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Biomedical Telemetry and TelemecJne
Similarly, the time that the circuit remains in the original stage is:
C1
• T1 = -•e
I m
t-
i;
r
L Biomedical Telemetry and Telemedicine 285
This shows that both portions of the astable period are directly proportional to the modulatin
~. g
~en a b~anced differential output from an amplifier such as the ECG amplifier is applied to
th~ mput pomts 1 and 2, the frequency of the astable multi-vibrator would remain constant, but the
width of the pulse available at the collector of transistor Q 2 shall vary in accordance with th
amplitude of the input signal. e
In practice, the negative edge of the square wave is varied in rhythm with the ECG signal.
Therefore, only this edge contains information of interest. The ratioP:Q (Fig. 9.3) represents the
momentary amplitude of the ECG. The amplitude or even the frequency variation of the square
L
J
wa~~ does not have an influence on the P: Q ratio and consequently on the ECG signal. The signal
output from this modulator is fed to a normal speech transmitter, usually via an attenuator, to
make-it suitable to the input level of the transmitter.
J I ~wt wj
I
I I I I .I I L
I
I
I I I I I I
,I ,I ,I ,I ,I ,I Input signal
·
► Fig. 9.3 Variation ofpulse width with amplitude of the input signal
W = Pulse width as generated by the mu,lti-vibrator.
P = Variable pul~e width; variation in accordance with input signal.
Off-period, which also gets varied as the pulse width P varies with the
amplitude of the input signal.
Commission). The lower frequency band of 174-216 MHz, coincides with the VHF television
broad~as~ band (Channels 7-13). Therefore, the output of the telemetry transmitter must be limited
to av_01d mte:ference with TV sets. Operation of telemetry units in this band does not normally
reqwre any licence. In the higher frequency band of 450-470 MHz, greater transmitter power is
allowed, but an FCC licence has to be obtained for operating the system.
Radiow aves can travel through most non-conducting material such as air, wood, and plaster
with relative ease. However, they are hindered, blocked or reflected by most conductive material
and by concrete because of the presence of reinforced steel. Therefore, transmission may be lost or
be of poor quality when a patient with a telemetry transmitter moves in an environment with a
concrete wall or behind a structural column. Reception may also get affected by radio frequency
w;ive effects that may result in areas of poor reception or null spots, under some conditions of
p~tient location and carrier frequency. Another serious problem that is sometimes present in the
telemetry systems is the cross-talk or interference between telemetry channels. It can be minimized
by the careful selection of transmitter frequencies, by the use of a suitable antenna system and by
the equipment design.
The range of any radio system is primarily determined by transmitter output power and frequency.
However, in medical telemetry systems, factors such as receiver and antenna design may make
the power and frequency characteristics less significant. The use of a higher-powered transmitter
than is required for adequate range is preferable as it may eliminate or reduce some noise effects
due to interference from other sources.
9.1.3 Transmitter
Figure 9.4 shows a circuit diagram of the FM transmitter stage commonly used in medical tele-
metry. The transistor Tacts in a grounded base Colpitts R.F oscillator withL1 and C1 and C2 as the
tank circuit. The positive feedback to the emitter is provided from a capacitive divider in the
collector circuit formed by C1 and C2 . Inductor L1 functions both as a tuning coil and a transmitting
antenna . Trim capacitor C2 is adjusted to precisely set the transmission frequency at the desired
220 K
.::. 1.35 V
5-20 pf
0.001 µf
-----f - -- T
3~0 pf
0.001 1.2 K
µf
point. In_thi~ case,_ it is within the standard FM broadcast band from 88 to 108 MHz. Frequency
~odulahon 1s ach:eved by variation in the operating point of the transistor, which in tum varies
its ~ol~ector capacitance, thus changing the resonant frequency of the tank circuit. The operating
pomt 1~ changed by the sub-carrier input. Thus, the transmitter's output consists of an RF signal,
tun_ed ~ the FM broadcast band and frequency modulated by the sub-carrier oscillator (SCO),
which m tum is frequency modulated by the physiological signals of interest. It is better to use a
separate power source for the RF osciliator from other parts of the circuit to achieve stability and
prevent interference between circuit functions (Beerwinkle and Burch, 1976).
Figure 9.5 shows the diagram of a single channel telemetry system suitable for the transmission
of an electroc ogram. There are two main parts:
• T e Telemetry Transmitter which consists of an ECG amplifier, a sub-carrier oscillator and
a UHF transmitter along with dry cell batteries.
• Telemetry Receiver consists of a high frequency unit and a demodulator, to which an elec-
trocardiograph can be connected to record, a cardioscope to display and a magnetic tape
recorder to store the ECG. A heart rate meter with an alarm facility can be provided to
continuously monitor the beat-to-beat heart rate of the subject.
Transmitter Receiver
antenna antenna
t
\V
II
Tape
Demodulator L---
I recorder
For distortion-free transmission of ECG, the following requirements must be met (Kurper et al, 1996).
• The subject should.be able to carry on with his normal activities whilst carrying the instru-
P:ents without the slightest discomfort. He should be able to forget their presence after
some minutes of application.
• Motion artefacts and muscle potential interference should be kept minimum.
• The battery life should be long enough so that a complete experimental procedure may be
carried out.
• While-monitoring paced patients for ECG through telemetry, it is necessary to reduce
pac emaker pulses. The amplitude of pacemaker pulses can be as large as 80 m V compared
to 1-2 m V, which is typical of the ECG. The ECG amplifiers in the transmitter are slew rate
(rate of change of output) limited so that the relatively narrow pacemaker pulses are re-
duced in amplitude substantially.
Biomedical Telemetry and Telemedicine
S 289
ome ECG telemetry
trans · · systems operate in the 450-470
iln;:5s1on within a hospital and has the add d d MHz band, which is well-suited for
ava a le. The circuit details of an ECG t 1 e a vantage of hav~g a large number of channels
Transmitter· A bl k d " e emetry system are described below:
· oc iagram of the tr · · • .
three pre-gelled electrodes attached ~tter ~s s~own m Fig. 9.6. The ECG signal, picked up by
modulate a 1 kHz sub c . th o e patients chest, is amplified and used to frequency
'
• - arner at in turn f d 1
signal is radiated by f h requency-mo u ates the UHF carrier The resulting
circuitry is rotected on: o t e electro~e leads (RL), which serves as the ante~a. The input
P agamst large amplitude pulses that may result during defibrillation.
Battery
~
Electrode Osc. bias
off Regulator and
Patient shutdown
~
electrodes 1 KHz
RA ... 6.2 volts
LA
'O ... 0
1: ~ ·cQ) -~
...
Q) 'O t'
... e
a>- '-.c
(U._
....... (,) >
......
·;:: Q) Q) (I)
e>= 0
RL c3 C.c:;:;
(U Q) (U 0 -
0 ::::,-
o-
.c-
t= o> 1:0 iii~
- ... (1)
0 Cl)~ ::J
Cl) 00
- 230 MHz
X2
frequency
multiplier
460 MHz
> Fig. 9.6 Block diagram of ECG telemetry transmitter (redrawn after Larsen et al.,
1972; by permission of Hewlett Packard, USA)
The ECG input amplifier is ac coupled to the succeeding stages. The coupling capacitor not
only eliminates de voltage that results from the contact potentials at the patient-electrode interface,
but also determines the low-frequency cut-off of the system which is usually 0.4 Hz. The
sub-carrier oscillator is a current-controlled multi"'.vibrator which provides ±320 Hz deviation
from the 1 kHz centre frequency for a full range(± 5 mV) ECG signal. The sub-carrier filter removes
the square-wave harmonic and results in a sinusoid for modulating the RF carrier. In the event of
one-of the electrodes failing off, the frequency of the multi-vibrator shifts by about 400 Hz. This
con~ii_!:ion when sensed in the receiver turns on an 'Electrode inoperative' alarm.
The carrier is generated in a crystal-controlled oscillator operating at 115 MHz. The crystal is a
fifth overtone device and is connected and operated in the series resonant mode. This is followed
by two frequency doubler stages. The first stage is a class-C transistor doubler and the second is a
- series connected step recovery diode doubler. With the output power around 2 mW, the system
has an operating range of 60 m within a hospital.
Receiver: The receiver uses an omnidirectional receiving antenna which is a quarter-wave
monopole, mounted vertically over the ground plane of the receiver top cover. This arrangement
works well to pick up the randomly polarized signals transmitted by moving patients.
The receiver (Fig. 9.7) comprises an RF amplifier, which provides a low noise figure, RF filtering
and image-frequency rejection. In addition to this, the RF amplifier also suppresses local oscillator
F
290 Handbook of Biomedical Instrumentation
438.18 MHz
Antenna
Local
oscillator
~ - - - - - - - - ; AFC
21.82 MHz
...
Cl) ... ...
C1l
.!!1
LL~ X LL :E
a: a. - a.
E ~ E
ctl ctl
460 MHz
► Fig. 9. 7 Block diagram ofhigh frequency section ofECG telemetry receiver (adapted
from Larsen et al, 1972; by pennission Hewlett Packard, USA)
radiation to -60 dBm to minimize the possibility of cross-coupling where several receivers are
used in one central station. The local oscillator employs a crystal (115 MHz) similar to the
one in the transmitter ~d x 4 multiplier and a tuned amplifier. The mixer uses the square law
characteristics of a FET to avoid interference problems due to third-order intermodulation. The
mixer is followed by an 8-pole crystal filter that determines the receiver selectivity. This filter with
a 10 kHz bandwidth provides 60 dB of rejection for signals 13 kHz from the IF centre frequency
(21.82 MHz). The IF amplifier provides the requisite gain stages and operates an AGC amplifier
which reduces the mixer gain under strong signal conditions to avoid overloading at the IF stages.
The IF amplifier is followed by a discriminator, a quadrature detector. The output of the discrimi-
nator is the 1 kHz sub-carrier. -This output is ave.raged and fed back to the local oscillator for
automatic frequency control. The 1 kHz sub-carrier is demodulated to convert frequency-to-voltage
to recover the original ECG waveform. The ECG is passed through a low-pass filter (Fig. 9.8)
having a cut-off frequency of 50 Hz and then given to a monitoring instrument. The 1 kHz sub-
carrier is examined to determine whether or not a satisfactory signal is being received. This is done
by establishing a window of acceptability for the sub-carrier amplitude. If the amplitude is within
the window, then the received signal is considered valid. In the case of AM or FM interferenc~, an
'inoperative' alarm lamp lights up .
Different manufacturers use differen t carrier frequencies in their telemetry equipment. Use _o f
the FM television band covering 174 to 185.7 MHz (VHF TV channels 7 and 8) is quite common.
However, the output is limited to a maximum of 150 µV /mat a distance of 30 rn to eliminate
interference with commercial television channels.
Some tr~~tters are also provided with special arrangements like low transmitter battery and
nur~e ~all facility. In bot~ these situations, a fixed frequency signal is generated, which causes a
d_evia~on ~f ~e sub-earner and when received at the receiver, actuate appropriate circuitry for
visual md1cations.
Also, some _telem~try systems include an out-of-range indication facility. This condition is
cause~ by a?aaen~1!.1:1'1g.~~ the leads or the patient getting out of range from the receiver cap abili .
For this, the RF earner signal from the transmitter is continuously monitored Wh th" · tyl
level falls below the limit set, the alarm will turn on. · en 15 sign a
Biomedical Telemetry and Telemedicine 303
prevent high frequency line noise is used. The main component of each receiver channel is a
phase-locked loop (PLL) used as a_frequency demo~~lator. The PLLsare set to lock at frequencies
of 750, 1750 and 2750 Hz for the first, second and third charu\~ls respectively. The Signetics NE
565, was selected as the PLL. After low-pass filtering the multiplexed signals, filters are used as
band-reject notch filters, followed by PLL detectors in each channel. Finally, low-pass filtering of
each output channel is needed to remove carrier ripple noise.
The channels were found to be identical in response to within ± 1 dB, cross-talk better than
-45 dB and total harmonic distortion. The system was used over a 40 kms distance on normal
telephone lines.
relemedicine systems are based on multi-media computing, which not only support live multi-
Nay conversations between physicians, patients and specialists but can also facilitate off-line
:onsultations among health-care team members. It is however, advisable to create a detailed
~lectronic patient record so that necessary information can be accessed, when desired. The
ollowing components relating to a patient are considered essential from the point of view of
2lemedicine:
• Primary Patient Data:Name, age, occupation, sex, address, telephone number, registration
number, etc. . ·
• Patient History: Personal and family history and diagnostic reports.
• Clinical infonnation: Signs and symptoms are interpretations of dpta obtained from direct
and in~ect patient observations. Direct observations include data obtained from the
senses ~sight, so~~, t~uch, smell, etc.) and through mental and physical interaction with
the patient, while mdirect observations include data obtained from diagnostic instru-
ments such as temperature, pulse rate, blood pressure.
• In~estigatio~s: C:omplete analysis reports of haemotology and biochemistry tests st00l d
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Report
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Patient [ECG _and _image display]
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s. Ea_ch frame is_an ~ t: rl~ced raster scan of 512 horiz~ntal lines sized to obtain a 4:3 a;pec::~o.
Vertical resolution IS hIDited by the number of scan Imes and horizontal resolution is limited b
the specified bandwidth of the signal-4.2 MHz. An alternative expression of resolution is th~
term television-ltne1,·(TVL), the number of alternating light and dark bars an observer can resolve
in the vertical d imens ion or along 75% of the horizontal dimension. NTSC luminance resolution
is 336 TVL.
At the resolution and frame rate associated with NTSC video, digital data are produced at a rate
Jf over 100 Mbps (Mega bits per seconds). Obviously, communication and storage limitations and