The following relates to the medical arts. It finds particular application in measuring core body temperature, and is described with particular reference thereto. However, the following finds more general application in measuring core body temperature-related values suitable for use in medical diagnostic, treatment monitoring, and related medical applications.
Core body temperature is an important medical vital sign. Unlike other vital signs such as heart rate or blood pressure, core body temperature is relatively insensitive to variations due to psychological or emotional state. Thus, core body temperature can be a good indicator of a medical problem. Moreover, a shift in core body temperature of only a few degrees Celsius away from the typical range can be life-threatening in and of itself, providing further motivation for monitoring this critical vital sign.
Unfortunately, core body temperature has heretofore been more difficult to measure than other vital signs such as heart rate or blood pressure. The core body temperature is defined as the temperature of blood flowing through the heart. However, for clinical purposes the core body temperature is typically taken as the brain temperature, since this value is typically close to the cardiac core temperature, and elevated brain temperature is a clinically serious condition that would be useful to monitor in clinical settings. As used herein, core body temperature is taken to correspond to the brain temperature. A rectal thermometer is also sometimes used to measure core body temperature, under the assumption that the rectal temperature is a suitable surrogate for the core body temperature. However, rectal temperature may differ substantially from core body temperature of the heart or brain. Insertion of a rectal thermometer is also uncomfortable for the patient, and rectal thermometry is not well-suited for extended monitoring over a period of hours, days, or longer.
To precisely measure core body temperature, a temperature sensor can be inserted into brain vasculature using a suitable catheter instrument. Although precise, this approach is clinically problematic because it is invasive and can produce disadvantageous side effects such as infection, vascular clotting, or so forth.
Core body temperature can also be estimated by measuring forehead temperature. This is the basis for the home diagnostic of placing a hand over the forehead of the patient to determine whether a fever is present. As a measure of core body temperature, this technique is inexact at best. A more precise core body temperature estimate can be obtained by placing a thermocouple, thermistor, or other temperature sensor into contact with the forehead. However, the temperature acquired by such sensors can differ substantially from the core body temperature due to temperature drop across the skin and other intervening tissue. This temperature drop is not constant, but varies significantly as a function of sweat, room temperature, skin thickness, and other factors.
Core body temperature is also sometimes estimated as the reading of an oral thermometer. However, the oral temperature also provided by an oral thermometer can vary substantially depending upon where the thermometer tip or other temperature sensor is placed within the patient's mouth. Respiration can also affect the measured temperature. More fundamentally, the oral temperature can differ substantially from the core body temperature due to the substantial distance and large amount of intervening tissue between the orally-placed temperature sensor and the brain.
Thermometers are also known which are inserted into the ear canal to contact the tympanic membrane, also known colloquially as the ear drum. The tympanic membrane has relatively close proximity to the brain and thus reflects the core body temperature relatively accurately. However, the shape of the ear canal varies from person to person, and in some instances access to the tympanic membrane may be impeded or blocked by curvature of the ear canal. Another potential source of error is wax buildup in the ear canal. Physical contact with the tympanic membrane by the thermometer can also promote ear infection, which can be a serious medical condition. Core body temperature measurement via the tympanic membrane is also not well suited for extended monitoring over a period of hours, days, or longer.
Abreu, U.S. Published Application 2004/0059212, discloses a recently developed technique for measuring core body temperature that overcomes some of these difficulties. The approach of Abreu is based on identification of a thermally conductive pathway to the brain, called a “brain tunnel” in US 2004/0059212, located between the eyes proximate to an orbit or eye socket. By using contact thermometry at the location of this “brain tunnel,” a relatively accurate core body temperature reading can be non-invasively obtained.
Unfortunately, the identified brain tunnel has a small external cross-section near the eye orbit, which makes the accuracy of the core body temperature measurement strongly dependent upon accurate placement of the temperature sensor. Deviations of as little as one or two millimeters can adversely affect the core body temperature measurement. Additionally, placement of a temperature sensor near the eye can be discomforting for the patient, can lead to eye infection, and is not well-suited for extended monitoring over a period of hours, days, or longer. The eye-based temperature sensor can also interfere with other diagnostic operations involving access of the patient's eye, nose, or other nearby facial regions.
The following provides a new and improved apparatuses and methods which overcome the above-referenced problems and others.
In accordance with one aspect, a core body temperature measurement device includes a temperature sensor, a head-mountable mechanical frame or pad configured to operatively couple the temperature sensor with skin overlaying an arterial blood rich superficial region disposed near to an auricle and outside of an ear canal, and a readout controller configured to acquire a temperature measurement using the temperature sensor and to output a core body temperature based on the acquired temperature measurement.
In accordance with another aspect, a core body temperature measurement method includes operatively coupling a temperature sensor with skin overlaying an arterial blood rich superficial region disposed near to an auricle and outside of an ear canal, and acquiring a core body temperature measurement using the operatively coupled temperature sensor.
In accordance with another aspect, a core body temperature measurement device comprises: a temperature sensor; a head- or neck-mountable mechanical frame or pad configured to operatively couple the temperature sensor with skin overlaying the carotid artery or a major arterial branch thereof; and a readout controller configured to acquire a temperature measurement using the temperature sensor and to output a core body temperature based on the acquired temperature measurement.
One advantage resides in providing an accurate non-invasive core body temperature measurement.
Another advantage resides in providing extended non-invasive core body temperature monitoring over a period of hours, days, or longer.
Another advantage resides in providing a head-mountable core body temperature measurement apparatus that is comfortable for the patient and does not impede the patient's vision.
Another advantage resides in providing a head-mountable core body temperature measurement apparatus that does not obscure or block the patient's face.
Another advantage resides in providing a head-mountable core body temperature measurement apparatus that includes a plurality of temperature sensors to identify a position for acquiring a most accurate core body temperature.
Still further advantages of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description.
With reference to
While
With reference to
An advantage of providing the plurality of temperature sensors 12, rather than a single temperature sensor, is that the plurality of temperature sensors 12 can sample different portions of the skin. The precise location of the region STA, or of the region PAA, may vary slightly from person to person and may be difficult to pinpoint precisely on a given human head. In a suitable approach for addressing this problem, the plurality of sensors are read by the readout controller 10 and a maximum reading selector 14 selected the highest temperature measurement acquired by the plurality of temperature sensors 12 as the temperature reading for determining the core body temperature. This approach relies on the recognition made herein that the measured temperature should be highest at that point where the skin temperature most closely approximates the core body temperature. Lower temperature measurements generally reflect thermal losses due to lower thermal conductance of the skin in areas away from the skin overlaying an arterial blood-rich superficial region. Lower temperature measurements may also reflect inaccurate temperature readings due to poor contact of the temperature sensor with the skin or other measurement errors. Thus, by using the plurality of temperature sensors 12 and employing the maximum reading selector 14 to select the highest temperature measurement, such difficulties are alleviated. In some embodiments, the plurality of temperature sensors 12 are disposed proximate to both left and right auricles. In some embodiments, the plurality of temperature sensors 12 are disposed both anterior and posterior to an auricle. In some embodiments, the plurality of temperature sensors 12 are disposed both anterior and posterior to both left and right auricles. Although the approach using the plurality of temperature sensors 12 has advantages, it is also contemplated to employ a single temperature sensor to acquire a single temperature measurement, and to omit the maximum reading selector 14.
The acquired temperature measurement is expected to be close to the core body temperature due to the high level of superficial arterial blood flow just under the skin overlaying the arterial blood-rich superficial region disposed near the auricle. However, some difference between the acquired temperature measurement and the core body temperature can be expected due to thermal losses across the skin. Optionally, a temperature corrector 16 corrects the acquired temperature measurement for this temperature drop across the skin to generate the measured core body temperature. In some embodiments, the correction is an approximate correction based on an expected temperature drop across the skin. For example, it is typical to have about a 1° C. difference between the core body temperature and the skin temperature, due to thermal losses across the skin. Hence, in some embodiments the temperature corrector 16 adds 1° C. (or about 1.8° F.) to the skin temperature (e.g., the highest temperature measurement acquired by the plurality of temperature sensors 12 as selected by the maximum reading selector 14) to generate the core body temperature. For example, if the highest temperature measurement acquired by any of the temperature sensors 12 is 97.3° F., then the core body temperature is estimated as 97.3° F.+1.8° F.=99.1° F. As another example, if the highest temperature measurement is 37.1° C., then the core body temperature is estimated as 38.1° C. Optionally, the temperature corrector 16 performs other corrections or adjustments of the core temperature reading, such as a units conversion, for example, from a thermocouple voltage to degrees Celsius and/or degrees Fahrenheit, correction for non-linearity or other pre-determined systematic errors of the temperature sensors 12, or so forth.
With continuing reference to
The resulting information including the core body temperature and optional other readings such as blood oxygenation and pulse are output by a suitable output path such as a wired connection, an illustrated wireless transmitter 24 or transceiver that outputs a wireless data signal 26, or so forth. The core body temperature measurement device optionally includes other features. For example, if the core body temperature data is offloaded using a wired connection, then the wired connection can incorporate a power input lead to power the sensors 12, 20 and processors 14, 16, 22. Alternatively, if the illustrated wireless transmitter 24 or transceiver is used such that the core body temperature measurement device is a wireless device, then an on-board battery 28, power capacitor, or other on-board electrical power supply is suitably included.
As mentioned previously, the optional skin temperature corrector 16 in some embodiments employs an estimated skin temperature drop correction, such as a 1° C. temperature drop correction. This approach is computationally straightforward, but can lead to some error since the actual skin temperature drop varies based on factors such as moisture (e.g., sweat), ambient temperature, air convection, and so forth. To accommodate such factors, in some embodiments the skin temperature corrector 16 employs a more complex corrective approach based on feedback. For example, the one or more skin temperature sensors 12 can each include parallel conductive plates or films spaced apart by a distance that is adjustable using inchworm actuators, MEMS actuators, or so forth. By acquiring temperature measurements across the two plates at different plate separations, the heat flux can be determined from which the skin temperature drop can be determined. Designating the temperatures of the two conductive plates as T1 and T2, respectively, and the core body temperature as Tcore, a system of equations is defined by:
where α=λ/ρcp, λ denotes thermal conductivity, ρ denotes density, and cp denotes specific heat. In a suitable coordinate system, x denotes depth with x=0 corresponding to a point inside the body at temperature Tcore and x=hs corresponding to the surface of the skin. The boundary conditions for Equation (1) include the core body temperature Tcore (to be determined) at x=0, and the measured temperature Ts at x=hs, that is, at the surface of the skin. If the plate at temperature T2 is contacting the skin, then Ts=T2 to a good approximation. The heat flux out of the skin is denoted qs herein.
Assuming the skin 104 can be represented as a plane of thickness hs and thermal conductivity λs, the heat flux out of the skin qs (that is, heat transfer rate on a per-unit area basis) can be written as:
and a solution of Equation (1) can be approximated as:
At equilibrium, Equation (3) reduces to:
which demonstrates that the core body temperature Tcore is higher than the skin temperature by a temperature drop across the skin corresponding to (hs/λs)·qs.
By using feedback control of the actuators separating the parallel conductive plates or films, the values of the quantities Ts, qs, and
can be measured for different moments in time ti={t1, . . . , tn}to produce a matrix of coupled equations:
in which the unknown quantities are Tcore,
and where:
It is assumed here that Tcore,
are time-independent during the time interval {t1, . . . , tn} over which the set of measurements are acquired. The system of Equations (5) can be solved by the temperature corrector 16 using a least squares minimisation (LMS) procedure or other suitable coupled equations solver to provide the body core temperature Tcore, and also the heat flux qs through the surface of the skin. The sampling moments ti are suitably chosen such that to ensure that the system of Equations (5) is well-conditioned.
As yet another approach, the temperature corrector 16 can make a skin temperature drop correction determined based on physiological measurements such as the ambient temperature (suitably acquired using a temperature sensor that is not in contact with or close to the skin), skin sheet resistance or conductivity (measurable using a first electrode pair driving a small current and a second electrode pair measuring voltage generated by the drive current), or so forth. A lookup table or empirical formula suitably relates the skin temperature drop correction to the measured ambient temperature, skin sheet resistance, or other parameters.
In general, the core body temperature measurement device includes the one or more temperature sensors 12, the readout controller 10, and a head-mountable mechanical frame configured to operatively couple the temperature sensor or sensors 12 with skin overlaying an arterial blood rich superficial region disposed near to an auricle and outside of an ear canal. The readout controller 10 can either be mounted on the head-mountable mechanical frame, or can be disposed away from the frame and connected with the temperature sensors 12 via a wireless or wired link.
With reference to
The readout controller is suitably embodied by microchips 48 disposed on the eyeglasses frame 42 as illustrated. Wired connections 50 provide power to the microchips 48 and sensors 12f, 12b and provide a pathway for offloading the acquired core body temperature measurements and optional blood oxygenation or other measurements. An advantage of the wired connection 50 is that the core body temperature measurement device 40 does not need an on-board battery or other on-board power supply, which enables the core body temperature measurement device 40 to be lightweight. Although four sets of temperature sensors 12f, 12b are illustrated (a set of temperature sensors front and back of each auricle) it is contemplated to have fewer sets of temperature sensors. For example, the back temperature sensors 12b may be omitted, or temperature sensors may be coupled with skin overlaying an arterial blood rich superficial region on only the left side, or on only the right side. Moreover, the microchips 48 are optionally omitted and the readings of the temperature sensors 12f, 12b offloaded directly via the wired connection 50 to a readout processor that is not mounted on the eyeglasses frame 42.
The mechanical frames illustrated in
With returning reference to
With reference to
The neck-mountable mechanical frames illustrated in
The invention has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/IB2008/050566 | 2/15/2008 | WO | 00 | 9/15/2009 |
Number | Date | Country | |
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60894915 | Mar 2007 | US |