# Patent

## Title
Medical sensor for reducing signal artifacts and technique for using the same

## Abstract

A sensor may be adapted to reduce signal artifacts by deflecting the effects of outside forces and sensor motion. A sensor is provided with a rigid annular structure adapted to reduce the effect of motion of a sensor emitter and/or detector. Further, a method of deflecting or minimizing outside forces and sensor motion is also provided.

## Background
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to medical devices and, more particularly, to sensors used for sensing physiological parameters of a patient.
2. Description of the Related Art
This section is intended to introduce the reader to various aspects of art that may be related to various aspects of the present invention, which are described and/or claimed below. This discussion is believed to be helpful in providing the reader with background information to facilitate a better understanding of the various aspects of the present invention. Accordingly, it should be understood that these statements are to be read in this light, and not as admissions of prior art.
In the field of medicine, doctors often desire to monitor certain physiological characteristics of their patients. Accordingly, a wide variety of devices have been developed for monitoring many such characteristics of a patient. Such devices provide doctors and other healthcare personnel with the information they need to provide the best possible healthcare for their patients. As a result, such monitoring devices have become an indispensable part of modem medicine.
One technique for monitoring certain physiological characteristics of a patient is commonly referred to as pulse oximetry, and the devices built based upon pulse oximetry techniques are commonly referred to as pulse oximeters. Pulse oximetry may be used to measure various blood flow characteristics, such as the blood-oxygen saturation of hemoglobin in arterial blood, the volume of individual blood pulsations supplying the tissue, and/or the rate of blood pulsations corresponding to each heartbeat of a patient. In fact, the “pulse” in pulse oximetry refers to the time varying amount of arterial blood in the tissue during each cardiac cycle.
Pulse oximeters typically utilize a non-invasive sensor that transmits electromagnetic radiation, such as light, through a patient's tissue and that photoelectrically detects the absorption and scattering of the transmitted light in such tissue. One or more of the above physiological characteristics may then be calculated based upon the amount of light absorbed and scattered. More specifically, the light passed through the tissue is typically selected to be of one or more wavelengths that may be absorbed and scattered by the blood in an amount correlative to the amount of the blood constituent present in the tissue. The measured amount of light absorbed and scattered may then be used to estimate the amount of blood constituent in the tissue using various algorithms.
Pulse oximetry readings measure the pulsatile changes in amount and type of blood constituents in tissue. Other events besides the pulsing of arterial blood may lead to modulation of the light path, direction, and the amount of light detected by the sensor, creating potential error in these measurements. Current pulse oximetry techniques may be sensitive to movement, and various types of motion may cause artifacts that may obscure the blood constituent signal. In the emergency room, critical care, intensive care, and trauma center settings, where pulse oximetry is commonly used for patient monitoring, the wide variety of sources of signal artifacts may include moving of a patient or the sensor by healthcare workers, physical motion of an unanaesthetised or ambulatory patient, shivering, seizures, agitation, response to pain and loss of neural control. These motions can have similar frequency content to the pulse, and may lead to similar or even larger optical modulations than the pulse.
Two categories of pulse oximetry sensors in common use may be classified by their pattern of use: the disposable sensor and the reusable sensor. Disposable sensors are typically flexible bandage-type structures that may be attached to the patient with adhesive materials, providing a contact between the patient's skin and the sensor components. Disposable sensors have multiple advantages, including ease of conformation to the patient. The flexible nature of disposable sensors further renders them susceptible to signal artifacts caused by mechanical deformation of the sensor, which changes the amount of light detected. Reusable sensors, often semi-rigid or rigid clip-type devices, are also vulnerable to signal artifacts, such as artifacts caused by partial opening of the clip in response to patient motion. Both categories of sensors may have modulations of detected light induced by the physical motion of the sensor components with respect to each other and the tissue.
Signal artifacts may sometimes be addressed by signal processing and filtering to mitigate the effects of motion after the motion has occurred. However, it would be desirable to provide a sensor that reduces the occurrence of events that may lead to signal artifacts.
SUMMARY
Certain aspects commensurate in scope with the originally claimed invention are set forth below. It should be understood that these aspects are presented merely to provide the reader with a brief summary of certain forms that the invention might take and that these aspects are not intended to limit the scope of the invention. Indeed, the invention may encompass a variety of aspects that may not be set forth below.
There is provided a sensor that includes: a sensor body; at least one sensing element disposed on the sensor body; and at least one rigid annular structure adapted to be removably applied to the sensor body.
There is also provided a physiologic monitoring system that includes: a pulse oximetry monitor; and a pulse oximetry sensor adapted to be operatively coupled to the monitor. The sensor includes: a sensor body; at least one sensing element disposed on the sensor body; and at least one rigid annular structure adapted to be removably applied to the sensor body.
There is also provided a method of operating a sensor that includes: deflecting mechanical force with a rigid annular structure dispersed around an emitter and a detector of a sensor applied to a patient, wherein the rigid annular structure is removably applied to the sensor.
There is also provided a method of manufacturing a sensor that includes: providing sensor body; providing at least one sensing element disposed on the sensor body; and providing at least one rigid annular structure adapted to be removably applied to the sensor body.
There is also provided a kit that includes: a sensor body; an emitter and a detector disposed on the sensor body; and a plurality of rigid annular structures of various sizes adapted to be removably applied to the sensor body.



BRIEF DESCRIPTION OF THE DRAWINGS
Advantages of the invention may become apparent upon reading the following detailed description and upon reference to the drawings in which:
FIG. 1 illustrates a side view of an exemplary bandage-style sensor with a removable ring structure applied to a patient's finger;
FIG. 2 illustrates a side view of an exemplary bandage-style sensor with a removable thimble structure applied to a patient's finger;
FIG. 3 illustrates a side view of an exemplary bandage-style sensor with a removable sleeve structure applied to a patient's finger;
FIG. 4 illustrates a side view of an exemplary bandage-style sensor with multiple removable ring structures applied to a patient's finger;
FIG. 5 illustrates a perspective view of an exemplary bandage-style sensor with an adjustable-diameter ring structure with a hinge applied to a patient's finger;
FIG. 6 illustrates a top view of an exemplary embodiment of a bandage-style sensor with alignment indicia to indicate placement for a ring structure;
FIG. 7A illustrates a perspective view of an exemplary embodiment of a bandage-style sensor with an oval annular structure that contacts the sensor at the sides of the finger;
FIG. 7B illustrates a cross-sectional view of the sensor and oval annular structure of FIG. 7A;
FIG. 8 illustrates a side view of an exemplary embodiment of a Y-style sensor with an annular structure;
FIG. 9 illustrates a side view of an exemplary embodiment of a bandage-style sensor with an annular structure including a collar;
FIG. 10 illustrates a perspective view of an exemplary embodiment of a bandage-style sensor with an arched semi-annular structure;
FIG. 11 illustrates a perspective view of a kit including a bandage-style sensor and multiple ring structures of different diameters and widths; and
FIG. 12 illustrates a pulse oximetry system coupled to a multi-parameter patient monitor and a sensor according to embodiments of the present invention.



DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS
One or more specific embodiments of the present invention will be described below. In an effort to provide a concise description of these embodiments, not all features of an actual implementation are described in the specification. It should be appreciated that in the development of any such actual implementation, as in any engineering or design project, numerous implementation-specific decisions must be made to achieve the developers' specific goals, such as compliance with system-related and business-related constraints, which may vary from one implementation to another. Moreover, it should be appreciated that such a development effort might be complex and time consuming, but would nevertheless be a routine undertaking of design, fabrication, and manufacture for those of ordinary skill having the benefit of this disclosure.
In accordance with the present technique, sensors for pulse oximetry or other applications utilizing spectrophotometry are provided that reduce signal artifacts by reducing sensor deformation in response to movement. For example, sensors are provided that have various removable rigid annular structures adapted to reduce the effect of motion or outside forces on sensor measurements by deflecting such forces away from the sensing components and/or preventing movement of the sensing components relative to one another. Such rigid annular structures provide multiple advantages. For example, they are relatively inexpensive, are easy to apply to a patient, and may be made in multiple sizes to accommodate differences in patient anatomy.
Signal artifacts in pulse oximetry are often generated by the movement of the pulse oximetry sensor relative to the optically probed tissue, which is typically caused by patient movement. Because pulse oximetry is often used in settings where it is difficult to prevent patient motion, it is desirable to provide a mechanism for reducing the effects of motion on the pulse oximetry measurement. Generally, sensors are vulnerable to motion artifacts when the optical distance between a sensor's emitter and detector varies due to an undesired mechanical change in the conformation of the sensor while in use.
A change in optical distance may include any change in position or geometry of the emitter and/or the detector relative to the tissue or relative to each other. More specifically, a change in optical distance may involve a change in the path length, a change in the angle of the emitter or detector relative to one another, and/or a change in the angle of the emitter or detector relative to the tissue. For example, signal artifacts may be caused by moving a sensor in relation to the tissue, by increasing or decreasing the physical distance between emitters and detectors in a sensor, by changing the direction of emitters or detectors with respect to tissue or each other, by changing the angles of incidence and interfaces probed by the light, by directing the optical path through different amounts or types of tissue, or by expanding, compressing or otherwise altering tissue near a sensor. A tapping or pressing motion by a patient may serve to compress a flexible bandage sensor, decreasing the path length between the emitter and detector. A jerking or flexing motion may separate the emitter and detector, thus increasing the optical path length. Additionally, any of the above motions may twist or bend the sensor, causing the angle of the emitter and/or the detector to change relative to the sensor and each other. As sensors do not typically emit nor detect light omnidirectionally, any motions that lead to variations in angle of sensor components may alter the amount of light detected, and may force detected light through different portions of tissue. In any case, variability in the optical path length due to motion can cause motion artifacts and obscure the desired pulse oximetry signal. Thus, it is desirable to reduce the effects of patient movement and outside forces on a sensor's emitter and detector such that their movement relative to one another is reduced.
By deflecting forces away from the sensing components such that the effective force experienced by the sensing components may be mitigated, the sensors provided herein limit the modulations of detected light that may occur and the resulting measurement errors. These sensors substantially reduce the occurrence of motion artifacts by minimizing the effects of outside forces or patient motion on the sensing components of the sensor.
Sensors are disclosed herein having removable rigid structures to reduce the effect of motion or outside forces on the measurements of physiological parameters, such as pulse oximetry measurements. Such rigid structures are generally annular, and may include structures that are partially annular, e.g. unclosed semicircular or partial ring structures. The rigid annular structures may be adapted for use on any patient digit, or may be adapted to be used on any other patient tissue, such as a foot, hand, or wrist, that may accommodate an annular structure.
The rigid annular structures may be formed from plastic, polymeric material, metal, wood, composites or any other suitable rigid material. For example, the annular structures may generally hold their shape with forces equal to or greater than 100 grams. In certain embodiments, it may be advantageous to provide lightweight, disposable rigid annular structures for use with disposable bandage-type sensors. In other embodiments, the rigid annular structures may be reusable. In such an embodiment, it may be advantageous to provide rigid annular structures that may be easily cleaned. In specific embodiments, the rigid annular structures may include additional non-rigid motion damping components, such as one or more spring or a foam layer, in order to enhance their motion-deflecting properties.
FIG. 1 illustrates an exemplary bandage-type sensor 10A applied to a patient's digit 13. The sensor 10A has a removable ring 14 disposed on the sensor body 12. The sensor 10A is adapted to be placed onto the patient digit 13, and may be further secured by a bandage or adhesive. The removable ring 14 is a rigid annular structure that may deflect a force that may otherwise result in an emitter 16 and detector 18 moving relative to one another. When a patient scratches or taps using the digit 13, the removable ring 14 deflects the force of the motion by spreading the force equally around the removable ring 14, which results in a reduction of the effects of the motion on the emitter 16 and the detector 18. The removable ring 14 may be of any suitable diameter to provide a fit for the patient's digit 13. Further, the removable ring may be of any suitable width. A ring may be only so wide as to cover 10% or less of the exterior (i.e. not in contact with the tissue when applied) surface area of the sensor body 12 when applied. In alternate embodiments, it may be advantageous for the ring to be wider, and to cover greater than 20%, greater than 30%, or greater than 50% of the exterior surface area of the sensor body 12 when applied. Wider rings may deflect forces over a broader area of the sensor.
FIG. 2 illustrates an alternative embodiment of a sensor 10B in which the rigid annular structure is a removable thimble 20 that may be applied to a sensor body 12 in order to mechanically stabilize the emitter 16 and the detector 18 after application of the sensor 10B. The thimble 20 may be slid over the fingertip after the sensor body 12 has been applied to the digit. The thimble 20 may be generally useful for deflecting motion caused by tapping with the fingertip.
FIG. 3 illustrates an alternate embodiment of a sensor 10C in which the rigid annular structure is a sleeve 22 that may be applied to a sensor body 12 in order to mechanically stabilize the distance between the emitter 16 and detector 18 after application of the sensor 10C. The sleeve 22 may be removably applied to a digit after the sensor body 12 is in place. The sleeve 22 may, in certain embodiments, cover a finger joint to prevent bending or flexing. In such an embodiment, the removable sleeve 22 may provide the further advantage of adding rigidity to a relatively flexible bandage-style sensor without adding the cost associated with reusable clip-style sensors.
In certain embodiments, it may be advantageous to apply several annular structures to a sensor body in order to deflect mechanical forces at different locations. FIG. 4 illustrates an embodiment of a sensor 10D in which rings 14a, 14b, and 14c have been applied to the sensor body 12. The ring 14c has been placed directly over the area of the sensor body 12 that includes the emitter 16 and the detector 18. Rings 14a and 14b are placed over areas of the sensor body 12 closer to the joint of the digit 13. Such an arrangement provides the opportunity to minimize forces acting over a wide portion of the sensor body 12 while maintaining a relatively lightweight and flexible sensor structure. In an alternative embodiment (not shown), the rings 14 may be connected to one another by one or more elongated strips to provide additional stability to the sensor assembly while maintaining a relatively lightweight structure. In other embodiments, such elongated strips may provide the advantage of holding the rings in position relative to one another, and may be rigid or relatively flexible to allow the finger to flex or bend slightly.
In order to achieve a more conforming fit for an annular structure as provided herein, it may be advantageous to provide sensors that include annular structures with adjustable diameters, as shown in FIG. 5. A sensor 10E has an adjustable ring 24 placed on the sensor body 12. The adjustable ring 24 may open at a hinge 26 and may be adjusted with a strap 28. The adjustable ring 24 may be sized to fit over a fingertip section of the patient's digit 13, which may include the emitter 16 and the detector 18, or may be adjusted to fit over the relatively broader joint section of the patient's digit 13.
As shown in FIG. 6, bandage-style sensors as provided herein may include alignment indices to indicate the proper placement of an annular structure on the sensor body. A sensor 10F is shown with alignment indices 30 that provide an indication of proper placement of a ring or other annular structure on the sensor body 12. In order to reduce the effects of motion on a sensor signal, it is advantageous to prevent such motion from disturbing the position of the emitter 16 and the detector 18 relative to one another. Thus, in certain embodiments, the alignments indices may indicate placement of an annular structure over a portion of the sensor body 12 that includes the emitter 16 and the detector 18.
In certain embodiments, it may be advantageous to provide an annular structure that does not closely conform to the digit. For example, a sensor 10G with an annular structure 52 shown in FIG. 7A and FIG. 7B only touches the digit 13 in certain areas. The sensor 10G includes an oval annular structure 52 that is adapted to be placed on the digit 13 over a sensor body 12. The annular structure 52 conforms closely to the sides of the digit 13, but does not touch the top or bottom of the digit 13. The annular structure 52 may include alignment indices 54 indicating the portions of the annular structure 52 corresponding to sides of the digit. Thus, a patient or healthcare worker is alerted to the proper placement of the annular structure on the sensor body 12. Such an arrangement of the annular structure 52 over the sensor body 12 tends to spread forces away from the emitter 16 and the detector 18. For example, if the digit 13 engages in a downward tapping motion, the annular structure 52 spreads the force of the motion around its structure. As the annular structure 52 only touches the digit 13 on the sides of the digit 13, the impact of the downward tapping force, shown by arrows 53 in FIG. 7B, is concentrated on the sides of digit 13, and thus the impact is generally directed away from the emitter 16 and the detector 18.
As shown in FIG. 8, annular structures as provided herein may be used with any appropriate sensor, including Y-style sensors or other cable sensors. As depicted, a sensor 10H includes a flexible Y-style cable 56 with an emitter 16 and a detector 18. An annular structure 58 may be slid over the Y-style cable 56 after it has been placed on the digit 13. The annular structure 58 not only serves to deflect forces away from the emitter 16 and the detector 18, but may also help hold the Y-style cable 56 in place.
FIG. 9 shows an alternate embodiment of a sensor 101 with a collar structure 60 that is generally in the shape of an Elizabethan-style collar that substantially encircles the fingertip region. The collar structure may be slid over the sensor body 12 and acts as a guard to prevent motion of the digit 13. A patient wearing such a sensor 10I may momentarily forget the presence of the sensor 10I and attempt to scratch or otherwise move the digit 13. The presence of the collar structure 60 may prevent the patient from being able to vigorously move the digit 13.
FIG. 10 shows an alternate embodiment of a sensor 10J that includes an arch structure 61 with protruding prongs 62. The arch structure 61 may be placed over the digit such that the protruding prongs extend in the direction most likely to experience outside forces. For example, during surgery, a patient may be positioned with the palm of the hand facing up. In such an embodiment, the arch structure 61 may be placed over the sensor body 12 such that the protruding prongs 62 are directed away from the palm and towards an operating table or other surface. Alternatively, an active patient may place the arch structure 61 such that the protruding prongs 62 face towards the palm to absorb forces from scratching or tapping. In the event of a downward tapping motion, the prongs 62 may deflect the motion of tapping, spreading much of the impact through the arch structure 61 and away from the emitter 16 and the detector 18. The protruding prongs 62 may be rigid, or may include motion damping structures such as springs (not shown).
FIG. 11 shows a kit 32 that includes a sensor body 12 and multiple rings 34, 46, 48, and 50. It should be understood that the depicted embodiment of a kit 32 including is merely exemplary, and a kit 32 may include any suitable number of rings 34, 46, 48, and 50 or any other rigid annular structure as provided herein. In one embodiment, the rings 34, 46, 48, and 50 may be of a variety of sizes, which may include a variety of diameters, profiles, and/or widths. In certain embodiments, a kit 32 may include a subsection of sizes that generally correspond to sizes appropriate for a certain type of patient, such as an adult or a child. In one embodiment, the rings 34, 46, 48, and 50 may have different diameters that are sized to correspond with standard jewelry sizes of rings. A healthcare provider or patient may select the appropriately sized ring to apply to the sensor body 12. For example, an individual ring 34 (such as 34a) may be selected from a group having different diameters for having the characteristics of providing a conforming, but not overly tight, fit over the portion of the sensor body 12 that contains the emitter 16 and the detector 18. In other embodiments, a ring may be wider, such as the range of widths shown in rings 34a, 34b, 34c, and 34d. In certain embodiments, it may be advantageous to select a wider ring 34d or 50d (depending on the ring diameter needed) that covers a greater percentage of the sensor body 12 when the patient is non-ambulatory, as a wider ring 34d may mitigate forces along more of the sensor body 12. However, an ambulatory patient may prefer a narrower ring such as 34a or 50a that does not prevent flexing of the finger joint. In another embodiment (not shown), the kit 32 may include rings of a variety of different colors and/or decorative patterns. Such an embodiment may provide enjoyment for a young patient, who may be allowed to select a ring of a preferred color or pattern. Additionally, colored and/or patterned rings may be used in a nursery to identify infants by gender or other clinical characteristics.
A sensor, illustrated generically as a sensor 10, may be used in conjunction with a pulse oximetry monitor 36, as illustrated in FIG. 12. It should be appreciated that the cable 38 of the sensor 10 may be coupled to the monitor 36 or it may be coupled to a transmission device (not shown) to facilitate wireless transmission between the sensor 10 and the monitor 36. The monitor 36 may be any suitable pulse oximeter, such as those available from Nellcor Puritan Bennett Inc. Furthermore, to upgrade conventional pulse oximetry provided by the monitor 36 to provide additional functions, the monitor 36 may be coupled to a multi-parameter patient monitor 40 via a cable 42 connected to a sensor input port or via a cable 44 connected to a digital communication port.
The sensor 10 includes an emitter 16 and a detector 18 that may be of any suitable type. For example, the emitter 16 may be one or more light emitting diodes adapted to transmit one or more wavelengths of light in the red to infrared range, and the detector 18 may one or more photodetectors selected to receive light in the range or ranges emitted from the emitter 16. Alternatively, an emitter 16 may also be a laser diode or a vertical cavity surface emitting laser (VCSEL). An emitter 16 and detector 18 may also include optical fiber sensing elements. An emitter 16 may include a broadband or “white light” source, in which case the detector could include any of a variety of elements for selecting specific wavelengths, such as reflective or refractive elements or interferometers. These kinds of emitters and/or detectors would typically be coupled to the rigid or rigidified sensor via fiber optics. Alternatively, a sensor 10 may sense light detected from the tissue at a different wavelength from the light emitted into the tissue. Such sensors may be adapted to sense fluorescence, phosphorescence, Raman scattering, Rayleigh scattering and multi-photon events or photoacoustic effects. For pulse oximetry applications using either transmission or reflectance type sensors the oxygen saturation of the patient's arterial blood may be determined using two or more wavelengths of light, most commonly red and near infrared wavelengths. Similarly, in other applications, a tissue water fraction (or other tissue constituent related metric) or a concentration of one or more biochemical components in an aqueous environment may be measured using two or more wavelengths of light. In certain embodiments, these wavelengths may be infrared wavelengths between about 1,000 nm to about 2,500 nm. It should be understood that, as used herein, the term “light” may refer to one or more of ultrasound, radio, microwave, millimeter wave, infrared, visible, ultraviolet, gamma ray or X-ray electromagnetic radiation, and may also include any wavelength within the radio, microwave, infrared, visible, ultraviolet, or X-ray spectra, and that any suitable wavelength of light may be appropriate for use with the present techniques.
The emitter 16 and the detector 18 may be disposed on a sensor body 12, which may be made of any suitable material, such as plastic, foam, woven material, or paper. Alternatively, the emitter 16 and the detector 18 may be remotely located and optically coupled to the sensor 10 using optical fibers. In the depicted embodiments, the sensor 10 is coupled to a cable 38 that is responsible for transmitting electrical and/or optical signals to and from the emitter 16 and detector 18 of the sensor 10. The cable 38 may be permanently coupled to the sensor 10, or it may be removably coupled to the sensor 10—the latter alternative being more useful and cost efficient in situations where the sensor 10 is disposable.
The sensor 10 may be a “transmission type” sensor. Transmission type sensors include an emitter 16 and detector 18 that are typically placed on opposing sides of the sensor site. If the sensor site is a fingertip, for example, the sensor 10 is positioned over the patient's fingertip such that the emitter 16 and detector 18 lie on either side of the patient's nail bed. In other words, the sensor 10 is positioned so that the emitter 16 is located on the patient's fingernail and the detector 18 is located 180° opposite the emitter 16 on the patient's finger pad. During operation, the emitter 16 shines one or more wavelengths of light through the patient's fingertip and the light received by the detector 18 is processed to determine various physiological characteristics of the patient. In each of the embodiments discussed herein, it should be understood that the locations of the emitter 16 and the detector 18 may be exchanged. For example, the detector 18 may be located at the top of the finger and the emitter 16 may be located underneath the finger. In either arrangement, the sensor 10 will perform in substantially the same manner.
Reflectance type sensors also operate by emitting light into the tissue and detecting the light that is transmitted and scattered by the tissue. However, reflectance type sensors include an emitter 16 and detector 18 that are typically placed on the same side of the sensor site. For example, a reflectance type sensor may be placed on a patient's fingertip or foot such that the emitter 16 and detector 18 lie side-by-side. Reflectance type sensors detect light photons that are scattered back to the detector 18. A sensor 10 may also be a “transflectance” sensor, such as a sensor that may subtend a portion of a baby's heel.
While the invention may be susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and have been described in detail herein. However, it should be understood that the invention is not intended to be limited to the particular forms disclosed. Indeed, the present techniques may not only be applied to measurements of blood oxygen saturation, but these techniques may also be utilized for the measurement and/or analysis of other blood and/or tissue constituents. For example, using the same, different, or additional wavelengths, the present techniques may be utilized for the measurement and/or analysis of carboxyhemoglobin, methemoglobin, total hemoglobin, fractional hemoglobin, intravascular dyes, and/or water content. Rather, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the following appended claims.

## Claims

1. A sensor comprising:
a conformable bandage-type sensor body adapted to be directly applied to a patient's digit;
at least one sensing element disposed on the sensor body on a tissue-contacting surface; and
at least one rigid annular structure not fixedly attached to the sensor body and adapted to be applied to the sensor body on a surface opposing the tissue-contacting surface with a pressure to retain the sensor body in place on the patient's digit and such that the rigid annular structure covers an area of the sensor body corresponding to the at least one sensing element and covers less than 50% of the surface of the sensor body when the sensor is applied to the patient.

2. The sensor, as set forth in claim 1, wherein the sensor comprises at least one of a blood constituent sensor or a tissue constituent sensor.

3. The sensor, as set forth in claim 1, wherein the sensor comprises at least one of a pulse oximetry sensor or a sensor for measuring a water fraction.

4. The sensor, as set forth in claim 1, wherein the sensing element comprises at least one emitter.

5. The sensor, as set forth in claim 1, wherein the sensing element comprises at least one detector.

6. The sensor, as set forth in claim 1, wherein the rigid annular structure comprises a ring.

7. The sensor, as set forth in claim 6, wherein the ring comprises a substantially oval shape.

8. The sensor, as set forth in claim 1, wherein the rigid annular structure comprises an arch, a collar, a thimble or a sleeve.

9. The sensor, as set forth in claim 1, wherein the sensor is adapted to operate in reflectance mode or transmission mode.

10. The sensor, as set forth in claim 1, wherein the sensor body comprises an alignment index adapted to indicate a predetermined position for the rigid annular structure on the sensor body.

11. The sensor, as set forth in claim 1, wherein the rigid annular structure has an adjustable diameter.

12. The sensor, as set forth in claim 11, wherein the rigid annular structure comprises a hinge.

13. The sensor, as set forth in claim 1, wherein the rigid annular structure is adapted to cover at least one joint of a patient's digit.

14. The sensor, as set forth in claim 1, wherein the sensor body is non-adhesive.

15. The sensor, as set forth in claim 1, wherein the rigid annular structure is applied to less than 20% of the surface of the sensor body.

16. The sensor, as set forth in claim 1, wherein the rigid annular structure is positioned only over a portion of the digit that does not correspond to a finger joint.

17. The sensor, as set forth in claim 1, wherein the rigid annular structure is coupled to a second rigid annular structure spaced apart from the first rigid annular structure and disposed on the surface opposing the tissue-contacting surface.

18. A physiologic monitoring system comprising:
a monitor; and
a sensor adapted to be operatively coupled to the monitor, the sensor comprising:
a conformable bandage-type sensor body adapted to be directly applied to a patient's digit;
at least one sensing element disposed on the sensor body on a tissue-contacting surface; and
at least one rigid annular structure not fixedly attached to the sensor body and adapted to be applied to the sensor body on a surface opposing the tissue-contacting surface with a pressure to retain the sensor body in place on the patient's digit and such that the rigid annular structure covers an area of the sensor body corresponding to the at least one sensing element and covers less than 50% of the surface of the sensor body when the sensor is applied to the patient.

19. The system, as set forth in claim 18, wherein the sensor comprises at least one of a blood constituent sensor or a tissue constituent sensor.

20. The system, as set forth in claim 18, wherein the sensor comprises at least one of a pulse oximetry sensor or a sensor for measuring a water fraction.

21. The system, as set forth in claim 18, wherein the sensing element comprises at least one emitter.

22. The system, as set forth in claim 18, wherein the sensing element comprises at least one detector.

23. The system, as set forth in claim 18, wherein the rigid annular structure comprises a ring.

24. The system, as set forth in claim 18, wherein the rigid annular structure comprises an arch, a collar a thimble or a sleeve.

25. The system, as set forth in claim 18, wherein the sensor is adapted to operate in reflectance mode or transmission mode.

26. The system, as set forth in claim 18, wherein the sensor body comprises an alignment index adapted to indicate a predetermined position for the rigid annular structure on the sensor body.

27. The system, as set forth in claim 18, wherein the rigid annular structure has an adjustable diameter.

28. The system, as set forth in claim 27, wherein the rigid annular structure comprises a hinge.

29. The system, as set forth in claim 18, wherein the rigid annular structure is adapted to cover at least one joint of a patient's digit.

30. The system, as set forth in claim 18, wherein the sensor body is non-adhesive.

31. A method comprising:
applying a conformable bandage-type sensor body to a patient's finger, the conformable sensor body comprising an emitter and a detector;
applying a rigid annular structure around an emitter and a detector of the sensor body applied to the patient's finger, wherein the rigid annular structure is not fixedly attached to the sensor body and wherein the rigid annular structure applies a pressure to retain the sensor body in place on the patient's finger, covers an area of the sensor body corresponding to the at least one sensing element, and covers less than 50% of the surface of the sensor body.

32. The method, as set forth in claim 31, wherein the rigid annular structure comprises an arch, a collar, a ring, a sleeve, or a thimble.

33. The method, as set forth in claim 31, comprising deflecting the mechanical force with a spring.

34. The method, as set forth in claim 31, wherein the rigid annular structure is applied to a position on the sensor body such that a patient joint is prevented from bending with the rigid annular structure.

35. A method of manufacturing a sensor, comprising:
providing a conformable bandage-type sensor body adapted to be directly applied to a patient's finger, wherein the conformable sensor body comprises an alignment indicator configured to indicate an alignment of a rigid annular structure;
providing at least one sensing element disposed on the sensor body on a tissue-contacting surface; and
providing at least one rigid annular structure not fixedly attached to the sensor body and adapted to be applied to the sensor body on a surface opposing the tissue-contacting surface such that the rigid annular structure covers an area of the sensor body corresponding to the at least one sensing element and covers less than 50% of the surface of the sensor body when the sensor is applied to the patient and wherein the rigid annular structure applies a pressure to retain the sensor body in place on the patient's finger.

36. The method, as set forth in claim 35, wherein the sensor comprises at least one of a pulse oximetry sensor or a sensor for measuring a water fraction.

37. The method, as set forth in claim 35, wherein the sensor comprises at least one of a blood constituent sensor or a tissue constituent sensor.

38. The method, as set forth in claim 35, wherein the rigid annular structure comprises a ring.

39. The method, as set forth in claim 35, wherein the rigid annular structure comprises an arch, a collar, a thimble, or a sleeve.

40. The method, as set forth in claim 35, wherein the sensor is adapted to operate in reflectance mode or transmission mode.

41. The method, as set forth in claim 35, comprising:
providing an alignment index adapted to indicate a predetermined position for the rigid annular structure on the sensor body.

42. The method, as set forth in claim 35, wherein the rigid annular structure has an adjustable diameter.

43. The method, as set forth in claim 35, wherein the rigid annular structure comprises a hinge.

44. A sensor kit comprising:
a conformable bandage-type sensor body adapted to be directly applied to a patient's tissue;
an emitter and a detector disposed on a tissue-contacting surface of the sensor body; and
a plurality of rigid annular structures of various sizes adapted to be not fixedly attached to the sensor body and adapted to be applied to the sensor body on a surface opposing the tissue-contacting surface such that, when one of the plurality of rigid annular structures is applied the rigid annular structure covers an area of the sensor body corresponding to the emitter and detector and covers less than 50% of the surface of the sensor body when the sensor body is applied to the patient and wherein at least one of the rigid annular structures is configured to apply a pressure to retain the sensor body in place on the patient's tissue.

45. The kit, as set forth in claim 44, wherein the plurality of rigid annular structures have various different diameters.

46. The kit, as set forth in claim 44, wherein the plurality of rigid annular structures have various different widths.

47. The kit, as set forth in claim 44, wherein the plurality of rigid annular structures have various different profiles.

48. The kit, as set forth in claim 44, wherein the wherein the plurality of rigid annular structures have various different colors.

49. The kit, as set forth in claim 4, wherein the plurality of rigid annular structures have various different patterns.