Patent Application: US-201213429663-A

Abstract:
a non - invasive method and apparatus utilizing a single wavelength for the instantaneous , reflective , non - pulsatile spatially resolved reflectance system , apparatus and mathematics that allows for the correct determination of critical photo - optical parameters in vivo . transcutaneous blood constituent measurements can be determined in real - time . the “ closed - form ” nature of the mathematics allows for immediate calculations and real - time display of hematocrit and other pertinent blood values in a variety of handheld or other like devices .

Description:
in describing preferred embodiments of the present invention illustrated in the drawings , specific terminology is employed for the sake of clarity . however , the invention is not intended to be limited to the specific terminology so selected , and it is to be understood that each specific element includes all technical equivalents that operate in a similar manner to accomplish a similar purpose . the present invention is described below with reference to mathematics and graphic illustrations of methods , apparatus ( systems ) and computer program products according to an embodiment of the invention . as used herein , “ sensor ” and “ detector ” and “ photo - detector ” are used interchangeably ; “ emitter ,” “ photo - emitter ,” “ source ,” and “ light source ” are used interchangeably ; and “ array ” is used to refer to an orderly arrangement of elements , which is not limited to a linear arrangement , but may also be matrix or circular , or a combination of linear , matrix , and / or circular arrangements . the elements in a “ photo - array ” as used herein include at least one emitter and at least two sensors in an array . reference is made to the following , the relevant portions of which are incorporated herein in their entireties , for technological background : t . j . farrell , et al . tissue optical properties . appl . opt . 37 , 1958 , 1998 . schmitt , j . m ., simple photon diffusion analysis of the effects of multiple scattering on pulse oximetry . ieee trans biomed eng ., 38 : 1194 - 1203 , 1991 (“ schmitt 1991 ”). schmitt , j . m . et al ., multiplayer model of photon diffusion in skin . j . opt soc . am a 7 ( 11 ): 2142 - 2153 , 1990 (“ schmitt 1990 ”). mathematical methods for physicists , arfken & amp ; weber , 6th ed , elsevier academic press , 2005 . handbook of differential equations , daniel zwillinger , 3rd ed , elsevier academic press , 1998 , pp 157 , 276 . barnett , alex . a fast numerical method for time - resolved photon diffusion in general stratified turbid media . jr of computational physics 201 : 771 - 797 , 2004 . prahl , s . a ., “ light transport in tissue ,” ph . d . thesis , university of texas at austin , 1988 ( http :// omlc . ogi . edu /˜ prah1 / pubs / pdf / prah188 . pdf ). the boltzman transport equation or , in general terms , the modified helmholtz equation α is the “ attenuation coefficient ”, ( the reciprocal of the diffusion penetration depth ), where : ρ 2 is a point in x , y , z space , where : η is related to the led / detector apertures , or fields of view ( photo - emitters and photo - detectors such as leds and photodiodes are constructed with pre - set apertures or fields of view , but these apertures or fields of view can be adjusted ( made smaller ) using masks , as well known by those of ordinary skill in the art ). ψ is fluence , the number of photons / volume in x , y , z space the definition of other appropriate mathematical terms is found in other cited references and to some extent in the following mathematical “ closed - form ” solution of the inhomogeneous modified helmholtz equation above . the word “ inhomogeneous ” has a specific mathematical meaning to those skilled in the art . likewise , the word “ homogeneous ” in physiological terms has a clear meaning , as explained below . anatomically , human tissue is multi - component or heterogeneous . however , from the vantage point of the photons , the boundaries between tissue layers are ill defined . likewise , since “ the optical properties of whole tissue samples and tissue homogenates are similar . . . [ and since our ] source and detector apertures cover a large enough area of the skin surface . . . small inhomogeneities do not substantially affect reflectance measurements ” ( p 2144 , schmitt , 1990 ), likewise a homogeneous milieu is assumed herein . therefore , one can consider the fingertip ( foot pad , etc ) as being closer in optical properties to homogeneous rather than layered tissue , with xb being the major modifier , or prorator , of these optical parameters . nevertheless , both homogeneous and layered tissue determinations ( heterogeneous ) will be described in detail . schmitt 1990 , p 2147 , farrell , 1998 , p 1959 , and others have shown that the reflectance , r , is proportional to term masks the true optical coefficients and the subtleties of the nonlinear function of r versus radial r . this masking is especially onerous in the 0 to 5 mm region , where scattering is the dominant physical phenomenon . it will be seen below that when r is multiplied by r 2 ( and then the logarithm taken ), the actual s and xb functionality with severe curvatures are clearly unmasked allowing for the determination of the true optical values . multiplying by r 2 has also been used by others to “ enhance the visualization of the fit ”, farrell 1998 . this unmasking use of r 2 has an additional benefit of determining s , to be described later . a source ( or driving ) function , above described as po * fo , can be a simple point source , dirac delta , a uniform light source or even a gaussian ( finite - impulse ) source function . the source being considered first herein is a cylindrical source function , where fo is written in ρ where ρ is a point in the x , y , z space , the above fo can be written in cartesian coordinates for clarity now , but later it will be written in spherical coordinates when solving the mathematics . as will be appreciated by those of skill in the art , the type of light source ( for example , a narrow - beam laser , fiber optic light source , or a simple led ) will affect the physical source irradiation patterns . as an example , the function : if η = 0 , then fo is a point source . if 0 & lt ; η & lt ; 1 then fo is a cylindrical source if r 1 , and a gaussian source if r 2 . the particular led that is used in the preferred embodiment has a narrow beam width or photon irradiation pattern , and since the first photodiode detection occurs at 1 . 75 mm , the need for a cylindrical convolution is not utilized in the preferred embodiment ( hence , η = 0 ), but the complete method is presented so that other source profiles can be convoluted if needed . such profiles could be : a cylindrical source , or e − sz r ( r ), where r ( r )= u ( r )− u ( r − a ), a step function , or where led irradiation patterns can be μ can also be thought of as an “ extrapolated boundary ” or “ the depth below the surface from which the first scattered photon emanates . . . the incident photons are converted to scattered photons within a scattering length ”. schmitt , p . 1196 , 1991 . there is no reintroduction of photons once they have exited the finger ( photons are not counted twice ). but a combination of the robins boundary condition and the “ extrapolated ” boundary condition will be applied . specular reflection ( rs ) will not be considered but the mismatch of the indices of refraction will be discussed in detail . where vblood is the volume of blood , vtissue is the volume of tissue and vwater is the volume of water in the illuminated space ( finger , foot , etc ). an important reason for using an isobestic wavelength ( i . e ., 800 ( 780 to 815 ) nm or 420 - 450 nm , or 510 - 590 nm , or 1300 nm , etc ) is that the need to distinguish both the arterial and venous prorations of the blood is eliminated . otherwise , blood oxygen saturation values would be required to measure the venous and arterial blood prorations as well . however , at isobestic wavelengths the above equation becomes : there is the requirement to know xw , where other wavelengths , usually greater than 800 nm , have higher water absorption values than at 800 nm , like 1300 nm . ss and ks ( bloodless tissue scattering and absorption coefficients ) are considered constants for the human fingertip ( with some variations due to scleroderma , reynaud &# 39 ; s , other disease states and aging ). the definitions of s , ss , ks , and α are discussed herein , but are well known to those skilled in the art . the 0 to 5 mm region in radial r is dominated by s and in the 5 to 14 + mm region in radial r , a has much greater sensitivity than s ( see bays 1996 ). the boltzman transport equation simply states that : the photon flux , which is the rate of change of the intensity , is equal to the loss plus the gain of photons . the photon diffusion approximation equation , pdae , is an approximation to the boltzman transport equation , generally written as : the pdae retains the first ( dipole ) term of angular dependence ( of the boltzman transport equation ) and is a good approximation when k & lt ;& lt ; s , 1 / s & lt ;& lt ; radial r and other geometric boundary conditions are met . this partial differential equation ( pde ) is seen in other physical applications and specified mathematically as the inhomogeneous modified helmholtz equation . now by dividing the pdae by − d and including the source function , the pdae becomes : po contains the “− sign ” but when equation ( 1a ) is solved using the green &# 39 ; s function ( and identity ) there is a “− sign ” ( as seen in prahl , p 91 ) and as such , the “−” will be cancelled out by the following : the first term in equation ( 1b ) is what is solved , because the surface integrals will vanish since the dirichet and neumann boundary conditions are satisfied ( arfken , p 597 ). r , reflection , is defined as the number of photons re - emitted or reflected out of the tissue . mathematically this means that only the photon flux in the − z direction or the marshak condition is of interest . as such , the solution to the pdae can be written in terms of r and ψ and its z derivative evaluated at z = 0 , equations ( 2 ) and ( 3 ) below . when considering the robin boundary condition ( barnett , pp 771 - 779 , 2003 ), total radiance is given by the proration of the fluence and the flux and equation ( 2 ) becomes one of the best ways to extract the reflectance directly from the fluence ( barnett , pp . 771 - 779 , 2003 ), written as : this is also prahl &# 39 ; s diffuse radiance term derived over a hemispherical geometry ( prahl , pp 70 - 71 ). generally a1 and b1 account for the detector apertures , fields of view , or refractive index mismatches . or equation ( 2 ) can be written as , evaluating the flux , the z derivative , at z = 0 of equations ( 2 ) or ( 3 ), having a radial r greater than 1 / s away from the source origin and determining b1 or a1 above will give the reflectance at each detector , which lay on the x axis of the fingertip . it will be shown later that for the preferred embodiment , a1 is generally small and the flux term dominates . depending on source and detector apertures , but in the case of leds , a1 may be large and the fluence then modifies the measured reflectance substantially . this proration of a1 and b1 is determined empirically , generally using phantom , intralipid mixtures , to be explained below . now , since the xy plane ( or radial r ) contains the emitter and detectors ( along the x axis ) and even though the flux is in the − z direction ( into the xy plane ) the solution will involve the z dimension ( at z = 0 ). the z parameter will be carried in the mathematics to demonstrate the dipole effect and later the source function in z , if not a point source . in other words , as r → 0 the signal detected in the xy plane comes from a dipole vertically located at z =− zb below the tissue , in our case . some literature ( kienle ) cites − zb = 1 . 96 / s , the value for human data but using the photo - array of the present embodiment is − zb is 3 . 5 / s . (− zb is often referred to as an extrapolated boundary condition or constraint ). mathematically : where “ rd ” is defined as the internal diffuse reflection coefficient . this is a strong function of the indices of refraction at the boundaries . it is this “ rd ” parameter or the index of refraction ( which varies dramatically ), it will be shown , but which is crucial to determine the correct s values . it is also another means to estimate the layer thickness ( or tissue heterogeneity ) when layered tissue optical parameters are to be determined . to solve for , ψ , the fluence , or ∂ z ψ , the flux , and before evaluating ψ = ψ i it is prudent to first consider the homogeneous modified helmholtz equation : differential equations as above commonly have multiple solutions ( or superpositions ), a complementary , a particular and / or even a trivial solution , written below as : numerous authors have primarily focused upon the straightforward solution to this homogeneous equation ( 4 ), resulting in only the complementary solution : the reflectance can be evaluated in the xy plane with the detectors / emitter located on the x axis . assume the fluence / flux enters the detectors perpendicular to the xy plane , then y → 0 and x → r . hence , if the solution to equation ( 6 ) is approached using cartesian coordinates ( xyz ), the results are : ψhomocomplementary = a α √ { square root over (( z − μ ) 2 + r 2 )} + b − α √ { square root over (( z − μ ) 2 + r 2 )} eq . ( 7 ) where ( z − μ ) represents that dipole translation distance in the z space . or stated differently , it represents a dipole strength extrapolated in − z , see barnett , 2003 , kienle , 1996 or allen , 1991 . but , if the reflectance is desired at any point in the xy plane ( and since there is cylindrical symmetry of the source ) then the solutions can be found using i and k , the modified cylindrical bessel functions : notice in using the bessel functions that there is a summation of terms and coefficients ( a , b , c , e . . . ) which results in the general or complete solution . those coefficients are determined by the boundary conditions as r → 0 ( dψ / dr = po ) and r →∞ ( or r → d , the thickness of the tissue ), hence ψ = 0 , where all photons are absorbed beyond that boundary and also empirically due to detector and source fields of view . further , notice that equations ( 7 ), ( 8 ) or ( 9 ) are only a partial solution to the inhomogeneous pdae — prior authors have used only these solutions and have not obtained the appropriate optical values , for α and s . if the width of the “ cylindrical ” source is not ignored in favor of a point source or a narrow - normal incident dirac source — i . e ., using only the dirac as the source function in the inhomogeneous differential equation , then there is need for a green &# 39 ; s function approach . the green &# 39 ; s function is a weighting function ; hence the solution will be a weighted integral over the source term . the solutions to the above equations will , of necessity , be in three dimensions . a common method of solutions to differential equations will entail the so called “ separation of variable ” technique , that is : using that technique each component of the solution , ( ρ , θ , φ ), will give ψ i . a . 5 mm to 14 mm from the light source , the pdae is accurate and α is dominant . b . & lt ; 4 mm from the light source , the pdae is not completely defined where s is dominant , hence , the fokker - planck equation , defined below , may be used to aid in the solution of the transport equation , below 4 mm . c . & gt ; 14 mm from the source , electronic noise ( snr ), inhomogeneities ( bone , blood flow gradients ) and physical pressure , etc can occur . 3a — mathematics for determining the solution for the region & gt ; 5 mm and & lt ; 14 mm , alpha being more dominant in this region as seen in fig1 . therefore , the inhomogeneous modified helmholtz equation can now be solved using a complete finite - cylindrical source function . ∇ 2 ψ − α 2 ψ = po * fo inhomogeneous 2nd . order differential equation eq . ( 11 ) spherical coordinates are used because of the system geometry . it should be noted that in using the modified spherical bessel functions , only io and i1 , below , are integrated ( and convoluted ), not i2 and higher order bessels , and integration is performed over the volume element of the sphere with ∫ 4πr 2 r , where 4πr 2 r = dvol hence , the r 2 will cancel out the i1 , k1 denominators but not the higher i2 , k2 bessels . those higher order bessel functions and integrals will result in imaginary values and are not suitable for the closed form discussion . once the partial differential equation , pde , becomes inhomogeneous ( having a driving or source function ) more difficult mathematical procedures are utilized to determine the solution sets . one of the most commonly utilized techniques is the green &# 39 ; s function ( see arfken ). two examples are shown in equations ( 12 ) and ( 13 ). realizing the need to deal with the z dimension , equation ( 13 ) will be used , but solving with ( 13 ) gives a particular solution not a complementary solution , see pp 663 - 7 , arfken . the complete or general solution of a pde will be a superposition of all solutions . however , the complementary and particular solutions of the homogeneous and inhomogeneous equations noted above will not be superimposed because of the physical boundary conditions of the green &# 39 ; s function ( arfken , p 667 ). even though modified spherical bessel functions are used in the mathematics , the finger geometry itself appears hemispherical . equation ( 9 ) is used for reasons discussed below when solving the integral - differential equation , but the hemispherical part of that solution will generate the final closed form results . to use the green &# 39 ; s function solutions , the homogeneous equation is utilized ; hence , restating equation ( 9 ) and using appropriate boundary conditions , we obtain : ( the first term above could also be , io = sin h , if desired ). both a and b exist ; yet as r →∞ the a term will diverge , therefore a , itself , must equal 0 . yet , this is what creates the need for and allows the use of the green &# 39 ; s function solution with certain boundary conditions ( that is , if the actual beam width is greater than the spacing of the first few detectors ): using green &# 39 ; s function integral - differential equation — arfken & amp ; weber , pp . 663 - 7 with equation ( 14 ), we define : g1 and g2 will satisfy the homogeneous requirement of the self - adjoint operator ( p 663 , arfken ). and now for the inhomogeneous solution ( which includes the homogeneous operators , g1 and g2 ( arfken , pp 663 - 7 )), equation ( 13 ) becomes : where ypzandmu is defined as the particular solution , y , including “ z and μ ( mu ).” ypzandmu is obtained using the above green &# 39 ; s function solutions to the inhomogeneous 2nd order partial differential equation . ypzandmu + ypzandmu2 , it will be shown , are the dominant solutions of ψ . using green &# 39 ; s function integral - differential equation — pp 663 - 7 arfken , with equation ( 15 ) satisfying the homogeneous requirement of the self - adjoint operator , arfken p 663 , we determine ypzandmu as ( see the appendix for detailed mathematics ): equation ( 17 ) is only the first term ( io , ko ) of the complete expansion , but includes the convolution of the cylindrical source function , fo = − ηρ . where t is not time , but rather a point defined as 0 & lt ; t & lt ; ρ , or ρ ≦ t ≦∞. note the convolution is integrated or “ convoluted ” over “ multiple points ”, not a specific point or source diameter . ∫ 0 ∞ cos [ α ( z1 − z2 )] α gives the z component where pages 599 , 601 , 609 , 792 , 944 and 987 ( arfken ) give the fourier integral transforms with the ko bessel resulting in : equation 17a is the “ convolution ” of a green &# 39 ; s function solution with a cylindrical source function ( a function of η and r ) under the boundary conditions of the green &# 39 ; s function . now ypzandmu2 , the second term of the modified spherical bessel solution : equation ( 18 ) is the second term ( i1 , k1 ) of the complete integral expansion . ∫ 0 ∞ cos [ α ( z1 − z2 )] α gives the z component where arfken pp 599 , 601 , 609 , 792 , 944 and 987 give the fourier integral transforms with the k1 bessel resulting in : only the io , ko , i1 and k1 bessel functions are convoluted because if the cylindrical driving function is multiplied within the integral by higher order bessels , then a non - numeric or non - imaginary integration is not possible . but allowing fo to be a cylindrical driving function , which is more like the real world for certain fiber optical , led or ld arrangements , the other functions , g1 and g2 , in the integrand , when multiplied by fo , have to be integrable in order to obtain a “ closed - form ” solution , as seen above in equations ( 17 - 18 ). so the solution to equation ( 10 ) is a superposition of equations ( 17a ) and ( 18a ), or even one or the other by itself , defined by the physical parameters of the preferred embodiment , as : ( ψ i = ψ inhomo )= z ηhemicylsph + z ηhemicylsph i 1 k 1 , eq . ( 19 ) in the present mathematical discussion and physical embodiment thereof in the apparatus according to the invention , only the flux term , not the fluence , dominates the detectors ( a1 = 0 , equation ( 3 ) above ). as mentioned however , by changing the field of view of the led or detectors , the fluence term will contribute with 0 & lt ; a1 & lt ; 1 . that field of view can be altered by using “ flat ” surface mount leds or cylindrical optical fibers . therefore to determine the degree of proration of the a1 and b1 terms in equation ( 2 ) the following ratio is important : where r0 is a measured reference reflection , in the present embodiment , measured at 1 . 75 mm and ψ0 is the fluence at 1 . 75 mm . r are the measured values at the radial r of the array . ψ is the fluence , described in equation ( 15 ) as g2 or ψ in equation ( 19a ) can also be described , if a1 is very small , by the flux as the linearity or curvature of equation ( 19a ) versus r determines the magnitude of the proration factor a1 . the slope of log [ r / r0 ] is defined as alphard ( determined by curve fitting or simple radial derivative measurements ). likewise , this log [ r / r0 ] ratio with r0 chosen at about 4 to 7 mm will be virtually independent of s and be a function of k . ypzandmu + ypzandmu2 are the dominant terms (& gt ; 4 mm and & lt ; 14 mm ) of equation ( 1a ). see fig2 and 3 , which are graphs of data of two patients ( the small and large dots ) with equation ( 19 ) through those data points showing the fit of equation ( 19 ) to the data . drr is the well known time ( or xb ) derivative of the logarithm of the reflectance , because of the change in xb of the tissue as a result of pulsatile blood flow . more specifically and mathematically correct , using the chain rule , equation ( 20 ) is obtained : but this quantity must be multiplied by ∂ xb /∂ t . see fig3 with actual patient data . 3b — mathematics for determining the solution for the region & lt ; 5 mm where s has much greater optical sensitivity than α , but it must also be included . referring to fig1 , the dashed line gives the d ( log [ r ])/ ds , or sensitivity to s . will now include the 0 to 5 mm effects of s , α and k . this region & lt ; 5 mm is important for many reasons , but simply stated it is the region that determines the profile or pattern of the incident light within the tissue . mathematically , numerous approaches are employed to model how photons injected into tissue , even with laser - like narrow beams , will “ spread ” and ultimately “ blur ” or “ smear ” an image ( especially seen in optical tomography ). hence , authors have used the monte carlo simulation approach to define more accurately the 0 to 5 mm region . but , this numerical crunching is like polynomials being fit to the data and then empirically finding the coefficients . many authors have recognized the need to develop a compact simple mathematical form of the lengthy and time consuming monte carlo simulations . he developed a polynomial which described his point spread function , psf , allowing faster parameter determinations which helped describe this blurring function . others have used the fokker - planck equation ( a probability density pde , zwillinger , p 276 ) to describe this 0 to 5 mm region . but , this equation is merely a special case of the parabolic partial differential equations i , ppdei ( see zwillinger , p 157 ; and also , see farlow , pp 58 - 60 ). these types of pdes basically describe the same phenomenon : diffusion plus drift or diffusion plus convection or diffusion plus an image charge ( dipole ) or diffusion plus lateral heat loss . using ppdei , note the laplacian operator , − d ∇ 2 ψ which deals with the “ heat ” or diffusion - only component ( see arfken , p 614 , farlow , p 58 - 60 , and others ). recognizing that s is dominant and that the “ drift ” or “ convection ” or “ lateral heat loss ” ( k ) terms also contribute to the spreading or blurring , the fokker - plank or ppdei becomes : while the above is technically sound , barnett &# 39 ; s discussion of the dipole ( as in heat transfer , barnett p 11 , 2003 ) incorporates k , absorbance , very simply . allen &# 39 ; s discussion of the dipole effects are similarly straight - forward ( pp 1621 - 1628 , 1991 ). these solutions can also be given as a so - called “ ansatz product ”, arfken , p 611 or farlow &# 39 ; s , pp 58 - 60 , or zwillinger &# 39 ; s form ( p 157 ) and becomes : we see here the diffusion term , ( zηcylsphi1k1 ), and the lateral loss , e − bk , components . the term d3 in equation ( 22 ) can be determined empirically as ˜ b k , where now d3 = k , and b =− 3 . however , using allen &# 39 ; s approach that same lateral loss component can be written as , where empirically b ˜ 3 . “ b ” will change with photo - optic parameters such as fiber optic ( or led ) field of view , beam widths , detector apertures , etc . in other words , d3 , the “ lateral heat flow rate ” is the absorption of photons , a “ lateral photon flow rate ” or specifically a photon loss in the x , y dimensions . as mentioned , b k , captures this flux in x and y . the detectors / emitter array is along x . this is under the assumption that a = 0 or the system being flux dominated . term and then taking the logarithm , equation ( 23 ) becomes , the final solution with no convolution shown ( a point source function is described in equation ( 24 ), but see the appendix for solutions with source convolutions ): where a8 = 17 . 52 ( incident intensity ) with b = 1 and e = 0 as proration factors of the ko and k1 bessel functions in equation ( 9 ) and dependent on light source optics for this present embodiment . yet depending on those optics , the e value will also contribute and that e value can be determined empirically and with the boundary conditions , hence allowing the k1 bessel to be significant ( see equation ( 19 )). mathematically , however , nothing limits the above from higher order bessel functions . a8 in the present equation ( 24 ) is shown as a constant value ( 17 . 52 ). however , as seen in equations ( 2 ) and ( 3 ) the a1 ( or fluence ) term can also be included in the parameter , a8 . this fluence term has the form of equation ( 15 ), specified as g2 . note again that ypzandmu and / or ypzandmu2 are the dominant contribution to the complete solution ( see fig2 & amp ; 3 ). these graphs will elucidate that this 0 to 4 mm region is crucial in determining s ( likewise k has a strong effect 0 to 4 mm ). the complete solution equation ( 24 ) is graphed in the validation section , see fig5 - 11 . real data : equation ( 24 ) can be verified for fit and accuracy using various types of actual data : a well - known phantom material of 1 % intralipid and varying amounts of human blood , or non - pulsatile “ dc ” human fingertip data and even pulsatile “ ac ” fingertip data . the equation ( 24 ) fits the human and phantom data with minor adjustments to the phantom optical parameters , ks , ss , xs and xw , which are in keeping with other authors &# 39 ; ks , ss , xs and xw values . those coefficients are described herein . phantom mixtures of intralipid and whole blood was prepared and used to fill phantom fingers made from the fingers of 1 ″ diameter latex gloves . the mixtures had varying intralipid concentrations . fig5 shows the dc measurement of the varying intralipid concentrations ( the background ) using one wavelength at 805 nm . there is good fit of equation ( 24 ) to the data points . the r 2 unmasking accentuates the s effect ( 0 to 5 mm ) of those intralipid concentrations and the thin solid line shows the k effect . another intralipid experiment shows varying the xb , from 1 . 25 % xb to 9 . 5 % xb , with a constant hct = 0 . 50 in the 1 % intralipid mixture . results shown in fig6 indicate an excellent fit of the mathematics and the data points . yet another experiment confirming the accuracy of equation ( 24 ) is to match the exact relationship between alpha and xb ( see below for that function ). recall that each of the xb values is known because of the simple mixing of the appropriate aliquots of blood with intralipid . see fig6 a . this good data and mathematics fit indicates that equation ( 24 ) and the curve fitting algorithm ( to be discussed below ) return the appropriate alpha and xb relationship . fig7 shows alpha versus s . the mathematics predicts and shows that precise square root functional relationship between alpha and s . the mathematics in equation ( 24 ) and graphics again shows that k and s behave as the mathematics above predicts — now a linear function between k and s . the ratio of k to s cancels out any xb and leaves a function of hct ( see equation set ( 28a )-( 28j ) here below ). this is significant because numerous optical parameters and human physiology can change the xb ( perfusion ), like calluses , raising and lowering the hand , warm and cold hands , coughing , valsalva , etc . using only the dc ( non - pulsatile ), one wavelength , 805 nm method , the resulting hct graphic of fig9 indicates that the xb has been cancelled out and the true hct function is obtained . the xb change that occurred in this experiment was produced by simply raising and lowering the hand . note that hct versus time is quite “ flat ” or almost independent of xb at hct = 0 . 50 . but xb versus time shows a 200 % change . therefore from equation ( 24 ) k and s can be determined and by self - normalization ( using a single isobestic wavelength ) the cancellation of these very large xb changes is accomplished . it should be noted that in photometry mathematics , the hct is always multiplied by xb or hct * xb ( described in equations ( 28a )-( 28j ) below ). therefore what fig9 also shows and infers is that at a constant xb this apparatus and method can also accurately measure a 200 % change in hct . since this graph has 155 unique data points this is as if 155 patients , who had different hcts , were just run . to verify that above statement further , fifteen patients were tested demonstrating the xb cancellation and resulted in hct determinations of very good accuracy and correlation . it is also clear that ac or “ pulsatile ” one wavelength 805 nm data and information can also give important verification to equation ( 24 ). to obtain the drr , multiple data sets of the α and s derivatives of equation ( 24 ) was co - temporaneously done , using the equations ( 20 ) and ( 20a ), with the correlating results shown in fig1 . the reason the drr is also important for verification is because many possible mathematical functions could fit equation ( 24 ) the log r versus radial r data quite well . but , when the α and s derivatives are taken , those other functions break down showing severe inaccuracies compared to human data using this ac ( pulsatile ) method . hence , because of those inaccuracies , including all the xb derivatives of equation ( 24 ) will be shown , beginning with equation ( 20a ) again . kb and sb will be described below in equations ( 28a )- 28 ( j ) below . must be multiplied by ∂ xb /∂ t since a human pulse occurs over a time period . term because it is multiplied by k , which is usually very small , ie the assumption is that k & lt ;& lt ; s . however , the full derivatives in α and s are needed to provide the correct offset in drr at r = 0 . likewise , fig2 , 5 and 6 show the effect of unmasking the subtleties in curvature not easily seen while merely plotting the logarithm [ r ] versus radial r . even though r 2 unmasking is just a mathematical maneuver , it does allow better understanding of the various regions for spatial resolution of reflected light . to solve for α , s , using only one isobestic wavelength , dc measurements and equation ( 24 ) some known absorption , k , and reduced scattering , s , coefficients at 805 nm isobestic wavelength ( from schmitt , 1992 and steinke , 1987 ): sw = 0 at 805 nm , sw is the absorption coefficient of water ( which is = 0 ). all coefficients are in per mm values ; see equation set ( 28s )-( 28j ) below for their physical interactions . the radial “ r ” values are known from the linear array dimensions , spaced at 1 . 75 mm in the present embodiment . log [( i1 − n1 )* r1 2 * r1 ]: i1 , r1 , r1 and n1 are defined as follows : the 1 , 2 , 3 . . . 8 in each case refers to the first . . . through eighth detector ( photodiode ) position located 1 . 75 mm from the source 805 nm led and a 1 . 75 mm separation from the other photo - detector . hence , i1 is the measured intensity at position 1 , r1 is the radial distance at position 1 , at 1 . 75 mm , r1 is a programmable gain factor for amplifier 1 and n1 is an optical “ crosstalk ” measured value due to stray or specular light at position 1 . n is measured without any medium present , just in free air . a fiber optic bundle or a clear plastic disposable and their reflectivity can be cancelled knowing their n value also . these same definitions apply to each individual photodiode from position1 to position 8 . r ( of equation ( 24 )) is not to be confused with r1 . . . r8 ( programmable gain factors ). significant assumptions in equations ( 28a )- 28 ( j ): at 805 nm ks and xw are small and can be ignored . h above is hct . d — using computer - based programs such as mathematica 7 . 0 or computer code embedded in circuits such as those shown in fig1 a and 13 b ( more specifically , in the microprocessors of the circuits ), and since k is not directly measureable , solving for s and α , can be accomplished using curve fitting algorithms as described herein . there are two algorithms using a derivative approach : d ( log [ r * r 2 ])/ dr ( eliminating the 17 . 52 ( a8 term ) and all offsets ): 2 . a two stage algorithm with w ={ 1000000 } where alpha is determined by averaging the last 3 d ( log [ r * r 2 ])/ dr values . using the w values to weight each data point with a one or zero allows for determination of s . these two algorithms of the curve fitter can be used for measurements in conditions of a varying ss or heavy pigmentation , such as black skin . the preferred embodiment uses measurements which are performed on the fat pad of the finger tip , which avoids the melanin issues , however . calluses are likewise a concern because they increase the internal diffuse reflectance , “ rd ”, and decrease xb or ratio equation ( 28i ) cancels out this type of xb problem . the callus , or epithelial thickening , simply changes the xb of the homogeneous system , which is cancelled as described in equations ( 28a )- 28 ( j ). this is the case for most human fingertip conditions . however , many patients may have epithelial thicknesses which may cause a significant index of refraction mismatch . hence that additional “ rd ” term of equation ( 3b ) must be determined or cancelled . one method to eliminate that “ rd ” term is to determine the radial r where the maximum of the log [ r ] versus radial , r occurs . that point is virtually independent of the “ rd ” effect and serves as a good representation of s . another method for knowing or eliminating the “ rd ” term is determining the value of the offset of log [ r ] at radial r = 0 . that value shows a large dependence on the “ extrapolated boundary value , “− zb ” and hence can eliminate the “ rd ” effect . likewise , applying the robin boundary condition as in equation ( 19a ) will cancel the “ rd ” terms . still another method for eliminating “ rd ” effects is by choosing the r0 value in equation ( 19a ) in the 4 to 7 mm radial region . the alpha value , alphard , determined from ( 19a ) is compared to the alpha value determined by a curve fitter algorithm , alphacf , ( or a simple slope method , alphaavg ). then any finger to finger variations due to callus or patients is eliminated with the ( alphacf / alphard ) n ratio ( or the ( alphacf / alphaavg ) n ), where n is determined empirically . in particular , s , in the equations below , will be modified by those alpha ratios . the third algorithm is the preferred method which is herewith defined as “ full fit ” of equation ( 24 ). first , a straight line fit of the last 4 data point , r5 , 6 , 7 , 8 gives a good estimate of alpha . secondly , extending that line to r = 0 , an offset value ( ao ) of less than 17 . 52 ( io ) is found . thirdly , the algorithm increments up in 0 . 01 units from that “ ao ” value until a best s is fitted to the data points . finally , with the best “ incremented ao ” ( near to 17 . 52 ) and the best s and α values , those values are again fitted one last time to the data to find the optimum s and α . this “ incremented ao ” can be called “ rastering ” and is important because io , source intensity , itself can have drifting due to led ( light source ) heating . also this “ rastering eliminates black skin or other first layer ( epithelial ) variations or inhomogeneities . hence , “ rastering ” or “ incrementing ao ” deals with the large variations that can occur in each patient circumstance . another method for determining α and s relies on the slopes ( determined by radial derivatives ) but done by the straight line fit of the last 3 - 4 data points ( 8 to 14 mm ) for α and a straight line fit of the first 2 points ( 1 . 75 to 3 . 5 mm ) for s . this s , however has a strong functionality in “ rd ” and hence needs that “ rd ” effect cancelled . one of the advantages of using curve fitting algorithms is that when tissue inhomogeneities are present ( or layered tissues ) the fitter provides a filtering of the data , i . e ., giving smoothed or averaged data values . since alpha , α , is a crucial optical parameter , implementing equation ( 19a ) by curve fitting . depending on the magnitude of a1 ( 0 & lt ; a1 & lt ; 1 ), the resultant value of equation ( 19a ) will be an alphard with no “ rd ”, a8 , intensity variations or even skin color effects . likewise , since s is the other crucial parameter to determine for this self normalizing process , the following non curve fitting method is described . using the log [ r * r 2 ] data , the radial derivative is performed on those logarithm values ; the radial value when the derivative is 0 is inversely related to s , called srat0 . in other words , it is the radial value of where the maximum log [ r * r 2 ] occurs and srat0 is almost independent of “ rd ”. in summary , because there are three variables with one equation , the above methods , such as rastering a8 , ao , or differentiating the radial data points in r , can eliminate one or another of those variables individually allowing for the solution of α and s . e — solve for hct and xb with α and s known , the self - normalization methodology : knowing the values α and s , the following equations are used to solve for hct : this “ solve ” equation ( mathematica 7 . 0 ) essentially finds the roots of equation ( 29 ) and will return three possible hct values because of the third order polynomial nature of the “ solve ” equation above . nevertheless , the “ solve ” equation merely needs to be bracketed in the hct range because the only meaningful hct values would be in the following range of values : fig1 is a graph illustrating the relationship between hct and the measured values k and s according to equation ( 29 ). or the direct use of equation ( 29 ) as the polynomial itself is : where fh22 can equal the measured values of equations ( 31 ) and ( 32 ) below . it is also clear from the above equation set ( 28a )-( 28j ) that if ks is small and ss is a constant , then hct can also be determined using fig1 , equation ( 29a ) and equation ( 31 ): this is the completely dc or non - pulsatile solution of hct . if , on the other hand , k is determined from equation ( 19a ) with r0 in the 4 to 7 mm range and α as above , then s becomes likewise , if a change in xb occurs over time due to normal respirations ( over 1 - 5 second interval ), heartbeats ( within a 1 second interval ), coughing , valsalva maneuvers , etc , then measuring a peak to peak change in intensity results in : equation ( 32 ) is used with fig1 or the solve equation ( 29 ) or ( 29a ) to find hct as well . this describes the pulsatile embodiment of the method as well , as used in a fingertip pulse oximeter . as shown in fig1 a and 13 b , the computing mechanisms are applicable to a main frame , pc , smart phone device having the number crunching , memory and processing capabilities of the state of the art . with that computer capability the above determinations can be easily displayed , or transmitted , in real time and continuously if desired . while the preferred embodiment shown in fig1 a and 15 b show a linear sensor array of equally spaced photodiodes , likewise a circular sensor array or ccd sensor array each maintaining known photo - detector distances from the light source would also meet the requirements of this spatially resolved reflectance method . the requirements would include a multi - element , co - planar array of either photo - detectors or light sources such as leds , lds or fibers situated in a known spatial arrangement , again linear or circular as example . knowing the spacial arrangement , that is , the radial r separations ( r1 - 8 ) exactly and the r1 - 8 gain values exactly and the n1 - 8 values exactly , the correct s , k determinations can be made first . the photodiode array of the preferred embodiment consists of silicon photodiodes . however , when other analytes are also to be determined , ingaas photodiodes can be included , as shown in fig1 a and 15 b . while not shown in the figures , an “ on - board ” photodiode can directly compensate for led intensity variations can be included on the printed circuit board . a8 ( or the source intensity ), if not a function of the fluence itself , would be measured and known . calibration for the physical embodiments can be done using intralipid mixtures ( described above ) or with “ false fingers ” made of epoxy resins ( shorea hardness of 20 ) mixed with appropriate amounts of 1 micron glass beads and powdered ink dyes . fig1 shows one such finger arrangement in contact with the photo - array . solving for tissue water , hct - independent o2sat , glucose ( a1c ), other analytes , psychotropic drugs and chemotherapeutic agents , etc an 800 nm wavelength ( or other wavelengths described herein ) is chosen because it is isobestic for hemoglobin ( hgb ). thus , ( a ) no additional oxygen saturation measurement is required and ( b ) no requirement to distinguish two separate xbs : xb = xvenous + xarterial . since reduced and oxyhemoglobin have the same extinction coefficient at 800 nm , venous and arterial blood is seen as just one constituent — blood . other isobestic regions will likewise be important for the measurement of other constituents ; one such isobestic wavelength is at 1300 nm . but this region has significant water absorbance and will need to be properly cancelled or known exactly . an example of the xw effect is seen in the following equation : where xw is the fractional water volume per total tissue volume , and kw is the water absorbance at 1300 nm . these would need to be known in order to determine kother , if kother is desired . these water values will be critical because many of the drugs and analytes , etc will have absorbance peaks in a dominant water region . for this new wavelength , 1300 nm , a new ss would be determined , since ss is a function of wavelength : in a similar way the hct and xb are important for the determination of plasma - dissolved constituents . the hct value is needed to allow the computation of specific plasma values . an example from ( aa ) above where kb contains the xxx desired chemical dissolved in the plasma : kbxxx = 1 . 04 h +( 1 − h )( k plasma + kxxx ) eq . ( 33b ) kbxxx = 1 . 04 h +( 1 − h )( c pla * ε pla + cxxx * ε xxx + cyy * . . . ) ( 33c ) cpla is the plasma concentration and ε pla is the plasma extinction coefficient . the other constituents , xxx , are then added via the proration of their extinction value times their concentration . since the plasma extinction value is about the same value as the water value , the measurement of xw is accomplished with the 1300 nm , as follows : if hct and xb are found as above , then with sb and xb known we measure s 13 and the tissue water content becomes : it is also clear that if 2 wavelengths are used , 800 nm and 1300 nm , the major unknowns of xb , xw , ss and hct can be determined without a pulsatile blood flow using equation set ( 35a )-( 35d ): s 8 =( sb 8 − ss 8 ) xb + ss 8 ( 1 − xw ); eq . ( 35a ) s 13 =( sb 13 − ss 13 ) xb + ss 13 ( 1 − xw ); eq . ( 35b ) k 8 =( kb 8 − ks 8 ) xb + ks 8 ( 1 − xw ); eq . ( 35c ) k 13 =( kb 13 − ks 13 ) xb + ks 13 ( 1 − xw ); ( 35d ) equations ( 35a )-( 35 ( d ) are four equations with five unknowns but either ss8 or ss13 is a constant and the s8 , 13 and k8 , 13 can be measured now . the relevance of knowing the tissue water concentration cannot be over stated since patients requiring renal dialysis due to end stage renal disease retain toxic levels of water . the choice of other wavelengths coupled with xb and hct done at 805 nm will allow the calculation of other blood constituents . as an example , the ratio of 660 nm / 805 nm plus hct results in an hct - independent , cold hand insensitive , non - pulsatile o2sat value . hence , only 660 nm / 805 nm alpha ratio is measured , the other values are known . ac ( pulsatile ) measured 02sat is already determined directly ( by standard algorithms ) and displayed in this present embodiment since there is already a max and min set of logarithm { intensity } values determined for each pulse . using 1300 nm for water , 1900 nm , 950 nm , 1050 nm for glucose determination , and other specific spectral peaks or valleys for the drugs and chemotherapeutic agents of interest , those blood and plasma parameters can also be calculated . indeed , for some desired constituents knowing the ks and ss at those wavelengths may be required . while the present embodiment utilizes eight photodiodes equally spaced , it should be clear that with the final known coefficients , equation ( 24 ) would only require at minimum two measured points , one known spatial measurement in the 0 to 5 mm region and one in the 10 to 14 mm region . likewise , it is clear that a single led ( 800 nm ) and a single photodiode , which can be physically moved to known radial values , would satisfy the requirements of equation ( 24 ) also allowing for the hct determinations as above . it should also be clear that the equations mentioned also allow for the hct determination transmissively through the tissue knowing the tissue thicknesses ( d ) or distances from the emitter and each detector . since the relationship between hct and hgb is well known ( mchc , the mean cell hemoglobin concentration , is typically 0 . 33 ), the present invention anticipates the display of hgb concentrations as well . since s , k , and α are fundamental optical parameters measured by this methodology for medical diagnostics or monitoring , other areas of use of this technology are anticipated . for example , it may be used in measuring the fat content in milk , in real time , as a cow is being milked and even in refurbishing motor oils . the intralipid used in the present invention is a fat emulsion ; hence milk fat or oil concentrations are easy determined . indeed , any semi - liquid which is not a pure solution but having scattering elements is contemplated with this technique . even though the apparatus in accordance with the present invention will measure and monitor hct as one of the constituents , it is primarily intended as an xb monitor . in order to measure the hct noninvasively , it is necessary to measure the xb also . these two parameters , hct and xb , are interlocked or multiplied together as xb * hct . the xb parameter is not reported or measured anywhere , but xb is overwhelmingly important because without knowing the xb , it is not possible to know the amount of , for example , glucose within the blood , but only to know the amount of glucose in the entire finger . to doctors , it does not matter how much glucose is in the entire finger ; it only matter how much glucose is in the blood itself . so xb is overwhelmingly important because to know the value of any constituent of the blood it is necessary have to know where the constituent ( glucose or drug ) is . is the measurement done in the blood or in the tissue spaces ? to summarize , the purpose of the method in accordance with the invention is to perform a “ self normalization ” ( as described in the paragraphs under the headings “ relationship of alpha and s ” and “ relationship of k and s ”). once alpha and s are found ( using only one wavelength , hence the term “ self normalization ”), the ratio of k / s cancels out ( eliminates ) xb , leaving the desired hct . the steps for determining alpha , k and s are described in the paragraphs under the heading “ to solve for α , s , using only one isobestic wavelength , dc measurements and equation ( 24 ).” these steps employ computer - implemented algorithms that determine the best curve fit or slopes from which the alpha , k and s are found . section d under heading “ to solve for α , s , using only one isobestic wavelength , dc measurements and equation ( 24 )” explains that “ rd ” may have to be removed and how to do so with those alphacf / alphard ratios , etc . ; and also explains a computer - implemented “ rastering ” method for eliminating skin color and other io , ao , absolute intensity effects . section e under the heading “ to solve for α , s , using only one isobestic wavelength , dc measurements and equation ( 24 )” describes crucial computer - implemented manipulations necessary for the actual “ self normalization .” the first paragraph under the heading “ 5 — preferred apparatus embodiments ” explains that known spatial arrangement is crucial , because knowing the radial , r , separations ( r1 - 8 ) exactly and the r1 - 8 gain values exactly and the n1 - 8 values exactly , the correct s , k determinations can be made first . thus , first , alpha and s are determined by slope , or using any of three curve fitting algorithms discussed in section d under the heading “ to solve for α , s , using only one isobestic wavelength , dc measurements and equation ( 24 ).” once alpha and s are known , the next step is to find δk / δs using equation ( 29 ) or to find fh22 using equation ( 29a ). eq . 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