Possible Error in Reflection Pulse Oximeter Readings as a Result of Applied Pressure

Pulse oximetry is one of the most widely used techniques in modern medicine. In pulse oximetry, photoplethysmography (PPG) signals are measured at two different wavelengths and converted into the parameter Gamma, which is used to calculate the oxygen saturation of arterial blood. Although most pulse oximetry sensors are based on transmission geometry, the reflection mode is required for different form factors such as the forehead or wrists. In reflection oximetry, local pressure is applied to the measurement surface. We investigated the relationship between applied pressure and Gamma and found that for the reflection mode, Gamma tends to increase with increasing applied pressure. To explain this, we described the PPG signal in terms of two alternative models: a volumetric model and a Scattering-Driven Model (SDM). We assumed that the application of external pressure results in a decrease in local blood flow. We showed that only SDM correctly qualitatively describes Gamma as a function of the decrease in blood flow. We concluded that both described models coexist and that the relative influence of each depends on the measurement geometry and blood perfusion in the skin.