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A NEW WIRELESS-TYPE PHYSIOLOGICAL SIGNAL MEASURING SYSTEM USING A PDA AND THE BLUETOOTH TECHNOLOGY
JIA-REN CHANG CHIEN, CHENG-CHI TAI
Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan

ABSTRACT
A light and portable-type wireless physiological signal retrieving system has always been a medical personnel's dream. To fulfill this dream, this paper investigates a feasible method to create a wireless-type physiological signal measuring system using a PDA and the bluetooth technology. The proposed system will reduce the service costs and raise the service efficiency for current medical care systems. The waveforms and data of physiological signals, such as electrocardiograms (ECGs), phonocardiograms (PCGs), electroencephalograms (EEGs), body temperatures, and so forth, are always the vital references for medical doctors to diagnose the patients' body condition. The traditional physiological signal measuring instruments or devices possess some shortcomings, such as high prices, bulky dimensions, ill-portability and excessive connection cables. In contrast, the proposed wireless-type physiological signal measuring system, being able to get rid of said shortcomings, holds apparent advantages in service costs and service efficiency and, hence, shall be the trend for the future. This study has completed some tests in ECG, PCG, and body temperature measurements. The proposed prototype system has successfully using the bluetooth technology to invisibly transmit and receive physical signals through the air. Biomed Eng Appl Basis Comm, 2005(October); 17: 229-235. Keywords: Physiological signal, bluetooth, PDA palm-type computer

1. INTRODUCTION
Applying information technology to medical services has been one of the crucial technical development subjects in the world's leading nations. A few industrialized nations in Europe and America have actively promoted the Health Care Information Infrastructure (HCII); Taiwan is currently promoting Received: Jan 31, 2005; Accepted: Aug 15, 2005 Correspondence: Cheng-Chi Tai , Professor Department of Electrical Engineering National Cheng Kung University No. 1 University Road, Tainan, Taiwan E-mail: ctai@mail.ncku.edu.tw

the Nation Information Infrastructure (NII) to establish the national standards in information and communications. The HCII utilizes information technology to raise medical quality, which can reduce medical costs, raise all people's health level and, eventually, lift up a nation's total productivity. Although a light and portable-type wireless physiological signal retrieving system has always been a medical personnel's dream, the dream could not have been realized due to the inability in raising the RF radio transmission rate and the related equipment s oversize problem. In recent years, the industry and the medical community have started using PDAs to meet the needs in control as SOC (System on Chip) embedded systems' development becomes more matured and the PDA palm-type computers' capacity experiences a substantial boost.

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Concerning the application of wireless transmissions in the medical care, Pavlopoulos, et al. [1] installed GSM communication systems inside ambulances to transmit vital physiological signals, such as electrocardiograms, heartbeats, blood pressures, and so on, to furnish prior preparations for hospitals. Yonghang Zang, et al. [2] developed a homebased data transmission system for electrocardiograms and blood pressures using radio technology to circumvent the home care wiring problem. Koichi Shimizu, et al. [3] applied analog radio techniques, digital GSM systems and satellite communications to distance medical-caring services and obtained fine results whether in physiological signals, audio voices or visual signals. In recent years, the bluetooth technology has been better developed. Since the bluetooth possesses 1 Mbps high transmission rate and is inherently a spectrum-hopping secrecy system, we anticipate that most instruments and equipment will bear a built-in bluetooth wireless-transmission system in the future. Since most of the current physiological signal measurements are done by personal computers or large-scale medical care equipment [4-5], there existed, as far as we know, no physiological signal retrieving systems using the combination of a PDA and the wireless bluetooth technology. The investigation in this paper on how to use a PDA and bluetooth devices to develop a low-cost, convenient, practical and portable physiological signal measuring system, hence, holds profound creativity. If succeeded and made available to the market, this new product can become a major contribution to both the medical community's service business and all the people's health care.

2. MATERIAL AND METHOD

The proposed physiological-signal measuring wireless communication system, as shown in Fig. 1(a), is capable of measuring three types of physiological signals, including phonocardiograms, electrocardiograms, and body temperature measurements. It can mutually transmit data in wireless mode through a bluetooth module. The system's receiving block diagram is shown in Fig. 1(b), of which the design and architecture details are explained as follows:

signals are retrieved through the microphone [6-8]. After the phonocardio signals pass a pre-amplifier and gets filtered, the signals will go through an analog multiplexer and arrive at an A/D converter to convert the analog signals into digital data (shown as G and H in Fig. 1(a)). The microprocessor will encode the digital data into bluetooth HCI packet format and, via the bluetooth module, transmit the packets in wireless mode to the PDA receiving end (shown as J and L in Fig. 1(a)). After the data are received through the bluetooth module in the PDA receiving end, they will be plotted and displayed on a screen or stored in a memory card. The user can read out the memory card s data via a personal computer to furnish a clinical physician for further data analysis (shown as O in Fig. 1(b)). 2.1.2 ECG Detection and Measuring Circuit First, an ECG electrode ( A ) plate is stuck to the right arm, left arm and left leg of the person receiving the test, then, as shown in Fig. 1(a), a buffer amplifier is added to the input end for impedance matching to prevent a post-stage signal interference with the pre-stage ECG signals ( B ). The magnitude of the ECG signals is in of range of mVp-p, and, after being amplified 1,000 times and filtered ( C ), said signals will be sent to the post-stage circuit for processing. The steps of which are identical to that of the aforementioned PCG detection and measuring circuit. The Burr-Brown INA128 Operational Amplifier (OP) is adopted for all amplifications in this circuit. The INA128 OP possesses high input impedance, high common-mode rejection (CMR) and can effectively isolate some noise interferences, such as 60-Hz noise, and so on [9-11]. 2.1.3 Digital-Type Temperature Detection and Measuring Circuit In body temperature measuring, we use the SMT160-30 sensor (show as K in Fig. 1(a)). This component outputs square-wave signals with fixed frequencies; when the temperature changes, the duty cycle will follow and vary, to which the computing method is: (1) where t is the temperature ( ); T is the period, and Td is the duty cycle. According to the computing method, we can measure the values of Td and T through a microprocessor and figure out the DC value. Once the DC value is obtained, we can reverse the computing to find the real temperature t [12]. 2.1.4 Central Processing Unit (CPU)

2.1 Hardware Implementation

2.1.1 PCG Detection and Measuring Circuit First, we insert a capacitor-type microphone into the sound transmission tube of a traditional stethoscope, as shown in Fig. 2. The heart sound

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We adopt the W78E516 microprocessor to perform the central controlling duty. It possesses a rapid data processing capability, up to 40 MHz clocking, and is very suitable for working together with the bluetooth module to fulfill the wireless communication task. The CPU is responsible for commanding and coordinating the data- and controlsignals ins and outs among all the system units, computing and processing the bluetooth packets (show as J and N in Fig. 1). 2.1.5 The Bluetooth Transmission Module This study adopts CSR s BC02 chip, as shown in Fig. 3, for the internal chip of the bluetooth module. This chip is in compliance with Bluetooth v1.1 Protocol and provides USB and UART communication interfaces. Hence, this system can use UART interface to carry out the data transmission between the module and the microprocessor (shown as L and M in Fig. 1). 2.1.6 The A/D Unit Since the physiological signals measured are all analog, we need to digitize them into digital type before they are sent to the microprocessor for further processing. To reduce discrepancies and the distortion rate, this study adopts Burr-Brown s high-speed, high-resolution ADS7800 component, which possesses a 12-bit resolution and a 333 kHz sampling rate, for our design (shown as I in Fig. 1(a)). 2.1.7 The Memory Unit This unit can store measurement parameters, including the heart rate, ECG, PCG, the body temperature, etc. The memory size can be expanded at will depending on the real need. The data in the memory can be read out using the SD/MMC Card Reader along with a personal computer for further data analysis (shown as P in Fig. 1(b)). 2.1.8 PDA Palm-Type Computer A Mio 338 PDA is used in this study. This PDA adopts a Microsoft Pocket PC 2002 Operation System that supports Embedded Visual Basic 3.0 for software development. The PDA's thickness is approximately 1 cm, with a weight of only 118 grams, so it is very suitable for the development of a portable measuring system (shown as O in Fig. 1(b)).

consuming and difficult to encode or decode any section of an HCI code. Hence, this study develops a new and much easier computing method to rapidly interpret the meaning of HCI codes. For example, if a section of the HCI code is 01 03 0C 00H, we can, as shown in Fig. 4, decode its message with the following steps: Step 1: First, interpret the hexadecimal 01 03 0C 00H into a binary expression. Step 2: Take out the binary code for 03 0CH in the middle and rotate it to the right twice, then rearrange and recombine the codes. Step 3: Separate the recombined codes from the right with 8 bits, 10 bits, 6 bits, and 8 bits in sequence, for a grouping and convert it into hexadecimal values. The decoded HCI code arrives 0x01, 0x003, 0x03, 0x00, respectively. The meaning of this HCI code section stands for a reset command according to the Bluetooth protocol [13]. To encode, we can process it by following and simply reversing the above-listed steps. Prior to using the bluetooth module, as shown in Fig. 3, we need to proceed with several parameter settings and the initialization to complete the masterslave connection (Fig. 5). First, we must send the HCI

(a)

2.2 Software Implementation

The IAR 8051 C Language is adopted for the programming of this microprocessor. The Microsoft Embedded Visual Basic 3.0 language is used for the programming of the PDA's graphic control interfaces. 2.2.1 Bluetooth Communication Flow Process The protocol command used in the bluetooth communication is the HCI code. It is very time-

(b) Fig 1. The system block diagrams. (a) Data measuring and wireless transmitting, (b) Data receving, processing, and display.

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Fig 2. The stethoscope being inserted with a microphone.

sound generator capable of outputting a sound of 1 Hz to 1 kHz at the input end to simulate the heart sound signals. When calibrating, first adjust the sound generator to output a sound from 1 Hz all the way up to 1 kHz. While observing the variation, adjust the filter's resistance and capacitance so as to correctly eliminate the frequencies outside the heart-sound frequency range. (c) Calibrate the body temperature detection and measuring circuit: We used MT-16811 digital thermometer with an accuracy of 0.1 to calibrate SMT160 temperature detector circuit. The temperature error values were also corrected by the software.

3. RESULT AND DISCUSSION

The screen shown in Fig. 6 is the human-machine interface programmed by using Embedded Visual Basic 3.0 language. After the whole system completes the communication connection, one can push a display button to send a command to control the measuring circuit and to display the received data on the PDA screen. The displayed parameters include Data Serial, Heart Rate and Temperature. The waveforms will be displayed in the middle of the screen. The function keys include: START, CLEAR, STOP, END, PCG, ECG, and TEMP, . The details of the function keys are explained as follows: (a)Data Serial: Indicate the total data amount received up to now. (b)Heart Rate: Indicate the heartbeat value, in the unit of BPM (beats per minute). (c)Temperature: Indicate the latest body temperature value. (d)START:Start up the measuring hardware. (e)CLEAR:Clear the display. (f)STOP:System halts temporarily. (g)END:Terminate system operation. (h)PCG:Display the phonocardiogram. (i)ECG: Display the electrocardiogram. (j)TEMP.:Display the body temperature distribution condition. Fig. 7 is the actual look of the proposed measuring system A B C . The transmitting end includes circuits for measuring ECG, PCG, the body temperature, and a bluetooth module. The receiving end, including the receiving circuit ( E ), a PDA palmtype computer ( D ) and a bluetooth module, uses UART interface to proceed with data transmission. The current system has completed the tests and operates successfully, as shown in Figs. 8-10, which represents the actual measurement displays for ECG, PCG and the body temperature.

Fig 3. The CSR bluetooth module. code of reset to the bluetooth module to return it to its initial setting, then enable inquiry and page scan functions, and the like, to start the bluetooth module's searching function. Then, we set the time for timeout. If the master-slave communication connection is not completed within a few seconds, the searching must be terminated. After completing the above settings, proceed with the communication connection if the master-end module successfully searches out a slave module. Should it fails, return to the previous step, and repeat this continuously until it succeeds. Once the master and slave modules complete their communication, they will transmit data to each other.

2.3 Calibration
(a) Calibrate the ECG detection and measuring circuit: Apply a 1-mV pulse at the input end to simulate an ECG signal. This system uses an HP 33120A function generator to generate a calibration signal. (b) Calibrate the PCG detection and measuring circuit: The frequency range of the heart sound is approximately 20 to 200 Hz. We, hence, can use a

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After the user presses the ECG button, the hardware will switch to the ECG measurement interface and transmit the data to the PDA screen. A typical ECG waveform can be clearly observed from Fig. 8, in which the QRS waveform is rather apparent. Since the R waveform s magnitude is the most apparent feature, the program will count the number of the R waveforms occurred, with one heartbeat for each R waveform, in computing the heart rate. The actual PCG recording for a cardiac cycle is shown in Fig. 9, wherein the first sound signal is related to the atrioventricular valves closing. The second sound signal is generated by the closing of the aortic and pulmonary valves. Each heartbeat will generate the first and the second heart-sounds once. Although the normal first heart sound's magnitude will be greater than the second one, its number cannot be directly taken as the heart rate. Because when the stethoscope is not placed correctly, the magnitudes measured for the first and the second heart sounds might be equal. Hence, we cannot solely depend on the first heart sound to compute the heart rate. The heart rate is computed by adding the numbers of the first and the second heart sounds and dividing the sum by two, as shown in Eq. (2): Heart rate = (2)

Fig 4. Bluetooth HCI packet filtering.

Fig. 10 is the display of a body temperature record. Since human body temperature change is neither great nor rapid, the proposed system hence samples the temperature once every 10 seconds and displays the measured temperature on the screen.

3.1 The System Limits

When testing, we observed that the refreshing of the display on the screen is seriously delayed when both the Bluetooth packets are receiving and the plotting function is performing by the PDA. We thus conclude that the plotting function in the PDA heavily consume the OS resource. The baud rate between the PDA and the bluetooth is 115,200 bits/sec. Although the frequency band seems sufficient, the overburden caused by the usage of the plotting function makes the system miss many packets when processing the bluetooth packets. When the sampling rate goes higher with more packets being transmitted, the packet-missing condition becomes worse. From the experiments, we observe that no data are missed, when either with or without performing the plotting function, if the sampling rate is set as 200 times/sec for the ECG and PCG signals. But when the

Fig 5. The flow chart for the bluetooth communication protocol.

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Fig 6. The GUI display of the PDA.

Fig 9. The actual display of the PCG waveform measurement.

Fig 7. A A stethoscope with a microphone inserted inside; B An ECG electrode plate (adhesive); C A measuring circuit and a transmitting circuit; D and E A PDA and the receiving circuit.

Fig 10. The display of the body temperature record. sampling rate is increased up to 3,000 times/sec., over a half of the data are missed in the receiving process if the PDA is performing the plotting function. If the sampling rate is reduced to 2,000 times/sec., 15% of the data is missed. To maintain an error within the acceptable error tolerance range, we reduce the actual sampling rate to 1500 times/sec., as shown in Fig. 11.

4. CONCLUSION
This study proposes and investigates the application of a PDA and the bluetooth technology to a wireless-type physiological signal measuring system and the feasibility of the proposed system. According to our experimental results, the proposed system is proved to be feasible. During the system testing and measuring, we encounter a few function limitations related to current PDAs, such as memory limitation,

Fig 8. The actual display of the ECG measurement.

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Fig 11. The relationship between the missing packets and the sampling rate. The Y-axis is the missing ratio for every 100 data transmitted through the bluetooth to the PDA; the two lines in the diagram designate the cases with and without performing the plotting function. insufficiency in CPU's computational power, and so forth. Some compromises need to be made in the system design. We anticipate that the current limitations encountered will be resolved when PDAs are equipped with faster computational capabilities or when PDA's OS is further improved in the future. Some functions can be further improved in the future, such as adopting hardware interrupts to do data transmission or compression with the PDA, to raise the system efficiency. At present, PDAs are mostly used to run business software, and the bluetooth is mostly applied to mobile phones. We propose to integrate and utilize them in the area of physiological signal measurements to help fulfill the dream of creating a light-weight, portable-type wireless physiological signal retrieving system, which has been long wished by the medical professionals. We hope the proposed system can also be augmented with EEG, blood pressure measurements, and so on. And finally, to develop it into an integrated, multi-functional physiological signal retrieving apparatus so that we can reduce the service costs and raise the medical service efficiency for the medial care communities.

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