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Physiological Signal Processing and Modelling in Cardiology
Adrianus Swenne Cornelius

Seat Ingegneria
A.A. 2016/2017
Credits 9
Hours 72
Period II
Language ENG

Prerequisites
General knowledge of human biology and of the mathematical background of signal processing; some experience in MATLAB programming.

Learning outcomes
KNOWLEDGE AND UNDERSTANDING:
To obtain an overview of and insight in the modelling and signal processing techniques that are used in clinical cardiology for diagnostic and for therapeutic purposes. Standard patient care as well as experimental procedures are covered. Also, the clinical and physiological background of these procedures is addressed, to stimulate the development of a critical attitude towards the clinical rationale of biomedical engineering projects in this medical specialty.
CAPACITY TO APPLY KNOWLEDGE AND UNDERSTANDING:
This teaching characterizes the Bioengineering sector (ING-INF / 06) and provides knowledge about the main theoretical and practical tools for the acquisition and numerical processing of biomedical data in cardiology. Examples are procedures like cardiac catheterization, imaging techniques like MRI, SPECT and echocardiography, signals like the electrocardiogram and intracardially obtained electrograms, techniques and algorithms for cardiac anti-bradycardia and anti-tachycardia pacing and cardiac resynchronization, arrhythmia ablation (manual and robotic). Also models are addressed, amongst others a model of the circulation, including blood pressure, cardiac output, filling status of the arterial and venous compartments, and applied to problems like sudden loss of consciousness, circulatory shock and intensive care. This variety of techniques and applications necessitates a variety of active learning forms in which the students can demonstrate that they are able to apply their knowledge. This subject is taught by lectures, illustrated by site visits, and active learning is stimulated by journal clubs, computer practicals and programming assignments.
TRANSVERSAL SKILLS:
Understanding of medicine as a discipline and a profession Cooperation skills / teamwork Critical reviewing skills Multidisciplinary reasoning and formulating Presentation skills Programming skills Synthesizing skills Writing skills

Program
Frontal teaching, 41 hours. Lectures about cardiovascular physiology/pathophysiology underlying cardiovascular signals and images, concerning electrical heart function (action potential, pacemaking and conduction, genesis of the electrocardiogram, arrhythmias, ECG lead systems and vectorcardiogram, ECG measurements), mechanical heart function (contraction mechanism, excitation-contraction coupling, pump function) and circulation (physical concepts, arteries / capillaries / veins, neural control, humoral control and autoregulation, exercise and orthostasis, atherosclerosis and infarction, heart failure). Lectures about signal and image processing, concerning electrocardiography (ECG), intravascular and intracardiac pressure measurement, blood pressure and pulse oximetry, coronary angiography, echocardiography, single photon emission computed tomography (SPECT) and positron emission tomography (PET), magnetic resonance imaging (MRI), computed tomography (CT), ECG monitoring, intracardiac electrograms and novel diagnostic and therapeutic procedures. Lectures about modelling and simulation of electrical heart activity (with a focus on the ECGSIM simulation program) and about modelling and simulation of the circulation (with a focus on the APLYSIA simulation program), including introductions to the ECGSIM and APLYSIA simulation and MATLAB programming assignments. Also included: frontal teaching during site-visits of the hospital. Student activities in lab/aula (31 hours). Initial simulation experiments with ECGSIM and with APLYSIA, and first ECG processing experiments with MATLAB. Plenary individual poster presentations of simulation assignments with ECGSIM and with APLYSIA, and of the Matlab solution for the ECG processing assignment (which is the same for all students). Plenary presentations, by teams of 2-3 students, in a journal club setting, of their litterature review assignments regarding the signal and image processing topics (electrocardiography, intravascular and intracardiac pressure measurement, blood pressure and pulse oximetry, coronary angiography, echocardiography, single photon emission computed tomography and positron emission tomography, magnetic resonance imaging, computed tomography, ECG monitoring, intracardiac electrograms, and novel diagnostic and therapeutic procedures); every student takes part in two different presentations on different subjects.

Development of the examination
LEARNING EVALUATION METHODS
The theoretical knowledge is tested by two multiple choice examinations, one about physiology/pathophysiology of the cardiocascular system, and one about the signal and image processing techniques. The journal club presentations (each student participates in two different presentations) are judged by a rubric; the presenters should also produce a short written report (2000-3000 words) that is graded by a mark. The ECGSIM and APLYSIA simulation assignments, and the MATLAB ECG processing assignment are presented in the form of posters, and are graded by marks.

LEARNING EVALUATION CRITERIA
In total, each student has five individually obtained marks (two for the multiple choice exams, V1 and V2, and three for the posters reporting about the ECGSIM simulation assignment, V3, the APLYSIA simulation assignment, V4, and the MATLAB ECG processing assignment, V5). Additionally, the student gets four scores that are obtained in a journal club team (two marks for the reports accompanying the journal club presentations, V6 and V7, and two rubric scores for the actual presentations, R6 and R7). Grades are on the Italian 0-30 scale. The rubrics yield a pass or a fail; when a team fails for the presentation, the presentation should be improved and should once more be held.

LEARNING MEASUREMENT CRITERIA
The various tests in this course should assert that the biomedical engineering student understands the major clinical issues in cardiology and that the student understands how the various signal and image processing methods meet/support specific diagnostic or therapeutic needs in this medical specialty. The student has also to demonstrate to have a critical attitude towards the litterature (journal club activities), and to be able to convey his/her ideas clearly by an oral presentations, by posters and by writing. Finally, by the simulations and signal processing assignments, the student is tested on insight, inventiveness, and creativity.

FINAL MARK ALLOCATION CRITERIA
The final mark for the course, V, is computed by: V = [1.5*V1 + 1.5*V2 + (the best two grades of V3-V5) + V6 + V7] / 7

Recommended reading
1) Klabunde - Cardiovascular Physiology Concepts, 2nd Edition; 2) Goldberger & Ng - Practical Signal and Image Processing in Clinical Cardiology; 3) selected scientific publications, individually assigned, for the journal club activities; 4) various internet resources (free). Educational simulation software: 1) ECGSIM (free; http://www.ecgsim.org/); 2) Aplysia Cardiovascular Lab (http://www.aplysia.se/aplysiacardiovascularlab.htm); 3) MATLAB

Courses

• Biomedical Engineering (Corso di Laurea Magistrale (DM 270/04))