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UNIT III
ASSIST DEVICES AND
BIO-TELEMETRY
UNIT III
UNIT III
Biotelemetry:
Biotelemetry is the measurement of biological parameters over longer
distance. The means of transmitting the data from the point of generation
to the point of reception can take any forms. Perhaps the simplest
application of the principle of biotelemetry is the stethoscope, whereby heart
beat sounds are amplified acoustically and transmitted through a hollow
tube to be picked up by the ear of the physician for interpretation.
Applications of Bio-Telemetry:
In many situations, it becomes necessary to monitor physiological
events from a distance. To quote a few applications are,
1. Radio frequency transmissions for monitoring the health of
astronauts in space.
2. Patient monitoring in an ambulance and in other locations away
from the hospital.
3. Collection of medical data from home or office.
4. Patient monitoring, where freedom of movement is desired, such as
in obtaining an exercise ECG. (In this instance, the requirement of
trailing wires is cumbersome and dangerous).
5. Research on unrestrained and unanesthetized animals in their
natural habitat.
6. Use of telephone links for the transmission of ECGs or other
medical data.
7. Special internal techniques, such as measuring pH or pressure in
the gastrointestinal tract.
8. Isolation of an electrically susceptible patient from power-line
operated ECG equipment, to protect him from accidental shock.
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helmet with built-in electrodes, so that the EEG can be monitored without
traumatic difficulties during play. In some clinic, the children are left to play
with other children in a normal nursery school environment. They are
monitored continuously while data are recorded.
Telemetry of EMG signals is useful for studies of muscle damage,
partial paralysis problems.
Physiological variables:
The physiological parameters are measured as a variation of
resistance, capacitance or inductance. The differential signal obtained from
these variations can be calibrated to represent pressure flow, temperature
and so on.
In
the
field
of
blood
pressure
and
heart
rate
research
in
Advantages of Biotelemetry:
1.
2.
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3.
4.
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Modulation systems:
The modulation system used in wireless telemetry for transmitting
biomedical signals makes use of two modulators. This means that
comparatively lower signal frequency carrier is employed in addition to the
VHF which finally transmits the signal from the transmitter.
The principle of double modulation gives better interference free
performance in transmission and enables the reception of low frequency
biological signals.
The sub-modulator can be a FM system or a PWM system. Where as
the final modulator is practically always an FM system.
The signal conditioner amplifies and modifies this signal for effective
transmission.
The transmission line connects the signal input blocks to the read-out
device by wire or wireless means.
UNIT III
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most
bio-medical
experiments,
it
is
desirable
to
have
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UNIT III
Radio pill:
Radio pill when swallowed, will travel the GI tract (Gastrointestinal
tract) and simultaneously perform multiparameter in physiological analysis.
After completing its mission it will come out of the human body by normal
bowel movement.
The pill is 10mm in diameter and 30mm long weighing around 5gm
and records parameters like temperature, pH, conductivity and dissolved
oxygen in real time.
The pill comprises an outer biocompatible capsule encasing micro
sensors, a control chip, radio transmitter and two silver-oxide cells.
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UNIT III
4. batteries.
ISFET:
1. It is used to measure pH.
2. It is used to determine the presence of pathological conditions
associated with abnormal pH levels, particularly associated with
pancreatic disease, hypertension, inflammatory bowel disease, the
activity of fermenting bacteria, the level of acid excretion, reflux to
the oesophagus and the effect of GI-specific drugs on target organs.
Gold electrodes:
A pair of direct contact gold electrode is used to measure conductivity.
The conductivity sensor is used to monitor the contents of the GI tract by
measuring water and salt absorption, bile secretion and the breakdown of
organic components into charged colloids.
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UNIT III
of
first
generation
enzyme
linked
amperometric
SENSORS:
The schematic diagram of sensor chips is as shown below.
The sensors are fabricated on two silicon chips located at the front
end of the capsule.
Chip1, measuring 4.75 x 5mm2,
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UNIT III
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Control chip:
The ASIC is the control unit that connects together other components
of the microsystem as shown in the figure below.
It contains an analogue signal conditioning module operating the
sensors, 10-bit ADC and DAC converters and a digital data processing
module. An oscillator provides the clock signal.
The temperature circuitry biases the diode at constant current so a
change in temperature reflects a corresponding change in diode voltage.
The pH ISFET sensor is biased as a simple source and drain follower
at constant current with the drain-source voltage changing with the
threshold voltage and pH.
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UNIT III
oxygen sensor with a 10-bit DAC controlling the working electrode potential
with respect to the reference.
The analogue signals have a full-scale dynamic range of 2.8V with the
resolution determined by the ADC. These are sequenced through a
multiplexer prior of being digitized by the ADC. The bandwidth for each
channel is limited by the sampling interval of 0.2msec.
The digital data processing module processes the digitized signals
through the use of a serial bit stream data compression algorithm, which
decides when transmission is required by comparing the most recent sample
with the previous sampled data. The digital module is clocked at 32KHz and
employs a sleep mode to conserve power from the analogue module.
Radio transmitter:
The size of the transmitter is 8x5x3mm. The transmission range is one
meter and the modulation scheme frequency shift keying has a data rate of
1 kbps. The transmitter is designed to operate at a transmission frequency
of 40.01 MHz at 20C generating a signal of 10KHz bandwidth.
Power consumption:
Two SR44 Ag2O batteries are used, which provide an operating time of
more than 40 hours of the microsystem. The power consumption of the
system is around 12.1mW and current consumption is around 3.9mA at
3.1V supply.
The ASIC and sensor consume 5.3mW corresponding to 1.7mA of
current and the free running radio transmitter consumes 6.8mW at 2.2mA
of current.
Range of measurement:
The microsystem can measure,
1. Temperature from 0 to 70C,
2. pH from 1 to 13,
3. Dissolved oxygen up to 8.2mg/litre,
4. Conductivity from 0.05 to 10 ms.cm-1( s=siemens).
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UNIT III
Defibrillators
Introduction:
Defibrillator
is
an
electronic
device
that
creates
sustained
Defibrillator types:
There are two types of defibrillators based on the electrodes
placement.
a) Internal defibrillator (Surgical Type)
b) External defibrillator (Therapeutic Type)
Internal defibrillator:
It is used when chest is opened.
Here large spoon shaped electrodes with insulated handle are used.
Sometimes electrodes in the form of fine wires of Teflon coated
stainless steel are used.
There are AC and DC defibrillator methods but DC defibrillator is used
today.
Since the electrode comes in direct contact with the heart, the contact
impedance is about 50 ohms.
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UNIT III
External defibrillator:
It is used on the chest.
Here paddle shaped electrodes are used.
There are AC and DC defibrillator methods but DC defibrillator is
used today.
Since the electrodes are placed above the chest, the contact
impedance on the chest is about 100 ohms even after applying
the gel.
In external defibrillation, the heart requires excitation energy of about
50 to 400 J.
The duration of the shock is about 1 to 5 milliseconds.
The paddle shaped electrode is as shown below.
The bottom of the electrode consists of a copper disc with 3 to 5 cm
diameter for pediatric patient and 8 to 10 cm diameter for adult
patients with a highly insulated handle.
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UNIT III
Mechanism:
Fibrillation results from a rapid discharge of impulses from a single or
multiple foci in the atria or in the ventricles. The atria or the ventricles are
unable to respond completely and effectively to each stimulus.
Under conditions of atrial fibrillation, the ventricles can still function
normally but they respond with irregular rhythms to the non-synchronized
bombardment of electrical stimulation from the fibrillating atria and the
circulation is still maintained although not as efficiently.
The sensation produced by the fibrillating atria and irregular
ventricular action can be quite traumatic for the patient. Ventricular
fibrillation is dangerous when the ventricles are unable to pump the blood.
Hence, resuscitative measures must be applied within 5 minutes or less
after the attack or irreversible brain damage and death will occur.
1. AC defibrillator:
Although mechanical methods like chest massage for defibrillation
have been tried for years, the most successful method of defibrillation
is the application of electric shock to the area of the heart which makes all
the heart muscle fibres enter their refractory period together after which
normal heart action may resume.
One of the earliest forms of an electrical defibrillator is the AC
defibrillator, which applies several cycles of alternating current to the heart
from the power line through a step-up transformer.
EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College
19
UNIT III
Disadvantages:
1. There are many disadvantages in using AC defibrillators.
2. Successive attempts to correct ventricular fibrillation are often
required.
3. AC defibrillator cannot be successfully used to correct atrial
fibrillation.
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UNIT III
voltage
to
which
is
charged
is
determined
by
the
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UNIT III
1
CV2
2
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UNIT III
3. Synchronised DC defibrillator:
Defibrillation is a risky procedure since if it is applied
incorrectly; it could induce fibrillations in a normal heart. There must be
proper diagnosis for ventricular fibrillation.
Simple DC defibrillator can arrest the ventricular fibrillation. But for
termination
of
ventricular
tachycardia,
atrial
fibrillation
and
other
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UNIT III
Working:
1.
2.
3.
4.
5.
The AND gate 'B' delivers on signal to the defibrillator only when the
R wave is absent, provided the signal from the medical attendant is
also present at one of the two inputs of that AND gate.
6.
At the two inputs of AND gate 'B' if any one of the inputs is missing,
then it would not give any output. By this way the defibrillator is
inhibited and would not deliver the defibrillation pulse.
7.
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UNIT III
8.
Thus when the AND gate B and AND gate C are simultaneously
triggering the defibrillator, the defibrillation pulse is delivered.
9.
10.
The ECG signal in the instrument is given to QRS detector. Its output
is used to time the delivery of the defibrillation pulse with a delay of
30 milliseconds. At this time, the ventricles will be in uniform state of
depolarisation and the normal heart beat will not be disturbed.
This delay of 30 milliseconds after the occurrence of R wave
allows
the
attendant
to
defibrillate
atrium
without
inducing
ventricular fibrillation.
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UNIT III
Analysis
In the figure above, Ro is the internal resistance of the defibrillator, RE
is the electrode - skin resistance and RT is the thorax resistance.
The Energy in the pulse is,
EP = VDIDTD
Where, VD and ID are the instantaneous voltage and current available from
the defibrillator pulse respectively and TD is the duration of the pulse.
Total circuit resistance, R = RD + 2RE + RT
Further, the energy in the pulse can also be written in terms of
voltage and resistance between the cable attached to the patient such that
2
VD
.TD = ID2 (2RE + RT)TD
EP =
2 R E + RT
The energy loss in the defibrillator
EDL = ID2RDTD
The energy loss in each electrode and skin,
EEL = ID2RETD
Energy delivered to the thorax,
ET = ID2RTTD
=
RT
EP
2 R E + RT
From the above equation we can know that the energy in the pulse is not
delivered completely to thorax. Similarly the energy delivered to the thorax can
be expressed in the form of available energy from the capacitor discharge in the
case of DC defibrillator whose output is assumed to a square pulse.
Energy available from the capacitor,
EC = ID2RTD =
EDL + 2EEL + ET
ET = EC - EDL - 2EEL
(Or) ET =
RT
EC
2 R E + RT + R D
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UNIT III
Advantages:
The advantages of square wave defibrillator are,
1. It requires low peak current
2. It requires no inductor
3. It is possible to use physically smaller electrolytic capacitors.
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UNIT III
6. Biphasic DC defibrillator
Biphasic DC defibrillator is similar to the double square pulse
defibrillator such that it delivers DC pulses alternatively in opposite
directions. This type of waveform is found to be more efficient for
defibrillation of the ventricular muscles.
Defibrillator Electrodes
The two defibrillator electrodes applied to the thoracic walls are called
either Anterior-Anterior or Anterior-Posterior paddles.
With anterior-anterior paddles, both paddles are applied to the chest.
Anterior-posterior paddles are applied to both the patient's chest wall
and back, so that the energy is delivered through the heart. This method of
paddle application offers better control over arrhythmias that occur as a
result of atrial activity.
These two methods are shown in Figure below.
To maintain good contact, the electrodes must be firmly placed
against the patient. The posterior paddle is flat and has a larger disc (with a
radial handle) than the anterior paddle (axial handle). The electrodes must
be sufficiently well insulated, so that the operator holding the electrodes is
safe.
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UNIT III
(a)
(b)
(c)
(d)
Two types of electrodes for defibrillation are shown in the above figure,
and Figure (c) shows the type of electrode used for external defibrillation.
This electrode consists of a large metal disc, approximately 100 mm in
diameter, in an insulated housing.
A control switch is located on the handle so that, once the electrodes
are in place, the operator can push the switch to initiate the pulse. While
being used, the electrodes surface is coated with a conducting gel of the type
used with an ECG recording.
Figure (d) shows an internal type of electrode which is spoon shaped,
for applying directly on the myocardium (during open-chest surgery), or it
may be applied to the chest of an infant.
In these applications, the energy levels required for defibrillation may
range from 10 to 50 watts. Special pediatric paddles are available with
diameters ranging from 2 to 6 cm.
The energy of a defibrillator is usually given in terms of watts/sec,
referenced across a 50 ohm resistor. Most defibrillators today have a
charging capacity of 400 watts.
29
UNIT III
S.No
Patient
Defibrillating Value
Adult (external)
200-400
Adult (internal)
35-75
Pediatric (external)
100-200
Pediatric (internal)
25-50
PACEMAKER
INTRODUCTION:
Pacemaker is an electrical pulse generator for starting and/or
maintaining the normal heart beat.
The output of the pacemaker is applied either externally to the chest
or internally to the heart muscle.
In the case of cardiac stand still, the use of the pacemaker is
temporary - just long enough to start a normal heart rhythm. But in the
case requiring long term pacing, the pacemaker is surgically implanted in
the body and its electrodes are in direct contact with the heart.
In cardiac diseases, where the ventricular rate is too low, it can be
increased to normal rate by using pacemaker.
By fixing the artificial electronic pacemaker, the above defects in the
heart can be eliminated.
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UNIT III
The above figure shows the shape of the pacemaker pulses. These
pulses should have the pulse to space ratio 1:10000 and that should be
negatively going pulses to avoid the ionization of the muscles.
The pulse voltage is made variable to allow adjustments in the energy
delivered by the pacemaker to the heart during each pulse.
During the pulse duration, the stimulus voltage drives energy into the
heart muscles.
The pulse repetition rate is usually 70 pulses/min but many
pacemakers are adjustable in the range of 50-150 pulses/min. The duration
of each pulse is between 1 and 2 milli seconds.
Output pulses from the pacemaker appear at the pair of electrodes
used for triggering the heart.
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UNIT III
Ranges
25 - 155 pulses per minute
0.1 - 2.3 milliseconds
3
4
5
6
Pulse amplitude
Battery capacity
Longevity
End-of-life indicator
2.5 - 10 volts
0.44 - 3.2 amp-hours
3.5 - 18 years
2 - 10% dropin pulse rate
7
8
9
Weight
Size
Encapsulization
33 - 98 grams
22 - 80 cm3
Silicon rubber, stainless steel, titanium
Methods of Stimulation:
There are two types of stimulation
1. External Stimulation and
2. Internal Stimulation
1. External Stimulation:
External stimulation is employed to restart the normal rhythm
of the heart in the case of cardiac stand still. Stand still can
occur during open heart surgery or whenever there is a sudden
physical shock or accident.
The paddle shaped electrodes are applied on the surface of the
chest
Currents in the range of 20 - 150 mA are employed.
2. Internal Stimulation:
Internal stimulation is employed in cases requiring long term
pacing because of permanent damage.
The electrodes are in the form of fine wires of teflon coated
stainless steel are used. In some cases, during restarting of the
heart after open heart surgery, spoon like electrodes are used.
The currents in the range of 2-15 mA are employed.
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UNIT III
S.
External Pacemaker
Internal Pacemaker
No
The pacemaker is placed outside The pacemaker is miniaturized and
the body. It may be in the form of is surgically implanted beneath the
1
wrist watch or in the pocket, from skin near the chest or abdomen
that one wire will go into the with its output leads are connected
heart through the vein.
The
electrodes
are
called
electrode
catheter
with
The
electrodes
are
called
surgery
The
battery
replaced
4
the circuit.
and
can
any
be
easily
defect
or
pain
do
not
arise
due
to
Here there is no safety for the Here there is a cent percent safety
33
UNIT III
pacemaker
case
in
of children carrying
pacemaker.
Mostly
7
these
are
used
for Mostly
these
are
used
for
1
1+
R2
R1 + R2
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UNIT III
R3 + R 4
R3 + R 4
Advantages:
1. It has the simplest mechanism and the longest battery life.
2. It is cheap.
3. It is least sensitive to outside interference.
35
UNIT III
Disadvantages:
1.
2.
3.
4.
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UNIT III
Working:
Using the sensing electrode, the heart rate is detected and is given to
the timing circuit in the pacemaker. If the detected heart rate is below a
certain minimum level, the fixed rate pacemaker is turned on to pace the
heart.
The lead used to detect the R wave is now used to stimulate the heart.
If a natural contraction occurs, the asynchronous pacer's timing circuit is
reset so that it will time its next pulse to detect heart beat. Otherwise the
asynchronous pacemaker produces pulses at its preset rate.
The pacemaker may detect noise and interpret as its ventricular
excitation so to eliminate this refractory period circuit or gate circuit is used.
In heart blocks, P waves occur at random times with respect to
ventricular excitation. However P and R waves have their principal energy in
different frequency bands.
A high pass filter with a lower cut off frequency at 20 Hz almost
completely eliminates the P wave. The R wave is differentiated by such a
filter and its peak to peak amplitude is increased using an input amplifier.
Advantages:
1. To arrest the ventricular fibrillation, this circuit can be used.
2. If the R-wave occurs with its normal value in amplitude and
frequency
then
it
would
not
work.
Therefore
the
power
consumption is reduced
3. There is no chance of getting side effects due to competition
between natural and artificial pacemaker pulses.
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UNIT III
Disadvantages:
1. Atrial and ventricular contractions are not synchronized.
2. In the olden type, the circuit is more sensitive to external
electromagnetic interferences such as electric shavers, microwave
ovens, car ignition systems, air port security metal detectors, and
so on. Therefore the patients could not work in radio or T.V.
stations. They could not undergo diathermy treatment and could
not be exposed to airport security metal detector. Further they
could not ride motor or scooters. But in the newer pacemakers,
this is eliminated by connecting a low pass filter in the input
circuit of the pacemaker
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UNIT III
The reversion circuit allows the amplifier to detect R wave in low level
signal to noise ratio. In the absence of R wave, it allows the oscillator in the
timing circuit to deliver pulses at its preset rate.
The timing circuit consists of an RC network, a reference voltage
source and a comparator which determines the basic pulse rate of the pulse
generator. The output of the timing circuit is fed into pulse width circuit
which is also a RC network.
The pulse width circuit determines the duration of the pulse delivered
to the heart. Then the output of the pulse width circuit is fed into the rate
limiting circuit which limits the pacing rate to a maximum of 120 pulses per
minute.
The output circuit provides a proper pulse to stimulate the heart.
Thus the timing circuit, pulse width circuit, rate limiting circuit and output
circuit are used to produce the desired pacemaker pulses to pace the heart.
There is a special circuit called voltage monitor which senses the cell
depletion and signals the rate slow-down circuit and energy compensation
circuit of this event.
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UNIT III
The rate slow-down circuit shuts off some of the current to the basic
timing network to cause the rate to slow-down 83 beats per minute when
cell depletion has occurred.
The energy - compensation circuit produces an increase in the pulse
duration as the battery voltage decreases to maintain constant stimulation
energy to the heart.
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UNIT III
41