On the Origin of the Photoplethysmography Signal: Modeling of Volumetric and Aggregation Effects

Abstract

This study aimed to examine the mechanisms of the photoplethysmography (PPG) signal formation using Monte Carlo simulations of light transport in biological tissues and experimental observations. Based on a three-layer skin model in backscattering geometry, we sequentially simulated volumetric blood changes and the aggregation/disaggregation of erythrocytes in the dermal layer and estimated their contribution to the registered PPG signal. The calculations were conducted for two wavelengths: 525 nm and 810 nm. For green light, absorption predominates over scattering in the formation of a PPG signal, whereas, for near-infrared light, scattering prevails over absorption. This theoretical result was verified using the Modified Beer–Lambert law and clinical in vivo PPG data of seven healthy subjects. Changes in the size of the scatterers during erythrocyte aggregation and disaggregation can significantly contribute to the PPG signal at near-infrared light. Thus, for the green waveband, the classical volumetric model can be considered dominant in the PPG signal formation. In contrast, for the near-infrared range, both volumetric and aggregation effects must be considered as being approximately equal.