fig3 is a functional block diagram showing the main components of a body sound analyzer 10 in accordance with the present invention . body sounds which may be analyzed by the analyzer 10 include heart sounds , peripheral vessel sounds , and breath sounds . depending upon which sounds are to be analyzed , some of the elements of analyzer 10 may be unnecessary . for example , when heart sounds or peripheral vessel sounds are being analyzed , the sounds , ecg , and respiration are detected simultaneously and analyzed as a group , because signal processor and analyzer 30 will sort the sounds according to respiratory phase and gate the sounds using the qrs complex ( or some other aspect ) of the ecg . when analyzing breath sounds , on the other hand , only the sound detector 12 and respiration detector 16 are used . generally , sound detector 12 is a conventional microphone assisted stethoscope having sound shielding 20 . conventional filtering may be accomplished by filter 18 , and the output signal is provided to analog to digital converter ( a / d converter ) 28 . ecg detector 14 is conventional . ecg detector 14 provides electrical heart signals to a / d converter 28 . respiration detector 16 is conventional and provides respiration data to a / d converter 28 . a / d converter 28 converts the analog body sounds , ecg and respiration signals into digital signals 29 for processing by signal processor and analyzer 30 . signal processor and analyzer 30 could be a computer or a microprocessor of various types . one convenient configuration is to have processor 30 be part of a laptop computer with display 32 being the monitor of the laptop and terminal 34 being the keyboard and monitor of the laptop as well . another configuration which may be implemented is to use ir or rf transmission from the isolation amplifiers to a desk or laptop computer at some distance for processing and display . the functions performed by signal processor and analyzer 30 are shown in detail in fig4 - 7 . visual data and text provided by signal processor and analyzer 30 are displayed on display 32 . examples of the displays generated by processor 30 are shown in fig8 a - 8e . the physician or other care giver using body sound analyzer 10 controls the signal processor and analyzer 30 via terminal 34 . fig4 is a flow diagram showing the basic processes accomplished by a / d converter 28 and signal processor and analyzer 30 of fig3 . a / d converter 28 digitizes the body sound data , which consists of a predefined number of cycles , comprising heart beats , breaths , vessel sounds , or other cyclical body sounds in step 100 . processor and analyzer 30 converts each cycle to the frequency domain in step 102 , for example by implementing a fast fourier transform ( fft ). alternatively , a wavelet transform or any other time to frequency transformation might be employed . in step 104 , a magnitude calculation or power calculation is performed on each frequency transformed cycle , to &# 34 ; phase fix &# 34 ; the cycles , or remove small differences in timing between the different cycles . the term &# 34 ; phase fix &# 34 ; is used herein to describe the process of adjusting for differences in the phase of frequency transformed sounds brought out by small timing differences , by using mathematical manipulations which make all signals positive within a given time window ( e . g . magnitude or power calculation ). in step 106 , processor and analyzer 30 signal averages the frequency transformed , phase fixed cycles . finally , in step 108 , the signal averaged data is displayed for an operator . steps 102 through 106 would always be performed . step 100 might be skipped if the operator were analyzing previously stored digital data . step 108 might be skipped if the operator were storing the signal averaged data for future analysis . fig4 is a very general , high level flow diagram describing the operation of body sound analyzer 10 for analyzing a variety of body sounds . fig5 - 7 are more detailed flow diagrams showing preferred operation of the signal processor and analyzer for specific body sounds . fig5 is a flow diagram showing the preferred process accomplished by signal processor and analyzer 30 of fig3 when analyzing heart beat sounds . processor and analyzer 30 begins in step 200 by displaying the raw heart sounds data received from a / d converter 28 in amplitude versus time format on display 32 via signal 31 . when the operator is content with the displayed signal , the operator signals processor 30 via signal 33 from terminal 34 to begin storing data 29 . the operator may specify the number of beats to be stored , the number of frames per second to store and the place of detection and maneuver , or these may be predetermined parameters stored within processor 30 . processor 30 stores the next specified number of beats by counting the qrs complex signals on the ecg signal in step 202 . processor 30 sorts the heart beat sounds into two sets , according to respiratory phase , in step 204 . next , in step 206 , processor 30 gates the stored heart sounds using the qrs component , so all of the heart sounds are roughly synchronized . in step 208 , the heart beat sounds are individually frequency transformed and phase fixed , for example by performing a magnitude fft calculation . taking the magnitude fft of each heart sound prevents differences in timing between successive heart sounds from causing data loss in the signal averaging step . step 210 accomplishes the signal averaging of the fft signals . all of the inspiration beats are averaged separately from all of the expiration beats . signal averaging generally improves signal to noise ratio as square root of n , where n is the number of acquisitions ( heart beat sounds stored ). the improvement in signal to noise ratio in the present invention will approach this level , but will not quite reach it because part of the improvement in the conventional scheme is due to cancellation of positive and negative noise . the improvement is sufficient so that the acquisition does not need to occur in ideal conditions in a sound proofed room , but can be accomplished in normal doctor &# 39 ; s office or hospital settings having a significant amount of background noise . the two averaged sets are displayed in step 212 . signal processor and analyzer 30 may suggest that the operator perform other maneuvers to collect more data in step 214 . if this occurs , process returns to step 200 to collect and process a second set of heart sound data . in any case , once all of the data is collected , it is compared to historical patient data in step 216 . in step 218 , processor 30 suggests a diagnosis . fig9 shows examples of how processor 30 can accomplish the steps of suggesting maneuvers and diagnosis . fig6 is a flow diagram showing the process accomplished by signal processor and analyzer 30 , when analyzing peripheral vessel sounds . processor and analyzer 30 begins in step 300 by displaying the raw peripheral vessel sounds data received from a / d converter 28 in amplitude versus time format on display 32 via signal 31 . when the operator is content with the displayed signal , the operator signals processor 30 via signal 33 from terminal 34 to begin storing data 29 . the operator may specify the number of beats to be stored , the number of frames per second to be stored and the vessel location , or these may be predetermined parameters stored within processor 30 . processor 30 stores the next specified number of sounds by counting the qrs complex signals on the ecg signal in step 302 . processor 30 sorts the vessel sounds into two sets , according to respiratory phase , in step 304 . next , in step 306 , processor 30 gates the stored heart sounds using the qrs component . in step 308 , the heart beat sounds are individually frequency transformed and phase fixed , for example by performing a magnitude fft calculation . step 310 accomplishes the signal averaging of the magnitude fft signals . the inspiration sounds are averaged separately from the expiration sounds . the two averaged sets are displayed in step 312 . the data is compared to historical patient data in step 316 . in step 318 , processor 30 suggests a diagnosis . fig7 is a flow diagram showing the process accomplished by signal processor and analyzer 30 , when analyzing breath sounds . processor and analyzer 30 begins in step 400 by displaying the raw breath sounds data received from a / d converter 28 in amplitude versus time format on display 32 via signal 31 . when the operator is content with the displayed signal , the operator signals processor 30 via signal 33 from terminal 34 to begin storing data 29 . the operator may specify the number of breaths to be stored , the number of frames per second to store and the chest location , or these may be predetermined parameters stored within processor 30 . processor 30 stores the next specified number of sounds by counting the respiration detector signals in step 402 . processor 30 sorts the breath sounds into two sets , according to respiratory phase , in step 404 . in step 408 , the breath sounds are individually frequency transformed and phase fixed , for example by performing a magnitude fft calculation . step 410 accomplishes the signal averaging of the magnitude fft signals . the inspiration sounds are averaged separately from the expiration sounds . the two averaged sets are displayed in step 412 . the data is compared to historical patient data in step 416 . in step 418 , processor 30 suggests a diagnosis . fig8 a , 8b , 8c , 8d and 8e show displays produced by the signal processor and analyzer of fig3 when analyzing heart sounds . fig8 a shows how the display of the heart sounds of a patient with a normal heart might look . s1 and s2 are nicely separated , with no extra sounds or murmurs appearing . the x - axis shows the frequency of the sounds , and the y - axis , along with the color of the dots , indicates the intensity of the sound . red dots indicate the highest intensity , followed by green dots , then blue , then white . intensity is also indicated by the height of the dots . time is displayed along the diagonal . fig8 b shows a representative tracing of the heart sounds of a patient with aortic stenosis . aortic stenosis is generally associated with a soft a2 sound , with a high - pitched extra sound ( systolic ejection click ) in early systole and an associated crescendo - decrescendo systolic murmur between s1 and s2 . see fig9 . fig8 b demonstrates how the murmur begins after s1 and ends before s2 . moreover , it is clear that the intensity and the frequency of the murmur are not constant . fig8 c shows a representative tracing of the heart sounds of a patient with mitral regurgitation . mitral regurgitation is generally associated with a soft s1 sound and an associated holo - systolic murmur from s1 to s2 , and is confirmed by hand grip making the murmur louder . fig8 c illustrates the presence of the murmur throughout systole ( i . e . from s1 to s2 ). fig8 d shows a representative tracing of the heart sounds of a patient having a pericardial friction rub . this sound results from rubbing of an inflamed pericardium during the cardiac cycle . although this may sound like systolic and diastolic murmurs , fig8 d confirms a unique frequency signature to this sound . fig8 e shows a representative display of the heart sounds of a patient with mitral stenosis . mitral stenosis is generally associated with a loud m1 sound , a low pitched decrescendo associated murmur in early diastole and opening snap in early diastole ( see fig9 ). fig8 e shows all of these features . fig9 is a chart showing an example of a diagnostic approach which could be taken by the signal processor and analyzer 30 in suggesting maneuvers and diagnoses to the operator , when analyzing heart sounds . first , abnormal sounds are divided into abnormal sounds , murmurs , and other extra heart sounds . next , sounds are classified according to their timing in the heart sound cycle , and whether the timing is consistent or not . then the frequency or pitch of the sound is added as a factor . respiratory phase is examined as a factor . signal processor and analyzer 30 then suggests a lesion based upon these factors . if a different maneuver will help confirm the diagnosis , signal processor and analyzer 30 displays a request for the user to perform this maneuver . those skilled in the art will appreciate that computer assisted diagnosis could be based upon these characteristics . fig1 is a chart showing an example of a diagnostic approach which could be taken by the signal processor and analyzer 30 in suggesting diagnoses to the operator , when analyzing breath sounds . sounds are classified according to their timing in the breathing cycle . then the frequency or pitch of the sound is added as a factor . location of sound detection is examined as a factor . signal processor and analyzer 30 then suggests a diagnosis based upon these factors . methods of confirming the diagnosis may also be suggested . those skilled in the art will appreciate that computer assisted diagnosis could be based upon these characteristics . fig1 is a chart showing an example of a diagnostic approach which could be taken by the signal processor and analyzer 30 in suggesting diagnoses to the operator , when analyzing peripheral vessel sounds . sounds are classified according to their timing in the heart beat cycle . then the frequency or pitch of the sound is added as a factor . location of sound detection is examined as a factor . signal processor and analyzer 30 then suggests a diagnosis based upon these factors . methods of confirming the diagnosis may also be suggested . those skilled in the art will appreciate that computer assisted diagnosis could be based upon these characteristics . fig1 shows the effect on heart beat sounds of signal averaging in the frequency domain . the plot in the upper left hand corner shows amplitude of sound versus time for one second of data ( no averaging ). the plot in the upper right hand corner shows a three dimensional plot indicating amplitude versus time and frequency of the one second sample . a large artifact is evident . the plot on the bottom shows one second of data obtained by signal averaging an entire data set in the frequency domain , after phase fixing . the artifact has disappeared , and a very clean signal is obtained . in addition to the obvious application for screening and diagnosis of anatomic and functional heart disease , another extremely useful capability of the present invention is following the natural history as well as treatment response once cardiac abnormalities have been documented and characterized . for example , suppose a patient &# 39 ; s mitral stenosis was detected by the present invention and the mitral valve area was quantified with an additional anatomic test ( e . g . echocardiography , costing around $ 1000 per study ). the progression of the stenosis could be followed by the present invention using the timing between the opening snap ( os ) and aortic closure ( a2 ) as well as the pitch and intensity of the diastolic murmur . once the present invention determined that the severity of the lesion had increased to the point which warranted surgical intervention , a follow - up echocardiogram could be performed to confirm this conclusion . the documentation and direct quantification of measurements made with the present invention obviates the need for frequently repeated anatomic studies , saving the patient time and money . while the exemplary preferred embodiments of the present invention are described herein with particularity , those skilled in the art will appreciate various changes , additions , and applications other than those specifically mentioned , which are within the spirit of this invention . for example , some physicians may possess greater skill at interpreting the graphical displays generated by the present invention . given the digital nature of the invention , it would be possible to transfer the data over telephone lines to obtain consultation with expert interpreters as well to allow for the user to perform comparison of studies which were acquired at different times and / or different places and stored at a remote site .
apparatus for assisting an operator to diagnose physical conditions in a patient by collecting and analyzing cyclical body sounds such as heart beat , peripheral vessel sounds , or breath sounds . several cycles of data are collected and digitized . each cycle is converted to the frequency domain and phase fixed . then all of the frequency converted and phase fixed cycles are signal averaged together , and the results displayed to the operator . the cycles may be sorted according to respiratory cycle and averaged in two groups . the cycles may be gated according to the patients ecg . the apparatus may suggest diagnoses or further maneuvers to be performed .