New insights into the origin of remote PPG signals in visible light and infrared

Remote photoplethysmography (PPG) is an optical measurement technique with established applications in vital signs monitoring. Recently, the consensual understanding of blood volume variations (BVVs) as the origin of PPG signals was challenged, raising validity concerns about the remote SpO₂ methodology. Recognizing the imperative for new opto-physiological evidence, this investigation supports the volumetric hypothesis with living skin experiments and Monte Carlo simulations of remote PPG-amplitude in visible light (VIS) and infrared (IR). Multilayered models of the skin were developed to simulate the separate contributions from skin layers containing pulsatile arterioles to the PPG signal in the 450-1000 nm range. The simulated spectra were qualitatively compared with observations of the resting and compressed finger pad, and complemented with videocapillaroscopy. Our results indicate that remote PPG systems indeed probe arterial blood. Green wavelengths probe dermal arterioles while red-IR wavelengths also reach subcutaneous BVVs. Owing to stable penetration depths, the red-IR diagnostic window promotes the invariance of SpO₂ measurements to skin non-homogeneities.