and communication subsystem coupled to the external microcontroller configured to wirelessly deliver power to the implant power and communication subsystem and transmit and receive data to and from the implant power and communication subsystem.
In one embodiment, the temperature sensor may include a thermistor or a resistance temperature detector (RTD). The thermistor may be configured as both the temperature sensor and the heating element. The temperature sensor may include a thermocouple. The heating element may include a surface mount resistor. The heating element may include a coil of electrically conductive wire or a printed circuit heater. The heating element may be directly attached to the external surface of the flow tube. The system may include a thermal insulator configured to thermally isolate the heating element and the temperature sensor from cooling paths other than the direct cooling path to the bodily fluid in the flow tube. The thermal insulator may include an insulation layer over the heating element and the temperature sensor. The thermal insulator may include a sealed volume of air surrounding the heating element and the temperature sensor. The flow through flow tube may be comprised of a thin wall of polymer material with low thermal conductivity configured to limit heat transfer along a length and a circumference of the tube while maintaining heat transfer in a radial direction to the fluid. The bodily fluid may include one or more of: cerebrospinal fluid (CSF), bile, blood, and urine. The encapsulated implant may be coupled to a shunt, tube, vessel or catheter implanted in a human body or an animal. The shunt may include one or more of: a ventriculo-peritoneal (VP) shunt, ventroarterial shunt, and lumboperitoneal shunt. The encapsulated implant may be coupled to a distal catheter of the shunt. The encapsulated implant may be coupled to a proximal catheter of the shunt. The heating element and the temperature sensor may be located proximate the outlet. The heating element and the temperature sensor may be located proximate the inlet. The heating element and the temperature sensor may be located between the inlet and the outlet. The external power and communication subsystem includes an external coil coupled to the external microcontroller and the implant power and communication subsystem includes an implant coil coupled to the microcontroller. The implant coil of the encapsulated implant may be located using the magnitude of the induced voltage wirelessly sent from the implant coil to the external coil. The external coil may be positioned proximate and in alignment with the implant coil to achieve sufficient inductive coupling between the external coil and the implant coil. The external coil may be remotely located from and tethered to the external power and communication subsystem. The implant coil may be integrated with the encapsulated implant. The implant coil may be remotely located from and tethered to the encapsulated implant. The external power and communication subsystem may include a resonant circuit comprised of the external coil and a capacitor, and a source of low-level voltage pulses, the external device resonant circuit configured to provide sinusoidal current in the external coil of sufficient amplitude to induce sufficient sinusoidal voltage in the implant coil. The implant power and communication subsystem may include an implant resonant circuit comprised of the implant coil and a capacitor having a resonance frequency closely matched to the resonance frequency of the external resonant circuit to maintain sufficient AC voltage amplitude to power the implant power and communication subsystem and to enable communication between the external power and communication subsystem and implant power and communication subsystem. The implant power and communication subsystem may be configured to convert induced sinusoidal voltages in the implant coil to a highly regulated DC voltage over the range of loading conditions to power the heating element, the temperature sensor, the microcontroller, and components of the implant power and communication subsystem. The external power communication subsystem may be configured to enable the external microcontroller to communicate data to the implant power and communication subsystem by changing the voltage supplied to the resonant circuit of the external power and communication subsystem to modulate the amplitude of the voltage induced in the implant coil and use that change in voltage to represent different binary states. The implant power and communication subsystem may transmit binary values serially to the external power and communication subsystem by sequentially applying and removing an electrical load from the implant coil to induce changes in voltage in the external coil that are decoded into data by the external microcontroller. The external power and communication subsystem may include a sense resistor configured to measure change in the amplitude of the current in external power and communication subsystem resulting from changes in the induced voltage in the external coil. The external microcontroller may be coupled to the series resistor and may be configured to decode changes in the current of the external power and communication subsystem into data. The implant microcontroller may be configured to store the set of previously obtained calibration measurements relating heating element temperature rise to flow rate. The implant microcontroller may be configured to determine the flow rate from the measured temperature rise when temperature of the heating element is determined to be no longer rising to minimize the length of time needed to determine the flow rate, the amount of heat generated by the heating device, and the amount of heat delivered to a patient. The implant microcontroller may be configured to store identification information associated with the encapsulated implant. The implant microcontroller may be configured to use the mean value of a set of temperature rise samples obtained over the predetermined amount of time as the temperature rises to determine the flow rate of the bodily fluid in order to increase the signal to noise ratio. The implant microcontroller may be configured to use a weighted average of a set of temperature rise samples obtained over a predetermined amount of time as the temperature rises to determine the flow rate of the bodily fluid in order to increase the signal to noise ratio. The encapsulated implant may be implanted in a human body. The external device may include a smart device including a flow sensor
App and a tethered external coil. The external device may include a display for displaying one or more of: the measured flow rate, the predetermined amount of time, induced voltage on the implant coil, and identification information associated with the encapsulated implant.
In another aspect, a flow rate sensor system for non-invasively measuring the flow rate of a bodily fluid is featured. The system includes an encapsulated implant having a flow tube having an inlet and an outlet configured to receive a flow of a bodily fluid. A heating element externally coupled to the flow tube is configured to dissipate heat at a predetermined rate over a predetermined temperature rise of the heating element. A temperature sensor externally coupled to the heating element is configured to measure a temperature drop of the heating element over a predetermined amount of time of cooling. An implant microcontroller coupled to the temperature sensor is configured to determine the flow rate of the bodily fluid in the flow tube from the measured temperature drop of the heating element over the predetermined amount of cooling time and a curve fit to a stored set of previously obtained calibration measurements. An implant power and communication subsystem coupled to the implant microcontroller is configured to wirelessly receive power and wirelessly transmit and receive data. The system also includes an external device having an external microcontroller, and an external power and communication subsystem coupled to the external microcontroller configured to wirelessly deliver power to the implant power and communication subsystem and transmit and receive data to and from the implant power and communication subsystem.
In another aspect, a flow rate sensor system for non-invasively measuring the flow rate of a bodily fluid is featured. The system includes an encapsulated implant having a heating element externally coupled to a shunt, catheter, tube, or vessel configured to receive a flow of a bodily fluid, the heating element configured to dissipate heat at a predetermined rate over a predetermined amount of time. A temperature sensor externally coupled to the heating element is configured to measure a temperature rise of the heating element over the predetermined amount of time. An implant microcontroller coupled to the temperature sensor is configured to determine the flow rate of the bodily fluid in the shunt, catheter, tube or vessel from the measured temperature rise of the heating element over the predetermined amount of time and a curve fit to a stored set of previously obtained calibration measurements. An implant power and communication subsystem coupled to the implant microcontroller is configured to wirelessly receive power and wirelessly transmit and receive data. The system also includes an external device having an external microcontroller and an external power and communication subsystem coupled to the external microcontroller configured to wirelessly deliver power to the implant power and communication subsystem and transmit and receive data to and from the implant power and communication subsystem.
In one embodiment, the encapsulated implant may be configured as a two-piece clamp externally coupled to the shunt, catheter, tube, or vessel.
In another aspect, a flow rate sensor system for non-invasively measuring the flow rate of a bodily fluid is featured. The system includes an encapsulated implant having a heating element externally coupled to the shunt, catheter, tube, or vessel configured to receive a flow of a bodily fluid, the heating element configured to dissipate . heat at a predetermined rate over a predetermined temperature rise of heating element. A temperature sensor externally coupled to the heating element is configured to measure a temperature drop of the heating element over a predetermined amount of time of cooling. An implant microcontroller coupled to the temperature sensor is configured to determine the flow rate of the bodily fluid in the shunt, catheter, tube or vessel from the measured temperature drop of the heating element over the predetermined amount of cooling time and a curve fit to a stored set of previously obtained calibration measurements. An implant power and communication subsystem coupled to the implant microcontroller is configured to wirelessly receive power and wirelessly transmit and receive data. The system also includes an external device having an external microcontroller and an external power and communication subsystem coupled to the external microcontroller configured to wirelessly deliver power to the implant power and communication subsystem and transmit and receive data to and from the implant power and communication subsystem.
In one embodiment, the encapsulated implant may be configured as a two-piece clamp externally coupled to the shunt, catheter, tube, or vessel.
In another aspect, a method for non-invasively measuring the flow rate of a bodily fluid is featured. The method includes providing an encapsulated implant coupled to a shunt, catheter, tube or vessel, receiving a flow of a bodily fluid in the shunt, catheter, tube or vessel, externally coupling a heating element to the shunt, catheter, tube or vessel configured to dissipate heat at a predetermined rate over a predetermined amount of time, externally coupling a temperature sensor to the heating element, measuring a temperature rise of the heating element over a predetermined amount of time, determining the flow rate of the bodily fluid in the shunt, catheter, tube or vessel from the measured temperature rise and a curve fit to a stored set of previously obtained calibration measurements, providing an external device, wirelessly delivering power to the encapsulated implant, and wirelessly transmitting and receiving data to and from the encapsulated implant.
In one embodiment, the method may include thermally isolating the heating element and the temperature sensor. The method may further include locating the encapsulated implant using data wirelessly sent from the encapsulated implant to the external device. The method may further include positioning an external coil of the external device proximate and in alignment with an implant coil of the encapsulated implant to provide sufficient inductive coupling between an external coil of the external device and an implant coil. The method may include storing on a microcontroller of the encapsulated implant the set of previously obtained calibration measurements of heat dissipation. The method may include storing on a microcontroller of the encapsulated implant identification information associated with the encapsulated implant. The method may include determining the flow rate from a current measured temperature rise up when the temperature of the heating element is determined to be no longer rising to minimize the length of time needed to determine the flow rate, the amount of heat generated by the heating device, and the amount of heat delivered to a patient.
In another aspect a method for non-invasively measuring the flow rate of a bodily fluid is featured. The method includes providing an encapsulated implant coupled to a shunt, catheter, tube or vessel, receiving a flow of a bodily fluid in the a shunt, catheter, tube or vessel, externally coupling a heating element to the shunt, catheter, tube or vessel configured to dissipate heat until a predetermined rate temperature rise is achieved, externally coupling a temperature sensor to the heating element, measuring a temperature drop of the heating element over a predetermined amount of time of cooling, determining the flow rate of the bodily fluid in the flow tube from the measured temperature drop and a curve fit to a set of previously obtained calibration measurements, providing an external device, wirelessly delivering power from the external device to the encapsulated implant, and wirelessly transmitting and receiving data to and from the encapsulated implant and the external device.
Other objects, features and advantages will occur to those skilled in the art from the following description of a preferred embodiment and the accompanying drawings, in which:
Aside from the preferred embodiment or embodiments disclosed below, this invention is capable of other embodiments and of being practiced or being carried out in various ways. Thus, it is to be understood that the invention is not limited in its application to the details of construction and the arrangements of components set forth in the following description or illustrated in the drawings. If only one embodiment is described herein, the claims hereof are not to be limited to that embodiment. Moreover, the claims hereof are not to be read restrictively unless there is clear and convincing evidence manifesting a certain exclusion, restriction, or disclaimer.
There is shown in
In this example, encapsulated implant 12,
Encapsulated implant 12,
In one example, the stored set of previously obtained calibration measurements shown by data points 40,
To create the stored set of previously obtained calibration measurements, the resulting temperature rise over the predetermined amount of time is preferably matched to the imposed flow rate, and two values are stored in the memory of the implant microcontroller 35 as the stored set of calibration measurements. In one design, rather than store only one value of temperature rise for calibration, multiple values of temperature rise versus flow rate over the predetermined amount time and rate of heat dissipation may be stored.
In one example, a pump capable of accurately delivering a known desired flow rate, such as a well-calibrated syringe pump may be used to create the stored calibrated measurement. The stored set of calibrated flow rate measurements may be obtained in this manner at each of multiple flow rate settings over the known range of feasible bodily fluid flow rates through flow tube 22, e.g., from about 0 to about 40 mL/hr.
The number of calibration values for the stored set of calibrated flow rate measurements is preferably sufficient to characterize a curve of the rise in temperature of heating element 32 as a function of flow rate, e.g., data points 40,
In operation, a regulated DC voltage is applied to heating element 32 and the temperature rise of heating element 32 is sensed by temperature sensor 34 and recorded by implant microcontroller 35. Curve fitting is preferably applied to the stored set preferably previously obtained calibration measurements of temperature rise versus flow rate to derive a continuous relationship between measured temperature rise and flow rate, as shown by curve 41,
Curve fitting is a well understood process of creating a curve or a continuous mathematical function that closely fits a series of data points. For determination of flow rate, curve fitting can involve either interpolation between calibration data points of measured temperature rises versus flow rates, or the determination of a smooth mathematical function that fits all the data points 40,
Plot 49,
If the implant microcontroller 35 determines that the temperature of heating element 32 is no longer rising (i.e. that steady state has been reach), then implant microcontroller 35 can terminate the measurement since it has already acquired a sufficient number of temperature values from temperature sensor 34 to determine the flow rate. This can reduce the predetermined amount of time needed to determine the flow rate of flow of bodily fluid 28, e.g., to between about 5 to 10 seconds and minimize the amount of heat needed to be generated by heating element 32.
The dependence of the temperature rise of heating element 32 over the duration of a flow rate measurement by encapsulated implant 12 rate arises from the flow rate of flow of bodily fluid 28,
h=Q/(AΔT) (1)
where Q is the heat dissipated by the heating element 32, A is the area of heat transfer, and AT is the difference in temperatures between heating element 32 and bodily fluid 28 flowing in tube 22. The heat transfer coefficient h increases monotonically with flow rate, at least over the range of CSF flow rates possible within a shunt. Therefore, since the level of heat dissipation Q produced by the heating element is fixed for a given applied DC voltage, the temperature rise of heating element 32 during a flow rate measurement will decrease with increasing CSF flow rate.
Flow rate sensor system 10, shown in one or more of
Encapsulated implant,
External device 14,
In one example, temperature sensor 34,
Preferably, heating element 32,
In one example, flow tube 22,
As discussed above, encapsulated implant 12,
In the example shown in
External power and communication subsystem 58,
It is well known that the presence of a time-varying current in one coil will induce a voltage in a nearby second coil. This principle is employed by system 10 for non-invasively measuring the flow rate of a bodily fluid to enable wireless power transfer and communication between external device 14 and encapsulated implant 12. The voltage (V2) induced in the implant coil 52 by external coil 90 may be shown by the equation:
V
2(t)=M(dI1/dt) (2)
where M is the mutual inductance between the implant coil 52 and external coil 90 and I1 (t) is the current in the external coil 90. If the current in the external coil 90 coil is sinusoidally-varying in time at a frequency ω=2πf, where f is the frequency in Hertz, then:
V
2
=ωMI
1, (3)
where V2 and I1 are the amplitude of the voltage induced in implant coil 52 and the amplitude of the current in the external coil 90, respectively. Likewise, if the current in the implant coil is time-varying, a voltage is induced in external coil 90 given by:
V
1
=ωMI
2, (4)
where V1 and I2 are the amplitude of the voltage induced in the external coil 90 and the amplitude of the current in external coil 90, respectively
The mutual inductance depends both on the self-inductances of the coupled external coil 90 (L1) and implant coil 52 (L2) coils and the coupling coefficient (KC) between them:
M=K
c(L1L2)1/2, (5)
where KC depends on relative orientation, lateral alignment and proximity of the external coil 90 and implant coil 52. The self-inductance of the external coil 90 (L1) is preferably set such that the source voltage 132,
DC voltage necessary to operate the implant microcontroller 35, heating element 32, temperature sensor 34 and other various electronic components of encapsulated implant 12,
External power and communication subsystem 58,
In one example, resonant circuit 92,
The inductance of external coil 90,
f
n=1/[2π(LC)1/2] (6)
where L is the inductance of external coil 90 and C is the capacitance of capacitor 94. At this frequency, the reactive impedance of capacitor 94 cancels out the reactive impedance of external coil 90, and in the vicinity of this frequency, both the reactance and overall impedance of the external power and communication subsystem 58,
The use of resonance frequency may be beneficial because square-wave pulses, which are conveniently produced by half bridge driver 103 or other AC voltage source known to those skilled in the art, give rise to sinusoidally-varying current in external power and communication subsystem 58. Further, the impedance of series resonant circuit 92 is a minimum at resonance, which maximizes the current for a given applied voltage, thereby lowering the voltages to levels as may be found in a common battery or USB interface, e.g., interface port 140. In addition, since the current through external coil 90 varies with the applied square wave frequency, the power delivered to the external coil 90 can be easily tuned by changing the square wave frequency. The value of capacitor 94 is preferably chosen such that the capacitor 94 and external coil 90 resonate at a desirable frequency. The choice of resonant frequency may include, inter alia, the available space for external coil 90, frequency-dependent coil losses, skin effect, FCC regulations, guidelines regarding patient exposure to electromagnetic fields, and the like. Preferably, resonant circuit 92 is driven by a square wave source voltage 132, with its frequency set at or near the resonant frequency of resonant circuit 92. This results in a sinusoidally-varying current in the external power and communication subsystem 58 at the frequency of the voltage source pulses. This current gives rise to a magnetic field in the space surrounding external coil 90. A fraction of the field lines of this magnetic field are inductively linked to implant coil 52,
Implant power and communication subsystem 50,
In one example, external device 14,
Implant power and communication subsystem 50,
Preferably, implant coil 52,
In one embodiment, external coil 90 of external device 14 may be located relative to implant coil 52 of encapsulated implant 12 in human body 15,
Preferably, implant microcontroller 35,
In one example, external device 14,
External device 14,
Although, as discussed thus far, implant coil 52, shown in one or more of
Although, as discussed above with reference to one or more of
External device 14,
The result is flow rate sensor system 10 and the method thereof, shown in one or more of
External device 14 enables the clinician to obtain and store a “snapshot” of flow rate of CSF or other bodily fluids whenever needed. Because patient posture and orientation can affect flow through a shunt, the clinician can choose to place patient in various orientations and then take a flow rate measurement at selected orientations. The external device or external coil can be affixed to the patient to enable automatically-initiated, periodic measurements and storage of the flow rates of bodily fluids, such as CSF, over an extended time period. This allows the clinician to see any trends in the flow characteristics of the shunt over a desired period of time. For example, CSF flow rate measurements could be automatically obtained every half hour to monitor shunt function, both in the hospital and after discharge, for the critical days following a shunt placement or a shunt revision surgery. In a second example, a CSF flow rate measurement could be taken every 5 minutes on a shunted patient who arrives at the emergency room with symptoms possibly indicative of shunt failure. This would give the clinician complete knowledge of the flow characteristics of the shunt, possibly preventing unnecessary diagnostic or surgical procedures, including MRI or CT imaging and shunt revisions.
For enablement purposes only, the computer program listing appendix provided can be executed on implant microcontroller 35 and external microcontroller 56 to carry out the primary steps and/or functions of flow rate sensor system 10 shown in one or more of
Although specific features of the invention are shown in some drawings and not in others, this is for convenience only as each feature may be combined with any or all of the other features in accordance with the invention. The words “including”, “comprising”, “having”, and “with” as used herein are to be interpreted broadly and comprehensively and are not limited to any physical interconnection. Moreover, any embodiments disclosed in the subject application are not to be taken as the only possible embodiments. Other embodiments will occur to those skilled in the art and are within the following claims.
In addition, any amendment presented during the prosecution of the patent application for this patent is not a disclaimer of any claim element presented in the application as filed: those skilled in the art cannot reasonably be expected to draft a claim that would literally encompass all possible equivalents, many equivalents will be unforeseeable at the time of the amendment and are beyond a fair interpretation of what is to be surrendered (if anything), the rationale underlying the amendment may bear no more than a tangential relation to many equivalents, and/or there are many other reasons the applicant cannot be expected to describe certain insubstantial substitutes for any claim element amended.
Other embodiments will occur to those skilled in the art and are within the following claims.
This invention was made with U.S. Government support under Grant No. 6R44NS056628-04 awarded by the National Institutes of Health. The Government may have certain rights in certain aspects of the subject invention.