Patent Publication Number: US-2013237798-A1

Title: Method of processing thoracic reflected radio interrogation signals

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of U.S. patent application Ser. No. 12/383,362 filed Mar. 23, 2009, which is a continuation-in-part of PCT/US2007/020487 which was filed Sep. 21, 2007 entitled “Method for Processing Thoracic Reflected Radio Interrogation Signals” and claims priority from U.S. Patent Application No. 60/846,404 entitled “Method of Processing Thoracic Reflected Radio Interrogation Signals”, filed Sep. 21, 2006 and U.S. Patent Application No. 60/973,988 entitled “Method of Processing Thoracic Reflected Radio Interrogation Signals”, filed Sep. 20, 2007, all of which are incorporated by reference herein in their entireties 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     The U.S. Government has a paid-up license in this invention and the right in limited circumstances to require the patent owner to license others on reasonable terms to the extent and under the provisions as provided for by Contract No. DAH001-05-S-0144 awarded by the U.S. Air Force Special Operations Command (AFSOC). 
    
    
     BACKGROUND OF THE INVENTION 
     In biomedical engineering, thoracic bioimpedance is a measure of changes in the electrical conductivity of the thorax and heart. The measurement is based on pulsatile blood volume changes in the heart and aortic root. First described in 1959 by Kubicek, this approach to hemodynamic measurement has been refined and used in practice since the early 1990&#39;s. Thoracic electrical bioimpedance (TEB) noninvasively measures rate, power and volume associated with the cardiac cycle. Validation studies have correlated the results of non-invasive thoracic impedance measurement with the invasive Swan Ganz Thermodilution measurement as well as the invasive Fick method of measuring cardiac output. 
     Existing, invasive methods of cardiac output and hemodynamic monitoring (Swan Ganz or Fick procedures) are not available or practical for use outside medical facilities. Even existing non-invasive thoracic impedance devices are impractical for field use, due to size and power requirement and the need to connect multiple (e.g. seven) electrodes to the patient&#39;s chest. 
     BRIEF SUMMARY OF THE INVENTION 
     A method of electronically evaluating medical state of a human subject in near real time on the subject comprising the steps of: positioning an antenna side of a self-contained radio apparatus for non-invasive, thoracic radio interrogation of a human subject proximally to the heart of the human subject outside the human subject, the apparatus including a radio transmitter operably connected to the antenna and configured to transmit only an unmodulated radio frequency interrogation signal of a predetermined, fixed frequency through the antenna and into the proximally positioned human subject; a radio receiver operably connected to the antenna and configured to capture through the antenna, reflections of the radio frequency interrogation signal returned from the human subject; processing circuitry including an electronic processor coupled with the radio receiver, and a battery power source powering the apparatus; providing a radio frequency interrogation interference signal from the human subject and the radio receiver to the processing circuitry of the apparatus, the radio frequency interrogation interference signal being low frequency components of reflections of the radio interrogation signal transmitted into the thorax of the human subject by the radio transmitter; and determining in the apparatus on the human subject, at least one stroke volume value of the human subject in near real time from the radio frequency interrogation interference signal with the processing circuitry. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing summary, as well as the following detailed description of the invention, will be better understood when read in conjunction with the embedded figures. For the purpose of illustrating the invention, there are shown in the figures embodiments which are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown. 
         FIG. 1  depicts diagrammatically, radio signal reflection surfaces within the torso of a human subject; 
         FIG. 2  depicts an exemplary trace of a typical Radio Frequency Impedance Interrogation signal with cardiac points of maximal impulse (“C”) indicated; 
         FIG. 3  is a simplified trace of the RFII signal of  FIG. 2  collapsed in time to illustrate a respiratory component (L) of the RFII signal; 
         FIG. 4  is a reproduction of the trace of  FIG. 2  illustrating a respiratory component baseline stretched over several consecutive heartbeats; 
         FIG. 5  is a reproduction of the trace of  FIG. 3  showing the full cyclical nature of the respiratory component of the RFII signal; 
         FIG. 6  is another detailed portion of the trace of  FIG. 2  to illustrate the slope that exist between the immediately adjoining extrema; 
         FIG. 7  is an exemplary trace indicating the impact of exaggerated breathing on the RFII signal; 
         FIG. 8  depicts traces illustrating one respiratory contribution that is reflected a cardiac cycle of the RFII signal for three different subject; 
         FIG. 9  depicts traces illustrating another respiratory contribution that is reflected in a cardiac cycle of the RFII signal for the same three different subjects of  FIG. 8 ; 
         FIG. 10  illustrates a RFII signal trace covering two heartbeat with respiratory component removed and the change in reflectivity (amplitude) over time; 
         FIG. 11  illustrates simultaneously generated RFII cardiac component signal and conventional conductive impedance generated dZ/dt signal superimposed upon one another. 
         FIG. 12  depicts the RFII and dZ/dt traces of  FIG. 11  separated from one-another, and the amplitude of the RFII cardiac component signal inverted; 
         FIG. 13  depicts the traces of  FIG. 12  combined in time synchronization and various cardiac landmarks from the ECG signal; 
         FIG. 14  depicts a similar pair of traces for a subject with a left bundle branch block; 
         FIG. 14   a  depicts in greater detail the intersection of the two traces at a T-wave in  FIG. 14 ; 
         FIG. 15  is an enlarged version of a single RFII wave with a single corresponding ECG cardiac event from  FIG. 13 ; 
         FIG. 16  is an enlarged version of a single RFII wave with a single corresponding ECG cardiac event from  FIG. 14  with a left bundle branch block; 
         FIG. 17  illustrates an identifies other components of the RFII signal that may be used for quantification or evaluation of respiration of a subject; 
         FIG. 18  is an RFII trace that identifies yet additional respiration subcomponents of the reflected RFII cardiac component signal; 
         FIG. 19  is a flow chart illustrating a method of heart rate and respiration rate calculation from the RFII signal; 
         FIG. 20  is a flow chart of the calculation of dR/dt from the reflected RFII signal; 
         FIG. 21  depicts diagrammatically, use of a noninvasive, non-contact, radio interrogation system; 
         FIG. 22  is a block diagram of the presently preferred, noninvasive, radio interrogation system of  FIG. 21 ; 
         FIG. 23  is a side view of an RFII antenna assembly; 
         FIG. 24  is a plan view of a “bottom” side of the RFII antenna assembly of  FIG. 23  showing an antenna layer. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Hemodynamic and bioimpedence states occur every heartbeat, or as a subcomponent of a beat. Each action within the heart causes a physical mechanical and electrical change. Although the repetition of these actions can be viewed as a general average over a period of time, each heartbeat is a unique event, and thus contains a unique set of values and characteristics that provide unique information. 
     Concurrently, external forces exert themselves onto these values and components of a heartbeat causing variations. These variations are generally very small and do not inject major deflections in the data ranges. External forces may include, but are not limited to the subject&#39;s physical position such as standing or sitting. Breathing rate changes can provide a variance as well. Physical exertion, environment, and overall physical state also affect these parameters. 
     Therefore when sudden changes occur, or deviations within a trend occur, an evaluation can be made as to the condition of the individual. When compared to the initial values or individual baseline, a determination may be made as to general health. Additionally, by predicting a future trend from the collected trend data, a patient can be evaluated in terms of future outcome. This includes improvement, stability or decline in the health of the monitored individual. Therefore therapeutic intervention may be guided in order to prevent decompensation and improve outcomes. 
     Conventional non-invasive cardiac impedance measures electrical conductivity within an individual between at least two sensing electrodes which are attached to a subject between two additional, interrogation signal injecting electrodes. It has been discovered that the reflected radio waves contain much if not all of the same hemodynamic data as is contained in conventional non-invasive thoracic bioimpedance signals. It has been further discovered that radio signals can be safely transmitted to penetrate a subject&#39;s torso and be reflected to varying degrees from various internal thoracic organs with enough strength and frequency variability to provide cardiological data like that obtained in conventional contact impedance signals as well as respiratory data not readily available in such signals. The present invention will be referred to generically by the acronym RFII for Radio Frequency Impedance Interrogation. 
     A radio interrogation signal is transmitted into the torso of a subject through an antenna positioned proximal to the subject. However, unlike conventional non-invasive thoracic bioimpedance measurements, the antenna does not have to be in direct contact with the subject, just sufficiently near to the subject opposite the subject&#39;s heart. As the transmitted radio interrogation signal passes through with the subject, various factors affect the interaction of the waves with the subject and provide investigational information. 
     Consider a single source of power in the form of an unmodulated radio signal having a predetermined fixed frequency which is transmitted from an antenna into the torso of a unmodulated subject positioned with the antenna and which reflects off of all thoracic organs and substances encountered. The major radio wave reflecting substances encountered by the radio interrogation signal are depicted diagrammatically in  FIG. 1 . Although this is a simplified image with several components missing, it does reflect the major influences on the transmitted radio interrogation signal. The radio interrogation signal landmarks are: D1 (Derma); M1 (Muscle); S1 (Skeletal); L (Lung); CM (Myocardium); CF (Cardiovascular Fluid); S2 (Skeletal); M2 (Muscle); and D2 (Derma). 
     When radio interrogation signal is transmitted into the subjects&#39; torso, the first deflection/reflection occurs on the skin (derma), followed by muscle followed by bone (the ribcage). As these three physical components are static in size and composition, the returned reflections of the radio interrogation signal from these components is a steady value. 
     Once the radio interrogation signal passes the ribcage, a portion of it reflects from the lungs. As the lungs expand and contract, the composition of the organ changes. When the lungs are exhausted of air, the bulk of the material within the volume of the lungs is tissue. The tissue contains salt and water. Salt water, including blood, is one of the most reflective materials to the radio interrogation signal. Salt water/blood causes the reflected signal to increase. 
     The radio interrogation signal portion which passes into and beyond the lungs comes into contact with the heart where a portion of the radio interrogation signal is reflected back. This portion provides a constant value as the composition of the muscle itself remains relatively constant. However, the radio interrogation signal which enters the heart is modified by a number of factors resulting in a varied signal return which can be monitored and evaluated. When the heart proceeds through its cardio-dynamic process, the shape and displacement of fluid levels changes. The shape of the heart changes as well. All of these physiological events modify the signal which is reflected back out of the body. Not only does the volume of fluid affect the signal reflection, its shape as it is defined by the container (the heart and blood vessels) provide a unique, consistent pattern of the reflected signal. The radio interrogation signal which reflect the fluid volume, have the opportunity to be reflected from the back or opposite surface on the fluidic shape. These reflections are smaller components. However, they affect the characteristics of the signal uniformly on a beat to beat basis due to the continuity of the fluidic shape as it appears within the heart. 
     Beyond the heart, the balance of the radio interrogation signal will again come into contact with bone such as the spinal column followed by muscle and skin. During this process, portions of the radio interrogation signal will be reflected back in a consistent manner as the composition and shape of these materials remains static during the process. 
     The lungs, myocardium and cardiovascular fluid experience the greatest amount of change cyclically. The lungs develop an atmosphere pocket with a specific shape based on internal topology which is relatively unique on a person by person basis. These atmosphere pockets create surfaces which reflect radio interrogation signals back and forth and provide alternating periods where higher reflectivity and lower reflectivity occur. The heart develops a fluid pocket (cardiovascular fluid) which moves and changes shape as it travels through the organ. The fluid (blood) is highly reflective of radio waves. 
     Not only is the radio interrogation signal affected by the reflectivity of the anatomical structures and bodily substances that it encounters, but it is also affected by the position of the heart and how it is positioned in proximity to the other anatomical structures. This is evidenced by signals obtained from individuals with barrel chests and large pectoral masses as opposed to thinner, more lean individuals. The reflected signal is not dampened or enhanced by body composition, but has a different slope. The reflections of the radio interrogation signal from each subject have properties that relate to anatomical positioning, anatomical shape and size, mechanical action, and the electrical conductivity/bioimpedance properties of each of the thoracic structures and substances encountered. 
     When analyzing the reflections of the radio interrogation signal, the Doppler components contain the cardiopulmonary information of interest. Hereinafter the Doppler components of the captured reflected radio interrogation signal will be referred to as the reflected Radio Frequency Impedance Interrogation signal or simply “RFII” signal. The Doppler components of interest are in the range of about 100 Hz and less. The RFII signal that is being processed represents the amplitude of the captured reflected radio waves in that Doppler bandwidth around the predetermined fixed frequency of the original radio interrogation signal. 
     At any given time T, the morphology of the subject is a static snapshot of it&#39;s behavior and characteristics. As it is a static snapshot at a given moment, bodily fluids such as blood should not be viewed or interpreted as a liquid, but rather as a three-dimensional solid existing in a static state at that given moment. Even though the radio wave is in motion and decaying in strength as it expends energy, at the given time T it is best to interpret the fluid as a singular solid object with reflective surfaces and angles of incidence. In order to determine velocity and/or direction of the wave, or energy motion, multiple time slices of information must be evaluated. 
       FIG. 2  depicts an example of a trace of an RFII signal from a subject. Again, this signal is the amplitude of the Doppler components of the captured reflections of the radio interrogation signal. This RFII signal can be obtained from the raw reflected returns in various ways but quadrature demodulation and band filtering (between about one to one hundred hertz) are preferred. The simplest and most obvious components within the traces of the RFII signal depicted in  FIG. 2  are the cardiac landmarks (“C”). The heart operates with a cyclical fluidic change. As the fluid is highly reflective for radio signals like the original radio interrogation signals, this interaction becomes quite pronounced. As the heart fills with fluid (blood), the signal response increases returning a topological representation in a one dimensional data array. Easily identified, the cycle of contractions (heartbeats) are determined by counting these variations (C events) within a specific time period. 
     Another cyclical system which occurs concurrently within the RFII signal is respiration. Although it is not as obviously apparent as the heartbeats, it is present within the RFII signal. Ideally to evaluate the signal from the heart in greater detail, the respiratory signal component should be removed. 
     In  FIG. 3 , about twenty seconds of the RFII signal is depicted to illustrate a normal respiratory cycle. The diagonal lines “L” show the rhythmic breathing pattern superimposed on the cardiac cycle by respiration. The internal topology of the lungs as well as their constitution affect their reflective abilities of the RFII signal. When empty, the lungs are more reflective as fewer surfaces are exposed to provide incidental angles of deflection as well as incidental angles of refraction for the RFII signal. When this is the case, more RFII signal is able to be reflected back towards the source. When the lungs filled with air, the bronchial tree and alveoli expand creating surfaces which provide angles in incidence for reflection as well as refraction of the RFII signal. During this phase, the strength of the reflected signal reduced. If the RFII signal from  FIG. 2  is closely reexamined, the respiratory subcomponent signal (L) of breathing becomes apparent as indicated in  FIG. 4 . The respiratory cycle creates a reoccurring baseline rise and fall as illustrated in  FIG. 5 , where the RFII of the previous figures are time compressed. The respiratory cycle can be quantified by counting the bottoms and/or tops of the underlying cycle as it appears within the RFII signal to provide a respiratory rate L in respirations per minute. This component can also be removed for isolation of the signal from the heart. 
     In  FIG. 6 , a slope “3” exists between points  1  and  2  within consecutive extrema of the RFII signal. Points  1  and  2  provide convenient anchor points for the removal of the base breathing component. As the reflected RFII signal is not affected in a linear manner by respiration, it is important to remove this component with a segmented approach. Utilizing the heart beat as a point of reference, a slope  3  between points  1  and  2  is determined for the increase or decrease of the baseline. This slope is systematically removed from all points between 1 and 2. This process is then repeated for the following pair of heartbeats, between 2 and the following point of reference (not depicted). When inhaling and exhaling are exaggerated, the baseline deflections and subsequent underlying amplitude of the breathing wave becomes more pronounced and exaggerated  FIG. 7  depicts a trace of an exemplary RFII signal where very deep breathes are taken by the subject generating a steeper slope. Alternately, the figure can reflect an exhalation effort to exhaust as much air as possible to from the lungs. The breathing cycle becomes very pronounced and creates a signal with a higher range of deviation than the heart beat. 
     Another pulmonary feature exists within the reflected RFII signal. A residual RFII echo occurs within the lung as well as a “drum mechanic”. As the lungs fill with air, they provide multiple surfaces which amplify the echoing characteristics of the RFII signal in addition to the reflected signal response decline. A pronounced characteristic becomes apparent within the signal as can be seen in  FIG. 8  depicting RFII signals from different subjects. The top line within this set of three RFII traces is from one exhaled duration. The small feature indicated at the leading edge of the heartbeat corresponds to residual air within the lungs, which may be interpreted as the Expiratory reserve volume under normal breathing or as the Residual volume after maximal exhalation. Signal deviators such as liquid in the lungs would most likely create a significant signal event for measurement. Additional respiratory and/or information exists within the feature which can be utilized to ascertain the condition of the lungs as can be seen in  FIG. 9 . Three separate portions of a trace are assembled above one another in  FIG. 9  and depict the cyclical modification of the signal over time for different subjects as the lungs expand and contract. 
     As the respiratory cycle related components are removed from the reflected RFII signal, the residual signal which exists constitutes clothing, skin, muscle, bone, static lung material, the heart muscle and fluid (blood). The primary dynamic component within this set of items is the fluid blood as it changes cyclically. As the fluid (blood) influences the magnitude of the reflected signal, volumes can be determined based on a response. Additional information regarding the health of the heart can be determined by various aspects of the residual signal which shall also be referred to as the RFII cardiac component. 
     When the RFII signal and particularly the RFII cardiac component is compared with a simultaneously generated thoractic electrical bioimpedance signal, a correlation can be seen to exist between the conventional conductive impedance signal dZ/dt and RFII cardiac component signal. Both are significantly influenced in similar ways by fluidic volume and its changes. 
     In  FIG. 10 , a single heartbeat from the (inverted) RFII cardiac signal is evaluated for amplitude and time changes. This has been found to provide a value for this cardiac characteristic comparable to the thoracic impedance characteristic value dZ/dt. This cardiac characteristic determined from the RFII signal can be viewed as the reflectivity change in relation to the time change (dR/dt). 
       FIG. 11  represents an exemplary screen capture of simultaneously generated RFII cardiac component and conventional conductive impedance generated dZ/dt signals superimposed upon one another. The timing and basic shape of the two signals can be compared. In  FIG. 12 , the reflected RFII cardiac component and the dZ/dt signals of  FIG. 11  have been separated and the amplitude of the reflected RFII cardiac signal is inverted with a non inverted dZ/dt signal underneath.  FIG. 13  shows an inverted, reflected cardiac RFII cardiac signal (top) with a concurrent ECG signal (bottom). 
     The characteristics of the leading and trailing slopes of both signals in  FIGS. 11 and 12  present similar characteristics in reference to amplitude versus time. It has been found that the similarity between dR/dt shown in  FIG. 10  and dZ/dt can be used to determine an at least relative value of Stroke Volume (“SV”) and Cardiac Output (“CO”) for a subject directly from the RFII signal. The value dR/dt can be determined in various ways. A simple expedient is to measure signal amplitude between minima to maxima points in one cardiac cycle of the RFII signal, determine the time duration of the period and use that number as a dZ/dt equivalent in the conventional Stroke Volume and Cardiac Output equations. While appropriate scaling would be necessary for an absolute determination of each of these two characteristics, it will be appreciated that for trend monitoring or gross characteristic determination, scaling would not be important. A nominal SV and/or CO value or a nominal range of such values can be determined by measurement of various subjects using dR/dt values and the value of an individual&#39;s SV and/or CO value compared to the nominal value(s) for a determination of subject condition. A more accurate determination can be made by calculating an average dR/dt value over several sequential cardiac cycles. It is important to note that for greater accuracy, the breathing component should be removed from these portions of the RFII signal ( FIG. 6 ). Otherwise the time portion would increase during inhalation thereby creating an unusable value for several beats per cycle skewing the resultant values. 
     Additionally, minute features within the dZ/dt signal at certain events are amplified and present more prominent features within the inverted RFII cardiac component signal. The timing of known events such as cardiac waves in the ECG can be utilized to further identify the same events and other characteristics from the RFII cardiac component signal. Referring to FIGS.  13  and  15 , the normal P wave which occurs within an ECG correlates precisely with a RFII cardiac slope deviation which is evident prior to the top extrema of the inverted RFII cardiac component signal. The QRS complex is constantly visible within the inverted RFII cardiac signal as the data segment beginning with the top of the peak extending to the visible deflection on the declining slope. When the single heartbeat capture from  FIG. 13  is magnified in  FIG. 15 , the correlations between the ECG event times and the RFII event times become more apparent. The T wave corresponds with the bottom on the event trough within the inverted RFII cardiac signal. By utilizing a matching ECG, significant events are discernable within the RFII cardiac signal. As a result, these cardiac event or landmarks, which constitute subcomponents within each cardiac cycle, can be identified and used to determine those cardiac characteristics normally requiring ECG data. For example, characteristics such as Ventricular Ejection Time (VET) can be determined from the RFII signal. 
     In  FIG. 14  concurrent ECG (bottom) and inverted, RFII cardiac component (top) signals show the relationship between the signals when the conditions in the heart are not optimal, for example, with a left bundle branch block. When the single heartbeat from  FIG. 14  is magnified in  FIG. 16 , the timing events between the ECG and RFII become very apparent. The corresponding slope deviation at the point of the P wave creates a discernable peak within the RFII signal. Although the P wave on the ECG is not dramatically out of proportion to a normal P wave, the mechanics of the heart and fluid present a noticeable deviation at that time period. Instead of a slope deviation as can be seen in  FIG. 13 , the deviation begins with a signal spike followed by a signal drop. Additionally the QRS complex signal signature in the RFII signal deviates from a normal RFII cardiac signal. The trailing slope change is moved further away from the peak on the time scale and is significantly more pronounced. When no breathing is taking place and the lungs are depleted of air, the RFII signal presents a dip in the signal. This event occurs at the corresponding time as the trailing deviation in the QRS complex. During the up-slope of the T wave, the bottom of the RFII signal changes from a uniform trough which appears U shaped to an unbalanced trough. The declining curve is sloped in a shallower manner. These changes in the RFII cardiac component can be used to identify the occurrence of these various cardiac events and conditions 
       FIG. 17  depicts RFII signal elements that are components of a detailed analysis of the heart. In the above signal trace, the respiration wave has components which can be utilized for quantification or evaluation of the subject&#39;s pulmonary/respiratory response. These include the following. The length A of the slope on the rising edge of the inverted RFII signal wave indicates depth of breath. Length B, the length of the declining slope of the falling edge of the RFII signal wave, is the exhalation portion of the respiratory cycle. The angle AC is the slope of A with respect to C and represents the depth of the inhalation. The deeper the inhalation, the greater the lung expansion and the steeper the slope. Slope times duration of the inhalation gives an indication of intake volume. Any of the three (respiratory rate, depth of breath and indication of intake volume) can also be monitored for change. 
     Referring as well to  FIG. 18 , additional respiration subcomponents include but are not limited to the extraction of the pulmonary generated section within each heartbeat, which is also directly related to the heart and it&#39;s mechanics and responses. These include, for example, the identification of the point in the heartbeat component where the slope of the cardiac wave levels out, which is due to pulmonary activity; the identification and evaluation of the end of the event where the slope again rises; the duration of the event as denoted as item (B) and seen in  FIG. 18  to vary cyclically within the heartbeat waves as a measure of respiratory rate; calculation of (A) multiplied by (B) in order to determine volume of the identified signal event as an indication of magnitude or volume of lung capacity, (B) divided by (A) and/or (A) divided by (B) in order to determine a ratio within the identified signal event; and identification within the (B) length of the cardiac component signal of specific events which correlate to the electrically identifiable physical events within the heart as indicated in  FIGS. 13 and 14 . 
     The  FIG. 19  is a flow chart that illustrates heart rate and respiration calculation from the RFII signal. The flow chart of  FIG. 20  depicts how dR/dt can be calculated from the cardiac component of the reflected RFII signal. As can be seen, dR/dt is determined from sequential blocks, for example, twenty to thirty second lengths of the RFII cardiac component signal. 
     The calculated dR/dt value can be used to determine Stroke Volume (SV) and cardiac Output (CO) with the following equations: 
     If male: 
         SV =((0.418−(0.0016 *HR ))*134 *dR/dt *( Len*Len*Len ))/( ZO*ZO )
 
         CO =( SV*HR )/1000; 
     If female: 
         SV =(0.418−(0.0017 *HR ))*112 *dR/dt *( Len*Len*Len )/( ZO*ZO )
 
         CO =( SV*HR )/1000; 
     Where the following are used:
         HR—Heart Rate   Len—Thoracic length (nominally 13 inches for male, the same or less for a female)   ZO—Baseline value of reflections from the original radio interrogation signal derived from reflected returns of the radio interrogation signal, in particular, the magnitude of the DC component of the reflections from the original radio interrogation signal; (nominal value 25 ohms male or female).       

     Thus is provided a method of evaluating or monitoring the medical state of a subject that begins with the steps of: providing the radio frequency interrogation interference signal from a subject, the radio frequency interrogation interference signal being a low frequency component of reflections of a radio interrogation signal transmitted into the thorax of the subject; and determining at least one cardiac or respiratory characteristic of the subject from radio frequency interrogation interference signal. The characteristic can be compared to predetermined values to assess state or monitored for changes over time to assess change in condition of the subject. 
     Each of these cardiopulmonary characteristics, respiration rate, heart rate, Stroke Volume and/or Cardiac Output, and others can be determined in sequential time segments of the RFII signal. Any of these determined characteristics can be outputted in real time in signal form as a printout or a visual display and/or stored for historical purposes. Changes in any of these characteristics compared with the characteristics of earlier sequential time segments or comparison of determined/calculated/derived characteristics exceeding predetermined limits or rates of change in any of these characteristics exceeding rates of change limits, can be identified in addition or in the alternative and stored or outputted in signal form. Several of these characteristic can be monitored to identify an overall condition (e.g. good, serious, critical) and changes in condition (improving, stable or deteriorating) of the subject identified. The determined condition can also be outputted in signal form. In the event of deterioration or deterioration of a sufficiently significant degree, an appropriate alarm signal can be generated. 
     One example of a method for monitoring condition and condition changes is to quantify or determine the value of and monitor changes in overall condition by monitoring values and changes in Cardiac Output. For example, Cardiac Output can be calculated per the above equation. The ranges for CO from the above equation should be 0 (expired) to about 12 (being an unhealthy, hyperactive heartbeat). The normally healthy range is about 3.5 to 6.5. 
     To put this into a more easily manipulated centiary scale of 0-100, the Cardiac Output can be multiplied by 10 (i.e. a cardiac output of 2.1 becomes 21). If the result is below 21, a value of 5 can be added to it. This is a “Emergent” situation (very unhealthy). If the result is between 21 and 26, a value of 44 can be added to it. This is “Urgent” (not healthy at the moment). If the result is above 26, a value of 44 can be added to it (it will be in the range of “Urgent” to “full health”). If the result value is greater than 100, it would be capped at 100 (full health). This value can be output to the user, compared with prior values for trending and/or stored for later comparison. 
     If the trend is towards lower numbers (regardless of current score) and has reduced by 10% in two or more subsequent entries in the array, it can be tagged as “Urgent” and capped at 65. If above 65, it can be brought down to 65 to flag a bad trend. If the trend is towards lower numbers (regardless of current score) and has reduced by 15% or more for two or more subsequent entries, it can be tagged as “emergent” and capped at 35. Again, if above 35 it can be brought down to 35 to flag serious deterioration. This is as an example only. This shows how cardio-pulmonary/respiratory data from the RFII signal can be used to broadly classify subjects such as patients or casualties in a way that provides an indication of current condition and/or the trend of that condition. 
     Instead of cardiac output, stroke volume or respiratory rate or heart rate or a cardiac wave event or other cardiac or respiratory characteristic or some combination of characteristics can be quantified and compared with prior values of the subject or with predetermined nominal values applicable widely to subjects. 
     Since the collection of RFII data can be done relatively quickly and easily, it is ideally suited for use in emergency situations and/or in situations where one or a limited number of care givers need to monitor the condition of many seriously ill or injured individuals. The condition and/or trend can be can be converted into a signal and provided to the care giver(s) by display on the RFII data collection apparatus, for example by the use of one or more light sources like color coded LED&#39;s and/or can be displayed continually or operated in different duty cycles of duration and/or intensity to indicate state and/or change of state. Sound signaling can be used as well, for example as an emergency alarm. Alternatively, values can be transmitted to a receiver on the care giver or someone or thing directing the care giver to assess and/or monitor patient condition. In the latter case, the transmitted values would have be sent with some type of identifier to identify the subject source. 
     The invention further includes extracting a cardiac function signal or pulmonary function signal from the radio frequency interrogation interference signal and processing the extracted function signal to derive subcomponents of cardiac cycles or respiratory cycles to determine intra cycle events produced by physiological changes during each such cycle. 
     Furthermore, derived subcomponents of cardiac or respiratory cycles are accrued over multiple cycles and comparison analyzed to identify changes reflective of deviations or trends or both within the subcomponent indicating physiological trends or deviations. 
     The invention further comprises comparing the subcomponents of the subject with corresponding subcomponents of other individuals for the purpose of determining physiological differences. 
       FIG. 22  shows in block diagram form, an RFII system indicated generally at  10 . The radio apparatus  100  portion of the system  10  for non-invasive radio collection of data of the system  10  include a transmitter portion or “transmitter” indicated generally  104 , a receiver portion or “receiver” indicated generally at  106  that partially overlaps the transmitter  104 , a reference voltage source  108 , and a transmitting/receiving antenna  150 . These are used with processing circuitry  102  such as a microprocessor configured by software and/or firmware, to provide the control and above described impedance data processing portion of the apparatus  100 . Another transmitter  210  (in phantom) optionally can be provided to transmit raw or processed data to a remote location. All of the foregoing components are sufficiently low power consumers that all can be packaged together in a palm sized housing  230  ( FIG. 21 ), sufficiently compact to be positioned proximally to the human subject  30  and powered by an internal battery power supply (“PS”)  220  (in phantom  FIG. 22 ). 
     More particularly, the presently preferred RFII system  100  includes a precision tone generator as a frequency source (“FS”)  110 , a power amplifier (“AMP”)  120  that constitute the basic transmission device, a duplexer (DUX)  130 , an RF Band Pass Filter (BPF)  140 , antenna  150 , a Low Noise Amplifier (LNA)  160 , a Demodulator (DUX)  170  that constitutes the basic receiving device, Low Pass filters  180  and  200  and High Pass filters  190  for in phase (I) and quadrature (Q) RFII signals. This baseline hardware can be implemented using commercially available surface mounted RF and mixed signal integrated circuits and components on a multilayer printed circuit board. Apparatus  100  outputs two RFII signals to the processing circuitry  102 , an in-phase signal I and a quadrature signal Q. The constant (DC) component of the RFII signals (I DC and Q DC) are comparable to Zo and are output from filter  180  while the time varying component of the RFII signals (I AC and Q AC) are output from the filters  190 ,  200  and represent dR/dt, the RFII equivalent of dZ/dt. 
     The presently preferred RFII system  10  and radio apparatus  100  uses a single, palm sized, patch antenna  150  ( FIGS. 23-24 ), for example, a fractional wave antenna, to both transmit and receive the radio signals. Referring to  FIG. 21 , the system  10  is positioned on the human subject  30  such that the antenna  150  is placed proximal the subject  30 , more particularly on the subject&#39;s chest proximal the subject&#39;s heart H and suggestedly opposite the center of the sternum, where it is aligned juxtaposed with the aorta. The antenna  150  can be placed on the patient&#39;s clothing  35  as no direct skin contact is required by the present method and apparatus and clothing of natural or polymer materials does not affect passage of the radio waves. The antenna  150  need only be sufficiently close to the thorax and aorta of the subject to receive usable reflections of the radio interrogation signal transmitted from the patch antenna at a safe power level, for example, about one milliwatt. It has been found that usable reflected signals can be received from the antenna  150  spaced up to about 10 mm from the subject&#39;s chest even when the radio interrogation signal is transmitted from antenna  150  at a strength of about one-half milliwatt. However, it is further noted that positioning or movement off the center of the sternum or up or down the sternum can perceivably reduce the signal strength of the received reflections. Therefore, if positioning or movement of the antenna  150  becomes a problem during use, the antenna  150  can be positioned in or under the patent&#39;s clothing or even adhered to the patient over the sternum. Again, contact with the subject is not required for the system to work. Furthermore, the apparatus can be operated intermittently, if desired, as changes in hemodynamic data and/or other bodily fluid data are much slower than the cycling frequency at which the apparatus  100  is capable of operating. For example, only twenty-five percent duty cycles of appropriate thirty second lengths need be run to long term monitor a subject&#39;s condition. 
     When operating, the radio apparatus  100  of the RFII system  10  described herein runs on “full duplex”, meaning that the radio interrogation signal is being transmitted and the reflections of that signal are being captured simultaneously through the same antenna  150 . Overlap is accomplished through duplexer  130  in  FIG. 22  that separates the transmitted and received radio signals. The need for only a single signal transmitter and single signal receiver with only a single antenna are important characteristics of the present invention that distinguish it from conventional contact impedance systems. 
     Again, it has been discovered that the captured reflections of the radio interrogation signal have a constant (zero frequency) components and a component that changes relatively slowly with time relative to the transmitted radio interrogation signal&#39;s amplitude and predetermined fixed frequency that relate to and mimic the impedance changes detected by conventional contact impedance measuring systems. The processing circuitry  102  in  FIG. 22  is configured by firmware or software to the cycling of the radio apparatus  100  and is further configured to at least temporarily store the RFII signals and preferably process the RFII signals to determine at least one of the above mentioned cardio-respiratory characteristics of the subject to measure and/or monitor. Again, these characteristics include but are not limited to heart rate, respiratory rate, stroke volume and cardiac output. Since radio measured “impedance” is also dependant on the overall conductivity and absorptiveness of the body&#39;s blood and tissue, it is dependent on vital chemical conditions that can change RF conductivity, such as body hydration, or deficient oxygen content. In particular, the more electrically conductive substances such as blood are more reflective of radio waves than are the less conductive tissues. The RFII signal has a constant or DC component of the signal is the equivalent baseline impedance, Z O . The moving parts of the heart and the blood flow also cause the amplitude and phase of the reflected radio signal to change over time at a very low frequency determined, in part, by the cardiac cycle. This very low frequency pattern is the dR/dt component that reflects ΔZ/Δt. That is, the mechanical motion of the heart and blood flow, relative to the antenna frequency, modulates the RFII signal with a frequency modulation (FM) content of about 1 to 100 Hz, in addition to amplitude modulation. The receiver portion  106  of the present apparatus  100  extracts both equivalent Z O  and equivalent ΔZ/Δt impedance components from the captured RFII signal reflections and forwards them to the processing circuitry  102  for quantification and analysis as previously described. 
     Referring to  FIG. 23  there is shown a diagrammatic side view of the RFII system  10 . The RFII system  10  is preferably an assembly that comprises a laminate of five layers. Preferably, the antenna  150  comprises a copper antenna layer  12  on a bottom side of the RFII antenna assembly  10 , a copper ground plane layer  16  and a dielectric layer  14  separating the antenna layer  14  from the ground plane layer  16 . The antenna layer  12  is preferably formed of 0.5 oz copper and the ground layer  16  is preferably formed of 1.0 oz copper. However, the thickness of the copper is not critical. Preferably the material comprising the dielectric layer  14  has a dielectric constant of greater than 10 and dissipation factor of less than 0.003 at a frequency of 915 MHz. In the preferred embodiment of the antenna  150 , the dielectric layer is provided by 25 mil thick Rogers  3210  ceramic filled laminate reinforced with woven fiberglass having a dielectric constant of 10.2. However, dielectric materials other than ceramic filled laminate could be used. 
     The circuitry of the system  10  (radio apparatus  100  and processing  102 ) is preferably constructed on a printed circuit board (PCB) on a top side of the RFII antenna assembly  10 . The PCB on which the circuitry of the system  10  is constructed comprises a dielectric layer  18  and a printed circuit layer  20 . In the preferred embodiment, the PCB layer  18  is made of 31 mil thick FR4 fiberglass epoxy-resin PCB material. However, other materials such as polyimide, ceramic or Teflon material could be used for the PCB material. The printed circuit layer  20  comprises circuit and ground patterns of 0.5 oz copper laminated to the PCB layer  18 . As shown in  FIGS. 23 ,  24 , a plated through hole  2  provides a connection between the antenna layer  12  and the printed circuit layer  20  for providing the output of the transmitter  104  to the antenna layer  12  and providing the output of the antenna layer  12  to the receiver  106 . 
     In use, the RFII system  10  is positioned by a user on the body of the human patient or subject  30  proximate to the heart region (“H”) of the patient. When the reflected radio frequency interrogation signal is found to be carrying the desired cardiac information, the microprocessor  102  preferably generates a signal to the user that the antenna  150  is correctly positioned and that the desired cardiac data is being acquired. 
     Typically, an antenna for transmitting and/or receiving electromagnetic energy is designed and used to radiate/receive electromagnetic energy into/from air or free space. In contrast to a typical antenna, the antenna  150  is designed to transmit the electromagnetic energy of the radio frequency interrogation signal a very short distance, i.e. 0.01 cm to 10 cm, into the thoracic region of the human body. As would be understood by those skilled in the art, the resonant frequency, the driving point impedance and the return loss of a resonant antenna such as the antenna  150  is influenced by the permittivity, permeability and conductivity of the medium within the near field antenna  150 . Because the permittivity, permeability and the conductivity of the human body differ significantly from that of free space, the dimensions of the antenna  150  and the location of the excitation point of the antenna  150  are different for operation when the patient is in the near field of the antenna  150 . 
     A distance of 0.01 cm to 10 cm plus the few centimeters to the heart itself inside the chest is considered to be within the near field of the antenna  150  when the antenna  150  is excited by a signal at a frequency of 915 MHz. For the purposes of this application, the term proximate is used to identify when the antenna  150  is positioned such that a patient is within the near field of the antenna  150 . 
     In the RFII system  10 , the antenna  150  is preferably a planar type patch antenna and preferably of one-quarter wavelength design. The preferred antenna  150  is approximately 1.2 by 1.5 inches in size, the parameters of which are optimized to radiate an ultra-high frequency radio signal received from the transmitter a relatively short distance through a patient&#39;s clothing and into the thorax of the patient and at least into the heart, and to receive a returned radio signal generated by reflection from blood and other thoracic contents and provide that signal to the receiver. 
     As shown in  FIG. 24 , the preferred embodiment of the antenna layer  12  and the ground layer  16  are each in the shape of two identical, nominally right triangles, the mirror images of each being joined together at the hypotenuse of each triangle to form the kite shaped antenna  150 . For operation of the antenna  150  at 915 MHz, the hypotenuse of each triangle, i.e. the length of the antenna  150 , is preferably 51 mm, the length of the shorter side of each triangle is preferably 31 mm, and the length of the longer side of each triangle is preferably 40 mm. Consequently, the interior angles of each right triangle forming the preferred antenna  150  are nominally, 90, 52 and 38 degrees, making the angles of the four sided figure formed by the two triangles be 90, 104, 90, and 76 degrees respectively. 
     As one skilled in the art would understand, each dimension of the antenna  150  would be altered in inverse proportion to the frequency of the radio frequency interrogation signal should the radio frequency interrogation signal be changed from the preferred frequency of 915 MHz. Further, the acute interior angles of each right triangle are not limited to precisely 52 and 38 degrees. The angle of the smaller acute interior angle of each right triangle can be any angle between 31 and 44 degrees, and more preferably 35-40 degrees, with the larger acute angle being complementary, and the antenna  150  would still be within the spirit and scope of the invention. Also, the antenna  150 , when constructed of two triangles need not include an interior angle which is exactly a right angle. 
     The effect of the kite shape is to broaden the bandwidth of the antenna  150 . Preferably, the bandwidth of the antenna  150  is such as to accommodate manufacturing tolerances in making the antenna  150  and any frequency uncertainty of the radio frequency interrogation signal. In the preferred embodiment, the 10 dB bandwidth of the antenna  150  is in the range of 14-30 MHz depending on the adjacent medium, but could be made larger or smaller by varying the shape of the antenna  150 . 
     The antenna  150  has two edges  25   a ,  25   b  in which the antenna layer  12  is conductively connected to the ground layer  16  and two edges  26   a ,  26   b  that are open with a bare dielectric margin area surrounding the copper of the antenna layer  12  and the ground layer  16 . In the preferred embodiment, as shown in  FIG. 4 , the conductive connection between the antenna layer  12  and the ground layer  16  is by a series of plated through holes  24  of preferably a nominal 0.02 inch diameter. The series of plated through holes  24  serve to provide a short circuit connection between the antenna layer  12  and the ground layer  16  at the two shorter sides of the antenna  150  to force the antenna  150  into a quarter-wave mode of operation. 
     PCT/US2007/020473 filed Sep. 21, 2007, entitled “Apparatus and Method for Non-invasive Thoracic Radio Interrogation”; U.S. Patent application Nos. 60/846,403 entitled “Method and Apparatus for Non-Invasive Bio Impedance Determination”, filed Sep. 21, 2006; U.S. Provisional application No. 60/846,402 entitled “Method for Conditioning Radio Signal Returns from Thoracic Components for Extractions of Cardiopulmonary Data”, filed Sep. 21, 2006; U.S. Provisional application No. 60/973,985, entitled “Apparatus and Method for Non-Invasive Thoracic Radio Interrogation”, filed Sep. 20, 2007; PCT/US2007/020492 filed Sep. 21, 2007, entitled “Antenna for Thoracic Radio Interrogation”; U.S. Provisional application No. 60/846,408 entitled “Transducer-antenna-probe for Thoracic Radio Interrogation”, filed Sep. 21, 2006, and U.S. Provisional Application No. 60/910,394, entitled “Antenna for Thoracic Radio Interrogation”, filed Apr. 5, 2007, and U.S. Provisional Application No. 60/973,970, entitled “Antenna for Thoracic Radio Interrogation”, filed Sep. 20, 2007, are also all incorporated by reference herein in their entireties. 
     It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but it is intended to cover modifications within the spirit and scope of the present invention as defined by the appended claims.