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Biomedical Instrumentation

A. Intro & ECG


B18/BME2 Dr Gari Clifford (Based on slides from Prof. Lionel Tarassenko)

Biomedical Instrumentation B18/BME2

Who am I?

UL in Biomed Eng Dir CDT in Healthcare Innovation @ IBME Signal Processing & Machine Learning for Clinical Diagnostics mHealth for Developing Countries Low Cost Electronics EWH / OxCAHT
Biomedical Instrumentation B18/BME2

Vital signs monitoring Clinical need


Every day, people die unnecessarily in hospitals 20,000 unscheduled admissions to Intensive Care p.a. 23,000 avoidable in-hospital cardiac arrests per annum Between 5% and 24% of patients with an unexpected cardiac arrest survive to discharge Vital sign abnormalities observed up to 8 hours beforehand in >50% of cases

Biomedical Instrumentation B18/BME2

Identifying at-risk patients

Acutely ill patients in hospital (e.g. in the Emergency Dept) have their vital signs (heart rate, breathing rate, oxygen levels, temperature, blood pressure) continuously monitored but
Patient monitors generate very high numbers of false alerts (e.g. 86-95% of alarms - MIT studies in 97 & 06) Nursing staff mostly ignore alarms from monitors (alarm noise), apart from the apnoea alarm, and tend to focus instead on checking the vital signs at the time of the 4-hourly observations
Biomedical Instrumentation B18/BME2

Continuous bedside monitoring in Emergency Department

Biomedical Instrumentation B18/BME2

Course Overview
1. The Electrocardiogram (ECG) 2. The Electroencephalogram (EEG) 3. Respiration measurement using Electrical Impedance Plethysmography/Pneumography 4. Oxygen Saturation using Pulse Oximetry

5. Non-invasive Blood Pressure


Biomedical Instrumentation B18/BME2

Course text books

Biomedical Engineering Handbook, Volume I, 2nd Edition, by Joseph D. Bronzino (Editor), December 1999, ISBN: 0-849-30461-X Medical Instrumentation: Application and Design, 3rd Edition, by John G. Webster (Editor), December 1997, ISBN: 0-471-15368-0

Biomedical Instrumentation B18/BME2

Relevant lecture notes

OP-AMP CIRCUITS Year 1, pages 1 to 42


FILTER CIRCUITS Year 1, pages 1 to 15

INSTRUMENTATION Year 2, pages 1 to 4, 17-18, 22 to 28 and 38 to 52.


Please e-mail val.mitchell@eng.ox.ac.uk if you would like copies of the above. Course website: http://www.robots.ox.ac.uk/~gari/teaching/b18/
Biomedical Instrumentation B18/BME2

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(You can use laptops etc to take notes, just dont check your email.)

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B18 (Undergrad)
Question sheet 1: three sessions, 9 a.m. - noon on Friday of Week 7, in LR4 Question sheet 2: three sessions 9 a.m. - noon on Friday of Week 8, in LR4

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Biomedical Instrumentation B18/BME2

Biomedical Instrumentation 1. The Electrocardiogram (ECG)

Biomedical Instrumentation B18/BME2

The Electrocardiogram

If two surface electrodes are attached to the upper body (thorax), the following electrical signal will be observed:

This is the electrocardiogram or ECG


Biomedical Instrumentation B18/BME2

The origin of the ECG

Atrial and ventricular contractions are the result of carefully timed depolarisations of the cardiac muscle cells

The timing of the heart cycle depends on:


Stimulus from the pacemaker cells Propagation between muscle cells Non-excitable cells Specialised conducting cells (Atrio-Ventricular Node)

Biomedical Instrumentation B18/BME2

Important specific structures


Sino-atrial node = pacemaker (usually) Atria After electrical excitation: contraction Atrioventricular node (a tactical pause) Ventricular conducting fibers (freeways) Ventricular myocardium (surface roads) After electrical excitation: contraction

Biomedical Instrumentation B18/BME2

Excitation of the Heart

Biomedical Instrumentation B18/BME2

Excitation of the Heart

Biomedical Instrumentation B18/BME2

Cardiac Electrical Activity

Putting it al together:

Biomedical Instrumentation B18/BME2

Approximate model of ECG

To a first approximation, the heart can be considered to be an electrical generator. This generator drives (ionic) currents into the upper body (the thorax) which can be considered to be a passive, resistive medium Different potentials will be measured at different points on the surface of the body
Biomedical Instrumentation B18/BME2

Recording the ECG


P1 RT1

P1
RP

RA

P2

LA RT2

P2
RL

LL

Points P1 and P2 are arbitrary observation points on the torso; RP is the resistance between them, and RT1 , RT2 are lumped thoracic medium resistances.
.

Biomedical Instrumentation B18/BME2

Typical ECG signal

Biomedical Instrumentation B18/BME2

Components of the ECG waveform


P-wave: a small low-voltage deflection caused by the depolarisation of the atria prior to atrial contraction.
QRS complex: the largest-amplitude portion of the ECG, caused by currents generated when the ventricles depolarise prior to their contraction.

Biomedical Instrumentation B18/BME2

Components of the ECG waveform


T-wave: ventricular repolarisation.
P-Q interval: the time interval between the beginning of the P wave and the beginning of the QRS complex.

Q-T interval: characterises ventricular repolarisation.

Biomedical Instrumentation B18/BME2

Recording the ECG

To record the ECG we need a transducer capable of converting the ionic potentials generated within the body into electronic potentials Such a transducer is a pair of electrodes and are:

Polarisable (which behave as capacitors) Non-polarisable (which behave as resistors) Both; common electrodes lie between these two extremes

The electrode most commonly used for ECG signals, the silver-silver chloride electrode, is closer to a nonpolarisable electrode.

Biomedical Instrumentation B18/BME2

Silver-silver chloride electrode


Electrodes are usually metal discs and a salt of that metal. A paste is applied between the electrode and the skin. This results in a local solution of the metal in the paste at the electrode-skin interface. Some of the silver dissolves into solution producing Ag+ ions: Ag Ag+ + eIonic equilibrium takes place when the electrical field is balanced by the concentration gradient and a layer of Ag+ ions is adjacent to a layer of Cl- ions.
Biomedical Instrumentation B18/BME2

Electrode-electrolyte interface
e-

Electrode
eeAg Ag Ag Ag

Ag+ Ag+ ClAg+ ClAg+ Cl-

Current I

Cl-

Gel

Illustrative diagram of electrode-electrolyte interface in case of Ag-AgCl electrode


Biomedical Instrumentation B18/BME2

Silver-silver chloride electrode


Electrodes are usually metal discs and a salt of that metal. A paste is applied between the electrode and the skin. This results in a local solution of the metal in the paste at the electrode-skin interface. Ionic equilibrium takes place when the electrical field is balanced by the concentration gradient and a layer of Ag+ ions is adjacent to a layer of Cl- ions. This gives a potential drop E called the half-cell potential (normally 0.8 V for an Ag-AgCl electrode)

Biomedical Instrumentation B18/BME2

Silver-silver chloride electrode

Electrode
Ag+ ClAg+ ClAg+ ClAg+ ClAg+ ClAg+ ClAg+ Cl-

Gel

Skin

Ag Ag+ + e-

The double layer of charges also has a capacitive effect. Since the Ag-AgCl electrode is primarily non-polarisable, there is a large resistive effect. This gives a simple model for the electrode. However, the impedance is not infinite at d.c. and so a resistor must be added in parallel with the capacitor.

Biomedical Instrumentation B18/BME2

Silver-silver chloride electrode


The double layer of charges also has a capacitive effect. Since the Ag-AgCl electrode is primarily non-polarisable, there is a large resistive effect. This gives a simple model for the electrode. However, the impedance is not infinite at d.c. and so a resistor must be added in parallel with the capacitor.

Biomedical Instrumentation B18/BME2

The Overall Model

The resistors and capacitors may not be exactly equal. Half cell potentials E and E' should be very similar. Hence V should represent the actual difference of ionic potential between the two points on the body where the electrodes have been placed.

Biomedical Instrumentation B18/BME2

Electrode placement
VI = (potential at LA) (potential at RA) VII = (potential at LL) (potential at RA) VIII = (potential at LL) (potential at LA) The right leg is usually grounded (but see later)

Biomedical Instrumentation B18/BME2

ECG Amplification

Problems in ECG amplification

The signal is small (typical ECG peak value ~1mV) so amplification is needed Interference is usually larger amplitude than the signal itself
Biomedical Instrumentation B18/BME2

1st Problem: Electric Field Interference

Capacitance between power lines and system couples current into the patient This capacitance varies but it is of the order of 50pF (this corresponds to 64M at 50Hz ... recall Xc=1/C ) If the right leg is connected to the common ground of the amplifier with a contact impedance of 5k, the mains potential will appear as a ~20mV noise input.
the 50 Hz interference is common to both measuring electrodes ! (common mode signals)

Electrical power system

50 pF

RA

LA

RL

LL

5k

Biomedical Instrumentation B18/BME2

The solution

The ECG is measured as a differential signal. The 50Hz noise, however, is common to all the electrodes.

It appears equally at the Right Arm and Left Arm terminals.

Rejection therefore depends on the use of a differential amplifier in the input stage of the ECG machine. The amount of rejection depends on the ability of the amplifier to reject common-mode voltages.
Biomedical Instrumentation B18/BME2

Common Mode Rejection Ratio (CMRR)

vin= vcm+ vd

Ad & Acm

vout= Acmvcm + Advd

CMRR = Ad / Acm
(ratio of differential gain to common mode gain)
Biomedical Instrumentation B18/BME2

Three Op-Amp Differential Amplifier

Biomedical Instrumentation B18/BME2

Three Op-Amp Differential Amplifier


Ad1 =
' v1' v1 v1 v 2 v 2 v 2 i R2 R1 R2

v1' (1
.
' 2

R2 R )v1 2 v 2 R1 R1

R2 R2 v (1 )v 2 v1 R1 R1 2 R2 v v (v 2 v1 )(1 ) R1
' 2 ' 1

2 R2 Ad1 = 1 R1
Biomedical Instrumentation B18/BME2

Three Op-Amp Differential Amplifier


Ad1 =
' v1' v1 v1 v 2 v 2 v 2 i R2 R1 R2

v1' (1
' 2

R2 R )v1 2 v 2 R1 R1

R2 R2 v (1 )v 2 v1 R1 R1 2 R2 v v (v 2 v1 )(1 ) R1
' 2 ' 1

When v1 = v2 = vcm, Acm = 1


Biomedical Instrumentation B18/BME2

Three Op-Amp Differential Amplifier


Ad1 =
' v1' v1 v1 v 2 v 2 v 2 i R2 R1 R2

v1' (1
' 2

R2 R )v1 2 v 2 R1 R1

R2 R2 v (1 )v 2 v1 R1 R1 2 R2 v v (v 2 v1 )(1 ) R1
' 2 ' 1

CMRR is product of CMRR for each input amplifier

CMRR =

Ad 1 . Ad 2 Acm1 . Acm 2

Biomedical Instrumentation B18/BME2

2nd problem: Magnetic Induction

Current in magnetic fields induces voltage in the loop formed by patient leads
RA LA

The solution is to minimise the coil area (e.g. by twisting the lead wires together)

RL

LL

Biomedical Instrumentation B18/BME2

3rd problem: Source impedance unbalance

If the contact impedances are not balanced (i.e. the same), then the bodys common-mode voltage will be higher at one input to the amplifier than the other.

Biomedical Instrumentation B18/BME2

3rd problem: Source impedance unbalance

If the contact impedances are not balanced (i.e. the same), then the bodys common-mode voltage will be higher at one input to the amplifier than the other. Hence, a fraction of the common-mode voltage will be seen as a differential signal.

see problem on example sheet

Biomedical Instrumentation B18/BME2

Summary

Output from the differential amplifier consists of three components:

The desired output (ECG) Unwanted common-mode signal because the common-mode rejection is not infinite Unwanted component of common-mode signal (appearing as pseudo-differential signal at the input) due to contact impedance imbalance

Biomedical Instrumentation B18/BME2

Driven right-leg circuitry

The common-mode voltage can be controlled using a Driven right-leg circuit. A small current (<1A) is injected into the patient to equal the displacement currents flowing in the body.

Biomedical Instrumentation B18/BME2

Driven right-leg circuitry


LA

+
A1

R2 Ra

RA

LA
R1

A4

+
Ra R2 RA

A2

RL

LL
RL

R0

Biomedical Instrumentation B18/BME2

Driven right-leg circuitry

Biomedical Instrumentation B18/BME2

Driven right-leg circuitry

The common-mode voltage can be controlled using a Driven right-leg circuit.

A small current (<1A) is injected into the patient to equal the displacement currents flowing in the body. The body acts as a summing junction in a feedback loop and the common-mode voltage is driven to a low value. This also improves patient safety (R0 is v. large see notes).

Biomedical Instrumentation B18/BME2

Other patient protection


(Defib Protection) Isolation Filtering Amplification Anti-alias filtering Digitization

Biomedical Instrumentation B18/BME2

Static defibrillation protection

For use in medical situations, the ECG must be able to recover from a 5kV, 100A impulse (defibrillation) Use large inductors and diodes

Biomedical Instrumentation B18/BME2

Patient Isolation

Opto-isolators

DC-DC Converters

Biomedical Instrumentation B18/BME2

RF Shielding & Emissions

Electromagnetic compatibility (EMC)

the ability of a device to function (a) properly in its intended electromagnetic environment, and (b) without introducing excessive EM energy that may interfere with other devices

Electromagnetic disturbance (EMD)

any EM phenomenon that may degrade the performance of equipment, such as medical devices or any electronic equipment. Examples include power line voltage dips and interruptions, electrical fast transients (EFTs), electromagnetic fields (radiated emissions), electrostatic discharges, and conducted emissions

Electromagnetic interference (EMI)

degradation of the performance of a piece of equipment, transmission channel, or system (such as medical devices) caused by an electromagnetic disturbance

Electrostatic discharge (ESD)

the rapid transfer of electrostatic charge between bodies of different electrostatic potential, either in proximity in air (air discharge) or through direct contact (contact discharge)

Emissions

electromagnetic energy emanating from a device generally falling into two categories: conducted and radiated. Both categories of emission may occur simultaneously, depending on the configuration of the device

Biomedical Instrumentation B18/BME2

Testing

Biomedical Instrumentation B18/BME2

Electrical safety
(from Lecture B)

Physiological effects of electricity:

Electrolysis
Neural stimulation Tissue heating

Biomedical Instrumentation B18/BME2

Electrolysis

Electrolysis takes place when direct current passes through tissue.

Ulcers can be developed, for example if a d.c. current of 0.1 mA is applied to the skin for a few minutes.
IEC601 limits the direct current (< 0.1 Hz) that is allowed to flow between a pair of electrodes to 10 A.
Biomedical Instrumentation B18/BME2

Neural stimulation

An action potential occurs if the normal potential difference across a nerve membrane is reversed for a certain period of time. This results in a sensation of pain (if sensory nerve has been stimulated) or muscle contraction (if motor nerve has been simulated).
Biomedical Instrumentation B18/BME2

Hazards of neural stimulation


The effects of neural stimulation depend on the amplitude and frequency of the current, as well as the location of the current injection.

If the current is injected through the skin, 75 mA 400 mA at 50 Hz can cause ventricular fibrillation.
Beware: under normal (dry) conditions, the impedance of the skin at 50 Hz is usually between 10 k and 100 k; if the skin is wet, the impedance can be 1 k or less.

If the current is directly applied to the heart wall (e.g. failure of circuitry in a cardiac catheter), 100A can cause ventricular fibrillation.
Biomedical Instrumentation B18/BME2

Tissue heating

The major effect of high-frequency (> 10 kHz) electrical currents is heating. The local effect depends on the current amplitude and frequency as well as the length of exposure.
Think about your mobile phone usage
Biomedical Instrumentation B18/BME2

Electricity can also be good for you

Electrical shock is also applied to patients in clinical practice for therapeutic purposes.

These applications make use of the neural stimulation effect:


Pacemakers (to stimulate the heart) Defibrillators (to stop ventricular fibrillation) Implantable Stimulators for Neuromuscular Control (to help paralysed patients regain some neuromuscular control).
Biomedical Instrumentation B18/BME2

Electricity can also be good for you

Biomedical Instrumentation B18/BME2