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IISIM 2.6.2; IIDT 1.1.5: Systolic Time Scaling for Waveform Plot Length
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#197

IIDT: Waveform Editor & Waveform Dictionary Builder
- Implemented SystoleLength in Editor, saving to .iiwf
- Carries through pipeline to Waveform.Dictionary.Plots.cs
IISIM: Scaling waveform plot length per SystoleLength
- Revised algorithm for Physiology.GetPulsatility_Seconds()
  - Based on 1/3 cardiac cycle for normocardia, 2 * QRS for brady/tachy
    - Clamped if QRS value is unset, prevents division by zero or unintended behavior
- Needed to adjust resolution coefficient implemented in 05889b3
  - Adjusted from 1-100 x scaling to 1-10
    - Poor iso/baseline resolution was cropping into plotted waveform concatenation
      - Visualized as early part of waveform being chopped off
      - Fixed by reducing hefty de-resolution scaling
  - Still fixes the problems from #208
IISIM: QRS/QTc defaults adjusted per #188
- Fine-tuned SVT for correct default morphology
- Ensured defaults exist for all rhythms that have ventricular activity (e.g. idioventricular)
IISIM: Intra-abdominal pressure waveforms tied to respiratory cycle
- Inflects on inspiration, deflects on expiration
IISIM: Intracranial pressure waveform dampened amplitude
- Draws best when not tied to systole
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@tanjera
tanjera committed Jun 3, 2024
1 parent 05889b3 commit 66511cb
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Showing 32 changed files with 474 additions and 336 deletions.
2 changes: 1 addition & 1 deletion II Development Tools/Versioning.txt
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Original file line number Diff line number Diff line change
@@ -1,6 +1,6 @@
Current Version:

1.1.4
1.1.5

Versioning for this solution is kind of silly, but it will help me keep track
of future changes and give an indexing system...
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3 changes: 3 additions & 0 deletions II Development Tools/Waveform Dictionary Builder/Dictionary_Builder.xaml.cs
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Original file line number Diff line number Diff line change
Expand Up @@ -85,6 +85,7 @@ private void ProcessFolder (object sender, DoWorkEventArgs e) {
string WaveName = "";
int DrawResolution = 0;
int IndexOffset = 0;
int SystoleLength = 0;
List<Vertex> Vertices = new List<Vertex> ();

/* Load individual .iiwf file */
Expand All @@ -106,6 +107,7 @@ private void ProcessFolder (object sender, DoWorkEventArgs e) {
case "WaveName": WaveName = pValue; break;
case "DrawResolution": DrawResolution = int.Parse (pValue); break;
case "IndexOffset": IndexOffset = int.Parse (pValue); break;
case "SystoleLength": SystoleLength = int.Parse (pValue); break;

case "Vertices":
Vertices = new List<Vertex> ();
Expand Down Expand Up @@ -135,6 +137,7 @@ private void ProcessFolder (object sender, DoWorkEventArgs e) {
dictOut.AppendLine (String.Format ("\t\tpublic static Plot {0} = new Plot () {{", WaveName));
dictOut.AppendLine (String.Format ("\t\t\tDrawResolution = {0},", DrawResolution));
dictOut.AppendLine (String.Format ("\t\t\tIndexOffset = {0},", IndexOffset));
dictOut.AppendLine (String.Format ("\t\t\tSystoleLength = {0},", SystoleLength));
dictOut.AppendLine (String.Format ("\t\t\tVertices = new double[] {{", IndexOffset));

for (int v = 0; v < Vertices.Count; v++) {
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32 changes: 25 additions & 7 deletions II Development Tools/Waveform Editor/Editor.xaml
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Expand Up @@ -112,6 +112,7 @@
<ColumnDefinition Width="*" />
<ColumnDefinition Width="*" />
<ColumnDefinition Width="*" />
<ColumnDefinition Width="*" />
</Grid.ColumnDefinitions>

<Grid Grid.Row="0" Grid.Column="0">
Expand All @@ -127,22 +128,39 @@
HorizontalAlignment="Stretch" VerticalContentAlignment="Center" />
</Grid>

<StackPanel Orientation="Horizontal" HorizontalAlignment="Center"
Grid.Row="0" Grid.Column="1">
<StackPanel Orientation="Horizontal"
HorizontalAlignment="Center"
Grid.Row="0"
Grid.Column="1">
<Label Content="Draw Length: " />
<xctk:DecimalUpDown Name="dblDrawLength" Value="1" Minimum="0.1" />
<Label Content=" seconds" />
<xctk:IntegerUpDown Name="intDrawLength"
Value="1000"
Minimum="100" />
<Label Content=" msec" />
</StackPanel>

<StackPanel Orientation="Horizontal"
HorizontalAlignment="Center"
Grid.Row="0"
Grid.Column="2">
<Label Content="Systole Length: " />
<xctk:IntegerUpDown Name="intSystoleLength"
Value="300"
Minimum="0"
ValueChanged="intSystoleLength_ValueChanged" />
<Label Content=" msec" />

</StackPanel>

<StackPanel Orientation="Horizontal" HorizontalAlignment="Center"
Grid.Row="0" Grid.Column="2">
Grid.Row="0" Grid.Column="3">
<Label Content="Draw Resolution (X Axis): " />
<xctk:IntegerUpDown Name="intDrawResolution" Value="10" />
<Label Content=" milliseconds per point" />
<Label Content=" msec per point" />
</StackPanel>

<StackPanel Orientation="Horizontal" HorizontalAlignment="Center"
Grid.Row="0" Grid.Column="3">
Grid.Row="0" Grid.Column="4">
<Label Content="Index (X Axis) Offset: " />
<xctk:IntegerUpDown Name="intIndexOffset" Value="0" Minimum="0" />
<Label Content=" vertices" />
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43 changes: 27 additions & 16 deletions II Development Tools/Waveform Editor/Editor.xaml.cs
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Original file line number Diff line number Diff line change
Expand Up @@ -24,8 +24,9 @@ public partial class Editor : Window {
private List<Vertex> Vertices;

/* Waveform settings */
private int DrawResolution;
private double DrawLength;
private int DrawResolution; // In milliseconds
private int DrawLength; // In milliseconds
private int SystoleLength; // In milliseconds
private int IndexOffset;
private string WaveName;

Expand Down Expand Up @@ -76,14 +77,17 @@ private void NewFile () {
DrawResolution = 10;
intDrawResolution.Value = 10;

DrawLength = 1;
dblDrawLength.Value = 1;
DrawLength = 1000;
intDrawLength.Value = 1000;

SystoleLength = 330;
intSystoleLength.Value = 330;

IndexOffset = 0;
intIndexOffset.Value = 0;

Vertices = new List<Vertex> ();
for (int i = 0; i < ((DrawLength * 1000) / DrawResolution); i++)
for (int i = 0; i < (DrawLength / DrawResolution); i++)
Vertices.Add (new Vertex () { Y = 0 });

UpdateWave ();
Expand Down Expand Up @@ -111,6 +115,7 @@ private void SaveFile () {
sb.AppendLine (String.Format ("{0}:{1}", "WaveName", WaveName));
sb.AppendLine (String.Format ("{0}:{1}", "DrawResolution", DrawResolution));
sb.AppendLine (String.Format ("{0}:{1}", "IndexOffset", IndexOffset));
sb.AppendLine (String.Format ("{0}:{1}", "SystoleLength", SystoleLength));

StringBuilder sbVert = new StringBuilder ();
for (int i = 0; i < Vertices.Count; i++)
Expand Down Expand Up @@ -171,6 +176,7 @@ private void LoadFile () {
case "WaveName": WaveName = pValue; break;
case "DrawResolution": DrawResolution = int.Parse (pValue); break;
case "IndexOffset": IndexOffset = int.Parse (pValue); break;
case "SystoleLength": SystoleLength = int.Parse (pValue); break;

case "Vertices":
Vertices = new List<Vertex> ();
Expand Down Expand Up @@ -198,7 +204,7 @@ private void LoadFile () {
}
}
}
DrawLength = (Vertices.Count * (double)DrawResolution) / 1000;
DrawLength = Vertices.Count * DrawResolution;
FilePath = dlgLoad.FileName;
} catch {
LoadFail ();
Expand Down Expand Up @@ -253,7 +259,8 @@ private void RemoveBackground () {
private void UpdateUI () {
txtWaveName.Text = WaveName;
intDrawResolution.Value = DrawResolution;
dblDrawLength.Value = Math.Round ((decimal)DrawLength, 1);
intDrawLength.Value = DrawLength;
intSystoleLength.Value = SystoleLength;
intIndexOffset.Value = IndexOffset;
}

Expand All @@ -273,7 +280,7 @@ private void UpdateWave () {

private void CalculateDrawOffsets () {
/* +2 accounts for beginning and end margin */
drawXMultiplier = cnvDrawing.ActualWidth / (((DrawLength * 1000) / DrawResolution) + 2);
drawXMultiplier = cnvDrawing.ActualWidth / ((DrawLength / DrawResolution) + 2);
drawYMultiplier = -cnvDrawing.ActualHeight / 2;

drawXOffset = (int)drawXMultiplier;
Expand Down Expand Up @@ -366,8 +373,8 @@ private void TrimWaveStart () {
IndexOffset -= removed;
intIndexOffset.Value = IndexOffset;

DrawLength = ((double)Vertices.Count * (double)DrawResolution) / 1000;
dblDrawLength.Value = (decimal)DrawLength;
DrawLength = Vertices.Count * DrawResolution;
intDrawLength.Value = DrawLength;

UpdateWave ();
}
Expand All @@ -381,8 +388,8 @@ private void TrimWaveEnd () {
}
}

DrawLength = ((double)Vertices.Count * (double)DrawResolution) / 1000;
dblDrawLength.Value = (decimal)DrawLength;
DrawLength = Vertices.Count * DrawResolution;
intDrawLength.Value = DrawLength;
UpdateWave ();
}

Expand All @@ -393,8 +400,8 @@ private void TrimWaveOffset () {
}

intIndexOffset.Value = IndexOffset;
DrawLength = ((double)Vertices.Count * (double)DrawResolution) / 1000;
dblDrawLength.Value = (decimal)DrawLength;
DrawLength = Vertices.Count * DrawResolution;
intDrawLength.Value = DrawLength;
UpdateWave ();
}

Expand Down Expand Up @@ -542,11 +549,11 @@ private void btnApplyResolutions_Click (object sender, RoutedEventArgs e) {
txtWaveName.Text = txtWaveName.Text.Trim ().Replace (' ', '_');
WaveName = txtWaveName.Text;
DrawResolution = intDrawResolution.Value ?? 10;
DrawLength = (double)(dblDrawLength.Value ?? 1);
DrawLength = intDrawLength.Value ?? 1000;
IndexOffset = intIndexOffset.Value ?? 0;

Vertices = new List<Vertex> ();
for (int i = 0; i < ((DrawLength * 1000) / DrawResolution); i++)
for (int i = 0; i < (DrawLength / DrawResolution); i++)
Vertices.Add (new Vertex () { Y = 0 });

UpdateWave ();
Expand All @@ -558,6 +565,10 @@ private void menuFilterNormalize_Click (object sender, RoutedEventArgs e)
private void menuFilterNormalizePositive_Click (object sender, RoutedEventArgs e)
=> Filter_Normalize (0, 1);

private void intSystoleLength_ValueChanged (object sender, RoutedPropertyChangedEventArgs<object> e) {
SystoleLength = intSystoleLength.Value ?? 330;
}

private void cnvDrawing_KeyDown (object sender, KeyEventArgs e) {
if (Keyboard.IsKeyDown (Key.LeftCtrl) || Keyboard.IsKeyDown (Key.RightCtrl))
return; // Prevent keyboard shortcuts from being "handled" and not actually running!
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31 changes: 26 additions & 5 deletions II Library/Classes/Physiology.cs
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Original file line number Diff line number Diff line change
Expand Up @@ -42,7 +42,7 @@ public class Physiology {
Electrical_Alternans = false;

public Cardiac_Axes Cardiac_Axis = new ();
public double QRS_Interval, QTc_Interval;
public double QRS_Interval, QTc_Interval; // In seconds (e.g. 0.1)
public double []? ST_Elevation, T_Elevation;

/* Obstetric profile */
Expand Down Expand Up @@ -401,12 +401,33 @@ public Vital_Signs GetLastVS (PhysiologyEventTypes pe, int amountEvents = 1) {
public double GetRRInterval_Inspiratory { get { return (GetRRInterval / (RR_IE_I + RR_IE_E)) * RR_IE_I; } }
public double GetRRInterval_Expiratory { get { return (GetRRInterval / (RR_IE_I + RR_IE_E)) * RR_IE_E; } }

// A functional length in seconds of pulsatile rhythms; based on set heart rate (not actual!)
// for consistency in irregular rhythms
public double GetPulsatility_Seconds { get { return CalculateHRInterval (VS_Settings.HR) * 0.9d; } }
/* A functional length in seconds of pulsatile rhythms:
- Normocardia (60-100): 1/3 of cardiac cycle (RR interval) is systole; 0.4 bridges better
- Bradycardia (<60): RR interval is elongated and would generate stretched waveforms if used
... approximate with 3.3 * QRS interval (bridges @ 60 and holds consistent downward)
- Tachycardia: (>100): RR interval is short and would cause overdrawing abnormally narrowed waveforms
... approximate with 2.7 * QRS interval (bridges @ 100 and mimics increased ino/dromotropy
... Goal coefficient should have allow for normal diastolic times @ 100 but have drastically
decreased distolic times > 180-200 to mimic this cause of poor cardiac output
*/
public double GetSystole_Seconds {
get {
if (VS_Settings.HR < 60) { // Brady
return Math.Clamp (3.3 * QRS_Interval, 0.1, 1); // Clamp to prevent GIGO
} else if (VS_Settings.HR > 100) { // Tachy
return Math.Clamp (2.7 * QRS_Interval, 0.1, 1); // Clamp to prevent GIGO
} else { // Normocardia
return CalculateHRInterval (VS_Settings.HR) * 0.4d; // Bridges w/ brady<->tachy well
}
}
}

// Using Fridericia Formula for QT <-> QTc calculation
public double GetQTInterval { get { return System.Math.Pow ((60d / System.Math.Max (1, VS_Actual.HR)), (1 / 3)) * QTc_Interval; } }
public double GetQTInterval {
get {
return System.Math.Pow ((60d / System.Math.Max (1, VS_Actual.HR)), (1 / 3)) * QTc_Interval;
}
}

public double GetSTInterval { get { return GetQTInterval - QRS_Interval; } }
public double GetSTSegment { get { return GetSTInterval * (1d / 3d); } }
Expand Down
26 changes: 16 additions & 10 deletions II Library/Classes/Rhythm.Strip.cs
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Original file line number Diff line number Diff line change
Expand Up @@ -622,22 +622,24 @@ public void Add_Beat__Cardiac_Baseline (Physiology? p) {
} else if (CanScale) {
double fill = (Length * forwardBuffer) - Last (Points).X;

// Interpolate HR Interval (.75 - 5 seconds) to a resolution coefficient of 1 - 100
// w/ default resolution of 10ms: @ HR 60 bpm, resolve @ 10ms, @ ~12 bpm, resolve @ 1000ms
// Interpolate HR Interval (.75 - 5 seconds) to a resolution coefficient of 1 - 10
// w/ default resolution of 10ms: @ HR 60 bpm, resolve @ 10ms, @ ~12 bpm, resolve @ 100ms
// Note: high resolution times (e.g. 100ms) cuts into drawing of following concatenation!
double length = fill > p.GetHRInterval ? fill : p.GetHRInterval;
double ilerpHRi = Math.Clamp(Math.InverseLerp (.75, 5, length), 0, 1);
double scaleRes = Math.Lerp(1, 100, ilerpHRi);
double scaleRes = Math.Lerp(1, 10, ilerpHRi);

Concatenate (Scale (p, Draw.Flat_Line (length, 0d, scaleRes)));
} else {
/* Fill waveform through to future buffer with flatline */
double fill = (Length * forwardBuffer) - Last (Points).X;

// Interpolate HR Interval (.75 - 5 seconds) to a resolution coefficient of 1 - 100
// Interpolate HR Interval (.75 - 5 seconds) to a resolution coefficient of 1 - 10
// w/ default resolution of 10ms: @ HR 60 bpm, resolve @ 10ms, @ ~12 bpm, resolve @ 100ms
// Note: high resolution times (e.g. 100ms) cuts into drawing of following concatenation!
double length = fill > p.GetHRInterval ? fill : p.GetHRInterval;
double ilerpHRi = Math.Clamp(Math.InverseLerp (.75, 5, length), 0, 1);
double scaleRes = Math.Lerp(1, 100, ilerpHRi);
double scaleRes = Math.Lerp(1, 10, ilerpHRi);

Concatenate (Draw.Flat_Line (length, 0d, scaleRes));
}
Expand Down Expand Up @@ -705,11 +707,7 @@ public void Add_Beat__Cardiac_Ventricular_Mechanical (Physiology? p) {
break;

case Lead.Values.ICP:
ReplaceAtOver (Draw.ICP_Rhythm (p, 1d));
break;

case Lead.Values.IAP:
ReplaceAtOver (Draw.IAP_Rhythm (p, 1d));
ReplaceAtOver (Draw.ICP_Rhythm (p, .3d));
break;
}

Expand Down Expand Up @@ -794,6 +792,10 @@ public void Add_Breath__Respiratory_Inspiration (Physiology? p) {
default: return;
case Lead.Values.RR: Replace (Draw.RR_Rhythm (p, true, Resolution_Respiratory)); break;
case Lead.Values.ETCO2: break; // End-tidal waveform is only present on expiration!! Is flatline on inspiration.

case Lead.Values.IAP:
ReplaceAtOver (Draw.IAP_Rhythm (true, p, 1d));
break;
}

SortPoints ();
Expand All @@ -807,6 +809,10 @@ public void Add_Breath__Respiratory_Expiration (Physiology? p) {
default: break;
case Lead.Values.RR: Replace (Draw.RR_Rhythm (p, false, Resolution_Respiratory)); break;
case Lead.Values.ETCO2: Replace (Draw.ETCO2_Rhythm (p)); break;

case Lead.Values.IAP:
Replace (Draw.IAP_Rhythm (false, p, -1d));
break;
}

SortPoints ();
Expand Down
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