Journal of Analysis and Computation (JAC)

(An International Peer Reviewed Journal), www.ijaconline.com, ISSN 0973-2861

Volume XII, Issue I, Jan-June 2019

TECHNIQUES FOR LUNG SOUNDS ANALYSIS TO ASSIST

MEDICAL PROFESSIONALS: A STUDY
Piyush Kumar1, Shivam Parashar2, A K Gautam3, J Bora4, M. Mishra5
1,2
B. Tech, North Eastern Regional Institute of Science and Technology, Nirjuli, India
3, 4, 5
Assistant Professor, North Eastern Regional Institute of Science and Technology, Nirjuli, India

ABSTRACT
With the use of latest technology for the clinical purposes, various methods have been developed for
analysis of pulmonary acoustic signals in an efficient manner. These acoustic signals are generated by
both internal and external means. Internal factors include breathing and vocal sounds, while external
factors include chest percussion and airway in sonification. A sound study of these acoustic signals
resulted in the development of new medical instruments with very high precision and low sensitivity to
noise. As some of the latest instruments are portable, so patients can do early tests at their home without
taking help from physicians as these devices are very easy to operate. In this study, we discussed about
various pulmonary diseases, type of sounds associated with them and their frequencies, with a focus to
various signal processing methods and classifiers used for the analysis of the pulmonary acoustic
signals.

Keywords - Lung Sound Analysis, Chest Percussion, Medical Instruments, Pulmonary Diseases,
Signal Processing.

[1] INTRODUCTION
Auscultation process for lung sounds analysis is a fundamental skill among the health
professionals, though it is not an easy skill to acquire and needs a substantial experience and
one has to be a good listener. As per the American heart Association, even the well-
experienced doctors sometimes make mistakes in this regard [2]. Historically the auscultation
process finds its way back to ancient Egyptians. The equipment (i.e. stethoscope) for
auscultation was introduced by Rene Laennec in the year 1816. Following the discovery of
stethoscope, the mediate auscultation has been used till now. The computer-aided
auscultation (CAA) is developed much later but over the years it has been proven the most
effective way to analyse lung ailments as it can yield more accurate and objective results and
is likely to surpass the auscultation skills and subjective interpretation of humans [3]. The
lung sound analysis using CAAs are based on the digitally recorded lung sounds. The CAAs
are aimed at detecting and characterizing lung ailments. This leads to limit the number of
missed disease while diagnoses as well as lessens the high costs for unnecessary and
sometimes painful medical tests. In this review, we will see through the CAAs analysis
methods of lung sounds used by researchers till now. We will study about the sensors used,
their locations, signal processing methods employed, lung disorders and classification

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 TECHNIQUES FOR LUNG SOUNDS ANALYSIS TO ASSIST MEDICAL PROFESSIONALS: A STUDY

methods used by the researchers. The review presents comparative results of different
methods, followed by the future perspective and research directions for the CAAs. Firstly, we
discussed about various lung diseases and auscultation methods used for the detection of
lung sounds. After that, we focussed on the various signal processing methods used for the
filtration of noise and better analysis of the acoustic signals. After that, classifiers are used for
the classification of these lung sounds.

[2] LUNGS DISEASES

Pulmonary diseases can cause lungs to be unexpectedly occupied by the air and fluid. So,
because of this structural change, the frequency of lungs sound also changes [3]. Lungs
diseases can be categorised into two groups on the basis of physiological processes associated
with the disease: fluid and air accumulation. Pneumonia, pleural effusion, asthma,
pneumothorax, and chronic obstructive pulmonary disease (COPD) are some of the common
lungs’ disorders. Asthma and COPD are inflammatory and chronic in nature.

Pneumonia: In this disease, a simple lung infection causes inflammation and collection of a
protein-rich fluid known as “exudate”. The collection of this fluid gives anatomical basis for
the chest examination findings in pneumonia [4].

Pleural effusion: As pneumonia, this also occurs when the lungs are filled with fluids. But,
in this case the fluids are collected in the pleural space [5]. Pleural space is a region between
lungs and chest.

Pneumothorax: If the air present in the chest cavity or the thoracic cavity, then it results in
pneumothorax [6]. Air present in the chest pushes the lungs, finally leads to breakdown of
lungs. The air present in the chest affects the lungs sound and it can be diagnosed by
analysing lungs sound [7].

Asthma: In this disease, the airways gets blocked by the mucus which causes difficulty in
breathing. Due to inflammation in the airways, wheezes and other breathe sounds related to
asthma are produced [8, 9].

Chronic Obstructive Pulmonary Disease (COPD): The patients affected by the COPD
finds very hard to breathe. It includes emphysema and chronic bronchitis. Emphysema refers
to destruction of air sacs in the lungs. In chronic bronchitis, inflammation of bronchial tubes
produces huge amount of mucus.

[3] METHODS OF LUNGS SOUND MEASUREMENT

Classically, lungs sound was analysed by using stethoscope. It filters out other frequencies
mechanically, which are not necessary for the analysis purpose and allows a certain range of
acoustic signals selected for analysis. The vibrating thoracic wall or the sound pressure can
be converted into electrical signals for the analysis of lung sounds.

Stethoscope: It is based on the filtration and amplification of analog signals. The amplified
signals are interpreted by the physicians [10]. It consists of two parts – bell and diaphragm.
Bell amplifies signals below 112 Hz and diaphragm attenuates low frequency signals [11].
The audible range of human ear is 20 – 20 KHz [11, 12]. As the human ear follows
logarithmic sensitivity, a large change is required in the high frequency signals in order to
detect them as dissimilar [10]. Electronic stethoscope uses various sensors such as condenser
microphones and piezoelectric sensors to convert the acoustic pressure into electrical signals.

Piyush Kumar, Shivam Parashar, A. K. Gautam, J. Bora, and M. Mishra 2

 Journal of Analysis and Computation (JAC)
(An International Peer Reviewed Journal), www.ijaconline.com, ISSN 0973-2861
Volume XII, Issue I, Jan-June 2019

The electrical signal are used for further analysis and extraction of required data [7, 13, 14].
Nowadays, electronic stethoscope are used for auscultation processes. As compared to its
earlier versions, electronic stethoscope amplifies the acoustic signals, filters out noise and
keeps record of all patients [11]. The frequency range of this measuring device depends upon
the sensors used and the type of filters applied.
Sensors:
Sensor converts the vibrations of thoracic wall into electrical signals. Requirements of an
ideal sensor includes - cost efficiency, reliability, low susceptibility to noise and high
sensitivity for low frequency signals [15]..
• Condenser microphones: It belongs to the family of air coupled microphones. Some
condenser microphones like electret microphones converts sound pressure into change
in capacitance between the movable diaphragm and a fixed plate [15, 16, 17]. Later
on, these capacitances are converted into electrical voltages. These type of sensors
causes minimum distortion as they have flat frequency response over the audible
range [15, 17]. Microelectrochemical systems (MEMS) also uses “condenser
transduction principle” and provides a similar range of frequencies and signal to noise
ratio (SNR) as compared to other condenser microphones [18]. Condenser
microphones are widely used and favoured over MEMS due of its high bandwidth,
wide bandwidth, low cost and high signal to noise ratio [17, 19, 21].
• Contact microphones: This microphone uses piezoelectric transduction principles to
convert the movement of the sensors into electrical signals [20]. The sensors are
placed over the chest without using air sacs in the chest. The vibrations in the chest
induces movements in the position of the sensors and the sensors are designed to
convert these mechanical vibrations into electrical voltages. Sensors used in this
microphone have very high sensitivity to motion of the thoracic wall but low
susceptibility to noise, which is not present in condenser type microphones [17, 20].

• Multi - point measurements (sensor array): Lungs diseases changes the routes of the
sound transmission in the chest. If we trace out exact locations of the abnormal lung
sounds, then we can get information about the diseases such as its types and
harshness. “Vibration response imaging” (VRI) is a type of multi sensor system which
is used in diagnosing patients for the detection of different sounds at various
locations. VRI creates a 2D image of breath sounds by the help of series of electronic
stethoscopes. To create an image that can identify variation in lung sounds, a total
number of 18 to 40 sensors are used to capture the acoustic signals in a digital
stethoscope [21]. The flat frequency response of the individual sensors is 50 – 400 Hz
[21]. This chain of sensors is used to differentiate between normal person and
abnormal person with pneumonia or pleural effusion [22, 23, 24], variations in the
lungs sound of the asthmatic and a normal person [25]. This device is bulky because it
consists of 40 different sensors placed on the patient’s back. This system only allows
signals having frequency between 150 - 250 Hz and filters out rest. So, the lung
sounds with frequencies above 250 Hz are not considered for analysis [26].

[4] SIGNAL PROCESSING

When sound travels through the thoracic cavity, chest behaves as low pass filter and it
absorbs high frequency signals [27, 28, 29, 30, 31, 32]. Anatomical change in the lungs due
to the collection of air or fluid affects the spectral characteristics.

Piyush Kumar, Shivam Parashar, A. K. Gautam, J. Bora, and M. Mishra 3

 TECHNIQUES FOR LUNG SOUNDS ANALYSIS TO ASSIST MEDICAL PROFESSIONALS: A STUDY

Frequency range for analysis: Frequency analysis is an important parameter to classify the
various pulmonary diseases such as asthma, emphysema and pneumonia [33, 12, 34, 35, 36].
The frequency range advised for the analysis of various pulmonary diseases are 0 to 2000 Hz
[33, 37].
Frequency ranges for specific diseases: Pneumonia is directly related to crackles and it has
mean frequency of 300Hz [38, 15]. Another paper purposed that 300Hz to 600 Hz is very
important for the diagnosis of the pneumonia due to the variation in bronchial breathing [39].
The diseases that causes blockage of airway like asthma and COPD have frequencies below
400Hz [33]. Pneumothorax has frequencies between 400-600Hz [6].
Analysis methods: There are many methods to collect the features from the lung sounds. By
using these collected features, a feature matrix is modelled which will help us for the
separation of different sound such as wheezes, crackles, stridor etc. We use statistical
analysis for time domain, for frequency domain we use Fourier transform and Mel frequency
cepstrum analysis. For time – frequency domain, autoregressive (AR) models and wavelet
analysis are used.
• Statistical Analysis: In this analysis, cross correlation distribution features, high order
statistics are applied to represent lung sounds. In time domain analysis, it extracts
unique data from non-periodic signals. Several classification parameters like median,
mean, mode and variance can be effective in representing the lung sounds. Lung
sounds, are usually considered as non gaussian, irregular and it affects the distribution
features [15, 40]. So, in this case, some high order statistics that includes kurtosis and
skewness are utilized for the analysis of lung sounds. Kurtosis is used to detect
crackles due to its high sensitivity [40]. Cross correlation is also a very crucial method
for the study of signal in time domain. It compares two signals and finds out
similarities between them. Multi - sensor arrays are used to measure the sound
intensity which gives information about the location and timing of the signal. [10, 41,
42].
• Discrete Fourier Transform (DFT): Fourier transform is applied for spectral analysis
of a signal and thus measures the frequency content. This method is used to examine
distinctly sampled signals like digitized lung sounds. DFT converts the signals from
time domain to frequency domain. The “short time Fourier transform” (STFT) gives
up frequency resolution to maintain the time window short and to mark non periodic
signals more precisely [43]. These Fourier transforms are computed by using “Fast
Fourier Transform” (FFT) [44]. Each and every lung disease possesses unique sound.
Different lung related ailments gives a noise of different frequencies. On analysing
these frequencies and time interval, we can differentiate various diseases.
• Frequency response function (FRF): FRF is a ratio of the output signal’s DFT to the
input signal’s DFT. It considers that input signal is computable and well - defined. In
this method, power and amplitude of the signal transmitting from input to output is
measured. In many studies, FRF was used to analyse the anatomy of the lungs [6, 31,
45, 46, 47, 48]. FRF is not static; it changes according to the condition. In pneumonia,
where physical structure of the lung changes, FRF directs it to transmit or attenuate
acoustic signals in a different way [49]. It is also used to find out glut of fluid in the
lungs.
• Mel frequency cepstrum: It is used to filter out features from the acoustic signals. Mel
frequency cepstrum follows mel scale, which follows human audible range [50]. MFC
is applied by utilising DFT coefficients which gets filtered via mel scale. MFCC is
generated as a result of feature extraction from MFC and this MFCC can be used in
various classification techniques for the analysis of lung sounds [50].

Piyush Kumar, Shivam Parashar, A. K. Gautam, J. Bora, and M. Mishra 4

 Journal of Analysis and Computation (JAC)
(An International Peer Reviewed Journal), www.ijaconline.com, ISSN 0973-2861
Volume XII, Issue I, Jan-June 2019

Classification algorithms

When classification algorithms and pre-processing techniques are used in series, then it
detects different lung diseases effectively. Various classification algorithms that are used to
categorise the signals into different classes are as follows.
• Support Vector Machine (SVM): SVM is a kernel based directed learning method
classifier. It is very effective in binary or nonlinear categorisation. SVM is trained by
constructing feature matrix, planning a decision limit for each group and defining
hyper plane that divides the group [50, 51]. Gap between the groups can be increased
by the expansion of hyperplane margin. It helps in improving accuracy of the
classifiers. A few studies have used SVM to classify the lungs sound [51, 52].
Palaniappan et al. used SVM in the classification of normal, abnormal and windpipe
blockage sounds, and managed to get an accuracy of 90.77% [50]. He also proved that
“k- nearest neighbour” (KNN) method better than the SVM for analysis and
categorisation of lungs sound [33]. Serbes et al. observed that enhanced pre-
processing method has increased the precision of the classification of crackles up to
97.20% [53].
• K- Nearest neighbour (KNN): It is an instance-based categorization method which is
used to categorize signals into various abnormal lung sounds [54]. It is one of the
simplest machine learning algorithms. This method is trained on a series of data. It
compresses the data into characteristic cluster centres for every irregular sound. Then
the new data is represented on the same place and the method is used to determine the
data points calculated by the “Euclidean distance” [54]. Rao et al. proposed KNN
provides better precision for the categorization of lung disorders as compared to ANN
and GMM [55].
• Artificial Neural Network (ANN): Neural network is used in the classification of lung
sound by many researchers as it automatically classifies pulmonary acoustic signals
with great accuracy [9, 49, 44]. In this method, a complex relationship between input
and output is created. It is a collection of interconnected nodes known as artificial
neurons that learns by changing its weights by utilising training data in order to
achieve better accuracy [51]. The path that connects artificial neurons are called
‘edges’.
• Gaussian Mixture Model (GMM):
It is generally used to identify the speaker in verification processes [63]. It is very
similar to KNN, because it also uses information collected during training to create
categories of acoustic signals.

[5] CONCLUSION

This study deals with the various recent technological advancements materialised in the
automated lungs sound analysis meant for assisting medical professionals. The advancements
in this area have made the treatment of various diseases simple and cost effective. It has also
reduced the risk associated with the classic methods of lung sounds analysis based on
auscultation. Acoustic monitoring by digital signal processing means has provided an
alternative to the hospitals. The patients may ensure preliminary tests at their home by
themselves, as these instruments do not require experts for operation. It may lead to reduction
in the numbers of patients in the hospitals, which has a significance in the developing
countries like India where the ratio of number of patients per doctor is extremely high besides

Piyush Kumar, Shivam Parashar, A. K. Gautam, J. Bora, and M. Mishra 5

 TECHNIQUES FOR LUNG SOUNDS ANALYSIS TO ASSIST MEDICAL PROFESSIONALS: A STUDY

lack of proper infrastructure. The patients may find these automated tools useful in case of
emergencies. It has a prominent role to play for the elderly patients who face difficulties in
the movement or are residing in the remote areas far away from the hospitals. However, there
still exists a wide scope in the development of automated system for analysis of the lung
sounds which may assist the physicians in the accurate and efficient diagnosis of the
respiratory abnormalities.

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