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COURSE INFORMATION SHEET
Course code: EC4303

Course title: Biomedical Instrumentation
Subject {L-T-P / C}: {3-0-0 / 3}
Department of ECE
NIT Rourkela
1
SYLLABUS
• INTRODUCTION: Generalized Medical Instrumentation System, Roles of Engineering in
Healthcare systems, Biometrics, Problems encountered in measuring physiological
parameters
• PHYSIOLOGICAL TRANSDUCERS: Various types of transducers for measurement of
temperature, pressure, flow etc. and their selection for medical applications, Different types
of electrodes
• BIO-ELECTRIC SIGNALS AND ELECTRONICS: Origin of bio-electric signals, Bioelectric
potentials, Biopotential electrodes
• CARDIOVASCULAR MEASUREMENT: Electrocardiograph, Measurement of ECG, ECG
electrodes, ECG Amplifiers, Common mode interference reduction circuits, Cardiac
pacemaker, Phonocardiograph, Measurement of heart rate, Plethysmography,
• Blood pressure measurement,
• BLOOD FLOW METERS: Electromagnetic blood flow meter, Ultrasonic blood flow meter,
Doppler flow meter
2
SYLLABUS
• Measurement of electrical activities in muscles and brain: Electroencephalograph,
Electromyograph and their interpretations.
• Measurement of temperature,
• Respiratory System Measurement: Respiration rate measurement, Lung Volume and
Capacity, Spirometer, Ventilators,
• Instrumentation for Clinical laboratory: BLOOD GAS ANALYZERS: Blood pH Measurement,
Pulse oximeter,
• BLOOD CELL COUNTERS: Coulter counters, Automatic recognition and differential counting of
cells, GSR measurement
• Medical Imaging: Ultrasonography, X-ray
3
Books recommended:
• Textbooks:
• L. Cromwell, F. J. Weibell, E. A. Pfeiffer, Biomedical Instrumentation and Measurements, Pearson Education
• J. G. Webster, Medical Instrumentation: Application and Design, Wiley
• Reference books:
• R. S. Khandpur, Handbook of Biomedical Instrumentation, Tata Mc Graw Hill
• J. G. Webster, Bioinstrumentation, Wiley Student Edition
• Journal and Conferences

• IEEE Transaction of Biomedical Engineering
• EMBC conference
4
Course Objectives & Outcomes:
Objective:
To keep student aware about various biomedical sensors and their applications
in measurement and diagnosis of physiological variables for better healthcare
technologies
Outcome:
A graduate should be able to understand bioelectric signals and design suitable
transducers, understand and use the functioning of biomedical recorders,
patient monitoring system and blood cell counters.
5
Assessment
Continuous Internal % Distribution

Assessment
1 presentation 10
Assignment(s) 10
Mid semester 30
End semester 50
6
Most valuable word of our life or body
LIFE
Heart
sounds
Heart
BODY
7
Most valuable word of our life or body
LIFE
ECG
Heart
BODY
8
Overview of blood flow system
9
Overview of blood flow system (cont.)
There are three main types of blood vessels:

Arteries: Send blood from heart. Arteries carry oxygen-rich
blood (not for pulmonary arteries) away from the heart to all of
the body's tissues. They branch several times, becoming smaller
and smaller as they carry blood further from the heart and into
organs.
Veins: Receive blood by the heart. These are blood vessels that
take blood back to the heart; this blood has lower oxygen
content and is rich in waste products (not for pulmonary vein)
that are to be excreted or removed from the body. Veins become
larger and larger as they get closer to the heart.
Capillaries: Exchange necessary and waste products between

arteries and veins. These are small, thin blood vessels that
connect the arteries and the veins. Their thin walls allow oxygen,
nutrients, carbon dioxide, and other waste products to pass to
and from our organ's cells.
10
Anatomy of the Heart
The heart has four chambers:
• The right atrium receives blood from the veins and
pumps it to the right ventricle.
• The right ventricle receives blood from the right atrium
and pumps it to the lungs, where it is loaded with oxygen.
• The left atrium receives oxygenated blood from the lungs
and pumps it to the left ventricle.
• The left ventricle (the strongest chamber) pumps oxygen-
rich blood to the rest of the body. The left ventricle’s
vigorous contractions create our blood pressure.
Four heart valves within the heart:

• Mitral valve
• Tricuspid valve
• Aortic valve
• Pulmonic valve
11
Working of Heart
• Main function: 3. Send oxygen-less
blood to lungs
1. Receive oxygen-less blood from body 4. Receive oxygen-rich
3. Send oxygen-less blood to lungs blood from lungs
4. Receive oxygen-rich blood from lungs

6. Send oxygen-rich blood to body 6. Send oxygen-rich
blood to body
Timings:
1 & 4 together: receive in atrium
3 & 6 together: send through ventricle
1. Receive oxygen-
less blood from body
Where are 2 & 5???

12
Working of Heart (cont.)
Cycle:
1 & 4: receive in atrium
3 & 6: send through ventricle
3 4
In between 1 & 3 and 4 & 6 blood will be sent
from atrium to ventricle.
2. Send oxygen-less blood from atrium to ventricle

5. Send oxygen-rich blood from atrium to ventricle
1 6
13
• Right Side of the Heart
• (1) Blood enters heart through veins, emptying
oxygen-poor blood from the body into the right
atrium.
• (2) Then atrium contracts, blood flows from right
atrium into right ventricle through the open
tricuspid valve. When the ventricle is full, the
tricuspid valve shuts. This prevents blood from
flowing backward into the atria while the ventricle
contracts.
• (3) Then ventricle contracts, blood leaves the
heart through the pulmonic valve, into the
pulmonary artery and to the lungs, where it is
oxygenated and then returns to the left atrium
through the pulmonary veins.
14
• Left Side of the Heart
• (4) The pulmonary veins empty oxygen-rich blood
from the lungs into the left atrium of the heart.
• (5) As the atrium contracts, blood flows from your
left atrium into your left ventricle through the
open mitral valve. When the ventricle is full, the
mitral valve shuts. This prevents blood from
flowing backward into the atrium while the
ventricle contracts.
• (6) As the ventricle contracts, blood leaves the
heart through the aortic valve, into the aorta and
to the body.
15
The cardiac cycle
• The cardiac cycle is the period of time from
the beginning of one heartbeat to the beginning
of the next
• I.e., the cardiac cycle consists of alternating periods of
contraction and relaxation
• Systole = the contraction phase of a chamber
• The chamber size decreases → ↑ pressure → the
ejection of blood
• Diastole = the relaxation phase of a chamber
• The chamber size increases → ↓ pressure → chamber
filling
• Both the atria and ventricles spend more time in
diastole than in systole
16
Systole & Diastole of the chambers
1. Receive oxygen-less blood from body in atrium
Atrium Diastole
4. Receive oxygen-rich blood from lungs in atrium
3. Send oxygen-less blood to lungs from ventricle
6. Send oxygen-rich blood to body from ventricle
Ventricle Systole
2. Send oxygen-less blood from atrium to ventricle Atrium Systole
5. Send oxygen-rich blood from atrium to ventricle Ventricle Diastole
17
Characteristics of Heart
• The heart is the muscular pump of the cardiovascular system
• At rest, a normal heart beats around 50 to 99 times a minute. Exercise,
emotions, fever, and some medications can cause your heart to beat faster,
sometimes to well over 100 beats per minute.
• It performs ~ 100,000 heartbeats/day
• It pumps ~ 8000 liters of blood/day
18
Heart diagnostic
Heart
sounds
ECG
19
Origin of the heart sound
For proper operation some valves should

be there which should operate properly.
Aorta
Valves are the “Communicating Doors”:
When open: Blood passes through
When closed: Holds blood within a chamber
Ref.: https://www.youtube.com/watch?v=pMV3y8r6WOU 20
When these valves are closing they create sound in the direction of blood flow.
Ventricle Ventricle
Ref.: https://www.youtube.com/watch?v=pMV3y8r6WOU 21
• The first sound is 2-3 times louder than the second one
• Period between 2nd and next 1st is twice as the period of 1st and 2nd
• This is normal…other than this abnormal

• Heart sounds travel through the body from the heart and major
blood vessels to the body surface.
22
23
Phonocardiography: Measurement of the heart sound
A Phonocardiogram is a recording of the sounds and murmurs made by the heart with the help of a stethoscope,
of the sounds made by the heart during a cardiac cycle.
• Different theory of heart sounds:
1. result of vibrations created by closure of the heart valves.
2. may be due to the acceleration and deceleration of blood whereas murmurs are due to blood turbulence.
• At least two sounds (may be four):
1. when the atrio-ventricular valves close at the beginning of systole
2. when the aortic and pulmonary valves close at the end of systole.
3. Third sound corresponds to the sudden cessation of the ventricular rapid filling. This low-amplitude, low
frequency vibration is audible in children and in some adults.
4. Occurs when the atria contracts and propel blood into the ventricles. This sound with very low amplitude
and low frequency is not audible, but may be recorded by the phonocardiography (PCG).
• Frequency range of 20 to 200 Hz.
• Certain heart murmurs produce sounds in the 1000-Hz region.
24
Phonocardiography: Measurement of the heart sound (cont.)
• The principal instrument used for the clinical detection of heart sounds is the
acoustical stethoscope
•The stethoscope is an acoustic
medical device for listening to
internal sounds of an animal or
human body.
•A stethoscope can be used to

listen to the sounds made by the
heart, lungs or intestines, as well
as blood flow in arteries and
veins.
25
Acoustic Stethoscope
• Operate on the transmission of
sound from the chest piece, via
air-filled hollow tubes, to the listener's ears.
• The chestpiece usually consists
of two sides that can be placed
against the patient for sensing sound:
• a diaphragm (plastic disc): transmits higher frequency sounds (S1 and S2 and
murmurs)
• bell (hollow cup): transmits low frequency sounds (S3 and S4)
• If the diaphragm is placed on the patient, body sounds vibrate the diaphragm,
creating acoustic pressure waves which travel up tubing to the listener's ears.
• If the bell is placed on the patient, the vibrations of the skin directly produce
acoustic pressure waves traveling up to the listener's ears. 26
Acoustic Stethoscope
• To deliver the acoustic energy
primarily to either the bell or
diaphragm, the tube connecting into
the chamber between bell and
diaphragm is open on only one side
and can rotate.
• The opening is visible when
connected into the bell.
• Rotating the tube 180 degrees in the
head connects it to the diaphragm.
27
Electronics Stethoscope
• One problem with acoustic stethoscopes was that the sound level was extremely low.
• An electronic stethoscope (or stethophone) overcomes the low sound levels by
electronically amplifying body sounds.
• Provide noise reduction, signal enhancement, and both visual and audio output
Concept of telemedicine or remote diagnosis
• An electronic stethoscope can be a wireless device, can be a recording device.
• Around 2001, Stethographics introduced PC-based software which enabled a
phonocardiograph, graphic representation of cardiologic and pulmonologic sounds to be
generated, and interpreted according to related algorithms. All of these features are helpful
for purposes of telemedicine (remote diagnosis) and teaching.
Basic requirement:
• Require conversion of acoustic sound waves to electrical signals which can then be
amplified and processed for optimal listening suing pre-amplifier, filter, ADC etc.
https://en.wikipedia.org/wiki/Stethoscope 28
Electronics Stethoscope
• Conversion of acoustic sound waves to electrical signal:
• The simplest and least effective method of sound detection is achieved by
placing a microphone in the chestpiece  This method suffers from ambient
noise interference and has fallen out of favor.
• Welch-Allyn's Meditron stethoscope: comprises placement of a piezoelectric
crystal at the head of a metal shaft, the bottom of the shaft making contact
with a diaphragm.
• 3M Littman Range: uses a piezoelectric crystal placed within foam behind a
thick rubber-like diaphragm.
• Thinklabs' Rhythm 32: uses an electromagnetic diaphragm with a conductive
inner surface to form a capacitive sensor. This diaphragm responds to sound
waves, with changes in an electric field replacing changes in air pressure.
https://en.wikipedia.org/wiki/Stethoscope 29
Electronics Stethoscope (cont.)
Limitation of Piezoelectric sensor for Stethoscope:
In a piezoelectric transducer, the sounds picked up by the stethoscope
diaphragm cause distortion of a crystal substance that is responsible for then
producing an electrical signal. The distortion of the crystal can produce the
electrical signal that may not truly capture the original sound ascertained by
the diaphragm
Solution:
There are also multiple mechanisms by which a digital stethoscope can
suppress ambient and friction noise to allow the listener to hear sounds that
are as original as possible.
For instance, the 3M Littmann Range offers piezoelectric sensor which uses the
ambient noise reduction as an adaptive noise canceller by which it allows to
amplify sounds up to 24 times.
Digital stethoscope: technology update, Medical Devices: Evidence and Research, 2018 30
Block diagram of digital heart sound signal acquisition, processing and analysis
Three main modules: (1) data acquisition (Electronic stethoscope), (2) pre-
processing and (3) signal processing module
Main parts
of Digital
electronic
stethoscope
https://biomedical-engineering-online.biomedcentral.com/articles/10.1186/s12938-015-0056-y 31
Circuit of electronic stethoscope
R1 10K 1/4W Resistor
R2 2.2K 1/4W Resistor
R5, R6, R7 33K 1/4W Resistor
R11 2.2K to 10K Audio Taper Pot
R13, R15,
1K 1/4W Resistor
R16
R14 3.9 Ohm 1/4W Resistor
C1, C8 470uF 16V Electrolytic Capacitor
C2 4.7uF 16V Electrolytic Capacitor
0.047uF 50V Metalized Plastic Film
C3, C4
Capacitor
C5 0.1uF 50V Ceramic Disc Capacitor
Preamplifier U1a TL072 Low Noise Dual Op-Amp
Second order low pass Power U1b 741 Op-Amp
Sallen-Key filter amplifier U5 LM386 Audio Power Amp
MIC Two Wire Electret Microphone
J1 1/8" Stereo Headphone Jack
32
Amplifiers for Phonocardiography
• Amplifier has bandwidth with a frequency range of about 20 to 2000 Hz.
• Filters permit selection of suitable frequency bands, so that particular heart
sound frequencies can be recorded.
• In general, the high frequency components of cardiovascular sound have a
much smaller intensity than the low frequency components and that much
information of medical interest is contained in the relatively high frequency
part of this spectrum. Therefore, high-pass filters are used to separate the
louder low frequency components from the soft and interesting high
frequency murmurs.
• PCG amplifiers usually have gain compensation circuits to increase the
amplification of high frequency signals, which are usually of low intensity.
Handbook of Second Edition Biomedical Instrumentation by R S Khandpur 33

Main parts
of Digital
electronic
stethoscope
• Heart sound data acquisition module:

• Electronic stethoscope sensor: Already discussed
• Amplifier and filter
• Amplification and filtering are the two major aspects in any signal acquisition system.
• Usually, a pre-amplifier with a small gain is used to suppress the 50 or 60 Hz interference from power lines.
• An anti-aliasing filter is then employed to prevent aliasing effect. In some system designs, the filter section
is built with a band pass filter circuit having the frequency range of most heart sound signals. The use of
band pass filter with proper passband selection not only prevents aliasing, but also removes some of the
noises outside the passband.
• In post amplification, the filtered signal is amplified to the level range required by the analog-to-digital
converter  necessary of VGA
• Analog-to-digital converter
• The amplified and filtered analog signal is converted to digital signal by the analog-to-digital converter. The
sampling frequency and bit resolution can be set by the system designer. Usually, a higher sampling rate
and bit resolution will provide greater accuracy, at the cost of more bandwidth required and power
consumption.
• Heart sound pre-processing module: In this stage, the digital HS signal will undergo noise
reduction, normalization and segmentation.
• Signal denoising unit:
• A digital filter is sometimes used to extract the signal within the frequency band of
interest from the noisy data. In order to equip the system with even better denoising
capability, some advanced artifacts removal techniques are generally utilized such that
the output signal-to-noise ratio (SNR) can be further improved.
• Normalization and segmentation:
• In data acquisition, different sampling and acquisition locations normally result in a
signal variation. Thus, the HS signals are normalized to a certain scale, so that the
expected amplitude of the signal is not affected from the data acquisition locations and
different samples.
• After getting the normalized signals, the HS signals are segmented into cycles which are
ready for HS components detection and features extraction.
• Heart sound signal processing module: The feature extraction and classification are conducted
in this stage.
• Feature extraction:
• Signal processing is carried out to convert the raw data to some type of parametric
representation. This parametric representation, called feature, is then used for further
analysis and processing.
• Classification:
• A classifier, trained with the extracted features, is used to categorize the data and assist
the medical specialist for clinical diagnostic decision making.
Block diagram of digital biomedical signal acquisition, processing and analysis
Sensor
Signal
normalization &
segmentation
Electronics Stethoscope advance
• Currently, digital stethoscopes allow for selection of different frequency
response modes allowing the listener to better hear sounds from the heart,
lung, and other areas of the body.
• Welch-Allyn Elite Electronic Stethoscope allows for a bell mode ranging from
20 to 420 Hz, specifically for heart sounds, and diaphragm mode ranging from
350 to 1900 Hz, which is better used for lung auscultation
• Ekoscope stethoscope offers built-in ECG capability
• ViScope stethoscope can empower a physician with real-time display of
multiple waveforms
Electronics Stethoscope advance
• Kaddoura et al used automated machine learning and language-recognition-
inspired-speech algorithm to ascertain if the digitally acquired heart sounds
were linked to pulmonary hypertension (PH). The algorithm used was able to
closely examine the heart sound and collect information such as amplitude,
intensity, shape, and frequency. The heart sounds from PH patients were
compared to non-PH patients, and they discovered the algorithm accurately
diagnosed PH 74% of the time.
Kaddoura T, Vadlamudi K, Kumar S, et al. Acoustic diagnosis of pulmonary hypertension:

automated speech-recognition-inspired classification algorithm outperforms physicians.
Sci Rep. 2016;6:33182
Electronics Stethoscope  Statement  Research domain involved
• “Aside from providing increased precision and audible advantage over the conventional
stethoscope, digital stethoscopes have also been studied for their utility of screening for
obstructive coronary artery disease. Turbulent blood flow occurs due to hemodynamically
significant coronary artery disease and manifests as intracoronary murmurs. However,
conventional stethoscopes lack the auscultation power to detect these murmurs. We
studied the correlation between diagnosis of coronary artery disease using an electronic
stethoscope and lesions noted on cardiac CT.”
Providing increased precision  sensor design  MEMS
Audible advantage  using signal acquisition system design  Analog circuit design 
Discrete components and CMOS IC based
Screening for obstructive coronary artery disease  Can be detected by expert doctor 
automated detection possible through biomedical signal processing  signal processing
Heart diagnostic
Heart
sounds
ECG
42
Electrocardiogram (ECG or EKG)
•What is the signal here?

•Should we need any transducer? If not why?
•What is the source of electric signal for the ECG?
43
How the ECG is recorded
The heart produces electrical currents
The body acts as a conductor of electricity
An ECG is a recording of the electrical activity of the heart
Then the question is how heart

produce electrical signal?
Ans: Study bio potential
44
Overview: Cell  Cell membrane  Cell membrane pumps  Bio-potential
https://courses.lumenlearning.com/nemcc-ap/chapter/the-cytoplasm-and-cellular-organelles/
https://www.alamy.com/stock-photo/cell-membrane-receptors.html
https://www.khanacademy.org/science/biology/human-biology/neuron-nervous-system/a/the-membrane-potential 45
Potential of an invertebrate nerve axon
46
Origin of biopotential
• The idea of electricity being generated in the body goes back as far as 1786,
when an Italian anatomy professor, Luigi Galvani, claimed to have found
electricity in the muscle of a frog's leg.
• In 1903 the Dutch physician Willem Einthoven introduced the string
galvanometer which helps to execute any practical application using these
potentials.
• Einthoven invented the first practical electrocardiogram (ECG or EKG) in 1895
and received the Nobel Prize in Physiology or Medicine in 1924 for it ("for the
discovery of the mechanism of the electrocardiogram").
• Much of the terminology used in describing an EKG originated with Einthoven.
His assignment of the letters P, Q, R, S and T to the various deflections are still
used.
https://en.wikipedia.org/wiki/Willem_Einthoven & L. Cromwell et. al., Biomedical Instrumentation and Measurements 47
1st ECG Machine by Willem Einthoven:
• String galvanometer used a very thin filament of conductive wire passing
between very strong electromagnets.
• When a current passed through the filament, the magnetic field created by
the current would cause the string to move.
• A light shining on the string would cast a shadow on a moving roll of
photographic paper, thus forming a continuous curve showing the movement
of the string.
• The original machine required water cooling for the powerful electromagnets,
required five people to operate it and weighed some 270 kilograms. This
device increased the sensitivity of the standard galvanometer so that the
electrical activity of the heart could be measured despite the insulation of
flesh and bones. !!!!

Origin of Biopotential (cont.)
• In carrying out various functions, certain systems of the body generate
electrical signals. These signals convey useful information about the functions
they represent.
• These signals are the bioelectric potentials associated with nerve conduction,
brain activity, heartbeat, muscle activity, and so on.
• Bioelectric potentials are actually ionic voltages produced as a result of the
electrochemical activity of certain special types of cells.
• Through the use of transducers capable of converting ionic potentials into
electrical voltages, these natural monitoring signals can be measured and
results displayed in a meaningful way

• Certain types of cells within the body, such as nerve and muscle cells, are encased in a
semipermeable membrane that permits some substances to pass through the membrane
while others are kept out.
• Surrounding the cells of the body are the body fluids.
• These fluids are conductive solutions containing charged atoms known as ions. The
principal ions are sodium (Na+), potassium (K+), and chloride (Cl-).
• The membrane of these cells permits the entry of some of these ions while blocking the
others depending on the situation / excitement.
• E.g., in resting condition entry of potassium and chloride ions are allowed within the cell
but effectively blocks the entry of sodium ions.
• Hence, the concentration of sodium ions inside the cell becomes much lower than in the
intercellular fluid outside.
• Sodium ion (Na+) concentration is 10 times higher outside the membrane than inside
50
• Only the concentrations of Na+ and K+ are
shown, because these are the ions that function
in the transmission of nerve impulses. Na+ is
pumped out of the cell while K+ is pumped in, so
the concentration of Na+ is higher outside than
inside of the axon, whereas the concentration of
K+ is higher inside than out. The resting
membrane is more permeable to K+ than to Na+
or other ions because it contains open K+
channels. The flow of K+ through these channels
makes the major contribution to the resting
membrane potential of -60 mV, which is
therefore close to the K+ equilibrium potential.
https://www.ncbi.nlm.nih.gov/books/NBK9847/figure/A1996/?report=objectonly 51
• Since the sodium ions are positive, this would tend to
make the outside of the cell more positive than the
inside.
• To balance the electric charge, additional potassium
ions, which are also positive, enter the cell, causing a
higher concentration of potassium on the inside than
on the outside.
• Concentration of potassium (K+) ions is 30-50 times
higher inside as compared to outside
• However, this charge balance cannot be achieved,
because of the concentration imbalance of potassium
ions.
• Equilibrium is reached with a potential difference
across the membrane, negative on the inside and
positive on the outside.
52
• In resting state the member is permeable only for potassium ions
Potassium flows outwards leaving an equal number of negative ions inside
Electrostatic attraction pulls potassium and chloride ions close to the membrane
Electric field directed inward forms
Electrostatic force vs. diffusional force
• This membrane potential is called the resting potential of the cell and is maintained until
some kind of disturbance upsets the equilibrium.
•Measurement of the membrane potential is
generally made from inside the cell with respect to
the body fluids, the resting potential of a cell is
given as negative.
•Membrane potentials in various cells ranging from -
60 to -100 mV.
53
Theoretical value of Bio-Potential
54
Theoretical value of Bio-Potential (cont.)
55
Theoretical value of Bio-Potential (cont.)
56
Membrane potential values of different biological tissues cells
Button, Vera. (2015). Electrodes for Biopotential Recording and Tissue Stimulation. 10.1016/B978-0-12-800774-7.00002-7 57
Resting potential & Action potential
• Resting membrane potential: ~ -70 mV (already discussed)
• Action potential:
• In response to the appropriate stimulus, the cell membrane of a cell goes
through a sequence of depolarization from its rest state followed by
repolarization to that rest state again. In the sequence, it actually reverses its
normal polarity for a brief period before reestablishing the rest potential.
• An action potential is a rapid rise and subsequent fall in voltage or membrane
potential across a cellular membrane with a characteristic pattern.
• Sufficient current is required to initiate a voltage response in a cell membrane;
if the current is insufficient to depolarize the membrane to the threshold level,
an action potential will not fire.
• Examples of cells that signal via action potentials are neurons and muscle cells.
https://www.moleculardevices.com/applications/patch-clamp-electrophysiology/what-action-potential#gref 58
Action Potential
When membrane stimulation exceeds a threshold
level of about 20 mV, so called action potential
occurs:
1. Sodium and potassium ionic permeabilities of
the membrane change
2. Sodium ion permeability increases very rapidly
at first, allowing sodium ions to flow from
outside to inside, making the inside more
positive
3. The more slowly increasing potassium ion
permeability allows potassium ions to flow
from inside to outside, thus returning
membrane potential to its resting value
4. While at rest, the Na-K pump restores the ion
concentrations to their original values
The number of ions flowing through an open channel
>106/sec
http://hyperphysics.phy-astr.gsu.edu/hbase/Biology/actpot.html 59
Action Potential (cont.)
• A stimulus is received by the dendrites
of a nerve cell. This causes some Na+
channels to open, and the diffusion
influx of Na+ ions starts to drive the
potential of the interior more positive.
• The nerve cells are sensitive to
external stimuli, but if such stimuli do
not cause the potential to rise to the
threshold level, the cell will tend to
settle back down to equilibrium.
• If the stimulus response is sufficient to
drive the interior potential from -70
mV up to -55 mV, the process
continues.
• Having reached the threshold, there is
no turning back and the cell will fire
into the full action potential.
• This situation is often referred to as
the "all-or-none" law.
• Once the threshold is reached, more
sodium gates open and Na+ ions flood
into the cell, raising the voltage rapidly.
This transition is said to be "voltage
gated" and occurs rapidly since the Na+
ions are driven by both the
concentration gradient and the voltage
gradient.
• The period of rapid rise of the interior
cell potential from its resting state of
about -70 mv on the order of
milliseconds is referred to as
"depolarization". The rise may be to
about +30 mV. The typical time for the
depolarization of a mammalian nerve
cell is on the order of a millisecond.
• Open sodium gates continue to
transport Na+ ions into the cell, driving
the depolarization and raising the
potential of the cell's interior. At some
point the K+ gates begin to open, but
their opening process is slower than
that of the Na+ gates, so the
depolarization process has time to
come to completion. The depolarization
continues until cell potential goes
positive to about 30mV.
• As the interior cell potential moves
through neutrality to positive values,
the sodium gates close, ending the
depolarization phase.
• Once open, the K+ gates remain open

and the free diffusion of potassium out
of the cell drives the potential back
toward negative values in the process
called repolarization.
• The drop in the interior cell potential as
a result of the open K+ gates is called
repolarization. This re-establishes the
"polarization" of having the interior of
the cell polarized negative with respect
to the outside.
• Hyperpolarization :
• Hyperpolarization is the name given to
the period of overshoot of the interior
cell potential to values more negative
than the normal rest state. One
influence in this phase is the fact that
the Na+ gates remain closed and the
lack of Na+ mobility across the
membrane causes the K+ process to
proceed toward the value of -80mV
which would occur if potassium alone
were present.
• Hyperpolarization (cont.) :
• While hyperpolarization might seem to be
counterproductive, it is actually important in
the transmission of information.
• (1) Hyperpolarization prevents the neuron
from receiving another stimulus during this
time, or at least raises the threshold for any
new stimulus.
• (2) Part of the importance of
hyperpolarization is in preventing any stimulus
already sent up an axon from triggering
another action potential in the opposite
direction. In other words, hyperpolarization
assures that the signal is proceeding in one
direction.
Nerve cell and signal propagation
70
Nerve cell and signal propagation
71
Diffusion and nerves impulses
72
Signal transmission through nerve cell
As an action potential (nerve impulse) travels down an axon there is a change

in polarity across the membrane of the axon. In response to a signal from
another neuron, sodium- (Na+) and potassium- (K+) gated ion channels open
and close as the membrane reaches its threshold potential. Na+ channels open
at the beginning of the action potential, and Na+ moves into the axon, causing
depolarization. Repolarization occurs when the K+ channels open and K+
moves out of the axon, creating a change in polarity between the outside of
the cell and the inside. The impulse travels down the axon in one direction
only, to the axon terminal where it signals other neurons.
https://en.wikipedia.org/wiki/Action_potential 73
Signal transmission through nerve cell
•In neurons, action potentials play a central role in cell-to-cell communication
assisting—the propagation of signals along the neuron's axon toward synaptic boutons
situated at the ends of an axon; these signals can then connect with other neurons at
synapses, or to motor cells or glands.
•Action potentials in neurons are also known as "nerve impulses" or "spikes", and the
temporal sequence of action potentials generated by a neuron is called its "spike
train". A neuron that emits an action potential, or nerve impulse, is often said to "fire".
•Action potential in other cells:
•In other types of cells, their main function is to activate intracellular processes. In
muscle cells, for example, an action potential is the first step in the chain of events
leading to contraction.
•In beta cells of the pancreas, they provoke release of insulin.
https://en.wikipedia.org/wiki/Action_potential 74
Cardiac action potentials
• The heart will beat without input from the nervous
system and will continue to beat, even outside the body,
as long as its cells are alive.
• The automatic nature of the heartbeat is referred to as
automaticity.
• Automaticity is due to the spontaneous electrical activity
of the SA node. Electrical impulses generated from the
SA node spread through the heart via a nodal tissue
pathway that coordinates the events of the cardiac
cycle.
• The heart's rhythm of contraction is controlled by the
sinoatrial node (SA node), often called the pacemaker.
This node is part of the heart's intrinsic conduction
system, which is made up of specialized myocardial
cells called nodal cells.
http://www.phschool.com/science/biology_place/biocoach/cardio1/electrical.html 75
• The activity of the conduction system, muscles, and
valves of the heart are synchronized so that the heart
can operate as a pump.
• The conduction system initiates and coordinates the
muscular activity of the heart.
• Pressure differentials that result from muscle activity
actuate the opening and closing of valves.
• The opening and closing of valves directs the flow of
blood through the heart.
http://www.phschool.com/science/biology_place/biocoach/cardio1/electrical.html 76
http://www.phschool.com/science/biology_place/biocoach/cardio1/electrical.html
https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-and-function-of-the-hearts-electrical-system 77
Systole & Diastole of the chambers
1. Receive oxygen-less blood from body in atrium
Atrium Diastole
4. Receive oxygen-rich blood from lungs in atrium
3. Send oxygen-less blood to lungs from ventricle
6. Send oxygen-rich blood to body from ventricle
Ventricle Systole
2. Send oxygen-less blood from atrium to ventricle Atrium Systole
5. Send oxygen-rich blood from atrium to ventricle Ventricle Diastole
78
Cardiac conducting system
• Atrium Systole / Contraction:
• Contraction of the heart follows the spontaneous
depolarization of the sinoatrial (SA) node
• SA node signal the artia to contract
• This spontaneous activity is called automaticity or
autorhythmicity
• Neural or hormonal input is not required
SA Node:
• Is found in the R. atrium
• Is called the “cardiac pacemaker” because its rate of
spontaneous depolarization is the fastest in the conducting
system
• Its cells are leaky to Na+
• The leakage causes a prepotential → threshold,
triggering an action potential
• Action Potential spreads along atrial cardiac muscle cells
and the internodal pathways to the AV node
79
Cardiac conducting system (cont.)
• Action Potential generates by SA node reach
AV node
• Upon reaching the atrioventricular (AV) node, the
signal is delayed.
• AV node:
• Is found in the R. atrium near the opening of the
coronary sinus
• Delays the conduction of the AP to the ventricles (~
100 msec), due to:
• A. Its cells being smaller
• B. Fewer gap junctions, so conduction is less
efficient
80
• Signal from Atrium to Ventricle:
• AV bundle (bundle of His) – conducts from the AV node
→ the bundle branches
• This is the only electrical connection between the
atria and ventricles
• Bundle branches (R. and L.) – conduct from the AV
bundle to Purkinje fibers
• The bundle branches are located within the
interventricular septum
81
• Ventricle systole / contraction:
• Signal transmit from AV bundle to Purkinje fibers 
Cause the ventricles to contract from the apex toward
the base
• Purkinje fibers
• Innervate the ventricular myocardium
• Have a very fast conduction speed
82
83
1895, Willem Einthoven (Dutch physiologist)

labeled the five distinct deflections as `P', `Q',
`R', `S' and `T'.
https://brilliantnurse.com/nclex-cardiac-electrical-conduction-system/ 84
The heart conduction system

with its main components, their
typical potential waveforms and
the corresponding points on
surface ECG
Spatio-temporal characterization of the surface electrocardiogram for catheter ablation outcome prediction in persistent atrial fibrillation, PhD thesis, Marianna Meo, 2013 85
https://upload.wikimedia.org/wikipedia/commons/0/0b/ECG_Principle_fast.gif 86
ECG signal
87
Leads of the ECG
• 1906: Einthoven introduced the standard limb leads - I, II and III
• Einthoven's triangle is an imaginary formation of three limb leads in a triangle
used in electrocardiography, formed by the two shoulders and the pubis. The
shape forms an inverted equilateral triangle with the heart at the center.
• Each lead measures the electric field created by the heart during the
depolarization and repolarization of myocytes.
Einthoven's triangle
Lead: Any pair of electrodes can measure the
electrical potential difference between the two
corresponding locations of attachment. Such a
pair forms a lead.
Limb Leads:
Lead 1: LA-RA
Lead II: LL-RA
Lead III: LL-LA
https://en.wikipedia.org/wiki/Einthoven%27s_triangle 88
Leads of the ECG (cont.)
• 1934: Dr. Frank N. Wilson (University of Michigan) defined the `Wilson Central Terminal‘, an
additional terminal at the center of the Einthoven triangle
Common virtual electrode, known as the

Wilson's central terminal (VW) =
https://en.wikipedia.org/wiki/Einthoven%27s_triangle and https://en.wikipedia.org/wiki/Electrocardiography#Limb_leads 89

• 1942: Dr. Emanuel Goldberger (Lincoln Hospital, New York) introduced the augmented leads
• Together with leads I, II, and III, augmented
limb leads aVR, aVL, and aVF form the basis of
the hexaxial reference system, which is used to
calculate the heart's electrical axis in the frontal
plane.
• Older versions of the nodes (VR, VL, VF) use
the Wilson's central terminal as the negative
Augmented limb leads: Leads aVR, aVL, and aVF are the pole, but the amplitude is too small for the thick
augmented limb leads. They are derived from the same three lines of old ECG machines.
electrodes as leads I, II, and III, but they use Goldberger's central
terminal as their negative pole.
• The Goldberger terminals
scale up (augments) the
Wilson results by 50%, at the cost of
sacrificing physical correctness by not having the
same negative pole for all three.
https://en.wikipedia.org/wiki/Einthoven%27s_triangle and https://en.wikipedia.org/wiki/Electrocardiography#Limb_leads 90
Goldberger terminals scale up (augments) the Wilson results by 50%: Explanation
• Medical instrumentation application and design, John G. Webster, 4th Edition

• Example 6.1
• Page 248- 249
91
• 1942: Wilson proposed the precordial/chest leads
(V1 to V6)
• The precordial leads lie in the transverse
(horizontal) plane, perpendicular to the other six
leads. The six precordial electrodes act as the
positive poles for the six corresponding precordial
leads: (V1, V2, V3, V4, V5, and V6). Wilson's central
terminal is used as the negative pole.
92
• Recently:
• 10 electrodes (4 electrodes same as introduced by
Einthoven + 6 electrodes for pericardial leads)
• 12 leads (I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6)
https://www.customed.de/otrs/public.pl?Action=PublicFAQZoom;ItemID=28;ZoomBackLink=QWN0aW9uPVB1YmxpY0ZBUVNlYXJjaDtTdWJhY3Rpb249U2VhcmNoO1NvcnRCeT1UaXRsZTtPcmRl%0Acj1VcDtTdGFydEhpdD0x%0A; 93
12 Leads normal ECG signals
https://elentra.healthsci.queensu.ca/assets/modules/ECG/normal_ecg.html 94
Sensor
Signal
normalization &
segmentation
Sensor for ECG signal
• Electrode:
• Two types of electrodes in common use:
• Flat paper-thin sticker: typically used in a single ECG
recording
• Self-adhesive circular pad: for continuous recordings as
they stick longer.
• Each electrode consists of an electrically conductive electrolyte gel and a
silver/silver chloride conductor. The gel typically contains potassium chloride
– sometimes silver chloride as well – to permit electron conduction from the
skin to the wire and to the electrocardiogram.
• The electrode gel reduces the electrical impedance at the point of contact
with the skin so that this impedance is as small as possible to avoid
attenuation of the signal.
https://en.wikipedia.org/wiki/Electrocardiography#Limb_leads 96
Sensor for ECG signal
• Electrode:
• Sucker-type electrocardiogram electrodes
• Textile Electrodes
• Wearable electrically conductive textile electrodes with high comfort for
the user. The textile composite implemented by a carrier (a T-shirt with
flame retardant) and sensing electrodes embroidered with yarn based on
a mixture of polyester coated with silver nanoparticles and cotton. The
electrodes provide great comfort and are also antibacterial and
antiallergic due to silver nanoparticles.
Vojtech, Lukas & Bortel, Radoslav & Neruda, M. & Kozák, Miloš. (2013). Wearable Textile Electrodes for ECG Measurement.
Advances in Electrical and Electronic Engineering. 11. 10.15598/aeee.v11i5.889
https://en.wikipedia.org/wiki/Electrocardiography#Limb_leads 97
Sensor for some electrodiagnostic techniques
• Electrode:
• Mostly used electrode for
• Electrocardiography (ECG) is the graph of voltage versus time of the electrical activity
of the heart (cardiac muscle )
• Electroencephalography (EEG): record electrical activity of the brain. EEG measures
voltage fluctuations resulting from ionic current within the neurons of the brain.
• Electromyography (EMG): an electrodiagnostic technique for evaluating the electrical
activity produced by skeletal muscles. An electromyograph detects the electric
potential generated by muscle cells when these cells are electrically or neurologically
activated. Two types: surface EMG and intramuscular EMG
Basic structure of the sensor for ECG, EEG, EMG:
Electrode and Electrolyte interface
So focus is required on Electrode and Electrolyte Interface.
98
Electrochemical cell (Anode & Cathode)
• The electrode of a battery that releases electrons during discharge is called anode
• The electrode that absorbs the electrons is the cathode.
• The battery anode is always negative and the cathode positive.
99
Current I: from electrode to electrolyte  Oxidation
Current I: from electrolyte to electrode  Reduction
Oxidation
Reduction
Figure 2.4(A) Metal electrode immersed in an electrolyte

solution and (B) electrode electrolyte interface.
The atoms of the metal M in the electrode electrolyte interface can be oxidized to form cations and one or
more free electrons. The cations are discharged into the electrolyte and the electrons are transported through
the electrode.
Any anion that comes from the electrode electrolyte interface can be oxidized into a neutral atom
transfering one or more free electrons to the electrode
Both oxidation reactions can be reversed with a reduction process.
Oxidation
Reduction
Figure 2.4(A) Metal electrode immersed in an electrolyte

solution and (B) electrode electrolyte interface.
When the resulting current flows from the electrode to the electrolyte, the oxidation reactions are dominant.
When current flows through the electrolyte to the electrode, the reduction reactions are dominant.
In addition, when the frequency of the oxidation reactions is equal to the rate of reduction
reactions, the net charge transfer, that is, the current through the interface, is null. It is
important to note that no electronic or ionic charge crosses the interface, but there is
electronic charge displacement through the metal electrode and there is ionic charge
displacement through the electrolyte.
1.1 V
Half-cell potential for common electrode materials at 25 degree C

(reference to the hydrogen electrode) (Reduction Half-Reaction):
https://www.researchgate.net/figure/An-example-zinc-copper-Galvanic-or-Voltaic-cell-demonstrating-the-principles-of_fig1_295261908
https://chem.libretexts.org/Bookshelves/Analytical_Chemistry/Supplemental_Modules_(Analytical_Chemistry)/Electrochemistry/Voltaic_Cells
102
Half-cell potential
• Half-cell potential (Vhc) refers to the potential developed at the electrode of
each half cell in an electrochemical cell. In an electrochemical cell, the overall
potential is the total potential calculated from the potentials of two half cells.
• It is not possible to measure the Vhc of a metal electrode without using a
second electrode as reference.
• A standard half-cell consists of a metal electrode in a 1 molar (1 mol/L)
aqueous solution of the metal's salt, at 298 kelvins (25 °C)
• The electrochemical series, which consists of standard electrode potentials
and is closely related to the reactivity series, was generated by measuring the
difference in potential between the metal half-cell in a circuit with a standard
hydrogen half-cell, connected by a salt bridge.
The standard hydrogen half-cell: Half-cell of Zn:
103
Half-cell potential
Figure 2.7Electrochemical cell used to determine the half-cell

potential (Vhc) of any metal, for instance, X
If we consider Reduction Half-Reaction the voltage will be negative (i.e., -0.76 V)

The standard hydrogen half-cell: Half-cell of Zn:
Nernst equation:
Potential measurement of an electrochemical half-cell or full cell
• The reversible, equilibrium, or half-cell potential of a given electrode–
electrolyte interface depends on the activity (almost synonymous with
concentration) of the ions taking part in the reactions. This potential, Erev, is
given by the Nernst equation,
Encyclopedia-of-medical-devices-and-instrumentation-vol-1 --- webster, pp-122 105

Nernst equation:
106
Nernst equation:
Nernst equation for a general oxidation-reduction reaction as,
107
Equivalent electronic circuit of electrode/electrolyte interface
No current
• The capacitance Cdl is in
the model because Vhc
is due to ionic charges
distribution, represented
as two layers of charges
with opposite polarities
separated by a region
free of charges, which
behaves as a capacitor.
• Cdl corresponds to the
double layer capacitance
(~0.1 and 10μF)
108
• Parallel resistance Rdl is

resistance across this
double layer (~above 2
kΩ).
• Series resistance Rel
represents the variation
of the ion concentration
in the electrolyte from
the interface with the
metal.
• DC voltage source half-
cell voltage
109
110
111
Electrolyte skin interface
Skin is represented by its layers:

• Epidermis
• dermis
• subcutaneous layers
112
Electrolyte skin interface
Cdl = Capacitance of the double layer in the
metal/electrolyte interface
Vhc = Half-cell potential of the metal electrode
Rdl = Resistance of the double layer in the
metal/electrolyte interface
R = Resistance of the electrolyte
Vsc = Potential drop, defined by Nernst equation, that
results from the difference of ionic
concentration between the stratum corneum
(semipermeable membrane) and the electrolyte
Ce and Re = Capacitance and resistance of the
epidermis impedance
Rdsl = Resistance that represents dermis and
subcutaneous layers (nerves, blood vessels, glands,
and sweat ducts and hair follicles)
Vgsd, Cgsd, and Rgsd = Elements that represent glands
and sweat ducts in the presence of thermal stimulus
Interfaces electrode electrolyte skin. The skin is represented by its layers: epidermis,
dermis, and subcutaneous layers and Equivalent simplified electric circuit.
113
Biopotential measurement with two electrodes
Figure 2.15 Biopotential measurement with two electrodes: (A) schematic representation and (B) equivalent circuit. Zin
is the input impedance of the amplifier; Vin is the voltage difference effectively amplified; Vhc1 and Vhc2 are half-cell
potentials of electrodes; VZ1 and VZ2 are the potential drops across the double layers of the interfaces; and Rel1 and Rel2
are the impedances of the electrolytes under the electrodes
114
Offset voltage
• The half-cell potential, ideally stable and constant for identical metal
electrodes, can constitute a source of artifact in the measurement.
• Even using two electrodes made by the same manufacturer and with the
same characteristics, they may have different Vhc, what can result in current
flow between the electrodes, giving rise to an undesired voltage, called offset
voltage.
• This voltage is added to the voltage drop across Rtissue (biopotential to be
measured) and can be mistakenly interpreted as a physiological event.
115
Motion artifact
• When a nonpolarized electrode is in contact to the electrolyte, a double layer
of charges is formed in the interface. Any event that modifies the charges
distribution in the metal/electrolyte interface modifies the electrodeVhc.
When measuring a biopotential with two equal electrodes and one of them
moves, for example, due to an excessive amount of electrolyte under the
electrode, while the other stays stationary, a DC potential will arise due to the
difference in theirVhc. The DC potential is called motion artifact; it is added to
biopotential signal, amplified and may be misinterpreted as a physiological
event. The electrode movement may also be due to patient’s respiration.
When the electrodes are applied to the patient’s thorax, for ECG recording,
and the skin under the metallic electrodes stretches during the inspiration
phase, the charges distribution is modified creating a potential difference
between the electrodes Vhc.
116
Electrode polarization or overpotential
• The equilibrium or half-cell potential of a metallic electrode is defined under
conditions in which no current flows between the electrode and the
electrolyte.
• Two types of electrode:
• “perfectly” polarizable electrode: only displacement current, electrode behave like a
capacitor. Example: noble metals like platinum Pt
• “perfectly” nonpolarizable electrode: current passes freely across
interface. Examples: silver/silver chloride (Ag/AgCl), mercury/mercurous chloride
(Hg/Hg2Cl2) (calomel)
• With current flowing the half-cell voltage changes  this voltage change is
called overpotential or polarization.
117
• Temperature and ion activity changings in the electrolyte are the main causes
of electrode Vhc modification.
• If current flows through the electrode/electrolyte interface, concentration and

ion activity change, modifying Vhcaccording to Nernst equation
118
• Temperature and ion activity changings in the electrolyte are the main causes
of electrode Vhc modification.
• If current flows through the electrode/electrolyte interface, concentration and

ion activity change, modifying Vhcaccording to Nernst equation
119
• When current flows through a real electrode, its Vhc changes due to electrode
polarization. The difference between the observed Vhc and the expected
equilibrium Vhc is known as polarization or overpotential. Some mechanisms
that contribute to electrode polarization are resistance or ohmic
overpotential, concentration overpotential, and activation overpotential
(Webster, 2010). These distinct types of electrode polarization are additive
and represent a deviation of the Vhc from equilibrium:
120
Ag/AgCl Electrode
• The Ag/AgCl electrode is a practical electrode
taht approaches the characteristics of a
perfectly nonpolarizable electrode.
• Easily fabricated in the laboratory.
• This electrode is stable in liquid that has large
quantity of Cl- such as biological fluid.
121
Electrode classification
• Noninvasive electrodes
• Metal electrodes
• Flexible electrodes
• Invasive electrodes
• Needle and wire electrodes
• Microelectrodes
• Electrode for tissue stimulation
• Constant current stimulation
• Constant voltage stimulation
122
Noninvasive electrodes
• Without invading the biological tissue, that is, without disrupting cell
membrane.
• Metal electrodes:
• Applied to the skin through electrolytic gel
• Used in ECG, eletromyogram (EMG), and electroencephalogram (EEG).
• To avoid chemical reactions with electrolyte or sweat, that may cause skin
irritation, the electrodes are made, preferably, of inert or almost inert metals
and metal alloys such as gold, platinum, silver, titanium, and stainless steel.
• Can be classified as limb, suction, disc, EEG, floating (top-hat and disposable),
and dry electrode
123
Noninvasive electrodes (cont.)
• Metal electrodes (cont.)
124
• Metal electrodes (cont.)
125
• Flexible electrodes
• A flexible electrode is fabricated depositing a metallic film, for example,
Ag AgCl, on a flexible substrate (polymeric); usually the substrate side
receives a layer of conductive adhesive to fix the electrode to the skin, and the
metallic face, which is connected to a lead wire, receives a layer of insulating
material.
Transcutaneous electrical
nervous stimulation or (TENS)
126
• Flexible electrodes (cont.)
• Advantage / Use:
• They are used primarily for monitoring children and premature newborns because they are light, thin, and
adapt to body contours, avoiding motion artifact and ulceration in the contact region, which may occur in the
case of rigid electrodes applied with electrolyte and adhesive tapes.
• Also transparent to X-rays, and this means that the patient may be subjected to X-ray examination without
removing the electrode
• The fixation of flexible electrode is made with a thin, also flexible layer, the same size of the contact surface
of the electrode, of a gelatinous material, called electrolytic hydrogel. It is adhesive (minimizes the motion
artifact) and conductive and its electrical impedance is higher than that of the conventional electrolytic gel.
127
Invasive electrodes
• The invasive capture of biopotentials requires transcutaneous electrodes,
which means cutting the skin and other biological tissues with the electrodes.
The patient skin / electrolyte no longer exists and in the metal electrode
/electrolyte interface, extra- and intracellular fluids of the patient body
replace the electrolyte.
• The diameter itself is chosen according to the biological tissue being
examined. For a transmembrane measurement, the diameter of the electrode
tip is determined through the cell size and its membrane resistance to avoid
the cell destruction. The diameters of the cells of biological tissues are usually
in the range between 50 and 500μm
Microelectrodes
128
Invasive electrodes
• The invasive capture of biopotentials requires transcutaneous electrodes, which means
cutting the skin and other biological tissues with the electrodes. The patient skin /
electrolyte no longer exists and in the metal electrode /electrolyte interface, extra- and
intracellular fluids of the patient body replace the electrolyte.
• Advantage:
• Invasive recording allows detecting electrical signals with less loss of frequency content.
• Reduce motion artefact.
• The diameter itself is chosen according to the biological tissue being examined. For a
transmembrane measurement, the diameter of the electrode tip is determined through the
cell size and its membrane resistance to avoid the cell destruction. The diameters of the
cells of biological tissues are usually in the range between 50 and 500μm
• Two types:
• Microelectrodes
129
Invasive electrodes (cont.)
• Needle and wire electrodes:
• EMG, ECG, and EEG and in invasive monitoring during surgical procedures.
• In the EMG recording, the electrode is placed within the muscle or group of muscles under
examination.
• In the ECG invasive recording, the
electrodes are inserted, for instance,
in the muscles of arms and legs,
according to the derivation used.
130
• Microelectrodes:
• The microelectrodes are used to study cell electrophysiology by intra- and extracellular
measurements.
Glass microelectrode
131
• Microelectrodes: (cont.)
• Metal microelectrode fabrication begins with a very fine metal needle, insulated by a film
of polymeric material, except at one end.
• Then the needle is mounted in an
electrochemical cell to slowly erode
the noninsulated end, while, at same
time, it is withdrawn from electrolyte
bath to form a sharpened thin tip.
Metal microelectrode
132
Electrodes for tissue stimulation
• Stimulation electrodes have similar materials and construction techniques of
biopotential recording electrodes.
• The main difference between them is in the magnitude order of the current
through the electrode/electrolyte interface. While during biopotential
recording current does not exceed the order of microamperes, stimulation
currents are of the order of miliamperes.
133
Electrodes for tissue stimulation (cont.)
• Stimulating microelectrodes are used in vitro to study the electrophysiology of isolated cells
or slices of different tissues.
• Stimulation electrodes are used in vivo in many applications, noninvasively, such as
somatosensory evoked potential (SSEP), transcutaneous electrical nerve stimulation (TENS)
for pain relief, functional sensory stimulation (FES), electrically eliciting muscle
contractions, or invasively, like in deep brain stimulation (has been effective at treating
neurological disorders such as Parkinson’s disease and epilepsy), cochlear implant (to
improve hearing by assisting stimulation of the auditory nerve), retinal implant (to offer
prospects of vision restoration for blind patients by eliciting visual percepts of spots of
light), etc.
• Stimulation electrodes are also used inin vivo applications, both invasively and
noninvasively, as part of medical devices, such as defibrillators, pacemakers, and
electrosurgery, among others. Some applications need the electrode to be implanted,
permanently or temporarily (pacemakers and defibrillators).
134
• Conventional stimulating metal microelectrodes, forin vitro and in vivo uses, are
• fabricated in monopolar, parallel bipolar, and concentric bipolar configurations, of insulated
wires of tungsten, iridium, platinum/iridium, and stainless steel, in diameters ranging from
2.5 to 150μm and impedances from 0.1 to 5.0 MΩ.
• Tungsten is the most versatile and widely used probe material because of its stiffness,
biocompatibility, and cost. It is extensively used for stimulation situations, such as deep
brain studies in Parkinson disease and other studies that require a long electrode.
• Platinum/iridium is extremely inert and biocompatible and is much more resistant to
corrosion than either tungsten or stainless steel when used in extensive stimulation
protocols; it is an excellent selection for chronic implants. Platinum/iridium also has lower
tip impedance than tungsten or stainless steel. Iridium (pure iridium) has by far the lowest
tip impedance of any of the noble metals; it is extremely inert and very resistant to
corrosion
135
136
137
138
Diagnosis of heart disease
• http://www.bem.fi/book/19/19.htm
• The Basis of ECG Diagnosis
139
Reference
• https://en.wikipedia.org/wiki/Atrioventricular_block
• https://stackoverflow.com/questions/23300521/libsvm-training-a-signal
• https://www.webmd.com/heart/picture-of-the-heart#2
• https://www.webmd.com/heart-disease/guide/how-heart-works#1
• https://www.medicinenet.com/heart_how_the_heart_works/article.htm
• https://www.youtube.com/watch?v=pMV3y8r6WOU
• https://biomedical-engineering-
online.biomedcentral.com/articles/10.1186/s12938-015-0056-y
• http://hyperphysics.phy-astr.gsu.edu/hbase/Biology/actpot.html
140
Nernst equation:
• A quantitative relationship between cell
potential and concentration of the ions
The constant F (the Faraday constant) is

a unit conversion factor F = NAq, where
NA is the Avogadro constant and q is
the fundamental electron charge.
https://en.wikipedia.org/wiki/Nernst_equation#:~:text=In%20electrochemistry%2C%20the%20Nernst%20equation%20is%20an%20equation,of%20the%20chemi
141
cal%20species%20undergoing%20reduction%20and%20oxidation.
Circuits of Biomedical Signal Acquisition
Course code: EC4303
Subject {L-T-P / C}: {3-0-0 / 3}
Department of ECE
NIT Rourkela
1
Main parts
of Digital
electronic
stethoscope
Circuit of electronic stethoscope
R5, R6, R7 33K 1/4W Resistor
R11 2.2K to 10K Audio Taper Pot
R13, R15,
1K 1/4W Resistor
R16
R14 3.9 Ohm 1/4W Resistor
C2 4.7uF 16V Electrolytic Capacitor
0.047uF 50V Metalized Plastic Film
C3, C4
Capacitor
C5 0.1uF 50V Ceramic Disc Capacitor
Preamplifier U1a TL072 Low Noise Dual Op-Amp
Second order low pass Power U1b 741 Op-Amp
Sallen-Key filter amplifier U5 LM386 Audio Power Amp
MIC Two Wire Electret Microphone
J1 1/8" Stereo Headphone Jack
3
Amplifiers for Phonocardiography
• Amplifier has bandwidth with a frequency range of about 20 to 2000 Hz.
• Filters permit selection of suitable frequency bands, so that particular heart
sound frequencies can be recorded.
• In general, the high frequency components of cardiovascular sound have a
much smaller intensity than the low frequency components and that much
information of medical interest is contained in the relatively high frequency
part of this spectrum. Therefore, high-pass filters are used to separate the
louder low frequency components from the soft and interesting high
frequency murmurs.
• PCG amplifiers usually have gain compensation circuits to increase the
amplification of high frequency signals, which are usually of low intensity.
Handbook of Second Edition Biomedical Instrumentation by R S Khandpur 4

Main parts
of Digital
electronic
stethoscope
• Heart sound data acquisition module:

• Electronic stethoscope sensor: Already discussed
• Amplifier and filter
• Amplification and filtering are the two major aspects in any signal acquisition system.
• Usually, a pre-amplifier with a small gain is used to suppress the 50 or 60 Hz interference from power lines.
• An anti-aliasing filter is then employed to prevent aliasing effect. In some system designs, the filter section
is built with a band pass filter circuit having the frequency range of most heart sound signals. The use of
band pass filter with proper passband selection not only prevents aliasing, but also removes some of the
noises outside the passband.
• In post amplification, the filtered signal is amplified to the level range required by the analog-to-digital
converter  necessary of VGA
• Analog-to-digital converter
• The amplified and filtered analog signal is converted to digital signal by the analog-to-digital converter. The
sampling frequency and bit resolution can be set by the system designer. Usually, a higher sampling rate
and bit resolution will provide greater accuracy, at the cost of more bandwidth required and power
consumption.
• Heart sound pre-processing module: In this stage, the digital HS signal will undergo noise
reduction, normalization and segmentation.
• Signal denoising unit:
• A digital filter is sometimes used to extract the signal within the frequency band of
interest from the noisy data. In order to equip the system with even better denoising
capability, some advanced artifacts removal techniques are generally utilized such that
the output signal-to-noise ratio (SNR) can be further improved.
• Normalization and segmentation:
• In data acquisition, different sampling and acquisition locations normally result in a
signal variation. Thus, the HS signals are normalized to a certain scale, so that the
expected amplitude of the signal is not affected from the data acquisition locations and
different samples.
• After getting the normalized signals, the HS signals are segmented into cycles which are
ready for HS components detection and features extraction.
• Heart sound signal processing module: The feature extraction and classification are conducted
in this stage.
• Feature extraction:
• Signal processing is carried out to convert the raw data to some type of parametric
representation. This parametric representation, called feature, is then used for further
analysis and processing.
• Classification:
• A classifier, trained with the extracted features, is used to categorize the data and assist
the medical specialist for clinical diagnostic decision making.
Sensor
Signal
normalization &
segmentation
Bio-medical Signal Acquisition System
Bio-
SENSOR INA VGA Digital Output
medical ADC
For Processing
signals
10
Input impedance
11
One Op-Amp differential amplifier
Good for low resistance source (Strain-gage)
12
Solution to over come low input impedance
Use of buffer…
However, this
solution does not
diminish the
common mode
voltage…
13
3 Op-Amp based INA
14
Analysis of the first stage
15
3 Op-Amp based INA
16
VGA
• Already discussed…
17
Basics of CMOS Analog
VLSI design
18
MOSFET characteristics and small signal model
Transfer
ID characteristics
D +
G
+ B VDS
VGS S - Output characteristics
-
-4
6
x 10 id D
VGS= 2.5 V G
Small signal model of  
5
v gs rds
MOSFET in saturation vds
Saturation region v gs g m
4
Triode VGS= 2.0 V  
ID (A)
S S
3
0 when VGS  Vt 0  Cut  off
VDS = VGS - VTH 
2 
VGS= 1.5 V
 
 K 2VGS  Vt 0 VDS  VDS

iD  
2
cut-off
 when VGS  Vt 0   0 and (VDS  VGS  Vt 0   Linear
1
VGS= 1.0 V

0 
 K VGS  Vt 0  when VDS  VGS  Vt 0   0  Saturation
0 0.5 1 1.5 2 2.5
VDS (V)  2
19
Common Source (CS) Amplifier
Biasing circuit V DD V DD 
RO 2 Impedance looking at
Load of the input MOS from output
Load of the
amplifier
amplifier
RO1 Impedance looking at
R1 RO1
VOut RO1 load from output
D VOut
G + RO 2  rds D
VDS G + RO 2
- VDS
vin vin -
R2 i/p S ROut  RO1 || RO 2
VGS S
Output voltage:
G id D vOut   g m v gs  ( RO1 || RO 2 )
     g m vin  ( RO1 || RO 2 )
vin v gs rds vds
RO1 vOut
v gs g m Gain of the amplifier:
  
vOut
S S   g m  ( RO1 || RO 2 )
RO 2  rds vin
20
How to increase gain?
Gain of the amplifier: W 
vOut gm  2 K n I DS  
  g m  ( RO1 || RO 2 )  L 
vin
1
RO 2  rds 
 I DS
We can increase gain by increasing gm

But increasing g mby increasing I DS More power consumption
Moreover, rdswill decrease with increase I DS Decrease the gain

The other options are:
Increase RO1
Increase RO 2
Increase both RO1 and RO 2
21
Resistive load CS amplifier
Gain of the amplifier:
V DD vOut
  g m  ( RD || rds )
vin
RD ID
  g m  RD As, RD  rds so, RD || rds  RD
RO1  RD
D
VOut Hence, to increase the gain we have to increase RD
G + RO 2  rds
VDS
vin -
S
VGS
22
Limitation of resistive load CS amplifier
V DD
vOut
RD ID   g m  ( RD || rds )
vin
RO1  RD
  g m  RD As, RD  rds so, RD || rds  RD
D
VOut
G + RO 2  rds
VDS Hence, to increase the gain we have to increase RD
vin -
S
VGS But, this will increase the d.c. voltage drop also  require higher supply voltage
Load line characteristics
Solution: Implement some techniques which

(1) does not increase the d.c. voltage drop, however, (2) increase a.c.
gain by increasing the a.c. resistance
Requirement:
Use load which provide: Low d.c. resistance but high a.c.
resistance  Require a non-linear device as load  such as, MOSFET
23
Output resistance of different MOS configuration
ID
IR ID
D M 2I D
G
R VDS
VOUT VDS VBias 2
VGS S M1
VGS  VDS VCas .
VGS1
MOS current
Resistive load MOS diode
source load Cascode
connected
configuration
ID Slope 
1
ID
IR ID rds
Slope 
1
Slope  g m g m 2 rds1rds 2
Slope = 1/R
VOUT VDS VCascode

Vth VDS  VGS
Output AC resistance = Output resistance =
rds
AC resistance = DC
Output AC resistance =
1/ gm g m 2 rds 2 rds1
resistance = R Output DC resistance low
24
Load line characteristics of different loads
Diode connected
MOS load
MOS current
source load
Cascode load
(VDD  Vth )
25
Typical value of output resistances for different configuration
Process 180 nm
W  1
The transistor has gm  2 K n I DS   and rds 
 L   I DS
Kn = 175 mA/V2,
L = 2 mm, and Now for Id = 128 mA
W = 40 mm
gm  947 uS rds  156 KΩ
λ = 0.05 V-1
Output resistance for MOS diode connected = = 1/ gm 1.06 K
Output resistance for MOS current source load = = rds 156 K
Output resistance of Cascode configuration = = g m 2 rds 2 rds1 23 M
26
pMOS Current source active load
pMOS Current
The input transistor has
V DD source load
Id = 128 mA
Kn = 175 mA/V2,
VB1
M2 ID rds1  rds 2  156 K
L1 = 2 mm, and
RO1  rds 2 g m  947 uS
W1 = 40 mm
D
VOut 
G + = 0.05 V-1
VDS RO 2  rds1
vin - M
S
VGS 1
vOut
  g m  (rds1 || rds 2 )  74  37.4 dB
vin
vOut
  g m  RD  6.34  16dB
vin
27
Cascode load
V DD
The input transistor has
VB 2 Id = 128 mA
M3 Kn = 175 mA/V2,
rds1  rds 2  156 K
L1 = 2 mm, and
VB1
ID M2 g m  947 uS
W1 = 40 mm
RO1  g m 2 rds 2 rds
3 = 0.05 V-1
D
VOut Gain of the amplifier:
G +
VDS RO 2  rds1 vOut
  g m1  ( rds1 || g m 2 rds 2 rds 3 )
vin -
M1
VGS S vin
  g m1  rds1  148  43 .4 dB
Gain improvement w.r.t. active load is only two times or only 6 dB .
28
Output resistance of Cascode structure

D ix
M 2I D v gs 2 rds 2
vx
v gs 2 g m 2 ROut 
 vx ix
VBias 2 S
M1 S
VCascode

VGS1
v gs1  0 rds1
v gs1 g m1
ix 

S S
v gs1 g m1  0
rds 2
v gs 2   v   ix rds1
v gs 2
v gs 2 g m 2
 vx
S
v (v x  v)
ix   g m 2i x rds1 
rds1 ix rds 2
vx
 Rout  rds1  rds 2  g m 2 rds1rds 2  g m 2 rds1rds 2
ix
29
Cascode input and cascode load
V DD The transistor has
VB 2 Kn = 175 mA/V2, Id = 128 mA
M4 Ln = 2 mm, and rds1  rds 2  156 K
Wn = 40 mm
VB1
ID M3 g m  947 uS
Lp = 2 mm, and
Wp = 160 mm
RO1 
= 0.05 V-1 RO1  g m 3 rds 3 rds 4
VOut
RO 2 RO 2  g m 2 rds 2 rds1
VB 3 Gain of the amplifier:
M2 vOut
  g m1  ( g m3rds 3rds 4 || g m 2 rds 2 rds1 )  10,000  80 dB
vin
Amplifier Eqn.
M1
vin Resistive load 16 dB
VGS pMOS Active load 37.4 dB
Cascode load 43.4 dB
Cascode input cascode load 80 dB
30
Simulation result
• Technology 180 nm
• Vdd = 1.8 V
Resistive load Active load
31
Simulation result
• Technology 180 nm
• Vdd = 1.8 V
Cascode load Cascode input and cascode

load
32
Simulation output
Amplifier Eqn. Sim.
Resistive load 16 dB 16 dB
Active load 37.4 dB 38 dB
Cascode load 43.4 dB 41 dB
Cascode input cascode 80 dB 47 dB

load
gmp = 750 u
rdsp = 30 K
Gain = 53 dB
Conclusion:
CMOS Cascode amplifier
can provide very high gain
33
Gain boosted technique
ID
Vref G D
ix
Av
 ROut  
 M2 v 
v gs 2 rds 2

Av v
  v g m 2 v gs 2
vx
S S
VOUT
M1
vin rds1 ROut 
vx
VGS ix
(v x  v) v gs 2   Av v   Av ix rds1
ix   g m 2 Av v 
rds 2
(v x  ix rds1 )
ix   g m 2 Av ix rds1 
rds 2
vx
ROut   rds 2  rds1  Av  ( g m 2 rds 2 )rds1  Av  ( g m 2 rds 2 )rds1
ix
34
Gain boosted amplifier
V DD
VB 2 RO1  Av 2 g m 3 rds 3 rds 4
M4
 RO 2  Av1 g m 2 rds 2 rds1

 M3
Vref 2
Av 2 RO1
Vref 1 VOUT
Av1
 RO 2
 M2 Gain of the amplifier:
vOut
  g m1  ( Av1 g m3rds 3rds 4 || Av 2 g m 2 rds 2 rds1 )
M1 vin
vin
VGS
35
Cancellation of common-mode noise
• Drift : A slow shift of the common-mode voltage is often observed as a drift. The drift error occurs by a
temperature change easily.
36
Basic Structure & Operating Principle of Diff. Amp
High Ad
Drawback of this circuit…

High Ac
Low CMRR
37
37
Basic Structure & Operating Principle of Diff. Amp
Advantage of this circuit…

High Ad
Low Ac
High CMRR
38
38
Active load fully differential amplifier
39
2-Stage fully differential amplifier
40
Telescopic fully differential amplifier
41
Fully differential folded cascode amplifier
42
Basic concept of CMFB
Vop Vop +Von
Common Mode 2
Von Detector
Voc
desired common
mode voltage
-
Dvb e Vcm,out
CMFB
+ R R
Vop Von
43
Resistive C.M. detectors
Vop  Von
, if Rcm  Rcm Vb
2
Prob : resistive loading effect.
Rcm Rcm use Rcm , Rcm very large
Vop Von
- difficult to achieve
- especially w henVo is
at an cascodednode
Rcm is part of feedback network.

Otherwise, Rcm becomes part of g0 & hence reduces AD.C.(v)
44
CMFB circuit using error amplifier in the FB loop
45
Current mirror differential amplifier / Single ended differential amplifier
46
3-OpAmp based INA
R1 = 10 MΩ R2 = 140 KΩ R3,R4 = 1 MΩ
Three Op-Amp INA
47
Difference between the two circuits
48
Features of Biopotential amplifier:
• 1. High CMRR
• 2. High input impedance : reduce distortion, loading effect
• 3. Protection circuits
• 4. Low output impedance
• 5. good driving capability
• 6. High gain
• 6. fast calibration
• 7. Limited bandwidth of the amplifier
• 8. Capable of rejecting the line frequency
49
Block diagram of an electrocardiograph
50
Problem frequently encountered while designing an bio-potential amplifier:
1. Frequency distortion
2. Saturation or cut-off distortion
3. Ground loops
4. Open lead wires
5. Artifact from large electric transient
6. Interference from electrical devices:
Electric field coupling between
a. powerlines and the electrocardiograph
b. powerlines and the patient
7. Electromagnetic interference.
51
Diagnosis of heart disease
• The Basis of ECG Diagnosis
52
Reference
• https://en.wikipedia.org/wiki/Atrioventricular_block
• https://stackoverflow.com/questions/23300521/libsvm-training-a-signal
• https://www.webmd.com/heart/picture-of-the-heart#2
• https://www.webmd.com/heart-disease/guide/how-heart-works#1
• https://www.medicinenet.com/heart_how_the_heart_works/article.htm
• https://www.youtube.com/watch?v=pMV3y8r6WOU
• https://biomedical-engineering-
online.biomedcentral.com/articles/10.1186/s12938-015-0056-y
• http://hyperphysics.phy-astr.gsu.edu/hbase/Biology/actpot.html
53
Nernst equation:
• A quantitative relationship between cell
potential and concentration of the ions
The constant F (the Faraday constant) is

a unit conversion factor F = NAq, where
NA is the Avogadro constant and q is
the fundamental electron charge.
https://en.wikipedia.org/wiki/Nernst_equation#:~:text=In%20electrochemistry%2C%20the%20Nernst%20equation%20is%20an%20equation,of%20the%20chemi
54
cal%20species%20undergoing%20reduction%20and%20oxidation.
EEG, EMG, ENG
Course code: EC4303
Subject {L-T-P / C}: {3-0-0 / 3}
Department of ECE
NIT Rourkela
1
Electroencephalography (EEG)
• Electroencephalography (EEG) is an
electrophysiological monitoring method
to record electrical activity of the brain.
• It is typically noninvasive, with the
electrodes placed along the scalp, EEG
although invasive electrodes are
sometimes used, as in
electrocorticography (ECoG), sometimes
called intracranial EEG.
ECoG
2
Electrocorticography (ECoG), or intracranial electroencephalography (iEEG)
• A type of electrophysiological monitoring that uses

electrodes placed directly on the exposed surface of the
brain to record electrical activity from the cerebral cortex.
• Because a craniotomy (a surgical incision into the skull) is
required to implant the electrode grid, ECoG is an invasive
procedure.
• Greater precision and sensitivity than an EEG scalp
recording - spatial resolution is higher and signal-to-noise
ratio is superior due to closer proximity to neural activity.
• ECoG has been used to localize epileptogenic zones during presurgical
planning, map out cortical functions, and to predict the success of
epileptic surgical resectioning.
3
Electrocorticography (ECoG), or intracranial electroencephalography (iEEG)
• The ECoG recording is performed from electrodes placed on the exposed

cortex.
• In order to access the cortex, a surgeon must first perform a craniotomy,
removing a part of the skull to expose the brain surface.
• This procedure may be performed either under general anesthesia or under
local anesthesia if patient interaction is required for functional cortical
mapping.
• Electrodes are then surgically implanted on the surface of the cortex, with
placement guided by the results of preoperative EEG and magnetic resonance
imaging (MRI).
4
Electrocorticography (ECoG)
• Application: Intractable epilepsy, Brain-computer interfaces (BCI)
Types:
• Extraoperative ECoG: outside of surgery. Find exact location of lesion
• Intraoperative ECoG: during surgery. Guide surgeon to monitor epileptic
activity of tissue and ensure that the entire epileptogenic zone is resectioned.
• Before a resectioning surgery, MRI must be performed to demonstrate the presence of a
structural lesion within the cortex, supported by EEG evidence of epileptogenic tissue.
• After lesion identification, ECoG determines location and extent of lesion and surrounding
irritative region.
• EEG lacks the precision necessary to localize the epileptogenic region.
• ECoG is considered as gold standard for assessing neuronal activity in patients with
epilepsy, and is widely used for presurgical planning to guide surgical resection of the lesion
and epileptogenic zone.
5
Electrocorticography (ECoG)
Brain-computer interfaces (BCI):
• BCIs are direct neural interfaces that provide control of prosthetic, electronic,
or communication devices via direct use of the individual’s brain signals.
• Brain signals may be recorded either invasively, with recording devices
implanted directly into the cortex, or noninvasively, using EEG scalp electrodes.
• ECoG serves to provide a partially invasive compromise between the two
modalities – while ECoG does not penetrate the blood–brain barrier like
invasive recording devices, it features a higher spatial resolution and higher
signal-to-noise ratio than EEG.
• ECoG has gained attention recently for decoding imagined speech or music,
which could lead to "literal" BCIs in which users simply imagine words,
sentences, or music that the BCI can directly interpret.
6
• EEG measures voltage fluctuations resulting from ionic current within the
neurons of the brain.
• EEG refers to the recording of the brain's spontaneous electrical activity over a
period of time, as recorded from multiple electrodes placed on the scalp.
• Diagnostic applications generally focus on:
i. Event-related potentials: investigates potential fluctuations time locked to
an event, such as 'stimulus onset' or 'button press'.
ii. Spectral content: analyses the type of neural oscillations (popularly called
"brain waves") that can be observed in EEG signals in the frequency domain.
• Traditionally, most EEG analysis methods fall into four categories: time domain,
frequency domain, time-frequency domain, and nonlinear methods. There are
also later methods including deep neural networks (DNNs)
7
• Applications:
• EEG is most often used to diagnose epilepsy, sleep disorders, depth of
anesthesia, coma, encephalopathies, brain death, memory loss, Alzheimer,
autism, BCI (Brain-computer Interface), emotion detection.
• EEG also used to be a first-line method of diagnosis for tumors, stroke and
other focal brain disorders, but this use has decreased with the advent of high-
resolution anatomical imaging techniques such as magnetic resonance imaging
(MRI) and computed tomography (CT).
• Advantages over CT/MRI:
• Despite limited spatial resolution, EEG continues to be a valuable tool for
research and diagnosis. It is one of the few mobile techniques available and
offers millisecond-range temporal resolution which is not possible with CT, PET
or MRI.
8
• Different methods to study brain functionality: functional magnetic
resonance imaging (fMRI), positron emission tomography (PET), nuclear
magnetic resonance spectroscopy (NMR or MRS), magnetoencephalography
(MEG), electrocorticography (ECoG), single-photon emission computed
tomography (SPECT), near-infrared spectroscopy (NIRS), and event-related
optical signal (EROS).
• Advantages of EEG over other methods:
• Despite the relatively poor spatial sensitivity of EEG, it possesses multiple
advantages over some of these techniques:
• Hardware costs are significantly lower.
• Provide immediate care in high traffic hospitals.
9
• Advantages: (cont.)
• EEG sensors easy to use than fMRI, SPECT, PET, MRS, or MEG, as these
techniques require bulky and immobile equipment.
• Very high temporal resolution, on the order of milliseconds rather than
seconds. EEG is commonly recorded at sampling rates between 250 and 2000
Hz in clinical and research settings, but modern EEG data collection systems
are capable of recording at sampling rates above 20,000 Hz if desired.
• relatively tolerant of subject movement
• is silent, which allows for better study of the responses to auditory stimuli.
• does not involve exposure to radioligands, unlike positron emission
tomography.
10
• Advantages: (cont.)
• does not involve exposure to high-intensity (>1 tesla) magnetic fields, as in
some of the other techniques, especially MRI and MRS. These can cause a
variety of undesirable issues with the data, and also prohibit use of these
techniques with participants that have metal implants in their body, such as
metal-containing pacemakers.
• EEG can be used in subjects who are incapable of making a motor response.
• EEG is a powerful tool for tracking brain changes during different phases of
life. EEG sleep analysis can indicate significant aspects of the timing of brain
development, including evaluating adolescent brain maturation.
11
• Disadvantages:
• Low spatial resolution on the scalp. fMRI, for example, can directly display areas of the
brain that are active, while EEG requires intense interpretation just to hypothesize what
areas are activated by a particular response.[30]
• poorly measures neural activity that occurs below the upper layers of the brain (the cortex).
• Unlike PET and MRS, cannot identify specific locations in the brain at which various
neurotransmitters, drugs, etc. can be found.
• Often takes a long time to connect a subject to EEG, as it requires precise placement of
dozens of electrodes around the head and the use of various gels, saline solutions, and/or
pastes to maintain good conductivity, and a cap is used to keep them in place. While the
length of time differs dependent on the specific EEG device used, as a general rule it takes
considerably less time to prepare a subject for MEG, fMRI, MRS, and SPECT.
• Signal-to-noise ratio is poor, so sophisticated data analysis and relatively large numbers
of subjects are needed to extract useful information from EEG.
12
• EEG focuses on the part of the brain that controls conscious activities. Whenever a subject decides to do
something those parts light up and create potential difference on different parts of cortex (EEG helps us to
diagnose all disease that effects on cortex) and that potential can be recorded using surface electrode.
• EEG records potential difference between two electrodes
• Bipolar montage or Referential montage.
• Electrode placement (10-20 system)
13
14
Brain structure
15
Brain structure
• Cerebrum:
• The cerebrum is the part of the brain that
receives and processes conscious sensation,
generates thought, and controls conscious
activity. It is the uppermost and largest part
of the brain and is divided into left and right
hemispheres, which are joined by and
communicated through the corpus
callosum.
16
Brain structure (cont.)
• Cerebellum
• The Cerebellum is a cauliflower-shaped
section of the brain located in the hindbrain,
at the bottom rear of the head, directly
behind the pons. The cerebellum is a
complex system mostly dedicated to the
intricate coordination of voluntary
movement, including walking and balance.
Damage to the cerebellum leaves the
sufferer with a gait that appears drunken
and is difficult to control.
17
Brain structure (cont.)
• Ventricles and Cerebrospinal Fluid
• A series of interconnected, fluid-filled cavities called
ventricles lie within the brain. The fluid is
cerebrospinal fluid (CSF), which also circulates over
the outside of the brain and spinal cord.
• Brain Stem
• The brain stem is the part of the brain continuous
with the spinal cord and comprising the medulla
oblongata, pons, midbrain, and parts of the
hypothalamus.
• Tentorium
• The tentorium is a fold of the dura mater, which
separates the cerebellum from the cerebrum, and
often encloses a process or plate of the skull called
the bony tentorium.
18
Brain structure
• Each cerebral hemisphere is divided into five lobes,
four of which have the same name as the bone
over them: frontal lobe, parietal lobe, occipital
lobe, and temporal lobe. A fifth lobe, the insula or
Island of Reil, lies deep within lateral sulcus.
• Frontal lobe is important for cognitive functions
and control of voluntary movement or activity.
• Parietal lobe processes information about
temperature, taste, touch and movement
• Occipital lobe is primarily responsible for vision.
• Temporal lobe processes memories, integrating
them with sensations of taste, sound, sight and
touch.
19
EEG
20
EEG
21
22
Brain structure
• Frontal Lobes:
• The frontal lobes are considered our emotional control center and home to our personality.
The frontal lobes are involved in motor function, problem solving, spontaneity, memory,
language, initiation, judgement, impulse control, and social and sexual behavior. The frontal
lobes are extremely vulnerable to injury due to their location at the front of the cranium,
proximity to the sphenoid wing and their large size. MRI studies have shown that the frontal
area is the most common region of injury following mild to moderate traumatic brain injury.
• There are important asymmetrical differences in the frontal lobes. The left frontal lobe is
involved in controlling language related movement, whereas the right frontal lobe plays a role
in non-verbal abilities. Some researchers emphasize that this rule is not absolute and that
with many people, both lobes are involved in nearly all behavior.
• One of the most common effects of frontal damage can be a dramatic change in social
behavior. A person's personality can undergo significant changes after an injury to the frontal
lobes, especially when both lobes are involved. There are some differences in the left versus
right frontal lobes in this area. Left frontal damage usually manifests as pseudodepression
and right frontal damage as pseudopsychopathic.
23
Brain structure
• Damage to the frontal lobes can result in:
• Loss of simple movement of various body parts (Paralysis)
• Inability to plan a sequence of complex movements needed to complete multi-stepped tasks,
such as making coffee (Sequencing)
• Loss of spontaneity in interacting with others, Inability to express language (Broca's Aphasia)
• Loss of flexibility in thinking and persistence of a single idea or behaviour (Perseveration)
• Inability to focus on a task and to filter out distractions (Attention)
• Mood fluctuations (Emotional lability), Difficulty problem solving
• Difficulty inhibiting or controlling a response or impulse (Disinhibition)
• Reduced motivation, initiation and persistence on activities (Adynamia)
• Reduced awareness/insight into difficulties
• Changes in social behaviour, Changes in personality
24
Brain structure
• Temporal Lobes
• The temporal lobes sit behind the ears and are the second largest lobe. They are most
commonly associated with processing auditory information and with the encoding of
memory. The temporal lobes are also believed to play an important role in processing
affect/emotions, language, and certain aspects of visual perception.
• The dominant temporal lobe, which is the left side in most people, is involved in
understanding language and learning and remembering verbal information. The non-
dominant lobe, which is typically the right temporal lobe, is involved in learning and
remembering non-verbal information (e.g. visuo-spatial material and music).
• Damage to the temporal lobes can result in:
• Difficulty in understanding spoken words (Receptive Aphasia), Disturbance with selective
attention to what we see and hear, Difficulty with identification and categorisation of objects,
Difficulty learning and retaining new information, Impaired factual and long-term memory,
Persistent talking, Difficulty in recognising faces (Prosopagnosia), Increased or decreased
interest in sexual behaviour, Emotional disturbance (e.g. Aggressive behaviour)
25
Brain structure
• Parietal Lobes
• The parietal lobes are located near the back and top of the head. They are important for
processing and interpreting somatosensory input. For example, they inform us about objects
in our external environment through touch (i.e., physical contact with skin) and about the
position and movement of our body parts (proprioception). The parietal lobes are also
responsible for integrating sensory input, and construction of a spatial coordinate system to
represent the world around us.
• Damage to the Parietal lobes can result in:
• Difficulty with drawing objects, Difficulty in distinguishing left from right
• Spatial disorientation and navigation difficulties, Problems with reading (Alexia)
• Inability to locate the words for writing (Agraphia), Difficulty with doing mathematics
(Dyscalculia)
• Lack of awareness of certain body parts and/or surrounding space (Neglect)
• Inability to focus visual attention, Difficulty with motor planning and complex
movements(Apraxia) 26
Brain structure
• Occipital Lobes
• The occipital lobes sit at the back of the head and are responsible for visual perception,
including colour, form and motion.
• Damage to the occipital lobe can include:
• Difficulty with locating objects in environment
• Difficulty with identifying colours (Colour Agnosia)
• Production of hallucinations
• Visual illusions - inaccurately seeing objects
• Word blindness - inability to recognise words
• Difficulty in recognizing drawn objects
• Inability to recognize the movement of an object (Movement Agnosia)
• Difficulties with reading and writing
27
Brain structure
• Temporal Lobes
• The temporal lobes sit behind the ears and are the second largest lobe. They are most
commonly associated with processing auditory information and with the encoding of
memory. The temporal lobes are also believed to play an important role in processing
affect/emotions, language, and certain aspects of visual perception.
• The dominant temporal lobe, which is the left side in most people, is involved in
understanding language and learning and remembering verbal information. The non-
dominant lobe, which is typically the right temporal lobe, is involved in learning and
remembering non-verbal information (e.g. visuo-spatial material and music).
• Damage to the temporal lobes can result in:
• Difficulty in understanding spoken words (Receptive Aphasia), Disturbance with selective
attention to what we see and hear, Difficulty with identification and categorisation of objects,
Difficulty learning and retaining new information, Impaired factual and long-term memory,
Persistent talking, Difficulty in recognising faces (Prosopagnosia), Increased or decreased
interest in sexual behaviour, Emotional disturbance (e.g. Aggressive behaviour)
28
Gamma  Active thought: > 30 Hz, 3-5 µV
Beta  Alert, Working: 14-30 Hz, 2-20 µV
Alpha  Relaxed, Reflective: 8-13 Hz, 20-60 µV
Theta  Sleeping, Meditative: 4-7 Hz, 20-100µV
Delta  Deep sleep: <3.5 Hz, 20-200µV
29
• Beta Wave: (frequency: 14-30 Hz, amplitude: 2-20 µV)
• The most common form of brain waves. Are present during mental thought and activity
• Alpha Wave: (frequency: 8-13 Hz, amplitude: 20-60 µV)
• Easily produced when quietly sitting in relaxed position with eyes closed (few people have trouble producing alpha waves)
• Alpha blockade occurs with mental activity
-exceptions found by Shaw(1996) in the case of mental arithmetic, archery, and golf putting
• Theta Wave: (frequency: 4-7Hz, amplitude: 20-100µV)
• Believed to be more common in children than adults
• Walter Study (1952) found these waves to be related to displeasure, pleasure, and drowsiness
• Maulsby (1971) found theta waves with amplitudes of 100µV in babies feeding
• Delta Wave: (frequency: .5-3.5 Hz, amplitude: 20-200µV)
• Found during periods of deep sleep in most people
• Characterized by very irregular and slow wave patterns
• Also useful in detecting tumors and abnormal brain behaviors
• Gamma wave: (frequency: 36-44Hz, amplitude: 3-5µV)
• Occur with sudden sensory stimuli
30
31
Beta: parietal &

Frontal
Alpha: Occipital
Theta: Parietal &
Temporal
Delta: Cortex
32
33
34
35
36
Signal Transduction
329 positions are defined as potential electrode locations:

• 24 to 36 channels are commonly used; 64 and 128-
channel EEGs are used in research
• 10/20 configuration (black): yields 19 channels plus
several reference channels (typically the ears and
forehead)
• 10/10 configuration (gray): typically doubles the number
of channels
• Differential voltages are typically measured between a
sensor and an ear (e.g., F3-T9)
• Common reference points include the ears (T9 and T10),
the nose (e.g., ???) and the heart/respiratory system
(e.g., EKG1 and EKG2)
37
38
39
EEG Electrodes
40
Consonant indicates brain region the electrode is
sampling
Fp = Frontal pole
F = Frontal
T = Temporal
C = Central
P = Parietal
O = Occipital
M = Mastoid
Subscript indicates side of the brain the electrode is

located
Even numbers = right side

Odd numbers = left side
Z = midline / zero
(The higher the number within a lobe, the farther

the electrode is located from the midline)
41
42
EEG Electrodes
43
44
EEG Measurement
45
46
EEG Signal Processing
47
48
EEG
49
Alpha, beta, theta, and delta rhythms
 Alpha rhythm: Has 8-13 Hz, less than 15 µV amplitude, blocks with eye opening.
 Beta rhythms: more than 13 Hz, normally observed within 18- to 25 Hz with the amplitude of less than 20 µV.
 Theta rhythms: 4-7 Hz frequencies less than 15 µV, frontal or frontocentral head regions.
 Delta rhythms are frequencies consist of less than 4 Hz activity.
50
Extra Cerebral Artifacts
• Various generators of non-physiological and physiological artifacts may deceive the interpreter:
• Eye artifacts: Higher amplitude activity in Fp1, Fp2, F7, F8
• Muscle artifact (EMG): Anterior muscles of the scalp produce EMG artifact on Fp1, Fp2, F4, F3, F7, F8
• EKG
51
Extra Cerebral Artifacts
Eye movement artifact
EMG Artifact
EKG Artifact
52
Normal EEG
The most important factors that a subject must have to be considered as normal are:
1. Anterior-posterior gradient
Beta frequencies in anterior regions with low amplitude
Over occipital region normally we should observe alpha rhythm with higher amplitude.
2. Posterior dominant rhythm

Posterior head regions has alpha frequency 8-12 Hz
3. Having symmetric activity

Having asymmetric activity represents abnormality:
More than 1 Hz and more than 50% amplitude represent abnormality
4. Normal sleep architecture

No anterior-posterior gradient
Spindle , k complex, POSTS, and v wave
53
Sleep Architecture
Transients of Sleep
Spindle (12-14 Hz),
K complex(less than 4 Hz),
POSTS(less than 8 Hz),
V wave (4-13 Hz).
54
Symmetry Activities
Asymmetric activity represents abnormalities
More than 1 Hz
More than 50% amplitude
55
Abnormal EEG
• Slowing (less than 8 Hz, higher amplitude)
• Diffused (or generalized)
• Focal abnormalities
Intermittent or continuous
Focal: Temporal, Frontal …
56
Abnormal EEG
Epileptiform Abnormalities
Interictal epileptiform discharges (IED): Waveforms that shows epilepsy
Frontal, anterior temporal, and midline IEDs have the highest correlation with seizures.
Commonly identified IEDs are spikes and sharp waves
57
Abnormal EEG
Sharp waves: 70 to 200 m sec
Spikes: very frequently negative polarity and 20 to 70 m sec.
Combinations of IEDs often occur in the same patient at different times.
58
Activation procedures
Activation procedures: They let us to trigger (induce) abnormalities mostly seizures.

Hyperventilation
Perform for 3 to 5 minutes to create cerebral vasoconstriction
Normally produces theta and delta in frontal, high amplitude, and effects within 1 minute.
59
Activation procedures
Intermittent photic stimulation
Greatest in the occipital location
Alpha rhythm in occipital regions, when the eyes are closed
60
PRES
Posterior reversible encephalopathy syndrome (PRES)
Also known as reversible posterior leukoencephalopathy syndrome (RPLS)
• Characterized by headache, visual disturbances, seizures, and radiological findings of edema
(swelling) .
• Diffuse theta slowing is the most frequent finding on EEG recordings.
61
PRES
Posterior reversible encephalopathy syndrome (PRES)
Also known as reversible posterior leukoencephalopathy syndrome (RPLS)
• They may also have delta slowing and rhythmic delta activity.
• Epileptic activity of occipital sharp-slow wave but no spikes.
62
MCA infarct
• PLED: Periodic Lateralized Epileptiform Discharge
• Acute infarct
• If infarct is not acute we have slowing in corresponding regions
63
Nervous System
64
65
Electroneurogram (ENG)
• An electroneurogram is a method used to visualize directly recorded electrical
activity of neurons in the central nervous system (brain, spinal cord) or the
peripheral nervous system (nerves, ganglions).
• The acronym ENG is often used.
• An electroneurogram is similar to an electromyogram (EMG), but the latter is used
to visualize muscular activity.
• An electroneurogram is usually obtained by placing an electrode in the neural tissue.
• The electrical activity generated by neurons is recorded by the electrode and
transmitted to an acquisition system, which usually allows to visualize the activity of
the neuron.
• Each vertical line in an electroneurogram represents one neuronal action potential.
• Depending on the precision of the electrode used to record neural activity, an
electroneurogram can contain the activity of a single neuron to thousands of
neurons. 66
Nervous System
67
Reflex arc
68
69
Extracellular field potential
70
Nervous System
71
Nervous System
72
73
74
75
76
77
78
79
Nervous System
80
81
82
Electro-Neuro-Gram (ENG)
• Field potentials of sensory nerves
• Motor-nerve conduction delay
• Reflexly evoked field potentials
 The ENG is an electrical signal observed as a stimulus and the associated nerve action potential
propagate over the length of nerve.
 ENGs may be recorded using concentric needle electrodes or Ag-AgCl electrodes at the surface
of the body.
 In order to minimize muscle contraction strong but short stimulus is applied (100 V amplitude,
100-300 μs).
 ENGs have amplitudes of the order of 10 μV.
83
• Typical values of propagation rate or nerve

conduction velocity are:
• 45-70 m/s in nerve fibers
• 0.2-0.4 m/s in heart muscle
• 0.03-0.05 m/s in time delay fibers
between the atria and ventricles.
• Neural diseases may cause a decrease in
conduction velocity.
• Wrist
• BElbow - below the elbow
• AElbow – above the elbow
84
85
86
87
88
89
90
Electromyography (EMG)
• Motor units
• Single Motor Unit Action Potential
(SMUAP)
91
92
• Normal SMUAPs are usually biphasic or triphasic

• 3-15 ms in duration, 100-300 μV in amplitude, 6-30 Hz in frequency range
93
• EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-
muscle signal transmission.
• Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and
recording the electrical activity produced by skeletal muscles.
• EMG is performed using an instrument called an electromyograph to produce a record
called an electromyogram.
• An electromyograph detects the electric potential generated by muscle cells when these
cells are electrically or neurologically activated.
• The signals can be analyzed to detect medical abnormalities, activation level, or to
analyze the biomechanics of human or animal movement.
• In Computer Science, EMG is also used as middleware in gesture recognition towards
allowing the input of physical action to a computer as a form of human-computer
interaction.
94
• Measures the electric activity of active muscle fibers
• Electrodes are always connected very close to the muscle

group being measured
• Rectified and integrated EMG signal gives rough indication

of the muscle activity
• Needle electrodes can be used to measure individual muscle fibers
• Amplitude: 1-10 mV
• Bandwidth: 20-2000 Hz
• Main sources of errors are 50/60 Hz and RF interference
• Applications: muscle function, neuromuscular disease, prosthesis
95
96
Surface and intramuscular EMG recording electrodes
• There are two kinds of EMG: surface EMG and intramuscular EMG.
• Surface EMG assesses muscle function by recording muscle activity from the
surface above the muscle on the skin.
• Surface electrodes are able to provide only a limited assessment of the muscle
activity.
• Surface EMG can be recorded by a pair of electrodes or by a more complex
array of multiple electrodes.
• More than one electrode is needed because EMG recordings display the
potential difference (voltage difference) between two separate electrodes.
97
• Surface EMG
• Surface EMG may be useful to detect the presence of neuromuscular disease (level
C rating, class III data), but there are insufficient data to support its utility for
distinguishing between neuropathic and myopathic conditions or for the diagnosis
of specific neuromuscular diseases.
• EMGs may be useful for additional study of fatigue associated with post-
poliomyelitis syndrome and electromechanical function in myotonic dystrophy (level
C rating, class III data).
• Recently, with the rise of technology in sports, sEMG has become an area of focus
for coaches to reduce the incidence of soft tissue injury and improve player
performance.
• A Silicon Valley startup, has led the way as the only company to have their
measurements validated as accurate and reliable compared to a medical grade
sEMG system.
98
• Surface EMG
• Limitations of this approach are the fact that surface electrode recordings are
restricted to superficial muscles, are influenced by the depth of the
subcutaneous tissue at the site of the recording which can be highly variable
depending of the weight of a patient, and cannot reliably discriminate
between the discharges of adjacent muscles.
99
• Intramuscular EMG
• It can be performed using a variety of different types of recording electrodes.
• To perform intramuscular EMG, typically either a monopolar or concentric needle electrode
is inserted through the skin into the muscle tissue.
• The simplest approach is a monopolar needle electrode.
• This can be a fine wire inserted into a muscle with a surface electrode as a reference; or two
fine wires inserted into muscle referenced to each other.
• Most commonly fine wire recordings are for research or kinesiology studies.
• Diagnostic monopolar EMG electrodes are typically insulated and stiff enough to penetrate
skin, with only the tip exposed using a surface electrode for reference.
• The needle is then moved to multiple spots within a relaxed muscle to evaluate both
insertional activity and resting activity in the muscle.
• Normal muscles exhibit a brief burst of muscle fiber activation when stimulated by needle
movement, but this rarely lasts more than 100ms.
100
Fasciculation and fibrillation potentials
• The two most common pathologic types of resting activity in muscle are
fasciculation and fibrillation potentials.
• A fasciculation potential is an involuntary activation of a motor unit within the
muscle, sometimes visible with the naked eye as a muscle twitch or by surface
electrodes.
• Fibrillations, however, are detected only by needle EMG, and represent the
isolated activation of individual muscle fibers, usually as the result of nerve or
muscle disease.
• Often, fibrillations are triggered by needle movement (insertional activity) and
persist for several seconds or more after the movement ceases.
101
• Intramuscular EMG
• After assessing resting and insertional activity, the electromyographer assess the activity of
muscle during voluntary contraction.
• The shape, size, and frequency of the resulting electrical signals are judged.
• Then the electrode is retracted a few millimetres, and again the activity is analyzed.
• This is repeated, sometimes until data on 10–20 motor units have been collected in order to
draw conclusions about motor unit function.
• Each electrode track gives only a very local picture of the activity of the whole muscle.
• Because skeletal muscles differ in the inner structure, the electrode has to be placed at
various locations to obtain an accurate study.
• Single fiber electromyography assesses the delay between the contractions of individual
muscle fibers within a motor unit and is a sensitive test for dysfunction of the neuromuscular
junction caused by drugs, poisons, or diseases such as myasthenia gravis. The technique is
complicated and typically performed only by individuals with special advanced training.
102
103
104
Electrooculography (EOG)
• Electric potentials are created as a result of the movement of the eyeballs

• Potential varies in proportion to the amplitude of the movement
• In many ways a challenging measurement with some clinical value
• Amplitude: 0.01-0.1 mV
• Bandwidth: DC-10 Hz
• Primary sources of error include skin potential and motion
• Applications: eye position, sleep state, vestibulo-ocular reflex
105
ERG
106
ERG
107
108
Reference
• https://en.wikipedia.org/wiki/Electroencephalography
• https://en.wikipedia.org/wiki/Electrocorticography
• https://en.wikipedia.org/wiki/EEG_analysis
• https://www.medicine.mcgill.ca/physio/vlab/biomed_signals/eeg_n.htm
• https://www.mayoclinic.org/brain-lobes/img-20008887
• https://sleeptechstudy.wordpress.com/2013/05/13/the-international-1020-
system-of-electrode-placement/
• https://www.mayoclinic.org/tests-procedures/emg/about/pac-20393913
• https://en.wikipedia.org/wiki/Electromyography
109
Summary
EEG is the most valuable tool in the evaluation of patients with a seizure disorders and stroke.
Both spikes and sharp waves are referred to as interictal epileptiform discharges
Strokes in arteries can be seen on EEG signals.
Most important findings in normal EEG:

1. Anterior-posterior gradient
2. Posterior dominant rhythm
3. Having symmetric activity
4. Normal sleep architecture
110
Oximeter, Blood Flow and Pressure
Measurement Instrument
Course code: EC4303
Subject {L-T-P / C}: {3-0-0 / 3}
Department of ECE
NIT Rourkela
1
2
Physiology of respiration
Oxygen/Carbon dioxide interaction: Metabolism
Oxygen -> lungs -> alveoli -> blood Oxygen
breath
CO2 produced by cellular metabolism diffuses across the
CO2 cell membrane into the circulating blood. muscles + organs
lungs
5-10% carried in solution Oxygen
CO2 20-30% bound to haemoglobin
60-70% carried as bicarbonate in the red blood cell
cells
blood energy
Oxygen
+
Glucose
CO2
3
4
Respiratory Monitoring
• Rapid progress with greater safety in Anesthesia field and better ICU outcome.
Main Anesthesia Enemies
5
Inadequate Oxygen Transport
• Anemia
• Reduces red blood cells reduce oxygen carrying capacity
• Inadequate hemoglobin results in the loss of oxygen saturation
• Poisoning
• Carbon monoxide on-loads on the hemoglobin more readily preventing
oxygen saturation and oxygen carrying capacity
• Shock
• Low blood pressures result in inadequate oxygen carrying capacity
6
Pathophysiology
• Oxygen is exchanged by diffusion from higher concentrations to lower
concentrations
• Most of the oxygen in the arterial blood is carried bound to hemoglobin
• 97% of total oxygen is normally bound to hemoglobin
• 3% of total oxygen is dissolved in the plasma
7
Terminology
• SpO2 : Non invasive oxygen saturation
• SaO2 : Arterial (invasive)Oxygen Saturation (oxygen bound to the
hemoglobin molecules)
• SpO2 indicates the oxygen bound to hemoglobin
• Closely corresponds to SaO2 measured in laboratory tests
• SpO2 indicates the saturation was obtained with non-invasive oximetry
• PaO2 : Arterial Partial Pressure, oxygen dissolved in the plasma (only

about 3% of total content) or PO2
• CaO2: Total amount of oxygen in the blood or the (SaO2 + PaO2).
8
Oxygen Saturation
• Percentage of hemoglobin saturated with oxygen
• Normal SpO2 is 95-98%
• 97-100% sat :Good gas exchange .
• 90-95% sat: Mild hypoxia
• <90% sat : Severe hypoxia
• Suspect cellular perfusion compromise if less than 92% SpO2

• Insure adequate airway
• Provide supplemental oxygen
• Monitor carefully for further changes and intervene appropriately
9
Saturation O2
10
PULSE OXIMETRY: WHAT DOES IT DO?
• MEASURES/DISPLAYS
• - O2 SAT OF HbG
• - PULSE RATE
• - INDICATES PERFUSION
• - PULSATE FLOW
11
Various forms of pulse ox’s
12
Pros of Pulse Oximeters
PROS
• Non-invasive
• Allows continuous measurement in real time
• Easy to use
13
Cons of Pulse Oximetry
CONS
• Measures Hb saturation rather than the actual level of Hb. Only
measures oxygenation status.
• Does not detect carbon dioxide levels in the blood. CO2 determines
the ventilation status.
• Measurements are not always accurate. Inaccuracy may occur due
to nail polish, light interference, poor peripheral perfusion,
intravenous dyes, the presence of carboxyhemoglobin and
hemoglobinopathies.
14
Pros/Cons of an arterial blood gas
PROS CONS
• Accurate • Invasive
• The gold standard for • Not easy to perform on a
measuring respiratory status patient
• Does not reflect measurements
in real time status
15
Photospectrometry
Photospectrometry is a method of using light

emission or absorption to determine the
composition of substances. It generally involves the
use of light emitters and receptors coupled with
signal analyzers.
16
17
Pulse Oximetry
• The pulse oximeter has Light-emitting diodes (LEDs) that produce red and
infrared light
• LEDs and the detector are on opposite sides of the sensor
• Sensor must be place so light passes through a capillary bed
• Requires physiological pulsatile waves to measure saturation
• Requires a pulse or a pulse wave (Adequate CPR)
Optical plethysmography: detects pulsatile changes in blood volume

Spectrophotometry: measures pulsatile hemoglobin saturation
Assumptions
all pulsation is arterial
light passes through pulsatile beds
18
Pulse Oximetry Physics (Beer-Lambert law)
Beer s law:
The concentration of a liquid is exponentially related to the
intensity of light that will pass through it.
* Lambert s Low:
The distance of light travelled through the liquid is exponentially
related to the intensity of light that will pass through it.
Oxygenated hemoglobin absorbs a different

wavelength of light than does deoxygenated blood
19
Beer - Lambert Law
Incident Transmitted
light light
20
Pulse Oximetry
Beer-Lambert Law
• The combination of both Beer’s Law and Lambert’s Law
• Beer’s Law – the absorption of light is proportional to the concentration
of a sample
• Lambert’s Law – absorption is proportional to the thickness of a sample
 Extinction Coefficient
21
Characteristics of Common Hb Species
Spectrophotometric
Name Symbol Normal (%) Peak (nM)
Oxy O2Hb 97 530
Reduced RHb <1 585.2
Adult HbA 97 530
Fetal HbF 85 NA
Carboxy COHb 2-5% 594.5
Sulf SulfHb <0.5 618
Meth Methb 1.5% 620
22
ABSORPTION SPECTRA
23
Pulse Oximetry
HEMOGLOBIN ABSORBS LIGHT.
- THE ABSORBED LIGHT VARIES WITH:
* OXYGEN SATURATION
* TYPE OF HEMOGLOBIN
* LENGTH OF THE OPTICAL PATH.
ABSORBENCE CAN BE CALCULATED
* EXTINCTION CO-EFFICIENTS
* OPTICAL DENSITY EQUATIONS
* BEERS-LAMBERT EQUATION
24
Pulse Oximetry
First Principle of operation – 1
Infrared absorption by oxygenated and de-oxygenated
haemoglobin at 2 different wavelengths
Second Principle of operation - 2

The success of pulse oximetry depends on its ability to measure
the saturation of the arterial blood by analysis of infrared
absorption of vascular bed throughout the whole pulsatile pulse
cycle.
Oxygenated blood and deoxygenated blood absorb different light

sources
Oxyhemoglobin absorbs more infrared light
Reduced hemoglobin absorbs more red light
Pulse oximetry reveals arterial saturation my measuring the
difference.
25
Pulse Oximetry
26
Second principle for pulse oximetry
• Light is absorbed by the

tissues and does not vary with
the cardiac cycle
• During the cardiac cycle there
IS a small increase in arterial
blood
• Light absorption is increased
during this phase.
27
Pulse Oximetry
• 2th -Principle of operation
The variable absorption due to pulse added volume of arterial blood is used to calculate the
saturation of arterial blood
28
Second principle for Spo2
• What is the amount of light absorbed by

the “peak” of the cardiac cycle
This is the only area that changes with

Wave of blood associated with the pulse
This area remains constant

and therefore irrelevant
29
Pulse Oximetry
30
Pulse Oximetry
• Main Limitations of SPo2 :

- Ambient light
- Patient movement or shivering.
- Hypothermia.
- Peripheral shut down.
- Hypovlemia and shock.
- Carbon monoxide poisoning(carboxy HB).
- Other dysfunctional Hemoglobins(met HB).
- Skin pigmentation.
- Dye injection(methylene blue).
31
Patient Environments
• Ambient Light
• Excessive Motion
32
Ambient Lighting
• Any external light exposure to capillary bed where sampling is occurring may
result in an erroneous reading
• Most sensors are designed to prevent light from passing through the shell
• Shielding the sensor by covering the extremity is acceptable
33
SOURCES OF ERROR
• Sensitive to motion
• Standard deviation is certified to 4% down to 70% saturation
• Sats below 85% increase the importance of error in the reading
• Calibration is performed by company on normal patients breathing
various gas mixtures, so calibration is certain only down to 80%
34
Hypothermia
• Severe peripheral vasoconstriction may prevent oximetry detection

• Shivering may result in erroneous oximetry motion
• Pulse rate on oximeter must coincide with palpable pulse rate to be
considered accurate
• Treat the patient according to hypothermic guidelines
and administer oxygen accordingly!
35
SOURCES OF ERROR
• Skin Pigmentation
• Darker color may make the reading more variable due to optical shunting.
• Dark nail polish has same effect: blue, black, and green polishes
underestimate saturations, while red and purple have no effect
• Hyperbilirubinemia has no effect
• Low perfusion state(hypotension-shock).
• Ambient Light
• Delay in reading of about 10 seconds
36
SOURCES OF ERROR
• Methylene blue and indigo carmine underestimate the saturation
• Dysfunctional hemoglobin
• Carboxyhgb leads to overestimation of sats because it absorbs at 660nm with an
absorption coefficient nearly identical to oxyhgb
• Methgb can mask the true saturation by absorbing too much light at both 660nm
and 940nm. Saturations are overestimated, but drop no further than 85%, which
occurs when methgb reaches 35%.
37
• Suspect the presence of carboxyhemoglobin in patient with:
• - Smoke inhalation
• - Intentional and accidental CO poisoning
• - Heavy cigarette smoking
Treat carboxyhemoglobin with high flow oxygen irregardless of the
pulse oximetry reading!
38
SOURCES OF ERROR
• Affect of anemia is debated
• Oxygen-Hemoglobin Dissociation Curve
• Shifts in the curve can affect the reading
• Oximetry reading could correspond to a PaO2 of 60mmHg (90% saturation) or 160mmHg
(99% saturation)
39
• Normal PaO2 is 80-100 mmHg
• Normally
• 80-100 mm Hg corresponds to 95-100% SpO2
• 60 mm Hg corresponds to 90% SpO2
• 40 mm Hg corresponds to 75% SpO2
40
Clarck Electrode
41
Reference
42
Anemia
• Low quantities of erythrocytes or hemoglobin
• Normal value of hemoglobin is 11-18 g/dl
• Values as low as 5 g/dl may result in 100% SpO2
Anemic patients require high levels of oxygen to compensate for low oxygen
carrying capacities!
43
Carboxyhemoglobin
• Carbon monoxide has 200-250 greater affinity for the hemoglobin

molecule than oxygen
• Binds at the oxygen binding site
• Prevents on-loading of oxygen
• Fails of readily off-load at the tissue cells
• Carboxyhemoglobin can not be distinguished from oxyhemoglobin
by pulse oximetry
• Erroneously high reading may present
44
Hypovolemia/Hypotension
• Adequate oxygen saturation but reduced oxygen carrying capacity

• Vasoconstriction or reduction in cardiac output may result in loss of
detectable pulsatile waveform at sensor site
• Patients in shock or receiving vasoconstrictors may not have
adequate perfusion to be detected by oximetry
Always administer oxygen to patients with poor perfusion!
45
Hypoxia Manegement
• Suspect severe cellular perfusion compromise when SpO2 is less than 90%
• Insure airway and provide positive ventilations if necessary
• Administer high flow oxygen
• Head injured patients should never drop below 90% SpO2
46
Topic of presentation:
ULTRASONOGRAPHY (USG)
Course code: EC4303 / Course title: Biomedical Instrumentation

Name Roll No.
Tanmaya Mohapatra 117EI0074
Tusar Kuldip 117EI0124
Department of ECE
NIT Rourkela
Date of presentation: 19th August 2020
1
What is Ultrasonography?
Ultrasonography is a diagnostic imaging

technique, or therapeutic application
of ultrasound. It is used to create an image
of internal body structures such as tendons
,muscles, joints, blood vessels, and internal
organs. Its aim is often to find a source of a
disease or to exclude pathology.
2
Application
• It is used to help diagnose the causes

of pain, swelling and infection in the
body's internal organs and to
examine a baby in pregnant women
and the brain and hips in infants.
• It's also used to help guide biopsies,
diagnose heart conditions, and
assess damage after a heart attack.
3
Components
The ultrasound machine has these following components:
• Monitor
• Keyboard
• Processor
• Data storage
• Probe/ transducer
4
How it works?
• It produces pictures of the inside of the body

using sound waves.
• Ultrasound imaging uses a small probe called a
transducer and gel placed directly on the skin.
• High-frequency (from 2 MHz to 15MHz) sound
waves travel from the probe through the gel into
the body.
• The probe collects the sounds that bounce back.
A computer uses those sound waves to create an
image.
5
Processing
• By switching on the machine, the ultrasound system is given access to a

source of electricity, which excites the tiny piezoelectric crystals within
the connected transducer.
• These piezoelectric crystals emit sound waves as a result of their
exposure to electricity.
• The sound waves produced by the piezoelectric crystals can then be
transmitted into the human body, normally aided by a coupling gel which
serves as an acoustic medium for eliminating the air between the surface
of the transducer and the skin.
6
How the report is generated?
• When the sound wave is returns back after

being reflected from any interior organ,
the ultrasound system processes these
signals to produce an image that
represents these reflections on the monitor.
• This is how the image looks like:
7
Electronics involved
• Piezoelectric crystals are used in the probe.

When electric current is supplied to it they
change their shapes so rapidly that their
vibration produces sound waves. The
frequency range from 2 MHz to 15MHz.
• Again when these sound waves come back
to these crystals, being reflected, they
generate electrical signals which we can see
on the monitor
• To avoid potentially detrimental tissue
heating and cavitation, the power density
(intensity) of the ultrasound wave should be
less than 1 W/cm2.
8
Recent research
• Aug. 13, 2020 : The researchers have developed a receiver that incorporates a
piezoelectric crystal and an organic light-emitting diode (OLED). When an ultrasonic
wave hits the crystal, it produces voltage, which causes the OLED to light up. In other
words, the image appears on the OLED screen, which is built into the receiver itself.
• July 10, 2020 : Few researchers have developed a deep neural network model, that
adopt the algorithmic structure and constraints of adaptive signal processing
techniques, can efficiently learn to perform fast high-quality ultrasound beamforming
using very little training data. We apply our technique to two distinct ultrasound
acquisition strategies (plane wave, and synthetic aperture), and demonstrate that
high image quality can be maintained when measuring at low data-rates, using under
sampled array designs.
9
Reference
• https://www.radiologyinfo.org/
• https://en.wikipedia.org/wiki/Medical_ultrasound https://www.google.com/
• https://www.intechopen.com/
• https://conquestimaging.com/wp-
content/uploads/2016/09/Ultrasound_Basics_Webinar_Slides.pdf
• https://www.youtube.com/watch?v=I1Bdp2tMFsY
• https://www.sciencedaily.com/
• https://ieeexplore.ieee.org/abstract/document/9138451
• https://radiopaedia.org/articles/ultrasound-
frequencies#:~:text=Ultrasound%20frequencies%20in%20diagnostic%20radiology,frequencie
s%20are%20not%20as%20penetrating.
10
Thank you…
11
COMPUTED TOMOGRAPHY
Course code: EC4303 / Course title: Biomedical Instrumentation
Name Roll No.

Amanjeet Singh 117EI0149
Triya Patnaik 117EI0312
Department of ECE
NIT Rourkela
Date of Presentation: 12th August 2020

INTRODUCTION & APPLICATION
What is COMPUTED TOMOGRAPHY?
Computed Tomography is a diagnostic imaging technique which uses a
combination of X-rays and computer technology to generate images of the interior
of our body. Compared to X-rays, CT scans are more detailed & thus provide more
insight to medical professionals.
APPLICATION:
• A CT scan can show detailed images of any part of the body including that of
bones, muscles, fat, organs and blood vessels.
• CT scans may be preformed to help diagnose tumours, investigate internal
bleeding, or check for other internal injuries.
• A CT scan is also the preferred examination for evaluating stroke as well as
abdominal tumours and abscesses.
X-rays vs Computed Tomography
 Before moving further into the topic we first learn about how
Computed Tomography is different from a normal X-ray and what
advantages it offers over an X-ray.
 Now, coming to X-rays, we know they are a form of electromagnetic
radiation similar to light. They are more energetic than UV light but
less energetic than Gamma rays.
 They pass easily through soft tissues (e.g. muscles, organs etc) but
same is not the case for hard tissues such as bones & teeth. So, there
they produce images of skeletal structures– the X-rays images most X-ray
familiar to us.
 In case of a CT scan, however, a series of x-rays are taken from
different angles and then they are assembled into a 3-D model using
a computer. The word Tomography refers to a picture of a slice.
 So, while an X-ray shows edges of soft tissues all stacked on top of
each other, the computer used for a CT scan uses algorithm to figure
out how these edges relate to each other in space thereby making a
CT scan more useful for understanding blood vessels and soft tissues.
 With the differences between X-rays and CT scan understood, we
now move onto our main topic i.e. Computed Tomography.
CT scan
How it works
 Instead of using a fixed x-ray tube, as is done in conventional x-ray, a CT
scanner employs a motorized x-ray source that rotates around the
circular opening of a donut shaped structure called gantry.
 The patient lies on a bed which slowly moves through the gantry while
the x-ray tube rotates around the patient, shooting narrow beams of x-
rays through the body during the scan.
 Instead of a film, CT scanners use a special digital x-ray detectors, which
are located directly opposite the x-ray source. As the x-rays leave the
patient, they are picked up by the detectors and transmitted to a
computer.
 Each time the x-ray source completes 1 full rotation, the CT computer
uses mathematical techniques to construct a 2D image slice of the
patient with the thickness of the tissue represented in each image slice
ranging from 1-10 mm.
 When a full slice is completed, the image is stored and the motorized bed
is moved forward incrementally into the gantry. The same process is
repeated to produce another image slice.
 The above process continues on till the desired number of slices is
collected. These image slices can either be displayed individually or
stacked together to generate a 3D image of the scanned entity.
Processing &Presentation
Some of the algorithms used in CT image reconstruction are described as follows:
 Iterative Reconstruction :
• Using raw data produced by the CT scanner a standard filtered back projection algorithm is utilised to create a
primary image.
• This is followed by a sequence where:
1. a forward projection to the primary image creates artificial raw data
2. Simulated data is then correlated to the measured raw data where an updated image is generated
3. And then, a filtered back projection is used to back project the updated image onto the new updated
image; this step is repeated until the differences in the images reach a pre-set value
 Filtered Back Projection :

• It applies a convolution filter to remove blurring, utilizes simultaneous equations of ray sums taken at differing
angles of a sine wave to compute the values of attenuation coefficients within a cross section.
• The attenuated projection produced represented by the anatomy is stored in the memory of the computer,
solved and reconstructed, Each pixel corresponds to the voxel (volume element) of the image
• Simultaneous equations are used to ascertain the correct attenuation values in a ray sum.
Components of a CT Scanner
There are 3 main components of a CT scanner :
 Gantry
 Data Acquisition System
 Operating Console.
Gantry: It is the toroid shaped part of the CT scanner and houses the many components necessary to produce and detect
x-rays.
Data Acquisition System: The DAS consists of the following parts
Operating Console: This is the master control centre of the CAT Scanner & is typically made up of a Computer, keyboard
and multiple monitors.
Now, we focus upon the electronics that make the working of a CT Scanner possible.
Electronics Involved
Since a CT Scanner consists of a lot of electronics components we will here focus on the ones
taught to us and some other novel ones. They are as follows:
Current to Voltage Converter Analog Integrator
X-ray Tube Solid State Crystal Detector

Apart from this a CT Scanner also employs other electronic devices such as Pre Amplifier & an
Analog to Digital Converter.
Electronics Involved Continued
Recent Research
Some of the advances made in this field are as follows:
 High resolution CT- This type of CT scan uses very thin slices (<0.254 cm ), which are
effective in providing greater detail in certain conditions.
 Helical CT- During this type of scan, both the X-ray beam and the patient move
continuously, with the X-ray beam circling the patient. This technique produces images
faster as compared to standard CT scans.
 Ultrafast CT (also called Electron Beam CT)- As the name suggests, this type of CT scan
produces images very rapidly, thus creating a type of “movie” of moving parts of the
body, such as the chambers and valves of the heart.
 Computed Tomographic Angiography (CTA)- Angiography refers to an X-ray image of
blood vessels. A CT angiogram uses CT technology instead of standard X-
rays/fluoroscopy to obtain the images of blood vessels.
 Combined Positron Emission Tomography & CT (PET/CT)- The CT and PET technologies
blended into a single machine is referred to as PET/CT. It combines the ability of CT to
provide detailed anatomy with that of PET to show cell function and metabolism in order
to offer greater accuracy in the diagnosis and treatment of certain types of diseases
(e.g. cancer).
References
 https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
 https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-
tomography-ct-scan
 https://www.britannica.com/topic/computed-tomography
 https://www.mayoclinic.org/tests-procedures/ct-scan/about/pac-20393675
 https://radiopaedia.org/articles/iterative-reconstruction-ct?lang=us
 https://radiopaedia.org/articles/filtered-back-projection-1?lang=us
 https://radiopaedia.org/articles/x-ray-tube-1
 https://www.radiologycafe.com/radiology-trainees/frcr-physics-notes/ct-equipment
 http://www.radtechonduty.com/2017/03/ct-scan-components.html
 https://www.lanl.gov/museum/news/newsletter/2016-12/x-ray.php
 Herman, G. T., Fundamentals of computerized tomography: Image reconstruction from
projection, 2nd edition, Springer, 2009
THANK YOU…
Magnetic
Resonance Imaging
Biomedical Instrumentation
Course Code :- EC4303
Presentation by :-
Biswajit Nayak
Abhishek Narayan
Introduction
MRI (Magnetic resonance imaging) is a medical imaging technique
which uses magnetism, radio-wave and computer to produce the
image of body part instead of using ionizing radiation . It based on the
principle of NMR(Nuclear magnetic resonance). It was invented by
Paul Christian Lauterbur. And developed in 1970s and 1980s. MRI
uses the magnetic properties of certain atomic nuclei(hydrogen
nuclei in case MRI) to create images.
Applications
● MRI is useful for diagnosis illness such as tumor.

● Sports injuries and musculoskeletal problems.
● Diagnosis of female pelvic problem and breast cancer screening.
● Diagnosis of tumor, cysts and other anomalies in body part.
● Helpful in diagnosis of both acute and chronic neurological
disease.
● Prostate Problems.
● Some gastrointestinal tract condition.
● Soft tissue and bone pathology. Certain nose, ear and throat
conditions.
Who cannot have a MRI scan?
● Patient with cardiac pacemaker.

● Intracranial aneurysm clips.
● Certain prosthetic devices.
● Certain intrauterine contraceptive devices.
● Any other type of iron-based metal implants.
● MRI is also contraindicated in the presence of internal metallic
objects such as bullets or shrapnel, as well as surgical clips, pins,
plates, screws, metal sutures, or wire mesh.
● Pregnant female or female that is suspected to get pregnant are
not allowed to MRI. Due to the potential for a harmful increase
in the temperature of the amniotic fluid.
working
As human body contain around 70% water with contain 2 hydrogen
atom per molecule and also contain hydrogen containing fat and
glucose. This imaging technique uses the interaction of hydrogen
with constant strong magnetic field and radio waves to create
image.
Each hydrogen nuclei or proton poses magnetic moment. Normally
all proton magnetic moments are aligned randomly and there is
zero magnetic moment as a whole but when high magnetic field in
MRI is applied, proton are start to align in direction or opposite
direction to the direction of external magnetic field depending on
the energy state. Now a radio waves are used to create resonance
in those aligned proton and supply energy to low energy protons
and turned them in the direction of inclination of high energy proton.
When this radio wave switch-off these protons are start going back
to there low energy state and release energy which is detected by
receiver and used to create images. Since, water and fat have
different chemical properties. So, they react differently and produce
difference in final image.
HardWare/Electronics
Continued ...
Recent Advancements:-
● Multi-Contrast MRI Images From a Single Acquisition

● Lung MRI
● Simplifying Cardiac MRI
● Silent Scanning
● Signa MRI
References:-
1. Advancements1
2. Advancements2
3. Wiki
4. Magnetic Resource Imaging
5. Electronics
6. Overall Structure
Thank You!!!

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COURSE INFORMATION SHEET

Course code: EC4303

• Journal and Conferences

Continuous Internal % Distribution

There are three main types of blood vessels:

Capillaries: Exchange necessary and waste products between

Four heart valves within the heart:

4. Receive oxygen-rich blood from lungs

Where are 2 & 5???

2. Send oxygen-less blood from atrium to ventricle

For proper operation some valves should

• This is normal…other than this abnormal

•A stethoscope can be used to

Handbook of Second Edition Biomedical Instrumentation by R S Khandpur 33

• Heart sound data acquisition module:

Kaddoura T, Vadlamudi K, Kumar S, et al. Acoustic diagnosis of pulmonary hypertension:

•What is the signal here?

Then the question is how heart

https://en.wikipedia.org/wiki/Willem_Einthoven & L. Cromwell et. al., Biomedical Instrumentation and Measurements 48

https://en.wikipedia.org/wiki/Willem_Einthoven & L. Cromwell et. al., Biomedical Instrumentation and Measurements 49

• Once open, the K+ gates remain open

As an action potential (nerve impulse) travels down an axon there is a change

1895, Willem Einthoven (Dutch physiologist)

The heart conduction system

Common virtual electrode, known as the

https://en.wikipedia.org/wiki/Einthoven%27s_triangle and https://en.wikipedia.org/wiki/Electrocardiography#Limb_leads 89

• Medical instrumentation application and design, John G. Webster, 4th Edition

Figure 2.4(A) Metal electrode immersed in an electrolyte

Figure 2.4(A) Metal electrode immersed in an electrolyte

Half-cell potential for common electrode materials at 25 degree C

Figure 2.7Electrochemical cell used to determine the half-cell

If we consider Reduction Half-Reaction the voltage will be negative (i.e., -0.76 V)

Encyclopedia-of-medical-devices-and-instrumentation-vol-1 --- webster, pp-122 105

• Parallel resistance Rdl is

Skin is represented by its layers:

• If current flows through the electrode/electrolyte interface, concentration and

• If current flows through the electrode/electrolyte interface, concentration and

• The Basis of ECG Diagnosis

The constant F (the Faraday constant) is

Handbook of Second Edition Biomedical Instrumentation by R S Khandpur 4

• Heart sound data acquisition module:

Good for low resistance source (Strain-gage)

We can increase gain by increasing gm

Moreover, rdswill decrease with increase I DS Decrease the gain

Solution: Implement some techniques which

VOUT VDS VCascode

Output resistance for MOS current source load = = rds 156 K

Output resistance of Cascode configuration = = g m 2 rds 2 rds1 23 M

Gain improvement w.r.t. active load is only two times or only 6 dB .

VGS pMOS Active load 37.4 dB

Cascode load 43.4 dB

Cascode input cascode load 80 dB

Resistive load Active load

Cascode load Cascode input and cascode

Active load 37.4 dB 38 dB

Cascode load 43.4 dB 41 dB

Cascode input cascode 80 dB 47 dB

 RO 2  Av1 g m 2 rds 2 rds1

Drawback of this circuit…

Advantage of this circuit…

Rcm is part of feedback network.

Three Op-Amp INA

• The Basis of ECG Diagnosis

The constant F (the Faraday constant) is