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1 J. of the Korean Sensors Society Vol. 19, No. 3 (010) pp p y w e» Á Á ŸÁw Á½ Á½ *Á Á½ Automation of urine dipstick test by simultaneous scanning : A pilot study Sang-Bong Lee, Seong-Su Choi, In-Kwang Lee, Jeong-Su Han, Wan-Seok Kim, Wun-Jae Kim*, Eun-Jong Cha, and Kyung-Ah Kim Abstract Urinalysis is an important clinical test to diagnose urinary diseases, and dipstick method with visual inspection is widely applied in practice. Automated optical devices recently developed have disadvantages of long measurement time, big size and heavy weight, accuracy degradation with time, etc. The present study proposed a new computer scanning technique, in which the test strip and the standard chart were simultaneously scanned to remove any environmental artifacts, followed by automated differentiation with the minimum distance algorithm, leading to significant enhancement of accuracy. Experiments demonstrated an accuracy of 100 % in that all test results were identical with the human visual inspection. The present technique only uses a personal computer with scanner and shortens the test time to a great degree. The results are also stored and accumulated for later use which can be transmitted to remote locations through a network, thus could be easily integrated to any ubiquitous health care systems. Key Words : urinalysis, dipstick method, simultaneous scanning, euclidean distance 1. (urine) x s z Ÿ ƒ mw.,, j p,» w, k, y, z,» yw. ù yk ƒ w ù,,, x, ³, x ù s xw [1]. (urinalysis) w yw y l» sƒw k w œw (Department of Biomedical Engineering, Chungbuk National University), w w w, BK1 w (BK1 Chungbuk Biomedical Science Center) * w» w (Department of Urology, Chungbuk National University) Corresponding author : kimka@chungbuk.ac.kr (Received : January 19, 010, Revised : February 5, 010 Accepted : March 1, 010) w» ù ƒ» ƒ w [-5]. w w ww y y k» š sƒw [6]. e (urinary sediment), yk (turbidity), p w t (dipstick method). e z 1 ü w w ü x, x ³ q w. yk q w, w (pale yellow) š, š n w. p y w t p ƒ Éü p ƒ w ùkü p( x ) t t q, kw. w 10 5~10. t, p, t t ww w ƒ k ƒ w. t q š, ù 169

2 이상봉 최성수 이인광 한정수 김완석 김원재 차은종 김경아 가 의도하지 않은 실수로 검사오류의 가능성을 피할 수 없다. 최근, 검사결과의 객관화를 위해 비색표 검사 결과를 자동으로 판별하는 분석기기들이 국내외에서 개발되고 있다. 국내에 시판되고 있는 대표적인 외 국 제품으로는 URISYS 1100(roche, swiss), Clinitek (SIEMENS, Germany), URITEK series(teco, U. S. A.), Miditron M(behringer manhein, Germany) 등이 있으며, 국내 제품으로는 CYBOW Reader((주)디에프아이사, Korea), URISCAN S-300(영동전자, Korea) 등이 있다. 이러한 기기들은 대부분 분광분석법을 적용하여 광원 에서 빛을 스트립에 조사하고 이로부터 반사 및 분산 되는 빛을 포토다이오드와 같은 광센서로 검출한 후 분석하여 색을 판별한다. 기기 내에 위치하는 광 원은 스트립 차트별로 순차적으로 빛을 조사하기 때문 에 측정시간이 수분 정도 소요되며 차트별로 빛을 조 사하기 위해 스트립이나 광원을 이동시켜야 하므로 전 기모터의 사용이 필수적이다. 따라서 크고, 무거우며, 가격이 상승한다는 문제점을 가지고 있다. 이에 더하여, 시간이 지남에 따라 광원의 특성이 변화하므로 기기 수명이 단축되고 정확도 역시 떨어지는 문제점 또한 가지고 있다. 본 연구에서는 기존 스트립 검사결과 분석기기들의 문제점들을 해결할 수 있는 요 성분검사 비색표 자동 분별기술을 새로이 개발하였다. 색을 구성하는 5가지 의 요소들을 산출하여 특정색을 5차원 공간상의 한 점 에 대응시키고 기하학적 거리(euclidean distance)를 비 교함으로써 가장 유사한 색을 선별하였다. 스트립과 표 준비색표를 동시에 스캔하여 항상 동일한 측정환경을 유지함으로써 기기의 환경적 변화요인을 근원적으로 제거하였다. 정상 성인남성을 대상으로 실험을 수행하 여 본 기법의 정확도를 실험적으로 검증하였다. Fig. 1. Test strip. [7-10] [11-13] [9,10]. 실험 방법 Fig.. Standard chart. 검사하고 있다. 표준비색표는 각 검사항목을 단계적으로 구분하며, 요를 묻힌 스트립의 각 차트와 해당 검사항목의 육안 판별시 기준값으로 사용한다. Fig. 에 표준비색표 (CYBOW10, (주)디에프아이사, Korea)의 실물사진을 제시하였다. 자동분별 기법 색(color)을 구성하는 중요한 세 가지 속성은 색상 (hue, H), 명도(brightness or lightness, Br), 채도(saturation or chroma, St)이며 H는 빨강(red, R), 녹색(green, G), 파랑(blue, B)의 조합으로 표현된다. Br은 색의 명 암에 관한 시감각이며, St는 색의 뚜렷함으로서 색의 선명도를 나타낸다. 따라서 본 연구에서는 색 분별을 위한 구성요소를 R, G, B, St, Br로 결정하였다. 두 개의 변수로 표현되는 임의의 물리량은 Fig. 3에 보 인 것처럼 차원 평면상에 위치하는 한 개의 점으로 표 기될 수 있으며, 두 점간의 직선거리(euclidean distance, L )는 식 (1)과 같이 피타고라스 정리에 의해 구해진다... 스트립 및 표준비색표 스트립은 얇고 긴 플라스틱 판 위에 요 성분을 검사 할 수 있는 차트가 붙어 있는 형태로 제작되며, 각 차 트에는 해당 성분의 이상 유무를 판단할 수 있는 시약 이 도포되어 있다(Fig. 1). 검사항목으로는 잠혈(blood), 빌리루빈(bilirubin), 우로빌리노겐(urobilinogen), 케톤 체(ketones), 단백질(protein), 아질산염(nitrite), 포도당 L = x x + y y (1) (glucose), 산도(pH), 비중(specific gravity), 백혈구(leukocytes), 비타민 C(vitamin C) 등이 있으며 검사목적 이때 두 점의 좌표가 유사하다면 직선거리는 상대적 에 따라 이 중 5~10개 항목을 검사한다. 한 예로 건강 으로 작아질 것이며, 동일한 경우 0을 나타낸다. 색의 검진시에는 통상 단백질, 포도당, 잠혈, 산도의 4종을 구성요소를 5개로 설정하였으므로 5개의 변수로 이루.1. D D 센서학회지 제 권 제 호 19 3, ( 1 ) ( 1 )

3 p y w e» 3 Fig. 4. Euclidean distance comparison of the test chart. Fig. 3. Euclidean distance between two points. 5 œ y w, 5 œ L D () w. ƒ w L D j e ùký, w 5 œ w ùkü 0. 5 œ e k z L D w w w. L D = ( R 1 R ) + ( G 1 G ) +( B 1 B ) +( St 1 St ) +( Br 1 Br ) ().3. ful e w w t t(cybow10, ( ) v, Korea) w t t l p t t t w e (PSC 310, HP, Korea)w z, ƒ p ƒ =30v kw p tw wš, R, G, B, St, Br ƒƒ w. t t w ƒ p l p t w p ƒƒ w j» w w. t R, G, B 0~55, St Br 0~100. ƒ t ƒ w sƒw» w 0~1 ³yw. ³y l l p t p p w w ùkü t t p L D ƒƒ w (Fig. 4 ). w 0~30 û 5 t ww (Fig. 5 ). ƒ» š Áòw» z p 1 ƒ Éü ƒ w. 40 ƒ ù z t t p w w ƒ w ùkü p kw»» w. t t p n n ew z q w. r v Adobe Photoshop(adobe photoshop CS, U.S.A.) k (style)» ƒ v w. p wš ü w w Marguee tool w p v kw. k v ü s³w œw» w w 5 ƒƒ w z 0~1 ³yw. p p t t w p L D ƒƒ w z ùkü p w. x ƒ š t q. q ƒ ƒ w ù, q w w w» ƒ š». w x q š»» q w x ü e 30 % w w y [14].»» ww š, q» w. q yw» w w ƒ y w š k ƒ y w z L D w. 171 J. Kor. Sensors Soc., Vol. 19, No. 3, 010

4 4 Á Á ŸÁw Á½ Á½ Á Á½ Fig. 5. Experimental set-up. Fig. 7. Absolute error histogram of color elements evaluation results. Fig. 6. Example of color elements evaluation. 3. š 3.1. t t w t ew. w p w ùký ƒ y w. w s negative p w Fig. 6 w ( d ó ƒ x). R, G 1, B 0 ùkü, % w w. St 1, Br 0 0%~1%., j» 1% ü w ùkü. w w p j» w Fig. 7 m w. 51 p j» 0~5 sw, 0~ ùkü ƒ %. 0~ 0%~0.8% w w ew ƒ š, w q ƒ w ùkü. ƒ p R, G, B, St, Br ƒƒ 1 ³yw z w p L D w. w Fig. 8. Minimum distance evaluation example between two identical charts. x w Fig. 8 ùkü. x x x (x ) x w neg q, µl x 5 p q. t t p neg. ùkü l p t p neg., w p ƒ ùkû. L D ƒ ƒ w q w w. 51 p l w w L D 73 pƒ w p w ùkü 100 % w y w. wz 19«3y,

5 p y w e» 5 Fig. 9. Strip test results example. Fig. 10. Minimum distance evaluation example of the test strip. w t ew w w. 3.. ww p t t w w w ùkü p q w Fig. 9 w. ù w w w š. ph=7 w. w w p t t q w ph=7 ùkü. w w ƒ p w L D w ùkü w w ph=7 q y w (Fig. 10 ). w w t t p L D w ùkü p q w pƒ ew ƒ y 100 % ew.» w w x ü e 30 % w, w w w ü x w e 90 % [14]. w { ƒ ƒ w ƒx l w ƒ y w š ù, w w Ÿ w w Ÿ Ÿ ƒ 50 % w» w Ÿ š w w [8]. w t t p ew z w q w w wš, w (100 %) q œ ùkü» k w w š q. 4. p yw» w e» w. q w w t t p e ew ƒ w w z»ww œ q w š w ƒ w w. w t t ww p q 100 % ew y w.»»» q e [14] 30 %~90 % š w s³ yw q ƒ w ùkü. w» p t t ew y w y w g. Ÿ w»»» Ÿw g w»» p w z 6~7 ƒ [10]. w» w» ful e w d w»»ƒ v w, e 1 ƒ w d»»» 1/6 k. w ew z PC w l w, il x f l w». 009 ( w» ) w w» 173 J. Kor. Sensors Soc., Vol. 19, No. 3, 010

6 6 Á Á ŸÁw Á½ Á½ Á Á½ (No. KRF D00580). š x [1], w, ½»x, Diagnostic value of dipastick urinalysis as a screening test for urinary tract infection, J. Korea Acad Fam Med, pp , 000. [] L. E. Armstrong, C. M. Maresh, J. W. Castellani, M. F. Bereron, R. W. Kenefick, K. E. La Gassee, and D. Riebe, Urinary indioes of hydration status, Int. J. Sport Nutr, vol. 4, pp , [3], Routine urinalysis in renal diseases, J. Korean Acad Farn Med, vol. 4, no., pp , 003. [4] C. G. Roehrborn, G. Bartsch, R. Kirby, G. Andriole, P. Boyle, and J. de la Rosette. Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview. Urology, vol. 58, pp , 001 [5] J. B. Henry, R. B. Lauzon, and G. B. Schumann. Basic examination of urine. In: J. B. Henry, ed, Clinical diagnosis and management by laboratory methods, 19th ed. Philadelphia, W. B. Saunders, 411, [6] L. E. Armstrong, J. A. Soto, F. T. Hacker, D. J. Casa, S. A. Kavouras, and C. M. Maresh, Urinary Indices During Dehydration, Exercise, and Rehydration, Int. J. Sport Nutr., vol. 8, pp , [7], ½»,, ½ w,, y, l» w, J. Biomed. Eng. Res., 4«, 3y, pp , 003. [8],,,, z, ƒx l Ÿ, wz, 17«, 5y, pp [9] ½»,,, ½ w,,, z,, t y» w l x, J. Biomed. Eng. Res., 4«, 3y, pp , 003. [10] x, p f w» w, r lwz, 17 «, 7y, pp , 007. [11] [1] Uv-visible spectrophotometer,g ippage/d/ipdata/004/03/file. [13] Ÿ w(1), up-file. [14] ½x,,» URISCAN S-300 Miditron M, Clinitek 100, w, 3«, «, pp , w œ w» œw (œw ) 008 Êx w œw 008 Êx f lü : d»», y 006 w w w w ( w ) 008 w œw (œw ) 008 ~x w œw 006 ~x f lü : d, Ÿ 006 w w w w ( w ) 008 w œw (œw ) 008 ~x w œw : y», w 1991 w w ( w ) 1994 ~x 1996 w w ( w ) 009 ~x w w w wz 19«3y,

7 p y w e» 7 ½ 1999 w w w (w ) 007 w w w w œw œ( w ) 008 ~x w w w : k», d 1980 w œ w œw (œw ) 1987 ûƒ w œw, Research Associate 1988 ~x w w œ w 001 ~x f lü t : d,, s», d ½ 1980 w w» w (w ) 1986 w w» w ( w ) 1988 w w» w ( w ) 1990 ~x w w» w :» w,» w ½ 1991 w w w w ( w ) 1993 w w w w ( w ) 001 w œw (œw ) 005 ~x w w œ w : y d,, k» 175 J. Kor. Sensors Soc., Vol. 19, No. 3, 010

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