Mechanical ventilation is vital for the treatment of patients in respiratory intensive care and can be life saving. However, the risks of regional pressure gradients and over-distension must be balanced with the need to maintain function. For these reasons mechanical ventilation can benefit from the regional information provided by bedside imaging such as electrical impedance tomography (EIT). In this thesis we develop and test methods to retrieve clinically meaningful measures of lung function from EIT and examine the feasibility of closing the feedback loop to enable EIT-guided control of mechanical ventilation. Working towards this goal we develop a reconstruction algorithm capable of providing fast absolute values of conductivity from EIT measurements. We couple the resulting conductivity time series to a compartmental ordinary differential equation (ODE) model of lung function in order to recover regional parameters of elastance and airway resistance. We then demonstrate how these parameters may be used to generate optimised pressure controls for mechanical ventilation that expose the lungs to minimal gradients of pressure and are stable with respect to EIT measurement errors. The EIT reconstruction algorithm we develop is capable of producing low dimensional absolute values of conductivity in real time after a limited additional setup time. We show that this algorithm retains the ability to give fast feedback on regional lung changes. We also describe methods of improving computational efficiency for general Gauss-Newton type EIT algorithms. In order to couple reconstructed conductivity time series to our ODE model we describe and test the recovery of regional ventilation distributions through a process of regularised differentiation. We prove that the parameters of our ODE model are recoverable from these ventilation distributions apart from the degenerate case where all compartments have the same parameters. We then test this recovery process under varying levels of simulated EIT measurement and modelling errors. Finally we examine the ODE lung model using control theory. We prove that the ODE model is controllable for a wide range of parameter values and link controllability to observable ventilation patterns in the lungs. We demonstrate the generation and optimisation of pressure controls with minimal time gradients and provide a bound on the resulting magnitudes of these pressures. We then test the control generation process using ODE parameter values recovered through EIT simulations at varying levels of measurement noise. Through this work we have demonstrated that EIT reconstructions can be of benefit to the control of mechanical ventilation.

Medical simulation has facilitated the understanding of complex biological phenomenon through its inherent explanatory power. It is a critical component for planning clinical interventions and analyzing its effect on a human subject. The success of medical simulation is evidenced by the fact that over one third of all medical schools in the United States augment their teaching curricula using patient simulators. Medical simulators present combat medics and emergency providers with video-based descriptions of patient symptoms along with step-by-step instructions on clinical procedures that alleviate the patient's condition. Recent advances in clinical imaging technology have led to an effective medical visualization by coupling medical simulations with patient-specific anatomical models and their physically and physiologically realistic organ deformation. 3D physically-based deformable lung models obtained from a human subject are tools for representing regional lung structure and function analysis. Static imaging techniques such as Magnetic Resonance Imaging (MRI), Chest x-rays, and Computed Tomography (CT) are conventionally used to estimate the extent of pulmonary disease and to establish available courses for clinical intervention. The predictive accuracy and evaluative strength of the static imaging techniques may be augmented by improved computer technologies and graphical rendering techniques that can transform these static images into dynamic representations of subject specific organ deformations. By creating physically based 3D simulation and visualization, 3D deformable models obtained from subject-specific lung images will better represent lung structure and function. Variations in overall lung deformations may indicate tissue pathologies, thus 3D visualization of functioning lungs may also provide a visual tool to current diagnostic methods. The feasibility of medical visualization using static 3D lungs as an effective tool for endotracheal intubation was previously shown using Augmented Reality (AR) based techniques in one of the several research efforts at the Optical Diagnostics and Applications Laboratory (ODALAB). This research effort also shed light on the potential usage of coupling such medical visualization with dynamic 3D lungs. The purpose of this dissertation is to develop 3D deformable lung models, which are developed from subject-specific high resolution CT data and can be visualized using the AR based environment. A review of the literature illustrates that the techniques for modeling real-time 3D lung dynamics can be roughly grouped into two categories: Geometrically-based and Physically-based. Additional classifications would include considering a 3D lung model as either a volumetric or surface model, modeling the lungs as either a single-compartment or a multi-compartment, modeling either the air-blood interaction or the air-blood-tissue interaction, and considering either a normal or pathophysical behavior of lungs. Validating the simulated lung dynamics is a complex problem and has been previously approached by tracking a set of landmarks on the CT images. An area that needs to be explored is the relationship between the choice of the deformation method for the 3D lung dynamics and its visualization framework. Constraints on the choice of the deformation method and the 3D model resolution arise from the visualization framework. Such constraints of our interest are the real-time requirement and the level of interaction required with the 3D lung models. The work presented here discusses a framework that facilitates a physics-based and physiology-based deformation of a single-compartment surface lung model that maintains the frame-rate requirements of the visualization system. The framework presented here is part of several research efforts at ODALab for developing an AR based medical visualization framework. The framework consists of 3 components, (i) modeling the Pressure-Volume (PV) relation, (ii) modeling the lung deformation using a Green's function based deformation operator, and (iii) optimizing the deformation using state-of-art Graphics Processing Units (GPU). The validation of the results obtained in the first two modeling steps is also discussed for normal human subjects. Disease states such as Pneumothorax and lung tumors are modeled using the proposed deformation method. Additionally, a method to synchronize the instantiations of the deformation across a network is also discussed.