MEDICAL ELECTRONICS

ASL PAULS COLLEGE OF ENGINEERING AND TECHNOLOGY Prepared by, S.Rameshprabhu M.E., (PhD) Asst professor EEE Dept

UNIT-1
Recording and monitoring instruments

Bio Electric Signal

In 18th century Galvani demonstrated that most

of the physiological process were accompanied with electrical changes. From this discovery the action of living tissue are explained in the terms of Bio electric potentials. The human body consist of living tissues and it is considered as power station generating multiple electrical signal with two internal sources namely muscles and nerves. The bio electric signal are the signal generated by nerve cells and muscle cells. The electric field generated by the action af many cell constitutes Bio electric signal. Eg : ECG,EEG,EMG,etc..

BIOELECTRIC POTENTIALS: Bioelectric potential are generated at a cellular level. Each cell is a minute voltage generator, because +ve and ve ions tends to concentrate unequally inside and outside the cell wall. Therefore the potential difference(resting potential) is established and the human cell acts as tiny biological battery. Their basic source is cell membrane potential(resting potential) which certain condition may be excited to generated an action potential. The discharging and recharging of the cell is termed as depolarization and repolarization respectively

Relationship between action potential and muscle contraction:

Resting and Action Potential

The

diffusion and drift process give rise to balance of ions between inside and outside of the cell. Generally the nerve cells readily permit the entry of potassium and chloride ions. But it blocks the entry of sodium ions. The equilibrium condition is reached with the potential difference across the membrane, such that negative potential on inside and positive potential on the outside. The membrane potential caused by different concentration of ions is called Resting Potential. When human cell is in resting stage, it is said to be polarized.

Characteristics of Resting Potential: The value of the resting potential is maintained as a constant until some kind of the disturbance will upset the equilibrium. It strongly depend upon the temperature. The range(VR) of resting potential is -60mV to -100mV. VR is derived from Goldman's equation, Where, o and i outside and inside the cell. VR resting potential, k Boltzman constant, T Absolute temperature in Kelvin.
q charge of electron, PK - permeability of potassium ion.

According to Goldmans equation resting potential. VR=-86.8mV According to nertz equation PNA & PCL 0 VR=- 94.9mV ACTION POTENTIAL: When the cell membrane is excited by some energy, then the permeability changes. So that the sodium ions are allowed to enter inside the cell. So the cell has +ve potential inside due to imbalance of potassium ions. The positive potential of cell membrane during excitation is called Action potential. The range(VR) of Action potential is 20mV.

 As long as the action potential exist the cell is said

to be Depolarized state. After sometime, when the passage of sodium ions is stopped, the cell membrane reversed back to the original condition is called Repolarization state. There are many Bio electric signal present in our own human body. They are , ECG(Electro Cardiogram)- Electrical activity of heart EEG(Electro Encephalogram)-Neuron of brain ERG(Electro Rectinogram) Eye EMG(Electro Myogram)- Muscle contraction

ELECTRODES:
Electrode are generally used to pickup electrical

signals from the body. The voltage developed at an electrodeelectrolyte(body fluid) interface is termed as half cell potential or Electrode potential. The half cell potential are obtained using surface electrode. Perfectly Polarized Electrode: No net transfer of charge occurs at the metal electrolyte interface. Perfectly Non Polarisable Electrode: Infinite exchange of charge occurs, across the metal electrolyte. Some of the electrode are: Surface electrode- potential across skin surface. Micro electrode- potential near or within single cell.

Recording Electrode: Bio electric events have to be pick up from the surface of the body before they can be put into the amplifier for subsequent record or display. This is done using electrode. They are two types Practice surface electrode (on the tissue without damaging living tissue) Deep seated electrode(Inside the living tissue or cell) Electrode used for ECG: Limb electrode Floating electrode Pre gelled disposable electrode Pasteless electrode

Limb electrode : Used in forelimbs of body The material used is German silver , nickel silver. They are applied to the surface of the body with electrode jelly. The electrode jelly forms vacuum seal. The impedance of this electrode is 2 to 5k. Measured at 10 Hz and size is 3X5 cm.

Floating electrode: Light weight floating electrode with press stud for long term monitoring of ECG. No jelly is used, impedance of this electrode is 50 k.

Pre gelled Disposable Electrode: Electrode which are employed in stress testing and long term monitoring. Gel contains electrolyte paste with bactericide/fungicide. Cause minimum skin irritation where this gel has pH range 3.5-9. Problems under stress can be detected using this electrode.

Pasteless electrode: It is Dry electrode i.e contains no paste. Free from problems reg gel. Draw back are it has high skin resistance and strong sensitivity to motion. Hence it can be overcome by using high value of amplifier input resistance. It has shell, 2 FET , can of diameter 4.5mm and opamp of high AC impedance(> 100M).

Electrodes for EEG: Among the commonly used electrode for EEG recording are the chloride silver discs having approximately 6-8mm diameters. Contact with the scalp via electrolytic paste through a washer of soft felt. They have resistance varying from 3-20k. Small needle electrode are sometimes used for carrying out special EEG studies when they are inserted subcutaneously. Pad electrode is used in EEG.

Electrodes for EMG: Electrode for EMG work are usually of the needle type. This electrode are used in neurography and other electrophysiological investigations of the muscle tissues under the skin and in deeper tissues and to record nerve action potential. The material of needle electrode is generally of stainless steel. Needle electrode are designed to be fully autoclavable and in any case they should be thoroughly sterilized before use. They are of various forms Monopolar one reference electrode are used. Bipolar one is reference and other is active.

 Hypodermic needle type EMG electrode are special

type where active and reference electrode are used in same needle.

Microelectrode: To measure the electrical activity of single cell. Very thin electrode so that the penetration by the electrode does not damage the cell. It is located within the cell, where the reference electrode are placed outside the cell. The metal microelectrodes are formed by electrolytically etching the tip of fine tungsten filament or simple stainless wire. The potential within the cell can be measured by using 2 electrode.
Microelectrode. Reference electrode.

Microelectrode are broadly classified into

Metallic electrode (Metal electrolyte) Micropipet( instead of metal electrolyte non

Chemical Electrode: Various type of chemical electrode are,

Hydrogen electrode It is used as standard reference electrode. It is used to measure the pH of body fluid. During the measurement of potential, the hydrogen gas should be supplied. This measurement is not stable one therefore, it should not act as reference electrode. Hence we go for practical reference electrode. Practical electrode(Silver silver chloride is

used as ref electrode) pH electrode:

The chemical balance of the human body is identified by

the measurement of pH content of the blood and other body fluids. To measure hydrogen ion concentration. The pH is given by, pH= - log [H+] Normally pH of blood is slightly greater than 7.

pH electrode:

 pCO2 electrode: It consist of standard glass pH electrode covered with the

rubber permeable membrane. Between the glass surface and membrane there is a thin film of water. The solution under the test which contains a dissolved CO2 is presented to the outer surface of the rubber membrane. pO2 electrode: The oxygen electrolyte consist of a piece of platinum wire embedded in an insulating glass holder. The electrode is exposed to the electrolyte into which oxygen from the solution under measurement is allowed to diffuse through the membrane. The reduction of O2 is takes place in platinum and current developed is proportional to the partial pressure of diffused oxygen.

Biomedical Recorders
Biomedical recorder are used record the

biomedical signals like ECG, EEG, EMG,etc. Electrocardiography[ECG]: Electrocardiograph shows the electrical activity of heart muscle. It gives information about cardiac disorder. The recorded ECG waveform is called eletyctrocardiograph and instrument used to record is called electrocardiogram. ECG lead system: The types of lead system are
Bipolar lead system(standard lead system) Unipolar lead system (Augmented unipolar limb

Bipolar lead system: In this lead system ECG is recorded by using 2 electrode. The final output(electrical potential) is taken between these 2 electrode. It is called Einthoven leads. In this system electrodes are placed in 4 different places,
LA(left arm) LL(left leg) RA(Right Arm) RL(Right Leg)

Lead I position: It gives voltage drop V1 from LA

to RA. Lead II position: It gives voltage drop V2 from LL to RA. Lead I position: It gives voltage drop V1 from LA to LA.

 The closed path from RA to LA to LL called Einthoven

triangle. V1=0.53mV, V2=0.71mV, V3=0.38mV Always V2=V1+V3(Kirchoff Law is followed)

Augumented Unipolar Limb leads: This system is introduced by Wilson, the voltage is taken between single exploratory electrode and central terminal. Two equal resistor are connected to a pair of limb electrode and the center point act as one terminal to measure voltage. In this lead system, small increase in the ECG voltage can be realized. 3 Augumented lead connection are possible, they are
Augumented Voltage Right Arm(aVR) Augumented Voltage Left Arm(aVL) Augumented Voltage foot(aVF)

Lead avL

Lead avR

Lead avF

ECG Recording Method

Lead Selector: The potential picked up by the patient electrode are taken to the lead selector switch. The electrode are selected two by two according to lead program. Preamplifier: It has 3 or 4 stage differential amplifier, which give stabilizing effect. It has high gain and CMRR. It prevents the patient from electrical shock and over voltage protection. Power amplifier: The amplified signal is picked up by the power amplifier It is used to drive output unit. The pen motor

Feedback Network: It consist of RC circuit. It provides necessary damping to the pen motor. Auxiliary circuit: It provided 1mV calibration signal. The automatic blocking is provided when change in position of lead switch. It include speed control circuit of chart drive motor. Output Display unit: CRO or paper chart recorder is used as output unit. Pen motor is used in output.
Paper speed- 25mm/s in US manufacturing

system. Paper speed - 50mm/s in European ECG.

Analysis of ECG Waveform:

Fig (b) shows first degree AV block. PQ is prolonged

cond time(>0.22s) (c) shows Widening of QRS complex.(QRS period >0.1s). (d) shows elevation in ST. results Myocardinal infarction. (e) shows negative T wave. It results in Coronary insufficiency. (f) shows completely different ECG waveform(triangular). It is due to ventricular

Electroencephalography(EEG): It is the study of electrical activity of the brain. The biological name of brain in encephalon. Electrodes are placed on the scalp. Monitoring EEG has proven to be effective method of diagnosing many neurological illness and disease as epilepsy, tumor and problems associated with trauma. Unlike ECG, the EEG measurement is made for longer time.

Action Potential of the brain: The resting potential along with a nerve fiber is used to transmit the information from end to another. Inhibitory post synaptic potential(IPSP)
If the transmitter substance is inhibitory, then

the membrane potential of the receptor neuron increases in a negative direction. So it is less likely to discharge. The induced potential change is called IPSP.
Excitatory Post Synaptic Potential(EPSP)
If the transmitter substance is excitatory, then

the membrane potential of the receptor neuron increases in a positive direction. So it is more likely to discharge and produce spike potential. The induced potential change is called EPSP.

Evoked Potential:

Placement of electrode in EEG measurement: Anterior-Posterior Measurement(10 -20 electrode system)

The distance between 2 electrode is 10% and 20%

of distance between specified points on scalp.

Lateral Measurement(21 electrode system)

The distance is measured from left to right points.

Block Diagram of EEG Recorder:

Montages: A pattern of electrode on the head and the channels they are connected is called montage. Electrode Montage Selector: It is a large panel containing switches and make array of channel output. Each channel is created in the form of input from

Preamplifier: Every channel has an individual, multistage, ac coupled and sensitive amplifier. The amplifier should have high gain and low noise characteristics because EEG potential are small in amplitude. Noise plays an crucial role hence skin electrode couple brain waves of only a few microvolt to the amplifier. Hence specially designed connector box can be mounted near the patient. Sensitivity control: The overall gain of EEG machine is the gain of the amplifier multiplied by the sensitivity of the writer. If the writer sensitivity is 1cm/V then amplifier should have 20,000 gain for 50uV signal. Artifacts cause excessive deflection to pen. To overcome this problem most of modern EEG

Filter: Due to scalp movement & neck movement the noise would generate. The most effective way to eliminate this artifact filter is used. The filters are
Low pass filter(frequencies like 0.16,0.53,1.6,5.3). High pass filter(frequencies like 15,30,70 & 300). Notch filter(It turns ON sharply at 50hz hence to

eliminate mains frequency interface).

Writing Part: Ink type direct writing recorder having frequency response of about 90Hz. Ink jet recording system gives response up to 1000Hz.

Paper drive: It is provided by synchronous motor. It has paper speed selection as speed of 15,30,60m/s. Channels: An EEG is recorded simultaneously from an array of many electrode. Record can be made from Bipolar or monopolar leads. Commercial EEG machine have up to 32 channel and although 8 or 16 channel are more common. Microprocessor are now employed in EEG machines. EEG Recording modes: Unipolar (potential can be measured with reference to one electrode) Average Mode: (between 1 electrode and avg of all other electrode) Bipolar mode: (between sucessive pair of electrode

Analysis of EEG waveform:

Application of EEG: Epilepsy. Anesthetic level. Brain injury. Monitor during surgery. Effect of yoga. EMG(electro myograph) It is an instrument used to record the electrical activity of muscle to determine whether muscle is contracting or not. Study of neuromuscular function is possible by using EMG. Muscular contraction are caused by the depolarization of muscle fibres.

EMG recording system: EMG potentials are taken from the tissue by electrode. Potentials are given to differential amplifier(high gain amp). Its frequency range is 10Hz to 10KHz. Bandwidth of EMG is large and CMRR of this diff amp i2 80 to 100db.

 There is no lead selector switch. Because only 2

electrodes are used. Output from diff amp is given to loudspeaker system, tape recorder and CRO. Before giving output to the loud speaker, it is given to the power amplifier. Power amplifier amplifies the signal given to it. The output is displayed using CRO. Here storage oscilloscope is used. And recorded by using tape recorder for future purpose. Conduction Velocity measurement: In modern EMG system, nerve conduction time and nerve velocity are measured. For this measurement initially nerve is stimulated, and EMG is measured. Steps Involved in measurement of conduction Velocity:
Stimulate is applied at point A Electrical activity of muscle is measured at point B.

 Now change the position of A into C. Now the space is

reduce it is noted as l2 meters. The time delay is noted as t2 second. The conduction velocity V=(l1-l2)/(t1-t2) Usually V=50m/sec, if it is <40m/sec it means some disorder in nerve conduction.

Application of EMG Electrophysiological testing Clinical neurophysiology Neurology

ERG: It is the method of recording and interpreting the electrical activity of the eye.The process of recording the potential when light falls on the eye is known as electro retinography. In ERG, bipolar recording technique is used. The exploring electrode is placed on a saline filled contact lens. The contact lens in fixed on an eye. Negative pressure technique is used to attach contact lens on an eye.so even during eye movement, contact lens is not removed. Normally used contact lens are not used for recording ERG. Special type of contact lens is used to record the action potential of eye when flash of light incident on eye.

EOG: EOG is the recording of the biopotentials generated by the movement of eyes. The electrodes are placed to measure horizontal and vertical movement. The signals from these electrode are given to the amplifier circuit. Effect of some drugs on the eye movement system s can be identified. The level of anesthesia can be indicated by characteristic of eye movement. Diagnosis of neurologic disorder are possible.

 If flash light on the eye for 2 sec, then some

waveform is generated in the output unit When the flash of light incident on eye, the wave starts from the point a, it is due to Early Receptor Potential(ERP). Second component b is due to late receptor (LRP) produced by the synaptic ending of the photoreceptors. At pt b max o/p is otained. C wave-offset of light stimulus. D wave- off response of ERP and LRP

PCG(phono cardiogram) The graphical record of heart sound is called phono cardiogram. The device which used to measure heart sound called phonocariograph. The technique of listening sound produced by organs and vessels of the body known as Ausculation. The different types of heart sound are measured. These heart sounds are due to the vibration set up in the blood inside the heart by sudden closure of valves. Murmurs are generally caused by improper opening of the valves.

Classification of heart sound: Valve closure sound, ventricular filling sound, valve opening sound, Extra cardiac sound.

 The system involves continuous measurement of physiology

Patient monitoring & intensive care system

parameters like respiratory rate, body temperature, blood pressure, heart rate. In some situation EEG,ECG,EMG are monitored. The use of continuous monitoring can be significantly improve the attention given by hospital staff to a patient in the most critical condition.

Requirement of patient monitoring system: For any desired parameter, continous monitoring should be possible. An alarm should be provided so that if particular parameter changes beyond the limit, then the doctor or nurse will be informed. For respiration rate, instead of spirometer type equipment a thermistor placed near the nasal opening is used, when the patient breath out, the variation resistance can give an indication of the respiratory rate. System Arrangement of an ICU: Bedside monitors consisting of individual unit with wall mount or mobile stands are used. Monitoring equipment information should displayed at nurse station. Patient monitoring system vary in size and

 In advance system central station is provided with

data recording provided with data recording tape recorder. It is recorded in digital form and given to comparator to sense the level of the signal and then to alarm. Time delay is given [due to artifacts only when long period abnormal data received then alarm is operated]. Data transmission System in ICU: In ICU transmission part is very important. There are four mode of transmission is occurs as,
Wire connection and radio link. Magnetic tape recorder and commercial telephone line.

Wire and radio link are most used technique and they are

simple and low cost. Their installation is complex. Radio links are useful where the ICU is installed in a

 Transmitter used usually have a range of 100m and

frequency must be according to permission with government authority. Radio link system has poor performance under certain atmospheric condition. Magnetic tape recorder is used for permanent record. LAN, Integrated service Digital network(ISDN) and communication system are useful in patient

Resuscitation Unit: It is must for every ICU. In modern hospital it is in form of mobile trolley. Equipment mounted are
Dual trace oscilloscope for ECG, pulse monitoring Heart rate monitor, graphic recorder, DC defibrillator Pacemaker

 Direct arterial or venous pressure monitoring with

meter may be included. Special attention should be given to make instrument as compact. Hence operator will not make mistake. Resuscitation unit may have power pack of 70 ampere/hour, storage battery, inverter and battery charger. Switch gear and relay are provided when trolley is moved it changes to self contained power.