Optical Engineering 448, 086401 August 2005

Prototype vein contrast enhancer

Herbert D. Zeman, MEMBER SPIE
Gunnar Lovhoiden
Carlos Vrancken
Robert K. Danish
University of Tennessee
Health Science Center
Department of Biomedical Engineering
920 Madison Avenue, Room 1005
Memphis, Tennessee 38163
E-mail: hzeman@utmem.edu

Abstract. Two different prototype vein contrast enhancers VCEs have

been designed and constructed. The VCE is an instrument that makes
vein access easier by capturing an infrared image of peripheral veins,
enhancing the vein contrast using software image processing, and projecting the enhanced vein image back onto the skin using a video projector. The prototypes use software alignment to achieve alignment accuracy between the captured infrared image and the projected visible
image better than 0.06 mm. 2005 Society of Photo-Optical Instrumentation

Engineers. DOI: 10.1117/1.2009763

Subject terms: infrared; contrast enhancement; video camera; video projector;

phlebotomy; venipuncture.
Paper 030645 received Dec. 24, 2003; revised manuscript received Dec. 21,
2004; accepted for publication Feb. 5, 2005; published online Aug. 15, 2005.

1 Introduction
1.1 The Need for Vein Contrast Enhancement
Major trauma and blood loss, cardiac arrest, dehydration,
deep shock, and other medical emergencies necessitate
rapid, reliable access to a patients bloodstream to administer drugs and fluids. In the prehospital emergency environment, an infusion line placed in an arm vein is the standard route for obtaining this access. Worldwide, 10% of
attempts at establishing an intravenous IV line, or more
than one million per year, fail. Although the average time
for achieving IV access can be as little as 1.5 min, it ranges
to more than 10.1 During emergencies outside the hospital
setting, paramedics often have to work in very difficult settings, frequently making it impossible to get rapid IV access. A study conducted in Canada reports that paramedics
had an 84% overall success rate at establishing IV lines in
the field in children 18 years old and younger, but only had
a 49% success rate at establishing IV lines in children
younger than 6 years old. Criteria for IV line placement
were determined retrospectively, and for this subgroup of
children only 43% of those younger than 6 years old had an
IV line placed successfully.2 In a study conducted on children younger than four years old presented in cardiac arrest
to a hospital emergency room, the success rate at establishing peripheral IV lines was only 17%, with the success
rates for central venous catheterization, surgical vein cutdown, and intraosseous infusion averaging around 80%.3
For adult inpatient phlebotomy procedures the success rates
are much higher, as few as 2% of all attempted venipunctures being unsuccessful.4 For adult outpatient phlebotomy
the failure rate is reported to be as low as 0.05%.5
If vascular access is accomplished within the first few
minutes of resuscitation, the patient is more likely to
survive.6,7 The quickest and easiest IV access is known to
be through a peripheral venous catheter, and although the
use of modern catheter sets, tourniquets, heat lamps, and
transillumination devices8 has made peripheral IV access
easier than it once was, there are still some emergency pa0091-3286/2005/$22.00 2005 SPIE

Optical Engineering

tients who cannot be accessed at all or require such a long

time to be accessed that the patients health can be severely
compromised. Alternatives to peripheral IV access that entail significantly increased risk to the patient or that require
additional time to achieve include central access, intraosseous administration,9,10 sublingual administration,11
and surgical venous cutdown.12 If there were an instrument
available that could aid a clinician in finding veins for peripheral IV access in all patients and this instrument were
easy to use, many complications due to slow venous access
could be avoided and vein access would be faster and less
traumatic in both emergency and nonemergency situations.
The proof-of-principle prototype VCE Fig. 1 demonstrates that such an instrument can be built. Clinical studies
have shown that the device can have significant clinical

Fig. 1 The prototype vein contrast enhancer VCE system. A commercial XGA-resolution LCD projector has been extensively modified to produce a 64 48 mm vein image on a subjects arm. The
projector, the infrared light source, the CCD TV camera, and the hot
mirror are all mounted on precision mechanical stages to allow precise alignment. The internal structure of the projector had to be significantly stiffened in order to ensure that the alignment accuracy
would be maintained when the VCE system was tilted from horizontal to vertical.

086401-1

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

utility in accessing difficult-to-find veins in pediatric

patients.13,14 The VCE devices are protected by two
patents.15,16 The significance of these two patents is described in previous publications.1719
1.2 The Clinical Evaluation of Near-Infrared
Subcutaneous Vein Imaging
It was desired to test the clinical utility of the VCE without
going through the costly and time-consuming process of
designing a projector-based prototype with accurate alignment between the captured camera vein images and the
projected enhanced vein images. A clinical study was designed using a test system that displayed the enhanced vein
images on an LCD monitor rather than projecting them
onto the skin. It was reasoned that any veins visible on the
monitor could be rendered visible on the skin with a
projector-based VCE.
1.2.1 Subjects
A total of 160 pediatric subjects 78 male and 82 female
were recruited at the Outpatient Phlebotomy Laboratory
and at the Pediatric CRC Metabolic Unit at LeBonheur
Childrens Medical Center between Oct. 2, 2001 and Feb.
13, 2003. The examiners and the phlebotomists worked together recruiting subjects with difficult venous access. The
phlebotomists determined difficult venous access either by
prior knowledge or after a brief examination of the subject.
Subjects with visible veins were excluded from the study.
Subject recruitment was affected by how busy the phlebotomists were and by how cooperative the subjects were.
The phlebotomists were less interested in the VCE information if they felt burdened due to a heavy patient volume
and would at those times help recruit a subject only if they
had severe difficulties in locating an accessible vein without the VCE. A few subjects were so uncooperative with
the venipuncture procedure that they had to be excluded
from the study because the examiners were so busy restraining them that they could not operate the VCE at the
same time. At the metabolic unit the nursing staff both
selected and helped recruit subjects with difficult venous
access. Subjects at the outpatient lab were examined either
sitting in a phlebotomy chair alone or on a guardians lap
or lying down on an examination table, while subjects at
the metabolic unit were examined lying in a hospital bed.
All subjects either were healthy or had one or more of a
wide variety of medical disorders for which they were undergoing testing. No exclusion criteria due to race, sex, or
age were applied. The study protocol was approved by the
UTHSC Institutional Review Board IRB and the LeBonheur Childrens Medical Center Research Committee
LBCMC-RC.
1.2.2 Study design and experimental methods
The clinical test systems were assembled on custom carts
with flexible arms that allowed adjustment of the camera
position. The carts were small enough to fit inside both
blood collection and hospital rooms, and the adjustable
ranges of the cameras positions allowed the VCE to enhance veins of subjects in a variety of positions, including
sitting in a phlebotomy chair and lying in a hospital bed.
Standard clinical procedures for venipuncture were used.
To make the veins more palpable, a tourniquet was applied
Optical Engineering

to the subjects arm and the subject was asked to pump

their hand. The antecubital area was examined first unless
the phlebotomist knew from prior experience that the subject could only be accessed elsewhere. The phlebotomist
used palpation to examine a venous site, while the examiner operated the VCE to acquire enhanced vein images. If
pumping the hand did not render a vein palpable, the phlebotomist would often slap the skin as a second aid. Occasionally a subject suggested a preferred venous site based
on previous venipuncture experiences, and the phlebotomist would then examine this site first. The phlebotomist
and the examiner interpreted the enhanced vein images together, and the phlebotomist tested the palpation of visible
veins in the enhanced images. The enhanced vein images
were used by the phlebotomist as clinically appropriate to
guide the phlebotomist in needle placement, and venipuncture was performed.
The VCE performance was classified as can see, can
poorly see, or cannot see a vein, based on the enhanced
vein images. An assessment of can see was recorded if
the VCE image at one or more sites showed a vein thought
to be large enough to be used for blood collection or IV
placement, and the image quality was good enough to be
used as a guide for needle placement. An assessment of
can poorly see was recorded if the best vein image
showed something the examiners thought could be an accessible vein, but the image had poor quality; an assessment of cannot see was recorded if the vein image did
not show any vein thought to be accessible. Subjects with
prior venipuncture experiences had their experiences classified as easy, somewhat difficult, or very difficult, and the
usual number of venipuncture attempts as one, two or three,
or many. An overall history score from 0 through 4 was
calculated from the matrix shown in Table 1.
1.2.3 Results
The VCE success rate shown in Table 2 is 93% when the
success rate is defined as the percentage of subjects whose
vein images were classfied as can see 84% or can
poorly see 9%. The can poorly see classification was
included in the success rate because these vein images were
also useful for finding accessible veins. Figure 2 shows one
example, where the phlebotomist could not feel the relatively large vein the VCE rendered visible in a, but could
feel the veins rendered visible in b.
It is very interesting to note that the other characteristics
shown in Table 2namely, the amount of subcutaneous fat,
the skin pigmentation, the age, and the ease with which the
veins can be felt by the phlebotomistdo not correlate
with the performance of the VCE.
2 System Description
Figure 3 shows a drawing of the major parts of the prototype. An Infocus LP290 LCD projector was modified to
project a 64 48 mm image on a screen 504 mm away
from the thin-lens-equivalent center position of the lens by
replacing the original projection lens with a 90-mm f / 4.5
Voss enlarging lens. The Voss lens was mounted in a custom lens mount that shifted the lens down to cause the
projected image to come out straight rather than upwards at
an angle. The projector was mounted on a Parker Hannifin
Corporation side-drive model 4428 micrometer-adjustable

086401-2

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Table 1 Subject history scoring.
Past history
of accessing
veins

Table 2 Numerical results.

Usual no. of
venipuncture
attempts

Contribution
to
score

Somewhat difficult

2 or 3

Difficult

Many

Easy

No. of observations

Patient data
Previous
venipuncture
history score

x-y table. The x axis of the x-y table translated the projector
image in the x direction, and the y axis adjusted the projector lens to screen distance. A Sentech STC-1000 CCD camera with a 35-mm f / 1.9 Schneider Xenoplan lens was
mounted on two Newport Corporation GON65 Series goniometers. The upper goniometer rotated the camera optical
axis in the y direction, and the lower goniometer rotated the
camera image about its optical axis. The camera-andgoniometer assembly was mounted on a Newport Corporation ULTRAlign model 461-Z-M micrometer-adjusted
linear z-axis slide that translated the camera image in the
vertical direction. The x-y table and the linear z-axis slide,
holding the camera and the projector, respectively, were
mounted on a 1.27-cm-thick, 30.5 45.7-cm aluminum
platform so that the projector and camera were mounted at
right angles to each other and with their optical axes crossing at a point 92.8 mm in front of the thin-lens-equivalent
position of both lenses. A 14.3 10.2-cm, 3-mm-thick hot
mirror with a 45-deg cutoff at 650 nm was mounted on a
Newport Corporation model 36 micrometer-adjustable tilt
and rotation platform with a rotation range of 2.5 deg.
The tilt-and-rotation platform was positioned in front of the
camera and the projector with both the projector optical
axis and the camera optical axis passing through the center
of the front surface of the hot mirror at a 45-deg angle. All
the micrometers were model SM-13 micrometers; they had
0.5-mm-pitch 50.8 TPI threads and read directly in units
of 10 m the finest tick marks, with vernier readings of
1 m. The resulting translation sensitivities for both the
camera and the projector were therefore the same as the
sensitivity of the SM-13 micrometers, while the angular
sensitivities using the vernier readings were 2 arcsec for the
mirror rotation, 4.1 arcsec for the camera y axis, and 2.9
arcsec for the image rotation about its axis. Using the direct
readout, the angular sensitivities were about ten times
poorer. One hundred ELD-740-524 infrared LEDs from
Roithner Lasertechnik, mounted symmetrically around the
camera body, illuminated the field of view. The light emitted by the LEDs was diffused by two LSD20PC10 F10
10/ PSA diffusers from the Physical Optics Corporation,
spaced 75 mm apart to make the illumination very uniform.
The infrared illumination was linearly polarized by a VPGS-12U polarizer from Visual Pursuits, Inc., designed for
polarizing visible light. The light entering the camera lens
was cross-polarized using the same polarizer turned at 90
deg to the LED polarizer. The cross-polarization removed
glare from the camera images.
Optical Engineering

Amount of
subcutaneous fat

Darkness of skin
pigmentation

Age

Phlebotomists
ability to feel vein

Subject score

Vein
poorly
seen

Vein
not
seen

21

20

28

Small

45

Medium

32

Large

41

Light

31

Medium

13

Dark

79

02

34

36

18

7+

71

Can easily feel

70

Can poorly feel

29

123

13

10

Cannot feel
Total subjects

Vein
easily
seen

146

3 Optical Design
The 1 / 3-in. CCD chip in the Sentech camera has 7.4
7.4-m pixels. Since the camera has 640 480 pixels,
the active area of the CCD chip is 4.74 3.55 mm. The
0.7-in. LCD chip in the Infocus projector has 13.89
13.89-m pixels. Since the projector has 1024
768 pixels, the active area of the LCD chip is 14.22
10.67 mm. A 35-mm-focal-length lens is used with the
camera, while a 90-mm-focal-length lens is used with the
projector. The desired field of view of the camera on the
subjects arm is 64 48 mm for a spatial resolution of 0.1
mm. Hence, the demagnification factor of the camera lens
must be 13.51, and the lens-to-arm distance must be 508
mm. For the camera field and the projector image to overlie
correctly over the depth of focus of the camera lens of
about 25.4 mm, the projector lens must also be 508 mm
from the arm. Then the desired 64 48-mm projected image must come from 992 744 pixels on the LCD chip. It

086401-3

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Fig. 3 Top view a and side view b drawings of the prototype VCE
system, showing the precision mechanical stages used to align the
LCD projector with the CCD TV camera. Each adjustment was
made with a micrometer screw with enough precision to align the
projector with the camera to fractional pixel accuracy.
Fig. 2 VCE images of the right hand a and the left hand b of an
11-year-old African American male. The phlebotomist could not feel
any veins in his right hand, and therefore accessed a vein in the left
hand. The VCE clearly visualizes veins in both hands.

is important that such a subset of the full LCD chip be used

for the projected image, so that the automatic alignment
software can correct for small misalignments between the
CCD and LCD chips by moving the 992 744-pixel image
to be projected around on the 1024 768 pixel array of the
LCD chip.
4 Image Processing
The proof-of-principle projector-based VCE system used
software to perform the necessary image-processing operations. The output of the progressive-scan CCD TV camera
was digitized using a Coreco PCVisionPlus 12-bit
progressive-scan video capture card mounted in a Dell Dimension 4600 Pentium IV 2.0-GHz IBM-compatible PC.
Adaptive unsharp-masking edge enhancement was performed using the Intel MMX instructions of the Pentium IV
processor to increase the contrast due to veins. In the adaptive unsharp-masking approach, a smoothed difference image is obtained by subtracting a blurred or smoothed version of the image from the image itself. This smoothed
difference image contains only details present in the acquired camera image and allows for a much higher contrast
increase before the image saturates than is possible in the
acquired camera image without processing. To make the
unsharp-masking procedure adaptive, the degree of contrast
enhancement is varied over the image, with low-contrast
areas enhanced more than high-contrast areas. This adaptive contrast enhancement is achieved by dividing the difference image by a smoothed version of the absolute value
of the difference image. Where the difference image has
large variations, the resulting denominator will be large,
and the final image will have less contrast enhancement at
Optical Engineering

that location. Where the difference image has only small

variations, the denominator will be small, and the contrast
enhancement will be greater.
Adaptive unsharp masking is illustrated in Fig. 4. Figure
4a shows a vein image, acquired on the anterior forearm
of a 22-year-old female subject, using linearly polarized
760-nm LED near-infrared illumination, before adaptive
unsharp edge enhancement is applied. The image in b
shows the image in a after the application of the adaptive
unsharp-masking algorithm. The image in c is the same as
the image in b, but with a vertical line showing the column of image data that will be analyzed in Fig. 4d. The
right traces in Fig. 4d show the data from the column of
image data taken from Fig. 4a jagged line and a
smoothed version of these data smooth line. The smoothing is performed using a 128 128-pixel smoothing kernel.
The middle trace shows the difference between the original
and smoothed data. The left trace shows the result of the
adaptive edge enhancement algorithm. Note that the vein,
the hairs, and the shape of the arm are all enhanced to the
same final contrast in this trace. Figure 4e is a photograph
of the subjects arm using a Nikon Coolpix 950 digital camera with normal visible-light room illumination. Note that
the vein shown in Fig. 4b is almost invisible here. Actually, with the naked eye, this vein was invisible. The digital
camera seems to have a greater contrast sensitivity than the
human eye in this case. Figure 4f is a photograph using
the same digital camera, but with the compact prototype
VCE image projected onto the vein. The projected image is
the same as that shown in Fig. 4b.
The Intel Image Processing Library and Microsoft Visual C Version 6 were used to achieve high performance in the proof-of-principle prototype VCE. The images were processed and displayed at nearly 30 frames/ s
with the software, with smoothing kernel sizes up to 256
pixels.14,20 Using a 2.0-GHz P IV computer with the 160
160 kernel allowed the VCE system to properly enhance

086401-4

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Fig. 4 Adaptive unsharp-masking edge enhancement algorithm. a shows an acquired VGA image of
a superficial vein on the anterior forearm of a 22-year-old female subject, obtained with 760-nm
linearly polarized near-infrared LED illumination. The CCD TV camera has a crossed Polaroid filter
and an infrared transmitting filter that removes light of wavelength shorter than 650 nm. The result of
the adaptive edge enhancement algorithm is shown in b. c shows the enhanced vein image with a
black line to show the column of the image the intensities of which are displayed in d. The right traces
in d are the intensity trace from the original image in a jagged line and the smoothed version of
this intensity trace smooth line. The middle trace is the difference between the original and smoothed
traces. The left trace is the adaptively edge-enhanced trace. e is a photograph taken with a conventional digital camera in visible room illumination. Notice that the vein shown in a is almost invisible in
e. In fact, with the naked eye, this vein is invisible. f is a photograph with the same digital camera
of the same arm with the vein contrast enhancer enhancing the vein. The image in b has been
projected onto the arm in exact alignment with the subjects anatomy.

full-size adult veins even with the high magnification of the

64 48-mm field of view i.e., a 0.1-mm-resolution element. In the compact prototype VCE, the Linux operating
system is used with the Intel Image Processing Library on a
2.6-GHz P IV computer with an 800-MHz front-side bus
and 400-MHz DDR main memory. For this newer system,
full 30-frames/ s performance of the adaptive unsharpmasking algorithm can be achieved with any kernel size
allowed on a 640 480-pixel VGA image.
Optical Engineering

Automatic Alignment

Software was also used to ensure that the vein image was
projected directly on top of the actual veins themselves.
The projector light was colored green with a green filter to
simulate the green LED illuminator and digital light processing DLP display chip that will be used for projecting
in later versions of the VCE, and was directed at a fluorescent screen, which converted the green light to deep red

086401-5

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Fig. 5 The average standard deviation for the x and y coordinates

of the four points, as the radii of the points were increased from 5 to
50 pixels in order to see how much the size of the points would
affect the measuring precision. The standard deviation decreased
rapidly as the point radii increased from 5 to 25 pixels, but stayed
almost constant from 25 to 50 pixels. The pixel radii for the alignment phantom points were therefore chosen to be 25 pixels.

light, which could just be detected by the CCD TV camera

in spite of the infrared-transmitting filter used to remove
visible light. A test pattern consisting of four 25-pixelradius dots located at the corners of a 320 240-pixel
rectangle* centered in the image was projected onto the
screen, and the locations of the dots on the CCD TV camera were measured in order to determine the parameters
needed for the magnification different in the horizontal and
vertical directions, rotation, and translation different in
the horizontal and vertical directions of the vein image in
order to achieve correct alignment with the subjects veins.
The radius of the test-pattern dots was chosen to be 25
pixels after a careful study of the detection accuracy of the
software was performed for dots with radii varying from 5
to 50 pixels. Figure 5 shows the standard deviation of 100
samples, and the standard deviation seems to decrease rapidly from a radius of 5 pixels to a radius of 25 pixels, and
then decreases much more slowly out to a radius of 50
pixels.21
6 Effects of Misalignment
A white-painted Lucite screen was placed in front of the
prototype on a mount that allowed the screen to be positioned at three fixed distances from the prototype: the focus
distance; 25.4 mm closer to the prototype than the focus
distance; and 25.4 mm further away than the focus distance. Figure 6 shows the front of the prototype and the
screen. Two aluminum spacers were used to position the
screen at the three different distances. A software program
was written that projected the four-dot test pattern onto the
screen, captured a camera image of the test pattern, measured the location of the dots, and calculated the average
difference between the x and y positions of the points in the
projected and captured images, as well as the rotation of the
captured image with respect to the projected image. The
program displayed the measured and calculated information
*N.B. These are camera pixels. The camera resolution is 640
480 pixels, while the projector resolution is 1024 768 pixels.
Optical Engineering

Fig. 6 A photograph of the experimental setup for determining the

alignment parameters for the prototype VCE system. The squarecross-section aluminum spacers were used to place the screen at
the focal plane and 25 mm further and closer to the projector and
camera.

on a computer monitor and repeated the measurements every 7 s to allow the effects of translating or rotating the
optical axes to be observed continually. If the projector
image and the camera image overlay exactly at the focal
distance, the average difference between the x and y positions of the points in the projected and captured images
would be zero, and there would be no detectable rotation
angle between the two images. If the prototype is aligned,
the average difference and the rotation angle should remain
zero as the screen is moved back and forth between the two
positions 25.4 mm closer to or further away from the focus
distance. Any measured average difference between the
points would be caused by the optical axes not being parallel. Each translation and rotation stage was calibrated by
first aligning the prototype manually, and then measuring
the average position of the four dots in the test pattern
versus the micrometer position. Once the axes were calibrated, the effects of misalignment were measured. The
software alignment overlies the projector and camera image
very accurately in the focal plane, but if there is a misalignment of the optical axes, there will be an increasing misalignment with an increasing distance away from the focal
plane, as illustrated in Fig. 7. A difference between the
distances from the projector lens to the focal plane and
from the camera lens to the focal plane would also result in
some misalignment.
Each optical axis rotation stage was individually adjusted in a range about its aligned position with the other

Fig. 7 The effect of misalignment of the optical axes. The alignment

software can align the camera and the projector at the focal plane
only. Elsewhere in the region of good focus, the alignment will be
incorrect unless the camera and projector optical axes are collinear.

086401-6

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Fig. 8 The accuracy of the alignment that uses a four-point phantom image was evaluated using a
one-point phantom image. The four-point phantom image has four 50-pixel-diameter points located at
the corners of a 320 240-pixel rectangle, centered in the image. After the alignment routine had
calculated translation, scaling, and rotation parameters, these parameters were applied to an image
containing one point, so that ideally the coordinates of the point in the projected image would be
identical to the measured coordinates in the captured image. The point was projected onto a fluorescent screen, starting with coordinates of x = 45, y = 30. After the coordinates in the captured image were
measured, the point was reprojected with different coordinates. The coordinates of the projected point
were varied systematically in 15-pixel increments in both x and y, to cover essentially the entire image.
The difference between projected and measured x coordinates is shown in the left graph; the difference between projected and measured y coordinates is shown in the right graph. As expected, the
alignment error is lowest near the pixel coordinates of the points in the alignment phantom, where the
difference is close to zero, but even at the extreme edges of the field of view the error is less than 0.8
pixels for both the x and the y coordinates.

two stages in their aligned positions. For each measurement

the image was translated and rotated mechanically until the
camera and projector images were aligned at the focal
plane to simulate software alignment. The recorded misalignments at the 25.4-mm positions were the averages of
five measurements to reduce measurement errors.
7 Results
The software alignment was so accurate that the image
overlay the original object to about half a CCD pixel over
the whole image, as can be seen in Fig. 8. The alignment
was best close to the four dots in the test pattern, but remained remarkably good over the entire image.
Figure 9 shows the effects of misalignment of the CCD
Y axis. The x axis of the graph is the displacement caused
by misalignment, and the y axis is the resulting misalignment at the 25.4-mm positions after the system was
aligned at the focal plane. The automatic software alignment is able to correct for about 90% of the deflection
caused by the misalignment of the CCD Y axis. The average slope of the three measured lines is 0.0928. If the camera were being rotated exactly around the center of the
camera lens, then the 508-mm lens-to-arm distance and the
25.4-mm depth of focus of the lens would imply that the
slope should be 0.1. The slope is slightly less because the
center of rotation is slightly behind the lens.
Figure 10 shows the effects of misalignment of the mirror x axis. The x axis of the graph is the displacement
caused by misalignment, and the y axis is the resulting
misalignment at the 25.4-mm positions after the system
was aligned at the focal plane. The automatic software
alignment is able to correct for about 90% of the deflection
caused by the misalignment of the CCD Y axis, or very
Optical Engineering

similar to that of the CCD y-axis misalignment. The average slope of the three measured lines is 0.1177. If the mirror were located exactly at the camera lens, then the
508-mm lens-to-arm distance and the 25.4-mm depth of
focus of the lens would imply that the slope should be 0.1.
The slope is slightly more because the mirror is obviously
mounted in front of the lens see Fig. 3.
Figure 11 shows the effects of the projector-lens-tofocal-plane distance being changed while the camera-lensto-focal-plane distance remains fixed. The Y displacement
was less than 0.3 pixels for the entire range of adjustments,
while the X displacement increased from 0.6 to 1.4 pixels.
Keeping the projector micrometer position less than 500

Fig. 9 The average misalignment 25 mm from the focal plane when

the y axis is misaligned to deflect the image by the given number of
pixels.

086401-7

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Fig. 10 The average misalignment 25 mm from the focal plane

when the hot mirror is tilted to deflect the image by the given number
of pixels.

keeps the resulting displacement less than one pixel. Thus,

a restriction to 5 mm about the zero position of the micrometer keeps the X displacement within one pixel.
8 The Compact Prototype VCE
Figure 12 shows the new compact prototype VCE being
used to enhance the contrast of antecubital veins on a 47year-old female subject. The optical head of the prototype
was designed and built by Optical Sciences Corp. of Huntsville, AL. The electronics for the optical head and the control interface to the PC were designed and built by Alpha
Beta Technologies in Huntsville, AL. The stand for the
compact prototype was designed and built at the University
of Tennessee out of the focusing column of an LPL photographic enlarger, and the base from a laptop stand. The
compact prototype demonstrates that a projector-based
VCE would be practical for use for clinical practice. The
compact prototype differs from the proof-of-principle prototype in that it uses a Texas Instruments DLP projector
chip instead of LCD chips. It also differs in that it uses a
high-intensity LED green light source for the projector instead of an arc lamp and a green filter. Also, for the compact prototype, the hot mirror is much smaller and is used

Fig. 11 The average misalignment 25 mm from the focal plane

when the projector is translated so that the distance from the projector to the screen was varied the given number of millimeters. The
displacement of the image in the x and y directions is shown.

Optical Engineering

Fig. 12 The compact prototype vein contrast enhancer is used here

to enhance the antecubital veins of a 47-year-old female subject.
These veins are difficult to find in this subject because they are not
visible to the naked eye under normal room illumination. They are
easily visualized with the VCE. The compact prototype VCE is
mounted on a stand that allows precise adjustment of the arm-toprojector distance, enabling exact focus of the projector and
camera.

only to direct light to the CCD TV camera, not to reflect the

infrared LED illumination light. The infrared LEDs are
placed in a ring around the front opening of the camera
head. Both the projector light and the light returning to the
camera pass through this opening.
9 Conclusions
For vein access, having the enhanced vein image projected
onto the patients arm makes actually accessing the vein far
easier than having the enhanced vein image available on a
computer monitor or virtual reality glasses. With the projected image, the phlebotomist does not have to take her
eyes off the patients arm in order to take advantage of the
VCE image. In fact, in our clinical experiments with
monitor-based VCE devices, we have not found a phlebotomist or nurse who was willing to perform an IV access
while looking at a monitor. The monitor image could only
be used to position a finger or a felt tip pen in order to mark
the position of the vein. The access was always performed
looking at the patients arm. However, using a projected
image introduces the problem of having to accurately align
the projected image with the patients anatomy. The results
presented here show that at the focal plane, the automatic
alignment procedure can achieve an alignment accuracy
better than one camera pixel i.e., less than 0.1 mm. The
misalignment measurements show that this high accuracy
can be maintained over the entire depth of focus of the
projector and camera if the mechanical accuracy of the optical system is better than 1 mm at the patients arm for the
angular degrees of freedom and better than 5 mm for
translation along the optical axes. Such positioning accuracy is easy to achieve with modern optical manufacturing
techniques.
Acknowledgments
We would like to acknowledge the support of the Culpeper
Foundation for this research. We would also like to acknowledge the support of the University of Tennessee,
Health Science Center, Center of Excellence in Vascular
Biology. We would like to acknowledge the assistance of
Jack Buchanan, MD, Milton Waner, MD, and Stephen

086401-8

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448

Zeman et al.: Prototype vein contrast enhancer

Shochat, MD, in evaluating the potential of infrared imaging technology for vein contrast enhancement in infants.
We would also like to acknowledge the support and encouragement of Frank A. DiBianca and Mohammad Kiani of
the Department of Biomedical Engineering.
References
1. Pyng Technologies Corp., http://www.pyng.com/pym/products/
problem.htm, Aug. 24, 2001.
2. K. A. Lillis and D. M. Jaffe, Prehospital intravenous access in children, Ann. Emerg. Med. 2112, 14301434 1992.
3. D. D. Brunette and R. Fischer, Intravascular access in pediatric cardiac arrest, Am. J. Emerg. Med. 66, 577579 1988.
4. P. J. Howanitz and R. B. Schifman, Inpatient phlebotomy practices.
A College of American Pathologists Q-Probes quality improvement
study of 2,351,643 phlebotomy requests, Arch. Pathol. Lab Med.
1186, 601605 1994.
5. J. C. Dale and D. A. Novis, Outpatient phlebotomy success and
reasons for specimen rejection, Arch. Pathol. Lab Med. 1264, 416
419 2002.
6. L. Chameides and M. Hazinski, Textbook of Pediatric Advanced Life
Support, American Heart Association 1994.
7. HealthAnswers Inc., http://health.discovery.com/diseasesandcond/
encyclopedia/2938.html Jul. 19, 2002.
8. M. Stovroff and W. G. Teague, Intravenous access in infants and
children, in Pediatric Surgery for the Primary Care Pediatrician,
Part II, M. G. Caty, M. S. Irish, and P. L. Glick, Eds., pp. 13731393,
W.B. Saunders, Philadelphia 1998.
9. Auckland District Health Board, http://www.adhb.co.nz/akhdem/
Guidelines/intraosseus access.htm Feb. 13, 2003.
10. B. W. Davies, Venous cutdown and intraosseous infusion, Update
in Anaesthesia, Issue 5 1995, Article 3; http://www.nda.ox.ac.uk/
wfsa/html/u05/u05 005.htm Feb. 13, 2003.
11. J. P. Orlowski, Emergency alternatives to intravenous access, in
Pediatric Critical Care, J. P. Orlowski, Ed., pp. 11831199, W.B.
Saunders, Philadelphia 1994.
12. M. W. L. Gauderer, Vascular access techniques and devices in the
pediatric patient, in Pediatric Surgery, H. C. Filston, Ed., pp. 1267
1284, W.B. Saunders, Philadelphia 1992.
13. G. Lovhoiden, H. Deshmukh, and H. D. Zeman, Clinical evaluation
of vein contrast enhancement, in Biomedical Optics, Proc. SPIE
4615, 6170 2002.
14. G. Lovhoiden, H. Deshmukh, C. Vrancken, Y. Zhang, H. D. Zeman,
and D. Weinberg, Commercialization of vein contrast enhancement, in Biomedical Optics, Proc. SPIE 4958, 189200 2003.
15. H. D. Zeman, Contrast enhancing illuminator, U.S. Patent No.
5,969,754 1999.
16. H. D. Zeman, Diffuse infrared light imaging system, U.S. Patent
No. 6,556,858 2003.
17. H. D. Zeman and G. Lovhoiden, Enhancing the contrast of subcutaneous veins, Proc. SPIE, 3595, 219230 1999.
18. H. D. Zeman, G. Lovhoiden, and H. Deshmukh, Optimization of
subcutaneous vein contrast enhancement, Proc. SPIE, 3911, 5057
2000.
19. H. D. Zeman, G. Lovhoiden, and H. Deshmukh, Design of a clinical
vein contrast enhancing projector, Proc. SPIE 4254, 204215
2001.
20. C. Vrancken, Image processing software for vein contrast enhancement, Master Project Report, Univ. of Tennessee, Health Science
Center 2003.
21. Y. Zhang, Automatic image alignment for the vein contrast enhancement system, Master Project Report, Univ. of Tennessee, Health
Science Center 2002.
Herbert D. Zeman is the chief research officer CRO at Luminetx Corp. Dr. Zeman
invented the Vein Viewer technology and
founded Conenhill Biomedics, which is now
called Luminetx. As CRO, he leads research efforts of the company. Dr. Zeman
received masters and doctoral degrees in
physics from Stanford University. He also
was awarded a post doctoral fellowship at
the Physikalisches Institut der Universitt
Mnster, Mnster, Germany. Dr. Zeman has
held positions at the Molecular Physics Center, SRI International,
Menlo Park, CA; the High Energy Physics Laboratory, Stanford University, Stanford, CA; Xerox Medical Systems, Advanced Imaging

Optical Engineering

Area, Palo Alto, CA; Brookhaven National Laboratory, National Synchrotron Light Source, Upton, NY; and the University of Tennessee
Health Science Center, Department of Biomedical Engineering,
Memphis, TN. Dr. Zeman has published over 80 papers in the fields
of medical imaging and atomic, molecular, and high-energy physics.
He holds three patents in medical imaging, two of which have been
transferred to Luminetx Corp. A fourth patent application has just
been submitted by the University of Tennessee, and Luminetx holds
an option for an exclusive license.
Gunnar Lovhoiden is the director of engineering, Luminetx Corp. Dr. Lovhoiden
worked with Dr. Zeman on the development
of the vein-viewer technology from its inception. As director of engineering, he works
with Dr. Zeman on the research and development of the vein-viewer technology. Dr.
Lovhoiden received his masters and doctoral degrees in biomedical engineering,
with Dr. Zeman as his research advisor, at
the University of Tennessee Health Science
Center in Memphis, TN. After his masters degree, Dr. Lovhoiden
spent one year at Brookhaven National Laboratory collaborating
with Dr. Kelvin Lynn at BNL and Dr. Zeman at UT. He then spent
three years teaching engineering technology at Andrews University
in Berrien Springs, Michigan. After his doctoral degree, Dr.
Lovhoiden spent another year teaching at Andrews University before returning to Memphis to join Luminetx Corp. Dr. Lovhoiden
played a key role in developing the proof-of-principle vein-viewer
device. He has published 16 papers in medical imaging ranging in
subject matter from vein imaging to bone densitometry to dualenergy x-ray imaging of contrast agents.
Carlos Vrancken is the director of software
development at Luminetx Corp. Mr.
Vrancken received his undergraduate degree in biomedical engineering from Universidad Nacional de Entre Rios in Argentina,
and his Master of Science in biomedical engineering from the University of Tennessee
Health Science Center in Memphis, TN.
While at the University of Tennessee he
worked on the project that created the realtime image-processing software for the
vein-viewer device. He has since joined Luminetx as the Director of
Software Development and works with Dr. Zeman on the design,
development, and implementation of all the software applications,
including the image processing algorithms and the human interface
used in the vein viewer. Mr. Vrancken has published four papers on
the vein-viewer technology in addition to his masters thesis.
Robert K. Danish is an Associate Professor of Pediatrics at the University of Tennessee Health Science Center, Memphis, TN.
He received his MD degree from Hahnemann Medical College, Philadelphia, PA. He
did his pediatric residency training at St.
Christophers Hospital for Children in Philadelphia, and a USPHS-NIH research fellowship in pediatric endocrinology at Johns
Hopkins University School of Medicine, Baltimore, MD. He was on the faculty of Case
Western Reserve University School of Medicine and MetroHealth
Medical Center, Cleveland, OH for 22 years before moving to Memphis. He serves as a Pediatric Endocrinologist at Le Bonheur Childrens Medical Center and St. Jude Childrens Research Hospital.
His areas of interest are endocrine system and bone changes in
childhood cancer, acute changes in water and solute balance in
children with severe diabetic ketoacidosis, and development of biomedical engineering devices for the clinical setting and evaluation of
their usefulness in human subjects.

086401-9

Downloaded From: http://opticalengineering.spiedigitallibrary.org/ on 01/20/2013 Terms of Use: http://spiedl.org/terms

August 2005/Vol. 448