ArticlePDF Available

Abstract

The article describes a dataset of doppler ultrasound audio tracks taken on a sample of 30 divers according to the acquisition protocol defined by the Divers Alert Network. The audio tracks are accompanied by a medical evaluation for the decompression sickness risk according to the Spencer's scale levels. During the acquisition campaign, each diver in the post-dive phase was subjected to a double doppler ultrasound examination of approximately 45 seconds each one in the precordial area using a Huntleigh FD1 Fetal doppler probe. The two measurements were separated by a time of 8-10 seconds necessary for carrying out specific physical exercises designed to free the bubbles trapped in the tissues. The audio tracks were stored without compression via the TASCAM DP-004 recorder and processed in order to eliminate the noise generated by the positioning of the probe and the time interval between the two measurements. The audio tracks recorded during the acquisition campaign have been evaluated by experts belonging to three independent blind teams in order to provide an assessment of the decompression sickness risk according to Extended Spencer's scale. The specific typology of doppler ultrasound audio tracks and the associated medical evaluation according to the Spencer's scale levels make this dataset useful for the development, testing, and performance evaluation of new audio processing algorithms capable of automatically detecting bubbles in the blood vessels.
Journal Pre-proof
Doppler ultrasound dataset for the development of automatic emboli detection
algorithms
Paola Pierleoni, Marco Mercuri, Alberto Belli, Massimo Pieri, Alessandro Marroni,
Lorenzo Palma
PII: S2352-3409(19)31094-7
DOI: https://doi.org/10.1016/j.dib.2019.104739
Reference: DIB 104739
To appear in: Data in Brief
Received Date: 5 September 2019
Revised Date: 7 October 2019
Accepted Date: 28 October 2019
Please cite this article as: P. Pierleoni, M. Mercuri, A. Belli, M. Pieri, A. Marroni, L. Palma, Doppler
ultrasound dataset for the development of automatic emboli detection algorithms, Data in Brief, https://
doi.org/10.1016/j.dib.2019.104739.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of
record. This version will undergo additional copyediting, typesetting and review before it is published
in its final form, but we are providing this version to give early visibility of the article. Please note that,
during the production process, errors may be discovered which could affect the content, and all legal
disclaimers that apply to the journal pertain.
© 2019 Published by Elsevier Inc.
Article Title
Doppler ultrasound dataset for the development of automatic emboli detection algorithms
Authors
Paola Pierleoni
1
, Marco Mercuri
1
, Alberto Belli
1
, Massimo Pieri
2
, Alessandro Marroni
2
, Lorenzo Palma
1
Affiliations
1. Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche
12, 60131 Ancona, Italy;
2. DAN Europe Foundation Research Division, Sir Ugo Mifsud Street, XBX 1431 Ta’ Xbiex, Malta.
Corresponding author(s)
Lorenzo Palma: l.palma@univpm.it; Tel.: +39-071-220-4847;
Marco Mercuri: mrc.mercuri@gmail.com .
Abstract
The article describes a dataset of doppler ultrasound audio tracks taken on a sample of 30 divers
according to the acquisition protocol defined by the Divers Alert Network. The audio tracks are
accompanied by a medical evaluation for the decompression sickness risk according to the Spencer's
scale levels.
During the acquisition campaign, each diver in the post-dive phase was subjected to a double doppler
ultrasound examination of approximately 45 seconds each one in the precordial area using a Huntleigh
FD1 Fetal doppler probe. The two measurements were separated by a time of 8-10 seconds necessary
for carrying out specific physical exercises designed to free the bubbles trapped in the tissues. The audio
tracks were stored without compression via the TASCAM DP-004 recorder and processed in order to
eliminate the noise generated by the positioning of the probe and the time interval between the two
measurements.
The audio tracks recorded during the acquisition campaign have been evaluated by experts belonging to
three independent blind teams in order to provide an assessment of the decompression sickness risk
according to Extended Spencer’s scale. The specific typology of doppler ultrasound audio tracks and the
associated medical evaluation according to the Spencer’s scale levels make this dataset useful for the
development, testing, and performance evaluation of new audio processing algorithms capable of
automatically detecting bubbles in the blood vessels.
Keywords
Embolic detection, decompression sickness, bubble detection, doppler ultrasound automatic analysis.
Specifications Table
Subject
Electrical
and
Electronic
Engineering
Specific
subject
area
Audio
signal
processing
for
embolic
detection
Type
of
data
Audio
wave
(.WAV)
files
Text file
How
data
were
acquired
Doppler
probe
(FD1
-
MHz,
Huntleigh
Ltd,
Cardiff,
UK)
Digital recorder (Tascam DP-004; TEAC America Inc., Montebello, CA,
USA)
Data
format
Raw
,
Filtered
and
analyzed
Parameters
for
data
collection
The
subjects
involved
in
the
dataset
were
30
professionals
and
amateurs
scuba divers (18 males and 12 women), aged between 25 and 65 years.
Doppler ultrasound acquisitions were performed in the divers about 35
minutes after surfacing. Diving activities were carried out in the Maldives
and Madagascar area. All participants who volunteered gave their
informed consent before each acquisition.
Description
of
data
collection
The
ultrasound
doppler
signals
were
acquired
in
the
precordial
area
with
two consecutive measurements of about 45 seconds each interspersed
with about 10 seconds of motor activity to free the bubbles trapped in
the tissues. The audio tracks once acquired have been filtered eliminating
a few seconds at the beginning and at the end of the entire recording and
the interval between the two measurements in order to reduce the
unwanted noise due to doppler probe positioning. For each acquisition an
assessment of the circulating bubbles according to the extended Spencer
scale has been provided by experts.
Data
source
location
Department
of
Information
Eng
i
neering,
Università
Politecnica
delle
Marche, Ancona, Italy
Data
accessibility
With
the
article
Related
research
article
Paola Pierleoni, Lorenzo Palma, Alberto Belli, Massimo Pieri, Lorenzo
Maurizi, Marco Pellegrini and Alessandro Marroni
“An EMD-Based Algorithm for Emboli Detection in Echo Doppler Audio
Signals”
Electronics
https://doi.org/10.3390/electronics8080824 [1]
Value of the Data
Data are useful to develop and test new audio processing algorithms for emboli events
detection and evaluation of the decompression sickness risk level.
Researchers and developers who want to implement systems for emboli detection using doppler
ultrasound acquisition;
Data can be used as a benchmark for performance evaluations of different algorithms able to
automatically detect gas bubbles in blood vessels;
In addition to the previously introduced values, this dataset is the only one that provides
doppler ultrasound acquisitions accompanied by medical evaluation for sickness risk according
to the Spencer’s scale;
Dataset could be exploited for teaching to operators on how to evaluate a doppler ultrasound
track accordingly to Spencer's scale levels.
Data
The proposed dataset provides a complete set of Doppler Ultrasound (DU) audio tracks acquired
from scuba divers after the emersion. Each DU audio track was evaluated by experts in order to assess
the decompression sickness risk according to the Extended Spencer’s scale (ESS) [2].
The dataset is contained in Dataset_DU.zip file accessible as a supplementary file of this article.
Within Dataset_DU.zip, data are organized in one main directory, Dataset_DU, containing the DU audio
tracks and a file Eval.txt. The Eval.txt file contains a table which provides the level of the ESS associated
with each DU audio track. In Eval.txt file the first column indicates the file number (X) of the DU audio
track and the second indicates the relative level of the Extended Spencer’s scale. The analysis and the
subsequent evaluation according to the ESS was conducted by DAN medical staff.
Each DU audio track is a WAVEform audio file format called DU_X.wav, where X=1, 2, …, 30
indicates the file number. Table 1 shows the number of DU audio tracks contained in the dataset for
each Spencer
level:
Table 1
ESS
Level
0
0,5
1
1,5
2,5
Number of
tracks
9 6 10 3 2
Experimental Design, Materials, and Methods
The data of the proposed dataset were acquired based on the guidelines defined in the acquisition
protocol set by the Divers Alert Network (DAN) [3] which defines the precordial region as the optimal
zone of the human body for the detection of bubbles in the blood vessels [4]. In fact, numerous studies
have shown that this region, although affected by cardiac noise that can be eliminated through signal
processing algorithms [5,6,7], allows to obtain a complete evaluation of all the bubbles present in the
blood vessel.
The protocol also defines the exact acquisition procedure to follow in order to obtain an overall
analysis of the bubble situation of each diver. The protocol provides for alternating measurements in the
precordial zone with a series of exercises to free the bubbles entrapped in the tissues. The exercises
defined by the DAN medical team, are 2/3 folds on the legs, repeated a few times and performed freely
according to the scuba divers' abilities and physical conditions, all to avoid endangering the person's
health.
The acquisition procedure of the protocol starts approximately 35 minutes after scuba diver
emersion in order to allow the formation of bubbles. In fact, according to some studies [8], the peak
time for release of the bubbles is between 30 min and 60 min after surfacing. It consists of three
consecutive phases:
45 seconds during which a measurement of the doppler signal of blood vessels in the precordial
is performed;
8 - 10 seconds in where the scuba diver performs the series of exercises;
45 seconds during which a measurement of the doppler signal of blood vessels in the precordial
is performed;
According to the previous protocol DU audio tracks were collected in a specific acquisition
campaign which was conducted on 30 scuba divers (60% male and 40% female) between professionals
and amateurs, aged between 25 and 65 years during the diving activities in the Maldives and
Madagascar. The audio tracks presented were collected through a Huntleigh FD1 Fetal Doppler with 2
MHz probe (FD1, Huntleigh Ltd., Cardiff, UK) and a digital recorder (Tascam DP-004, TEAC America Inc.,
Santa Fe Springs, California, USA) which does not compress audio files and uses a linear pulse code
modulation (LPCM) format for data storage. Moreover, great care has been taken in adjusting the input
signal of the recorder to a level that avoids audio saturation because it could irreparably compromise
the recorded file. It was decided to process the audio tracks in order to eliminate any unwanted noise
generated by the doppler probe positioning during the initial and final phase of the measurement, as
well as in the interval between the two acquisitions. For this reason, at the beginning and at the end of
the recording 1-2 seconds of acquisition were cut, but also the whole interval between the two
measurements.
The dataset provided also presents an evaluation of the decompression sickness risk which was
performed by experts belonging to three independent blind teams. The DU audio tracks of the proposed
dataset were evaluated by each blind team that provide file’s annotations report containing the number
of embolic event and the corresponding Extended Spencer’s scale level. The level of the ESS indicated in
this dataset was derived from a subsequent analysis of the file’s annotations reports carried out by DAN
medical staff.
Acknowledgments
The authors would like to thank the Divers Alert Network Europe Foundation for their contribution in
data acquisition and research activities.
References
1. [1] Pierleoni, P.; Palma, L.; Belli, A.; Pieri, M.; Maurizi, L.; Pellegrini, M.; Marroni, A. An EMD-
Based Algorithm for Emboli Detection in Echo Doppler Audio Signals. Electronics 2019, 8, 824.
https://doi.org/10.3390/electronics8080824
2. [2] Payne SJ, Chappell MA. Automated determination of bubble grades from Doppler ultrasound
recordings. Aviat Space Environ Med. 2005; 76:771–777.
3. Marroni, A.; Cali-Corleo, R.; Denoble, P. Understanding the safety of recreational diving. In DAN
Europe’s Project SAFE DIVE Phase I: Fine Tuning of the Field Research Engine and Methods
Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, EUBS,
ECHM, ICHM, DAN; 1996; pp. 279–284.
https://www.daneurope.org/c/document_library/get_file?folderId=13501&name=DLFE-113.pdf
4. Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock.
2009;2(3):180–185. doi:10.4103/0974-2700.55330
5. Chappell M, Payne S. A method for the automated detection of venous gas bubbles in humans
using empirical mode decomposition. Ann Biomed Eng. 2005; 33:1411- 1421.
https://doi.org/10.1007/s10439-005-6045-8
6. Kisman K. Spectral analysis of Doppler ultrasonic decompression data. Ultrasonics. 1977;
15:105–110 https://doi.org/10.1016/0041-624X(77)90026-9
7. B. C. B. Chan, F. H. Y. Chan, F. K. Lam, Ping-Wing Lui and P. W. F. Poon, "Fast detection of venous
air embolism in Doppler heart sound using the wavelet transform," in IEEE Transactions on
Biomedical Engineering, vol. 44, no. 4, pp. 237-246, April 1997.
doi: 10.1109/10.563293
8. Sykes O, Clark JE. Patent foramen ovale and scuba diving: a practical guide for physicians on
when to refer for screening. Extrem Physiol Med. 2013; 2:10 https://doi.org/10.1186/2046-
7648-2-10
... Recently, a dataset of post-dive Doppler recordings was released for the purposes of automated VGE extraction and grading algorithm development [14]. Several signal-separation algorithms have been explored using this data such as adaptive empirical mode decomposition and complete ensemble empirical mode decomposition [15,16]. ...
Article
Full-text available
Doppler ultrasound (DU) measurements are used to detect and evaluate venous gas emboli (VGE) formed after decompression. Automated methodologies for assessing VGE presence using signal processing have been developed on varying real-world datasets of limited size and without ground truth values preventing objective evaluation. We develop and report a method to generate synthetic post-dive data using DU signals collected in both precordium and subclavian vein with varying degrees of bubbling matching field-standard grading metrics. This method is adaptable, modifiable, and reproducible, allowing for researchers to tune the produced dataset for their desired purpose. We provide the baseline Doppler recordings and code required to generate synthetic data for researchers to reproduce our work and improve upon it. We also provide a set of pre-made synthetic post-dive DU data spanning six scenarios representing the Spencer and Kisman-Masurel (KM) grading scales as well as precordial and subclavian DU recordings. By providing a method for synthetic post-dive DU data generation, we aim to improve and accelerate the development of signal processing techniques for VGE analysis in Doppler ultrasound.
... This study was performed using 274 real post-dive DU datasets. While this is an order of magnitude larger than in previous work automating VGE analysis [54], it should be noted that this remains a limited dataset in the context of machine learning. To supplement the limited available data, we introduce a method for procedural-generation of synthetic DU data for network hyperparameter tuning and pre-training. ...
Article
Objective: Doppler ultrasound (DU) is used to detect venous gas emboli (VGE) post dive as a marker of decompression stress for diving physiology research as well as new decompression procedure validation to minimize decompression sickness risk. In this paper, we propose the first deep learning model for VGE grading in DU audio recordings. Methods: A database of real-world data was assembled and labeled for the purpose of developing the algorithm, totaling 274 recordings comprising both subclavian and precordial measurements. Synthetic data was also generated by acquiring baseline DU signals from human volunteers and superimposing laboratory-acquired DU signals of bubbles flowing in a tissue mimicking material. A novel squeeze-and-excitation deep learning model was designed to effectively classify recordings on the 5-class Spencer scoring system used by trained human raters. Results: On the real-data test set, we show that synthetic data pretraining achieves average ordinal accuracy of 84.9% for precordial and 90.4% for subclavian DU which is a 24.6% and 26.2% increase over training with real-data and time-series augmentation only. The weighted kappa coefficients of agreement between the model and human ground truth were 0.74 and 0.69 for precordial and subclavian respectively, indicating substantial agreement similar to human inter-rater agreement for this type of data. Conclusion: The present work demonstrates the first application of deep-learning for DU VGE grading using a combination of synthetic and real-world data. Significance: The proposed method can contribute to accelerating DU analysis for decompression research.
... In this respect, having computer-automated analysis software for this type of recordings, such as proposed by Chappell and Payne to remove user bias, is advantageous [43,44]. Additionally, databases providing Doppler ultrasound of divers are valuable in the development of these automated algorithms, such as the one acquired by Pierleoni, et al. [45]. 100 ...
Article
It is widely accepted that bubbles are a necessary but insufficient condition for the development of decompression sickness. However, open questions remain regarding the precise formation and behavior of these bubbles after an ambient pressure reduction (decompression), primarily due to the inherent difficulty of directly observing this phenomenon in vivo. In decompression research, information about these bubbles after a decompression is gathered via means of ultrasound acquisitions. The ability to draw conclusions regarding decompression research using ultrasound is highly influenced by the variability of the methodologies and equipment utilized by different research groups. These differences play a significant role in the quality of the data and thus the interpretation of the results. The purpose of this review is to provide a technical overview of the use of ultrasound in decompression research, particularly Doppler and brightness (B)-mode ultrasound. Further, we will discuss the strengths and limitations of these technologies and how new advancements are improving our ability to understand bubble behavior post-decompression.
Article
Full-text available
Divers’ health state after underwater activity can be assessed after the immersion using precordial echo Doppler examination. An audio analysis of the acquired signals is performed by specialist doctors to detect circulating gas bubbles in the vascular system and to evaluate the decompression sickness risk. Since on-site medical assistance cannot always be guaranteed, we propose a system for automatic emboli detection using a custom portable device connected to the echo Doppler instrument. The empirical mode decomposition method is used to develop a real-time algorithm able to automatically detect embolic events and, consequently, assess the decompression sickness risk according to the Spencer’s scale. The proposed algorithm has been tested according to an experimental protocol approved by the Divers Alert Network. It involved 30 volunteer divers and produced 37 echo Doppler files useful for the algorithm’s performances evaluation. The results obtained by the proposed emboli detection algorithm (83% sensitivity and 76% specificity) make the system particularly suitable for real-time evaluation of the decompression sickness risk level. Furthermore, the system could also be used in continuous monitoring of hospitalized patients with embolic risks such as post surgery ones.
Article
Full-text available
Divers are taught some basic physiology during their training. There is therefore some underlying knowledge and understandable concern in the diving community about the presence of a patent foramen ovale (PFO) as a cause of decompression illness (DCI). There is an agreement that PFO screening should not be done routinely on all divers; however, when to screen selected divers is not clear. We present the basic physiology and current existing guidelines for doctors, advice on the management and identify which groups of divers should be referred for consideration of PFO screening. Venous bubbles after diving and right to left shunts are common, but DCI is rare. Why this is the case is not clear, but the divers look to doctors for guidance on PFO screening and closure; both of which are not without risks. Ideally, we should advise and apply guidelines that are consistent and based on best available evidence. We hope this guideline and flow chart helps address these issues with regard to PFOs and diving.
Article
Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.
Article
Several aspects of spectral analysis of bubble transients in Doppler ultrasonic decompression data are discussed. The computation of energy density spectra, using fast Fourier transform techniques for analyzing bubble transients, is described. Spectral analysis of data from probes implanted within animals, using a conventional Fourier analyzer, provided good visual indications of bubble events and interesting changes in spectral structure. A new transient spectral analysis technique that is suitable for quantitative real-time monitoring of small decompression bubbles is described. In a feasibility study using data from an implanted probe, an increase of 900% in bubble signal/noise ratio was observed.
Article
One of the difficulties in the development of automated algorithms for the detection of bubbles in Doppler ultrasound recordings is that expert labels are only available on an aggregate basis, i.e., the expert provides a single label for a recording which may contain many bubbles. It is thus very difficult to determine whether an algorithm is correctly identifying the actual bubbles or simply identifying the correct number of events, but mislabeling some events that are not due to bubbles. The analysis presented here shows that the classification probabilities for the detection of bubble events and other artifacts can be determined if a large number of recordings are available. Using a half-integer scoring system from 0-4 gives a bias of approximately 1-2% and a standard deviation that varies with the number of event sequences available, dropping from approximately 7.5% for 100 60-s recordings to 3% for 1000 60-s recordings. These values are larger if an integer scoring system is used, but using a scale finer than half-integers confers no extra benefit due to the fact that the expert labels the whole recording rather than individual bubbles. It is thus possible to estimate the classification probabilities with a reasonably high degree of accuracy, but difficult to show that one bubble detection algorithm is superior to another to any degree of statistical significance. Expert labels can be used to validate, but not to compare the performance of bubble detection algorithms.
Article
Doppler ultrasound signals are widely used to grade the quantity of circulating venous bubbles in divers. Current techniques rely on trained observers, making the grading process both time-consuming and subjective. The automated detection of bubbles, however, is confounded by the presence of other signals, primarily those arising from blood motion. Empirical Mode Decomposition was used here to calculate the intrinsic mode functions (IMFs) of a number of Doppler ultrasound signals from recreational divers, post-decompression. The IMFs provide a basis set for signal decomposition, each IMF corresponding to a different timescale in the signal. Each signal was found to comprise approximately 20 IMFs: the precise number being dependent upon the nature of the signal. A method is presented to detect bubbles using the IMF; features are first identified in the individual heart cycles, these having been previously determined using a robust peak detection method, by examining deviations from the ensemble averaged IMF. Bubbles are then identified as features appearing in more than one IMF, with significant energy in the original signal. This method has been applied to a subset of the available database and appears to perform with good sensitivity even when the signal has variable signal strength.
Article
The introduction of air bubbles into the systemic circulation can result in significant morbidity. Real-time monitoring of continuous heart sound in patients detected by precordial Doppler ultrasound is, thus, vital for early detection of venous air embolism (VAE) during surgery. In this study, the multiscale feature of wavelet transforms (WT's) is exploited to examine the embolic Doppler heart sound (DHS) during intravenous air injections in dogs. As both humans and dogs share similar physiological conditions, the authors' methods and results for dogs are expected to be applicable to humans. The WT of DHS at scale 2 j(j=1,2) selectively magnified the power of embolic, but not the normal, heart sound. Statistically, the enhanced embolic power was found to be sensitive (P<0.01 at 0.01 ml of injected air) and correlated significantly (P<0.0005, τ=0.83) with the volume of injected air from 0.01 to 0.10 ml. A fast detection algorithm of O(N) complexity with unit complexity constant for VAE was developed (processing speed=8 ms per heartbeat), which confirmed the feasibility of real-time processing for both humans and dogs.
Understanding the safety of recreational diving
  • A Marroni
  • R Cali-Corleo
  • P Denoble
Marroni, A.; Cali-Corleo, R.; Denoble, P. Understanding the safety of recreational diving. In DAN Europe's Project SAFE DIVE Phase I: Fine Tuning of the Field Research Engine and Methods Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, EUBS, ECHM, ICHM, DAN; 1996; pp. 279-284.
Understanding the safety of recreational diving
  • Marroni