Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 1 Biopotential Amplifiers
These are very important part of modern medical instrumentation
We need to amplify biopotentials which are generated in the body at low levels with a high source impedance
Biopotentials amplifiers are required to increase signal strength while maintaining fidelity
Basic Requirements of Biopotential Amplifiers Essential functions of a bioamplifier are: To take a weak biopotential and increase its amplitude so that it can be processed, recorded or displayed
To amplify voltage, but it could be considered as a power amplifier as well
To amplify current since in some cases a biopotential amplifier is used to isolate the load from the source current gain only
Input Impedance (Z in ) All biopotential amplifiers must have high input impedance minimize loading (remember the characteristics of biopotential electrodes resulting into loading and distortion if input impedance of the amplifier is not high enough) typical values of Z in over the frequency range of the measurand = 10 M (remember the loading rule)
Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 2 Protection & Isolation The input circuit of a biopotential amplifier must provide protection to the live measurand
V bio
Any potential or current at amplifiers input terminals can affect V bio
Electric currents produced by the biopotential amplifier can result in microshock and macroshock
The bioamplifier must have isolation and protection circuitry so that the current through the electrodes can be kept at safe levels and any artifact generated by such current can be minimized
Output Impedance (Z out ) The output circuit does not present any critical problems, all it needs to do is to drive the load Output impedance must be low with respect to the load impedance and it must be capable of satisfying the power requirements of the load
R out
V in R in A . V in R load
Bioamplifier
Bioamplifier ~ Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 3 Bandwidth (BW) Frequency response requirements The biopotential amplifier must be sensitive to important frequency components of the biosignal Since biopotentials are low level signals, it is important to limit bandwidth optimize signal-to-noise ratio
Gain (G) Biopotential amplifiers have a gain of 1000 or greater
Mode of Operation Very frequently biosignals are obtained from bipolar electrodes
Electrodes symmetrically located with respect to ground need differential amplification
High CMRR required because: 1. Common mode signals much greater than the biosignal appear on bipolar electrodes
2. Symmetry with respect to ground is not perfect (mismatch between electrode impedances) more on this later
Calibration Signal Medical and clinical equipment require quick calibration The gain of the biopotential amplifier must be calibrated to provide us with an accurate indication of the signals amplitude Push button to apply standard signal to the input of the biopotential amplifier Adjustable gain switch carefully selects calibrated fixed gains (in microprocessorbased systems, gain adjustment can be achieved by software setting) Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 4 Electrocardiography A very widely used medical instrument, which is utilized to diagnose and monitor cardiac beat abnormalities is the electrocardiograph It measures the electrical activity of the heart (more precisely biopotential differences arising from the electrical activity of myocardium). Weve already talked about the genesis of the ECG signal. The ECG machine uses surface electrodes and high input impedance Differential amplifiers with good common mode rejection ratio to record the electrocardiogram Normal ECG amplitude ranges between 0.5-4 mV. Normal frequency content of ECG (for diagnostic purposes) is 0.05-100 Hz. A typical ECG waveform is shown below:
Obviously all human hearts are not the same and this leads into variability in different parts of the ECG signal Significant diagnostic features of the ECG signal are: Duration of component parts of the signal Polarities and magnitudes The details of the ECG signal and the degree of variability in different parts of the ECG signal is shown below: Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 5 The QRS amplitude, polarity, time duration, the RR interval (indicator of heartbeat per min.) and the T-wave amplitude are some very important and distinctive features of the ECG signal. The heart rate in BPM = Beats Per Minute) is simply = 60 (RR interval in seconds) Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 6 Some ECG waveform abnormalities that may indicate illness are: An extended PR interval may be diagnosed as AV node block
A widening of the QRS complex may indicate conduction problems in the bundle of His
An elevated ST segment may indicate occurrence of myocardial Infarction (MI)
A negative polarity in the T wave may be due to coronary insufficiency
ECG Leads Normal ECG recordings for the standard lead connections leads I, II and III (Lead II provides the strongest signal)
Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 7 Obviously, all human hearts are not the same and this results into a high degree of variability Note the degree of variability of different parts of the ECG signal Some abnormalities that may indicate illness: An extended P-R interval may be diagnosed as AV node block Widening of the QRS complex conduction problems in the bundle of His Elevated ST segment may indicate occurrence of MI Negative polarity T wave may be due to coronary insufficiency QRS amplitude, polarity, time domain, PR interval (indicator of heat beat per min. & T-wave amplitude are some very important distinctive features. 1. Loss of P-wave (un-coordinated twitching) 2. Atria undergoing very rapid regular flapping movement 3. An irritable focus discharge in the ventricle (Extrasystole) 4. Loss of QRS blood circulation, severely impaired lots of ectopic foci Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 8 Origin of the ECG signal We have already covered this concept extensively in the previous lectures (The Dipole filed of the heart, the Eindhovens Triangle, the electrical circuit model for the electrocardiographic problem, etc.)
Standard Limb Leads (I, II, III)
The lead wires are color-coded according to some conventions. One example is: White RA (Right Arm), Black LA (Left Arm), Green RL (Right Leg), Red LL (Left Leg), and Brown C (Chest) Note: There is a CM (common mode) amplifier connected to the right leg. We will discuss this in detail later. Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 9 Augmented Limb Leads These leads offer a free 50% increase over leads VR, VL, and VF connections (unipolar leads) with respect to Wilson terminal AV R = -I III/2, AV L = I II/2, aV F = II I/2
Note: Each measurement is made from the reflected limb and the average of the other two limbs. Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 10 Chest Leads (Precordial) Chest Lead Anatomical Positions V 1 - 4 th intercostal space Right sternal margin V 2 - 4 th intercostal space Left sternal margin V 3 Midway between V 2 & V 4
V 4 5 th intercostal space on mid-clavicular line V 5 Same as V4, on the anterior axillary line V 6 Same as V5, on the mid-axillary line
Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 11 12 Lead Clinical Electrocardiography
Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 12 The ECG Machine Most representative Specs: Z in = 10 M Frequency response = 0.05 100 Hz Strip Chart Recorder Speed = 25 mm/sec. Fast Speed = 100 mm/sec. For detailed Specs. Refer to the Table in your text Summary of performance requirements for electrocardiographs
Block Diagram of a modern electrocardiograph Sensing Electrodes Lead-fail Detector Amplifier Protection Circuit A Lead Selector Driven Right-leg Circuit Right leg Electrode
Keyboard Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 13 Problems frequently encountered in electrocardiography There are many factors that must be considered in the design & application of the ECG machine
These considerations should address the common problems in electrocardiography
The more common problems are: Frequency distortion Saturation or cut-off distortion Ground loops Open lead wires Artifact from large electric transients Interference from electric devices Other sources of electric interference Lets go through these problems carefully and focus on some of their causes.
Frequency distortion If the ECG machine does not meet the frequency response requirements for amplification of the ECG signal, frequency distortion occurs a. True ECG b. High frequency distortion due to inadequate gain of ECG amplifier at high frequencies Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 14 c. Low frequency distortion due to inadequate gain of ECG amplifier at low frequencies Note: In high frequency distortion, the corners are rounded off and the amplitude of the QRS is diminished In low frequency distortion, the baseline gets distorted and monophasic waves appear to be more biphasic
Saturation or cutoff distortion This type of distortion occurs if there are high offset voltages at the electrodes or the amplifiers in the ECG machine are improperly adjusted.
a. Undistorted ECG recording b. Clipping of peak of the ECG due to positive saturation effects in amplifier c. Clipping of lower voltages in the ECG due to negative saturation or cutoff effects in amplifier
Note: In saturation distortion, the combination of the ECG signal and offset voltages drives the amplifier into saturation. As a result the QRS peaks are cutoff because the output of the amplifier can not exceed the saturation voltage Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 15 In cutoff distortion, the lower portions of the ECG are cutoff (clipped). Ground loops
Ground loops can arise when patients having their ECGs taken on either a clinical ECG machine or on a cardiac monitor are also connected to other pieces of apparatus
Each electric device has its own ground connection either through the power line or in some cases through a heavy ground wire attached to some ground point in the room Ground loop currents may present a safety problem Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 16 They elevate the patients body potential to some voltage above the lowest ground to which the instrumentation is attached (ground A in the figure)
This potential produces common mode voltages that may increase the amount of interference seen if the CMRR of the device is not high enough
In electrocardiographs the ground leads usually run alongside the ECG signal leads, magnetic fields caused by the grounding circuit can induce small voltages in the signal lead wires interference on the tracing
Ground loops represent closed current paths. They subtend some geometrical areas within the loop. If this area is large and is in a strong time varying magnetic filed, a current can be induced in the ground loop, the current flows through the patient and common mode voltages are generated
Open lead wires A frequently occurring problem in electrocardiography is one of the lead wires becoming disconnected as a result of rough handling
This results in relatively high potentials being induced on the open lead wire due to electric fields emanating from the power lines or other electrical devices in the vicinity of the ECG machine
This in turn leads to a big constant-amplitude deflection of the ECG pen at 50 or (60) Hz. Such an electrode is not making good contact with the patient. Therefore, this phenomena translates into having a circuit for detecting poor electrode contact
Department of Electrical and Computer Engineering UTEP EE 4385 Biomedical Instrumentation 1
BI1 Lecture Series Prepared by Homer Nazeran PhD Please read carefully and check for typos! 17 Artifacts from large electric transients
These transients occur during the following situations:
Defibrillating the patient with a high-current high-voltage electric pulse called the defibrillating pulse (more on this in BI)
Motion artifacts
The patient encountering a build-up of electric charges that can be partially discharged through the body
Switching leads manually in older ECG machines (not a problem in new machines) Note: These effects can be alleviated by reducing the source of the artifact.
Include an electronic protection circuitry to limit max. Input voltage across ECG amp. To minimize saturation during defibrillation Reduce the build up of charge on personnel by having them use conductive clothing, shoes, etc and touch the bed frame before touching the patient