17

Electrical Impedance
Tomography

17.1 The Electrical Impedance of Tissue . . . . . . . . . . . . . . . . . . . . 17-1

17.2 Conduction in Human Tissues . . . . . . . . . . . . . . . . . . . . . . . . . 17-1
17.3 Determination of the Impedance Distribution . . . . . . . . 17-3
Data Collection • Image Reconstruction • Multifrequency
Measurements
17.4 Areas of Clinical Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-10
Possible Biomedical Applications
17.5 Summary and Future Developments . . . . . . . . . . . . . . . . . . . 17-11
Defining Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11
D.C. Barber References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-12
University of Sheffield Further Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-13

17.1 The Electrical Impedance of Tissue

The specific conductance (conductivity) of human tissues varies from 15.4 mS/cm for cerebrospinal fluid
to 0.06 mS/cm for bone. The difference in the value of conductivity is large between different tissues
(Table 17.1). Cross-sectional images of the distribution of conductivity, or alternatively specific resistance
(resistivity), should show good contrast. The aim of electrical impedance tomography (EIT) is to produce
such images. It has been shown [Kohn and Vogelius, 1984a,b; Sylvester and Uhlmann, 1986] that for
reasonable isotropic distributions of conductivity it is possible in principle to reconstruct conductivity
images from electrical measurements made on the surface of an object. Electrical impedance tomography
(EIT) is the technique of producing these images. In fact, human tissue is not simply conductive. There
is evidence that many tissues also demonstrate a capacitive component of current flow and therefore, it is
appropriate to speak of the specific admittance (admittivity) or specific impedance (impedivity) of tissue
rather than the conductivity; hence the use of the world impedance in electrical impedance tomography.

17.2 Conduction in Human Tissues

Tissue consists of cells with conducting contents surrounded by insulating membranes embedded in a
conducting medium. Inside and outside the cell wall is conducting fluid. At low frequencies of applied
current, the current cannot pass through the membranes, and conduction is through the extracellular
space. At high frequencies, current can flow through the membranes, which act as capacitors. A simple

17-1

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17-2 Medical Devices and Systems

TABLE 17.1 Values of Specific

Conductance for Human Tissues

Tissue Conductivity, mS/cm

Cerebrospinal fluid 15.4

Blood 6.7
Liver 2.8
Skeletal muscle 8.0 (Longitudinal)
0.6 (Transverse)
Cardiac muscle 6.3 (Longitudinal)
2.3 (Transverse)
Neural tissue 1.7
Gray matter 3.5
White matter 1.5
Lung 1.0 (Expiration)
0.4 (Inspiration)
Fat 0.36
Bone 0.06

S C

FIGURE 17.1 The Cole-Cole model of tissue impedance.

model of bulk tissue impedance based on this structure, which was proposed by Cole and Cole [1941], is
shown in Figure 17.1.
Clearly, this model as it stands is too simple, since an actual tissue sample would be better represented
as a large network of interconnected modules of this form. However, it has been shown that this model fits
experimental data if the values of the components, especially the capacitance, are made a power function
of the applied frequency ω. An equation which describes the behavior of tissue impedance as a function
of frequency reasonably well is

Z0 − Z∞
Z = Z∞ + (17.1)
1 + ( j(f /fc ))α

where Z0 and Z∞ are the (complex) limiting values of tissue impedance low and high frequency and fc is
a characteristic frequency. The value of α allows for the frequency dependency of the components of the
model and is tissue dependent. Numerical values for in vivo human tissues are not well established.
Making measurements of the real and imaginary components of tissue impedivity over a range of
frequencies will allow the components in this model to be extracted. Since it is known that tissue structure
alters in disease and that R, S, C are dependent on structure, it should be possible to use such measurements
to distinguish different types of tissue and different disease conditions. It is worth noting that although
maximum accuracy in the determination of the model components can be obtained if both real and
imaginary components are available, in principle, knowledge of the resistive component alone should
enable the values to be determined, provided an adequate range of frequencies is used. This can have
practical consequences for data collection, since accurate measurement of the capacitive component can
prove difficult.

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Electrical Impedance Tomography 17-3

Although on a microscopic scale tissue is almost certainly electrically isotropic, on a macroscopic

scale this is not so for some tissues because of their anisotropic physical structure. Muscle tissue is a prime
example (see Table 17.1), where the bulk conductivity along the direction of the fibers is significantly higher
than across the fibers. Although unique solutions for conductivity are possible for isotropic conductors,
it can be shown that for anisotropic conductors unique solutions for conductivity do not exist. There are
sets of different anisotropic conductivity distributions that give the same surface voltage distributions and
which therefore cannot be distinguished by these measurements. It is not yet clear how limiting anisotropy
is to electrical impedance tomography. Clearly, if sufficient data could be obtained to resolve down to
the microscopic level (this is not possible practically), then tissue becomes isotropic. Moreover, the tissue
distribution of conductivity, including anisotropy, often can be modeled as a network of conductors,
and it is known that a unique solution will always exist for such a network. In practice, use of some
prior knowledge about the anisotropy of tissue may remove the ambiguities of conductivity distribution
associated with anisotropy. The degree to which anisotropy might inhibit useful image reconstruction is
still an open question.

17.3 Determination of the Impedance Distribution

The distribution of electrical potential within an isotropic conducting object through which a low-
frequency current is flowing is given by

∇(σ ∇φ) = 0 (17.2)

where φ is the potential distribution within the object and σ is the distribution of conductivity (generally
admittivity) within the object. If the conductivity is uniform, this reduces to Laplace’s equation. Strictly
speaking, this equation is only correct for direct current, but for the frequencies of alternating current used
in EIT (up to 1 MHz) and the sizes of objects being imaged, it can be assumed that this equation continues
to describe the instantaneous distribution of potential within the conducting object. If this equation is
solved for a given conductivity distribution and current distribution through the surface of the object,
the potential distribution developed on the surface of the object may be determined. The distribution of
potential will depend on several things. It will depend on the pattern of current applied and the shape
of the object. It will also depend on the internal conductivity of the object, and it is this that needs to
be determined. In theory, the current may be applied in a continuous and nonuniform pattern at every
point across the surface. In practice, current is applied to an object through electrodes attached to the
surface of the object. Theoretically, potential may be measured at every point on the surface of the object.
Again, voltage on the surface of the object is measured in practice using electrodes (possibly different from
those used to apply current) attached to the surface of the object. There will be a relationship, the forward
solution, between an applied current pattern ji , the conductivity distribution σ , and the surface potential
distribution φi which can be formally represented as

φi = R(ji , σ ) (17.3)

If σ and ji are known, φi can be computed. For one current pattern ji , knowledge of φi is not in general
sufficient to uniquely determine σ . However, by applying a complete set of independent current patterns,
it becomes possible to obtain sufficient information to determine σ , at least in the isotropic case. This is
the inverse solution. In practice, measurements of surface potential or voltage can only be made at a finite
number of positions, corresponding to electrodes placed on the surface of the object. This also means that
only a finite number of independent current patterns can be applied. For N electrodes, N −1 independent
current patterns can be defined and N (N − 1)/2 independent measurements made. This latter number
determines the limit of image resolution achievable with N electrodes. In practice, it may not be possible
to collect all possible independent measurements. Since only a finite number of current patterns and

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17-4 Medical Devices and Systems

measurements is available, the set of equations represented by Equation 17.3 can be rewritten as

v = Ac c (17.4)

where v is now a concatenated vector of all voltage values for all current patterns, c is a vector of
conductivity values, representing the conductivity distribution divided into uniform image pixels, and
Ac a matrix representing the transformation of this conductivity vector into the voltage vector. Since Ac
depends on the conductivity distribution, this equation is nonlinear. Although formally the preceding
equation can be solved for c by inverting Ac , the nonlinear nature of this equation means that this cannot
be done in a single step. An iterative procedure will therefore be needed to obtain c.
Examination of the physics of current flow shows that current tends to take the easiest path possible in
its passage through the object. If the conductivity at some point is changed, the current path redistributes
in such a way that the effects of this change are minimized. The practical effect of this is that it is possible
to have fairly large changes in conductivity within the object which only produce relatively small changes
in voltage at the surface of the object. The converse of this is that when reconstructing the conductivity
distribution, small errors on the measured voltage data, both random and systematic, can translate into
large errors in the estimate of the conductivity distribution. This effect forms, and will continue to form, a
limit to the quality of reconstructed conductivity images in terms of resolution, accuracy, and sensitivity.
Any measurement of voltage must always be referred to a reference point. Usually this is one of the
electrodes, which is given the nominal value of 0 V. The voltage on all other electrodes is determined by
measuring the voltage difference between each electrode and the reference electrode. Alternatively, voltage
differences may be measured between pairs of electrodes. A common approach is to measure the voltage
between adjacent pairs of electrodes (Figure 17.2). Clearly, the measurement scheme affects the form
of Ac . Choice of the pattern of applied currents and the voltage measurement scheme used can affect the
accuracy with which images of conductivity can be reconstructed.
Electrical impedance tomography (EIT) is not a mature technology. However, it has been the subject
of intensive research over the past few years, and this work is still continuing. Nearly all the research effort
has been devoted to exploring the different possible ways of collecting data and producing images of tissue
resistivity, with the aim of optimizing image reconstruction in terms of image accuracy, spatial resolution,
and sensitivity.

1
16 2

3 Drive
15

14
4

13 5

6
12

7
11 Receive

10 8
9

FIGURE 17.2 Idealized electrode positions around a conducting object with typical drive and measurement electrode
pairs indicated.

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Electrical Impedance Tomography 17-5

Very few areas of medical application have been explored in any great depth, although in a number
of cases preliminary work has been carried out. Although most current interest is in the use of EIT for
medical imaging, there is also some interest in its use in geophysical measurements and some industrial
uses. A recent detailed review of the state of Electrical Impedance Tomography is given in Boone et al.
[1997].

17.3.1 Data Collection

17.3.1.1 Basic Requirements
Data are collected by applying a current to the object through electrodes connected to the surface of the
object and then making measurements of the voltage on the object surface through the same or other
electrodes. Although conceptually simple, technically this can be difficult. Great attention must be paid to
the reduction of noise and the elimination of any voltage offsets on the measurements. The currents applied
are alternating currents usually in the range 10 kHz to 1 MHz. Since tissue has a complex impedance,
the voltage signals will contain in-phase and out-of-phase components. In principle, both of these can be
measured. In practice, measurement of the out-of-phase (the capacitive) component is significantly more
difficult because of the presence of unwanted (stray) capacitances between various parts of the voltage
measurement system, including the leads from the data-collection apparatus to the electrodes. These stray
capacitances can lead to appreciable leakage currents, especially at the higher frequencies, which translate
into systematic errors on the voltage measurements. The signal measured on an electrode, or between a
pair of electrodes, oscillates at the same frequency as the applied current. The magnitude of this signal
(usually separated into real and imaginary components) is determined, typically by demodulation and
integration. The frequency of the demodulated signal is much less than the frequency of the applied
signal, and the effects of stray capacitances on this signal are generally negligible. This realization has
led some workers to propose that the signal demodulation and detection system be mounted as close to
the electrodes as possible, ideally at the electrode site itself, and some systems have been developed that
use this approach, although none with sufficient miniaturization of the electronics to be practical in a
clinical setting. This solution is not in itself free of problems, but this approach is likely to be of increasing
importance if the frequency range of applied currents is to be extended beyond 1 MHz, necessary if the
value of the complex impedance is to be adequately explored as a function of frequency.
Various data-collection schemes have been proposed. Most data are collected from a two-dimensional
(2D) configuration of electrodes, either from 2D objects or around the border of a plane normal to the
principal axis of a cylindrical (in the general sense) object where that plane intersects the object surface. The
simplest data-collection protocol is to apply a current between a pair of electrodes (often an adjacent pair)
and measure the voltage difference between other adjacent pairs (see Figure 17.2). Although in principle
voltage could be measured on electrodes though which current is simultaneously flowing, the presence
of an electrode impedance, generally unknown, between the electrode and the body surface means that
the voltage measured is not actually that on the body surface. Various means have been suggested for
either measuring the electrode impedance in some way or including it as an unknown in the image-
reconstruction process. However, in many systems, measurements from electrodes through which current
is flowing are simply ignored. Electrode impedance is generally not considered to be a problem when
making voltage measurements on electrodes through which current is not flowing, provided a voltmeter
with sufficiently high input impedance is used, although, since the input impedance is always finite, every
attempt should be made to keep the electrode impedance as low as possible. Using the same electrode
for driving current and making voltage measurements, even at different times in the data collection cycle,
means that at some point in the data-collection apparatus wires carrying current and wires carrying
voltage signals will be brought close together in a switching system, leading to the possibility of leakage
currents. There is a good argument for using separate sets of electrodes for driving and measuring to
reduce this problem. Paulson et al. [1992] have also proposed this approach and also have noted that it
can aid in the modeling of the forward solution (see Image Reconstruction). Brown et al. [1994] have
used this approach in making multi-frequency measurements.

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17-6 Medical Devices and Systems

Clearly, the magnitude of the voltage measured will depend on the magnitude of the current applied.
If a constant-current drive is used, this must be able to deliver a known current to a variety of input
impedances with a stability of better than 0.1%. This is technically demanding. The best approach to
this problem is to measure the current being applied, which can easily be done to this accuracy. These
measurements are then used to normalize the voltage data.
The current application and data-collection regime will depend on the reconstruction algorithm used.
Several EIT systems apply current in a distributed manner, with currents of various magnitudes being
applied to several or all of the electrodes. These optimal currents (see Image Reconstruction) must be
specified accurately, and again, it is technically difficult to ensure that the correct current is applied at each
electrode. Although there are significant theoretical advantages to using distributed current patterns, the
increased technical problems associated with this approach, and the higher noise levels associated with
the increase in electronic complexity, may outweigh these advantages.
Although most EIT at present is 2D in the sense given above, it is intrinsically a three-dimensional
(3D) imaging procedure, since current cannot be constrained to flow in a plane through a 3D object.
3D data collection does not pose any further problems apart from increased complexity due to the need
for more electrodes. Whereas most data-collection systems to date have been based on 16 or 32 elec-
trodes, 3D systems will require four times or more electrodes distributed over the surface of the object
if adequate resolution is to be maintained. Technically, this will require “belts” or “vests” of electrodes
that can be rapidly applied [McAdams et al., 1994]. Some of these are already available, and the applic-
ation of an adequate number of electrodes should not prove insuperable provided electrode-mounted
electronics are not required. Metherell et al. [1996] describe a three-dimensional data collection system
and reconstruction algorithm and note the improved accuracy of three-dimensional images compared to
two-dimensional images constructed using data collected from three-dimensional objects.

17.3.1.2 Performance of Existing Systems

Several research groups have produced EIT systems for laboratory use [Brown and Seagar, 1987; Rigaud
et al., 1990; Smith 1990; Gisser et al., 1991; Jossinet and Trillaud, 1992; Lidgey et al., 1992; Riu et al., 1992;
Brown et al., 1994; Cook et al., 1994; Cusick et al., 1994; Zhu et al., 1994] and some clinical trials. The
complexity of the systems largely depends on whether current is applied via a pair of electrodes (usually
adjacent) or whether through many electrodes simultaneously. The former systems are much simpler
in design and construction and can deliver higher signal-to-noise ratios. The Sheffield Mark II system
[Smith, 1990] used 16 electrodes and was capable of providing signal-to-noise ratios of up to 17 dB at
25 datasets per second. The average image resolution achievable across the image was 15% of the image
diameter. In general, multi-frequency systems have not yet delivered similar performance, but are being
continuously improved.
Spatial resolution and noise levels are the most important constraints on possible clinical applications
of EIT. As images are formed through a reconstruction process the values of these parameters will depend
critically on the quality of the data collected and the reconstruction process used. However practical
limitations to the number of electrodes which can be used and the ill-posed nature of the reconstruction
problem make it unlikely that high quality images, comparable to other medical imaging modalities, can
be produced. The impact of this on diagnostic performance still needs to be evaluated.

17.3.2 Image Reconstruction

17.3.2.1 Basics of Reconstruction
Although several different approaches to image reconstruction have been tried [Wexler et al., 1985;
Yorkey, 1986; Barber and Seagar, 1987, Kim et al., 1987; Hua et al., 1988; Breckon, 1990; Cheny et al.,
1990; Zadecoochak et al., 1991; Kotre et al., 1992; Bayford et al., 1994; Morucci et al., 1994], the most
accurate approaches are based broadly on the following algorithm. For a given set of current patterns,
a forward transform is set up for determining the voltages v produced form the conductivity distribution c
(Equation 17.4). Ac is dependent on c, so it is necessary to assume an initial starting conductivity

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Electrical Impedance Tomography 17-7

distribution c0 . This is usually taken to be uniform. Using Ac , the expected voltages v0 are calculated and
compared with the actual measured voltages vm . Unless c0 is correct (which it will not be initially), v0 and
vm will differ. It can be shown that an improved estimate of c is given by

c = (Sct Sc )−1 Sct (v0 − vm ) (17.5)

c1 = c0 + c (17.6)

where Sc is the differential of Ac with respect to c, the sensitivity matrix and Sct is the transpose of Sc . The
improved value of c is then used in the next iteration to compute an improved estimate of vm , that is, v1 .
This iterative process is continued until some appropriate endpoint is reached. Although convergence is
not guaranteed, in practice, convergence to the correct c in the absence of noise can be expected, provided
a good starting value is chosen. Uniform conductivity seems to be a reasonable choice. In the presence
of noise on the measurements, iteration is stopped when the difference between v and vm is within the
margin of error set by the known noise on the data.
There are some practical difficulties associated with this approach. One is that large changes in c may
only produce small changes in v, and this will be reflected in the structure of Sc , making Sct Sc very difficult
to invert reliably. Various methods of regularization have been used, with varying degrees of success,
to achieve stable inversion of this matrix although the greater the regularization applied the poorer the
resolution that can be achieved. A more difficult practical problem is that for convergence to be possible
the computed voltages v must be equal to the measured voltages vm when the correct conductivity values
are used in the forward calculation. Although in a few idealized cases analytical solutions of the forward
problem are possible, in general, numerical solutions must be used. Techniques such as the finite-element
method (FEM) have been developed to solve problems of this type numerically. However, the accuracy of
these methods has to be carefully examined [Paulson et al., 1992] and, while they are adequate for many
applications, may not be adequate for the EIT reconstruction problem, especially in the case of 3D objects.
Accuracies of rather better than 1% appear to be required if image artifacts are to be minimized. Consider
a situation in which the actual distortion of conductivity is uniform. Then the initial v should be equal
to the vm to an accuracy less than the magnitude of the noise. If this is not the case, then the algorithm
will alter the conductivity distribution from uniform, which will clearly result in error. While the required
accuracies have been approached under ideal conditions, there is only a limited amount of evidence at
present to suggest that they can be achieved with data taken from human subjects.
17.3.2.2 Optimal Current Patterns
So far little has been said about the form of the current patterns applied to the object except that a
set of independent patterns is needed. The simplest current patterns to use are those given by passing
current into the object through one electrode and extracting current through a second electrode (a
bipolar pattern). This pattern has the virtue of simplicity and ease of application. However, other current
patterns are possible. Current can be passed simultaneously through many electrodes, with different
amounts passing through each electrode. Indeed, an infinite number of patterns are possible, the only
limiting condition being that the magnitude of the current flowing into the conducting object equals the
magnitude of the current flowing out of the object. Isaacson [1986] has shown that for any conducting
object there is a set of optimal current patterns and has provided an algorithm to compute them even
if the conductivity distribution is initially unknown. Isaacson showed that by using optimal patterns,
significant improvements in sensitivity could be obtained compared with simpler two-electrode current
patterns. However, the additional computation and hardware required to use optimal current patterns
compared with fixed, nonoptimal patterns is considerable.
Use of suboptimal patterns close to optimum also will produce significant gains. In general, the optimal
patterns are very different from the patterns produced in the simple two-electrode case. The optimal
patterns are often cosine-like patterns of current amplitude distributed around the object boundary

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17-8 Medical Devices and Systems

rather than being localized at a pair of points, as in the two-electrode case. Since the currents are passed
simultaneously through many electrodes, it is tempting to try and use the same electrodes for voltage
measurements. This produces two problems. As noted above, measurement of voltage on an electrode
through which an electric current is passing is compromised by the presence of electrode resistance, which
causes a generally unknown voltage drop across the electrode, whereas voltage can be accurately measured
on an electrode through which current is not flowing using a voltmeter of high input impedance. In
addition, it has proved difficult to model current flow around an electrode through which current is flowing
with sufficient accuracy to allow the reliable calculation of voltage on that electrode, which is needed for
accurate reconstruction. It seems that separate electrodes should be used for voltage measurements with
distributed current systems.
Theoretically, distributed (near-) optimal current systems have some advantages. As each of the optimal
current patterns is applied, it is possible to determine if the voltage patterns produced contain any useful
information or if they are simply noise. Since the patterns can be generated and applied in order of
decreasing significance, it is possible to terminate application of further current patterns when no further
information can be obtained. A consequence of this is that SNRs can be maximized for a given total data-
collection time. With bipolar current patterns this option is not available. All patterns must be applied.
Provided the SNR in the data is sufficiently good and only a limited number of electrodes are used, this may
not be too important, and the extra effort involved in generating the optimal or near-optimal patterns may
not be justified. However, as the number of electrodes is increased, the use of optimal patterns becomes
more significant. It also has been suggested that the distributed nature of the optimal patterns makes the
forward problem less sensitive to modeling errors. Although there is currently no firm evidence for this,
this seems a reasonable assertion.

17.3.2.3 Three-Dimensional Imaging

Most published work so far on image reconstruction has concentrated on solving the 2D problem. How-
ever, real medical objects, that is, patients, are three-dimensional. Theoretically, as the dimensionality of
the object increases, reconstruction should become better conditioned. However, unlike 3D x-ray images,
which can be constructed from a set of independent 2D images, EIT data from 3D objects cannot be so
decomposed and data from over the whole surface of the object is required for 3D reconstruction. The
principles of reconstruction in 3D are identical to the 2D situation although practically the problem is
quite formidable, principally because of the need to solve the forward problem in three dimensions. Some
early work on 3D imaging was presented by Goble and Isaacson [1990]. More recently Metherall et al.
[1996] have shown images using data collected from human subjects.

17.3.2.4 Single-Step Reconstruction

The complete reconstruction problem is nonlinear and requires iteration. However, each step in the
iterative process is linear. Images reconstructed using only the first step of iteration effectively treat image
formation as a liner process, an assumption approximately justified for small changes in conductivity from
uniform. In the case the functions Ac and Sc often can be precomputed with reasonable accuracy because
they usually are computed for the case of uniform conductivity. Although the solution cannot be correct,
since the nonlinearity is not taken into account, it may be useful, and first-step linear approximations
have gained some popularity. Cheney et al. [1990] have published some results from a first-step process
using optimal currents. Most, if not all, of the clinical images produced to date have used a single-step
reconstruction algorithm [Barber and Seagar, 1987; Barber and Brown, 1990]. Although this algorithm
uses very nonoptimal current patterns, this has not so far been a limitation because of the high quality
of data collected and the limited number of electrodes used (16). With larger numbers of electrodes, this
conclusion may need to be revised.

17.3.2.5 Differential Imaging

Ideally, the aim of EIT is to reconstruct images of the absolute distribution of conductivity (or admittivity).
These images are known as absolute (or static) images. However, this requires that the forward problem

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