Assessment of bioimpedance spectroscopy devices: a comparative study and error analysis of gold-plated copper electrodes

Objective. Bioimpedance spectroscopy (BIS) is a non-invasive diagnostic tool to derive fluid volume compartments from frequency dependent voltage drops in alternating currents by extrapolating to the extracellular resistance (R 0) and intracellular resistance (R i). Here we tested whether a novel BIS device with reusable and adhesive single-use electrodes produces results which are (in various body positions) equivalent to an established system employing only single-use adhesive electrodes. Approach. Two BIS devices ('Cella' and the 'Body Composition Monitor' [BCM]) were compared using four dedicated resistance testboxes and by measuring 40 healthy volunteers. In vivo comparisons included supine wrist-to-ankle (WA) reference measurements and wrist-to-wrist (WW) measurements with pre-gelled silver/silver-chloride (Ag/AgCl) electrodes and WW measurements with reusable gold-plated copper electrodes. Main results. Coefficient of variation were <1% for all testbox measurements with both BIS devices. Accuracy was within +/- 1% of true resistance variability, a threshold which was only exceeded by the Cella device for all resistances in a testbox designed with a low R 0/R i ratio. In vivo, WA-BIS differed significantly between BIS devices (p < 0.001). Reusable WW electrodes exhibited larger resistances than WW-BIS with Ag/AgCl electrodes (R 0: 738.36 and 628.69 omega; R i: 1508.18 and 1390 omega) and the relative error varied from 7.6% to 31.1% (R 0) and -15.6% to 37.3% (R i). Significance. Both BIS devices produced equivalent resistances measurements but different estimates of body composition both in silico and in WA setups in vivo, suggesting that the devices should not be used interchangeably. Employing WW reusable electrodes as opposed to WA and WW measurement setups with pre-gelled Ag/AgCl electrodes seems to be associated with measurement variations that are too large for safe clinical use. We recommend further investigations of measurement errors originating from electrode material and current path.