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Biomed Inform Insights. 2017 Dec 7;9:1178222617745557. doi: 10.1177/1178222617745557. eCollection 2017.

A Software Tool for the Annotation of Embolic Events in Echo Doppler Audio Signals.

Author information

Department of Information Engineering, Marche Polytechnic University, Ancona, Italy.
Consortium GARR, Roma, Italy.
DAN Europe Foundation, Ta'Xbiex, Malta.


The use of precordial Doppler monitoring to prevent decompression sickness (DS) is well known by the scientific community as an important instrument for early diagnosis of DS. However, the timely and correct diagnosis of DS without assistance from diving medical specialists is unreliable. Thus, a common protocol for the manual annotation of echo Doppler signals and a tool for their automated recording and annotation are necessary. We have implemented original software for efficient bubble appearance annotation and proposed a unified annotation protocol. The tool auto-sets the response time of human "bubble examiners," performs playback of the Doppler file by rendering it independent of the specific audio player, and enables the annotation of individual bubbles or multiple bubbles known as "showers." The tool provides a report with an optimized data structure and estimates the embolic risk level according to the Extended Spencer Scale. The tool is built in accordance with ISO/IEC 9126 on software quality and has been projected and tested with assistance from the Divers Alert Network (DAN) Europe Foundation, which employs this tool for its diving data acquisition campaigns.


Echo Doppler analysis; annotation tool; bubble detection; decompression sickness; diving safety; embolism

Conflict of interest statement

Declaration Of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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