Radio Pill

UNIT III
ASSIST DEVICES AND BIO - TELEMETRY
UNIT III
ASSIST DEVICES AND BIO-TELEMETRY
EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College
UNIT III
UNIT III
ASSIST DEVICES AND BIO-TELEMETRY
Cardiac pacemakers, DC Defibrillator, Telemetry principles, frequency selection, Bio-telemetry, radio-pill and tele-stimulation.
Biotelemetry:
Biotelemetry is the measurement of biological parameters over longer distance. The means of transmitting the data from the point of generation to the point of reception can take any forms. Perhaps the simplest application of the principle of biotelemetry is the stethoscope, whereby heart beat sounds are amplified acoustically and transmitted through a hollow tube to be picked up by the ear of the physician for interpretation.
Applications of Bio-Telemetry:
In many situations, it becomes necessary to monitor physiological events from a distance. To quote a few applications are, 1. Radio frequency transmissions for monitoring the health of astronauts in space. 2. Patient monitoring in an ambulance and in other locations away from the hospital. 3. Collection of medical data from home or office. 4. Patient monitoring, where freedom of movement is desired, such as in obtaining an exercise ECG. (In this instance, the requirement of trailing wires is cumbersome and dangerous). 5. Research on unrestrained and unanesthetized animals in their natural habitat. 6. Use of telephone links for the transmission of ECGs or other medical data. 7. Special internal techniques, such as measuring pH or pressure in the gastrointestinal tract. 8. Isolation of an electrically susceptible patient from power-line operated ECG equipment, to protect him from accidental shock.
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Principles of Design of Bio-Telemetry System:

1. The telemetry system should be selected to transmit the bio-electric signal with maximum fidelity and simplicity. 2. System should not affect living system by interference. 3. It should have more stability and reliability. 4. The power consumption at the transmitter and the receiver should be small to extend the source lifetime in the case of implanted units. 5. The size and weight of the telemetry system should be compact. 6. For wire transmission, the shielding of cable is a must to reduce noise levels. At the transmitter side, the amplifiers should be differential amplifiers to reject common mode interference. 7. Miniaturization of the radio telemetering system helps to reduce noise.
Physiological parameters adaptable to biotelemetry

Based on the hardware systems, measurements can be applied to two categories: 1. Bioelectrical Parameters, such as ECG, EEG and EMG. 2. Physiological variables that require transducers such as blood pressure, gastrointestinal pressure, blood flow and temperatures.
Bioelectric Parameters: (such as ECG, EMG and EEG) The signal is obtained directly in electrical form. One example is ECG telemetry - the transmission of ECGs from an ambulance or site of emergency to a hospital. A cardiologist at the hospital can immediately interpret the ECG, instruct the trained rescue team in their emergency resuscitation procedures and arrange for any special treatment that may be necessary upon the patients arrival at the hospital. In this application, the telemetry to the hospital is supplemented by two-way voice communication. Telemetry of EEG signals has also been used in studies of mentally disturbed children. The child wears a specially designed spacemans EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College 3
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helmet with built-in electrodes, so that the EEG can be monitored without traumatic difficulties during play. In some clinic, the children are left to play with other children in a normal nursery school environment. They are monitored continuously while data are recorded. Telemetry of EMG signals is useful for studies of muscle damage, partial paralysis problems.
Physiological variables: The physiological parameters are measured as a variation of resistance, capacitance or inductance. The differential signal obtained from these variations can be calibrated to represent pressure flow, temperature and so on. In the field of blood pressure and heart rate research in
unanesthetized animals, the transducers are surgically implanted with leads brought out through the animals skin. A male plug is attached postoperatively and later connected to the female socket contained in the transmitter unit. The use of thermistors to measure temperature is also easily adaptable to telemetry. In addition to the continuous monitoring of skin temperature or systemic body temperature, the thermistor system has been found to be used in obstetrics and gynecology. One more application is the use of radio pill to monitor stomach pressure of pH. In this application, a pill that contains a sensor plus miniature transmitter is swallowed and the data are picked up by a remote receiver and recorded.
Advantages of Biotelemetry:
1. Major advantage of using biotelemetry is removing the cables from patient and providing a more comfortable medium to patient. Patient needs to carry only a small transmitter. 2. Isolation of patient from high voltage completely. Transmitters in the patient side work with batteries without any danger of electrical shock.
UNIT III 3.
Battery operated amplifiers and transmitters will cause no additional noise as long as no connection with line voltage at patient side. (Electrical Interference of 50Hz).
4.
Continuous monitoring of the patient can be obtained.
Radio Telemetry systems:

Many hospitals use radio telemetry systems to monitor certain patients. The most common use of radio telemetry is to keep track of improving cardiac patients and at the same time keep them ambulatory. These units are sometimes called as post coronary care units (PCCU) or step down CCU. The telemetry unit uses tiny VHF or UHF radio transmitter that is attached to the patient either by a clip or a small sack is hung around the patients neck. Most transmitters contain an analog ECG section that acquires the signal and uses it to modulate the frequency of the radio transmitters. The receiver station is equipped with a bank of radio receivers tuned to the same frequency as the transmitters. The receiver demodulates the frequency modulation signal to recover ECG waveform. The waveform is then displayed on an oscilloscope or strip chart recorder as in other patient monitoring systems.
Classification of Telemetry Systems:

Telemetry Systems are classified as, 1. Based on data transmitted a. Analog b. Digital 2. Based on transmission distance a. Short b. Long 3. Based on whether user as control over transmission channel or not.
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Modulation systems:
The modulation system used in wireless telemetry for transmitting biomedical signals makes use of two modulators. This means that comparatively lower signal frequency carrier is employed in addition to the VHF which finally transmits the signal from the transmitter. The principle of double modulation gives better interference free performance in transmission and enables the reception of low frequency biological signals. The sub-modulator can be a FM system or a PWM system. Where as the final modulator is practically always an FM system.
Elements of Biotelemetry Systems:

The essential blocks of a biotelemetry system are shown in Figure below. The transducer converts the biological variable into an electrical signa1. The signal conditioner amplifies and modifies this signal for effective transmission. The transmission line connects the signal input blocks to the read-out device by wire or wireless means.
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Single Channel Telemetry system:

A Single Channel Telemetry system is as shown in the figure below. The stages of a typical biotelemetry system can be broken down into functional blocks as shown in figure below for the transmitter and the receiver. For a single channel system, a miniature battery operated radio transmitter is connected to the electrodes of the patient. This transmitter broadcasts the biopotential to a remotely located receiver. The receiver detects the radio signals and recovers the signals for further processing. Physiological signals are obtained from the subject by means of appropriate transducers. The signal is then passed through a stage of conditioning circuit where amplification and processing is done. Later the processed signal is transmitted using radio transmitter. The radio frequency used in this system varies from few hundred KHZ to 300 MHZ. Either amplitude modulation or frequency modulation can be used but due to reduced interference, FM transmission is often used for telemetry.
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Radio Telemetry with a subcarrier:

When the relative position of transmitter to the body or other conduction object changes, the carrier frequency and amplitude will change. This is due to the loading change of the carrier frequency resonant circuit. This effect is not distinguishable from the signal at the receiver end. If the signal has a frequency different from the loading effect, they can be separated by filters. Otherwise the real signal will be distorted by the loading effect. To avoid this loading effect, the subcarrier system is needed. The signal is modulated on a subcarrier to convert the signal frequency to the neighbourhood of the subcarrier frequency. Then the R.F carrier is modulated by this sub carrier carrying the signal. At the end, the receiver detects the R.F and recovers the subcarrier carrying the signal. Since the sub carrier frequency is quite different form all noise interference and loading effect, it can be separated by filters. So one additional stage of demodulation is needed to convert the signal from the modulated subcarrier back to its real frequency and amplitude.
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Multiple Channel telemetry Systems:

For most bio-medical experiments, it is desirable to have simultaneous recordings of several signals for correlation study. Each signal requires a telemetry channel. When the number of channels is more than two or three, the simultaneous operation of the several single channel units is difficult. At that time, multiple channel (multiplex) telemetry system adopted. There are two types: 1. Frequency division multiplexing 2. Time division multiplexing
Frequency division multiplex System: Each bio-signal is frequency modulated on a subcarrier frequency. Then these modulated subcarrier frequencies are combined to modulate the main R.F. carrier.
At the receiver side, modulated subcarriers will be separated by the proper band pass filters after the first discrimination (demodulation). Later the individual signals are recovered from these modulated subcarriers by the second set of discriminators (Demodulators).
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The frequency of the subcarriers has to be carefully selected to avoid interference. The low pass filters are used to extract the signals without any noise.
Time division multiplex System:

Most of the biomedical signals have low frequency bandwidth requirements; so, time division multiplex system can be used by the time sharing basis. The transmission channel is connected to each signal-channel input for a short time to sample and transmit that signal. Then the transmitter is switched to the next signal channel in a definite sequence. When all the channels have been scanned, the operation is repeated from the first channel. At the receiver end, the process is reversed. The sequentially arranged, signal pulses are distributed to the individual channels by a synchronized switching circuit. If the number of scanning cycles per second is large and if the transmitter and the receiver are synchronized, the signal in each channel at the receiver side can be recovered without noticeable distortion. Conditions: 1. The scanning frequency fn should be at least greater than twice the maximum signal frequency fs. (i.e) fn > 2fsmax 2. If Tn = 1/ fn = scanning period, and tn is the sampling time of each channel, then the maximum number of channels that can be obtained is n = Tn/tn. Practically the number of channels allowed is smaller than the calculated value of n' to avoid interference between channels.
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Radio pill:
Radio pill when swallowed, will travel the GI tract (Gastrointestinal tract) and simultaneously perform multiparameter in physiological analysis. After completing its mission it will come out of the human body by normal bowel movement. The pill is 10mm in diameter and 30mm long weighing around 5gm and records parameters like temperature, pH, conductivity and dissolved oxygen in real time. The pill comprises an outer biocompatible capsule encasing micro sensors, a control chip, radio transmitter and two silver-oxide cells.
INSIDE THE CAPSULE: The schematic diagram of the microelectronic pill is as shown in figure below. The outer casing of the pill is made by machining chemically resistant polyetheterketone, which is biocompatible. It is made up of two halves, which are joined together by screwing. The pill houses a PCB chip carrier that acts as a common platform for attachment of, 1. sensors, 2. application- specific integrated circuit (ASIC), 3. radio transmitter and
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UNIT III 4. batteries.
Task of the sensors: The device is provided with four micro sensors, namely 1. a silicon diode, 2. an ion-selective field effect transistor (ISFET), 3. a pair of direct- -contact gold electrodes and 4. a 3-electrode electrochemical cell. Silicon diode: The silicon diode is used to measure the body core temperature and also identify local changes associated with tissue inflammation and ulcers.
ISFET: 1. It is used to measure pH. 2. It is used to determine the presence of pathological conditions associated with abnormal pH levels, particularly associated with pancreatic disease, hypertension, inflammatory bowel disease, the activity of fermenting bacteria, the level of acid excretion, reflux to the oesophagus and the effect of GI-specific drugs on target organs.
Gold electrodes: A pair of direct contact gold electrode is used to measure conductivity. The conductivity sensor is used to monitor the contents of the GI tract by measuring water and salt absorption, bile secretion and the breakdown of organic components into charged colloids.
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3- electrode electrochemical cell: The 3-electrode electrochemical cell is used to detect the level of dissolved oxygen in solution. The oxygen sensor measures the oxygen gradient from the proximal to the distal GI tract. This enables a variety of syndromes to be investigated including the growth of aerobic bacteria or bacterial infection. The implementation of a generic oxygen sensor will also enable the development of a first generation enzyme linked amperometric
biosensors, thus extending the range of future applications to include (eg.) glucose and lactate sensing, as well as immunosensing protocols.
The microelectronic sensors are attached to the PCB chip carrier by a 10 pin, 0.5mm pitch polyimide ribbon connector. The PCB carrier is made from 1.6mm thick fiberglass board. The transmitter and the ASIC are also integrated on the board. The integrated radio transmitter sends the signal to a local receiver prior to data acquition on a computer. The unit is powered by two standard 1.55V silver-oxide cells with a capacity of 175mAh.The batteries are connected in series and provide an operating time of 40 hours at the rated power consumption of 12.1mW. The sensor chips are provided at the front end of the pill and are exposed to the ambient environment through access ports. They are scaled by two sets of stainless-steel clamps incorporating an o.8m thick sheet of fluoroelastomer seal. The 3mm diameter access channel in the center of each steel clamp exposes the sensing region of the chips to the ambient environment.
SENSORS: The schematic diagram of sensor chips is as shown below. The sensors are fabricated on two silicon chips located at the front end of the capsule. Chip1, measuring 4.75 x 5mm2, comprises the silicon diode
temperature sensor, the pH ISFET sensor and the two-electrode 5x 10-4mm2
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conductivity sensor. Predefined n-channels in the p-type bulk silicon form the basis for the diode and the ISFET. The 15x600m floating gate of the ISFET is precovered with a 50nm thick proton-sensitive layer of Si3N4 for pH detection. The pH sensor consists of the integrated 3x 10-2mm2 Ag/Agcl reference electrode, a 500m diameter and 10-nL electrolyte chamber and 15x600m floating gate of the ISFET sensor.
Chip2, measuring 5 x 5mm2, comprises the electrochemical oxygen sensor and a NiCr resistance thermometer. The oxygen sensor is embedded in the electrolyte chamber. The 3-electrode electrochemical cell of the oxygen sensor comprises the 1x10-1 mm2 counter electrode made of gold, a microelectrode array of 57x10m diameter working gold electrodes and an integrated 1.5x 10-2mm2 Ag/Agcl reference electrode.
The microelectrode array has an inter-electrode spacing of 25m and a combined area of 4.5x 10-3mm2. It promotes electrode polarization and reduces response time by enhancing transport to the electrode surface. EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College 14
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The NiCr resistance thermometer is made from a 100nm thick layer of NiCr and is 5m wide and 11mm long. The 500nm thick layer of thermally evaporated silver is used to fabricate the reference electrode. It is then oxidized to Ag/Agcl by chronopotentiometry.
Control chip: The ASIC is the control unit that connects together other components of the microsystem as shown in the figure below. It contains an analogue signal conditioning module operating the sensors, 10-bit ADC and DAC converters and a digital data processing module. An oscillator provides the clock signal. The temperature circuitry biases the diode at constant current so a change in temperature reflects a corresponding change in diode voltage. The pH ISFET sensor is biased as a simple source and drain follower at constant current with the drain-source voltage changing with the threshold voltage and pH.
The conductivity circuit operates at direct current, measuring the resistance across the electrode pair as an inverse function of solution conductivity. An incorporated potentiostat circuit operates the amperometric
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oxygen sensor with a 10-bit DAC controlling the working electrode potential with respect to the reference. The analogue signals have a full-scale dynamic range of 2.8V with the resolution determined by the ADC. These are sequenced through a multiplexer prior of being digitized by the ADC. The bandwidth for each channel is limited by the sampling interval of 0.2msec. The digital data processing module processes the digitized signals through the use of a serial bit stream data compression algorithm, which decides when transmission is required by comparing the most recent sample with the previous sampled data. The digital module is clocked at 32KHz and employs a sleep mode to conserve power from the analogue module.
Radio transmitter: The size of the transmitter is 8x5x3mm. The transmission range is one meter and the modulation scheme frequency shift keying has a data rate of 1 kbps. The transmitter is designed to operate at a transmission frequency of 40.01 MHz at 20C generating a signal of 10KHz bandwidth.
Power consumption: Two SR44 Ag2O batteries are used, which provide an operating time of more than 40 hours of the microsystem. The power consumption of the system is around 12.1mW and current consumption is around 3.9mA at 3.1V supply. The ASIC and sensor consume 5.3mW corresponding to 1.7mA of current and the free running radio transmitter consumes 6.8mW at 2.2mA of current. Range of measurement: The microsystem can measure, 1. Temperature from 0 to 70C, 2. pH from 1 to 13, 3. Dissolved oxygen up to 8.2mg/litre, 4. Conductivity from 0.05 to 10 ms.cm-1( s=siemens).
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Defibrillators
Introduction:
Defibrillator is an electronic device that creates a sustained myocardial depolarization of a patients heart in order to stop ventricular fibrillation or arterial fibrillation. The instrument for administering the electric shock is called as defibrillator. Defibrillation is the application of electric shock to the area of the heart which makes all the heart muscle fibers enter their refractory period together, after that normal heart action may resume. If the heart does not recover spontaneously after delivering the shock to the heart using defibrillator then a pacemaker may be employed to restart the rhythmic contraction of the myocardium. Ventricular fibrillation is dangerous when compared to arterial fibrillation.
Defibrillator types:
There are two types of defibrillators based on the electrodes placement. a) Internal defibrillator (Surgical Type) b) External defibrillator (Therapeutic Type)
Internal defibrillator:
It is used when chest is opened. Here large spoon shaped electrodes with insulated handle are used. Sometimes electrodes in the form of fine wires of Teflon coated stainless steel are used. There are AC and DC defibrillator methods but DC defibrillator is used today. Since the electrode comes in direct contact with the heart, the contact impedance is about 50 ohms.
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In internal defibrillation, the heart requires excitation energy of about 15 to 50 J. The duration of the shock is about 2.5 to 5 milliseconds. The spoon shaped electrode is as shown below.
External defibrillator:
It is used on the chest. Here paddle shaped electrodes are used. There are AC and DC defibrillator methods but DC defibrillator is used today. Since the electrodes are placed above the chest, the contact impedance on the chest is about 100 ohms even after applying the gel. In external defibrillation, the heart requires excitation energy of about 50 to 400 J. The duration of the shock is about 1 to 5 milliseconds. The paddle shaped electrode is as shown below. The bottom of the electrode consists of a copper disc with 3 to 5 cm diameter for pediatric patient and 8 to 10 cm diameter for adult patients with a highly insulated handle.
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Mechanism:
Fibrillation results from a rapid discharge of impulses from a single or multiple foci in the atria or in the ventricles. The atria or the ventricles are unable to respond completely and effectively to each stimulus. Under conditions of atrial fibrillation, the ventricles can still function normally but they respond with irregular rhythms to the non-synchronized bombardment of electrical stimulation from the fibrillating atria and the circulation is still maintained although not as efficiently. The sensation produced by the fibrillating atria and irregular ventricular action can be quite traumatic for the patient. Ventricular fibrillation is dangerous when the ventricles are unable to pump the blood. Hence, resuscitative measures must be applied within 5 minutes or less after the attack or irreversible brain damage and death will occur.
Types of defibrillator based on operation or Voltage delivered:

There are six types of defibrillators based on the nature of the output voltage delivered. They are, 1. AC defibrillator 2. DC defibrillator 3. Synchronized DC defibrillator 4. Square pulse DC defibrillator 5. Double square pulse DC defibrillator 6. Biphasic DC defibrillator
1. AC defibrillator:
Although mechanical methods like chest massage for defibrillation have been tried for years, the most successful method of defibrillation is the application of electric shock to the area of the heart which makes all the heart muscle fibres enter their refractory period together after which normal heart action may resume. One of the earliest forms of an electrical defibrillator is the AC defibrillator, which applies several cycles of alternating current to the heart from the power line through a step-up transformer. EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College 19
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To achieve defibrillation with internal electrodes placed on the surface of the heart (in open heart surgery), voltage ranging from 80 to 300V rms is required. When external electrodes are used on the chest, voltages of twice the value are required. The transformer must be capable of supplying 4 to 6 amperes current during the stimulus period.
Disadvantages:
1. There are many disadvantages in using AC defibrillators. 2. Successive attempts to correct ventricular fibrillation are often required. 3. AC defibrillator cannot be successfully used to correct atrial fibrillation.
2. Capacitive Discharge DC Defibrillators

The Capacitive Discharge type DC Defibrillator is as shown in the figure below.
The 220V AC main supply is connected to a variable autotransformer in the primary circuit. The output of the autotransformer is fed as input to a step-up transformer to produce high voltage with a rms value of about 8000 V.
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A half-wave rectifier rectifies this high AC voltage to obtain DC voltage, which charges the capacitor C. The voltage to which C is charged is determined by the
autotransformer in the primary circuit. A series resistance, Rs, limits the charging current to protect the components. An AC voltmeter across the primary is calibrated to indicate the energy stored in the capacitor. Five times the RC time constant circuit is required to reach 99% of a full charge-a value it should reach in 10 seconds, which means that the time constant must be less than 2 s. With the electrodes firmly placed at appropriate positions on the chest, the clinician or technician discharges the capacitor by momentarily changing the switch S from position 1 to position 2.
The capacitor is discharged through the electrodes and the patient's torso represented by a resistive load, and the inductor L. The inductor is used to shape the wave in order to eliminate a sharp, undesirable current spike that would occur at the beginning of the discharge. The energy delivered to the patient is represented by the typical waveform shown in figure above. The area under the curve is proportional to the energy delivered. The wave is monophasic and the peak value of the current is nearly 20 A.
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Depending on the defibrillator energy setting, the amount of electrical energy discharged by the capacitor may range between 100 and 400 watts or joules when the electrodes are applied externally and the duration of the effective portion of the discharge is approximately 5 m/s. Once the discharge is completed, the switch automatically returns to position 1 and the process can be repeated, if necessary. When the electrodes are applied directly to the heart, about 50 to 100 joules only is required for defibrillation. The energy stored in the capacitor is given by the equation W=
1 CV2 2
Where, C is the capacitance and V is the voltage to which the capacitor is charged. Capacitors used in the defibrillator range from 10 to 50 F. Thus, the voltage for a maximum of 400 J ranges from 2 to 9 KV, depending on the size of the capacitor.
Delay-Line Capacitive Discharge DC Defibrillator

Even with DC defibrillation, there is a danger of damage to the myocardium and the chest walls, because peak voltages as high as 6000 V may be used. To reduce this risk, some defibrillators produce dual-peak waveforms of longer duration (approximately 10 m/s) at a much lower voltage. The circuit diagram of such a system is shown in figure below. The parallel combination of C1 and C2 stores the same energy as the single capacitor in the above figure. But its discharge characteristic is more rectangular in shape (1onger duration of approximately 10 m/s) at a much lower voltage, as shown in figure below.
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With this type of waveform, effective defibrillation can be achieved in adults with lower levels of delivered energy - between 50 and 200 watts.
3. Synchronised DC defibrillator:
Defibrillation is a risky procedure since if it is applied incorrectly; it could induce fibrillations in a normal heart. There must be proper diagnosis for ventricular fibrillation. Simple DC defibrillator can arrest the ventricular fibrillation. But for termination of ventricular tachycardia, atrial fibrillation and other
arrhythmias it is essential to defibrillator with synchronizer circuit. There are two vulnerable zones in a normal cardiac cycle, T wave and U wave segments. If the counter shock falls in the T segment then the ventricular fibrillation is developed. If the counter shock falls in the U wave segment then atrial fibrillation is produced. DC defibrillator circuit consisting of defibrillator, electrocardioscope and pacemaker is as shown in the figure below. The pacemaker is used in the case of emergency as a temporary pacing. It includes diagnostic circuitry which is used to assess the fibrillation before delivering the defibrillation pulse and synchroniser circuitry which is used to deliver the defibrillation pulse at the correct time. So, as to eliminate the ventricular fibrillation or atrial fibrillation without inducing them.
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Working:
1. The electrocardiogram is obtained by means of an ECG unit, connected to the patient who is going to receive defibrillation pulse. 2. The switch is placed in the defibrillator mode if ventricular fibrillation is suspected. 3. The QRS detector in that mode consists of a threshold circuit that would pass a signal as output if R wave is absent in the electrocardiogram. Other it would not give any output if R Wave is present. 4. Meanwhile the medical attendant energizes the switch to deliver a defibrillation pulse. 5. The AND gate 'B' delivers on signal to the defibrillator only when the R wave is absent, provided the signal from the medical attendant is also present at one of the two inputs of that AND gate. 6. At the two inputs of AND gate 'B' if any one of the inputs is missing, then it would not give any output. By this way the defibrillator is inhibited and would not deliver the defibrillation pulse. 7. The fibrillation detector searches the ECG signal for frequency components above 150 Hz. If they are present, fibrillation is probable and the fibrillation detector gives an output signal. A defibrillator pulse is delivered only if the fibrillation detector produces an output at the same time that the attendant energizes the switch. This is provided by the AND gate 'C'.
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UNIT III 8.
Thus when the AND gate B and AND gate C are simultaneously triggering the defibrillator, the defibrillation pulse is delivered.
9.
In the synchronization mode, the defibrillator is synchronised with the ECG unit. Suppose a patient is suffered by atrial fibrillation. First the doctor diagnoses it correctly and then the treatment is initiated using this circuit.
10.
The ECG signal in the instrument is given to QRS detector. Its output is used to time the delivery of the defibrillation pulse with a delay of 30 milliseconds. At this time, the ventricles will be in uniform state of depolarisation and the normal heart beat will not be disturbed. This delay of 30 milliseconds after the occurrence of R wave allows the attendant to defibrillate atrium without inducing
ventricular fibrillation.
4. Square wave defibrillator:

In this defibrillator, capacitor is discharged through the subject by turning on a series silicon controlled rectifier (SCR). When sufficient energy has been delivered to the subject a shunt SCR short circuits the capacitor and terminates the pulse. The output can be controlled by varying the voltage on the capacitor or duration of discharge. Here the defibrillation is obtained at low peak current and so there is no side effect. Digital circuits can also produce a square pulse used for defibrillation.
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Analysis
In the figure above, Ro is the internal resistance of the defibrillator, RE is the electrode - skin resistance and RT is the thorax resistance. The Energy in the pulse is, EP = VDIDTD Where, VD and ID are the instantaneous voltage and current available from the defibrillator pulse respectively and TD is the duration of the pulse. Total circuit resistance, R = RD + 2RE + RT Further, the energy in the pulse can also be written in terms of
voltage and resistance between the cable attached to the patient such that
VD .TD = ID2 (2RE + RT)TD EP = 2 R E + RT

The energy loss in the defibrillator EDL = ID2RDTD The energy loss in each electrode and skin, EEL = ID2RETD Energy delivered to the thorax, ET = ID2RTTD =
RT EP 2 R E + RT
From the above equation we can know that the energy in the pulse is not delivered completely to thorax. Similarly the energy delivered to the thorax can be expressed in the form of available energy from the capacitor discharge in the case of DC defibrillator whose output is assumed to a square pulse. Energy available from the capacitor, EC = ID2RTD = ET = EC - EDL - 2EEL (Or) ET = EDL + 2EEL + ET
RT EC 2 R E + RT + R D
Thus the energy delivered to the thorax, ET is diminised from the available energy due to effects of resistance of defibrillator and electrode-skin resistance.
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Advantages:
The advantages of square wave defibrillator are, 1. It requires low peak current 2. It requires no inductor 3. It is possible to use physically smaller electrolytic capacitors.
5. Double Square Pulse Defibrillator:

Double square pulse defibrillator is normally used after the open heart surgery.
Conventional DC and AC defibrillators are producing myocardial injury with a diminished ventricular function for a period of approximately 30 minutes following the delivery of shock. If the chest is opened, only lower energy electric shock should be given. Instead of 800 1500V, employed in DC capacitor discharge in the case of DC defibrillators, Here 8-60 V double pulse is applied with a mean energy of 2.4 wattsecond as shown in figure above. When the first pulse is delivered, some of the fibrillating cells will be excitable and will be depolarised. However cells which are in refractory during the occurrence of first pulse will continue to fibrillate. In order to, obtain a total defibrillation; the second pulse operates on latter group of cells. The pulse amplitude and width together with the interval should be such that the cells defibrillated by the first pulse will be refractory to the second pulse. The timing of the second pulse should be such that those cells which were refractory to the first pulse are now become excitable. Thus complete
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defibrillation can be obtained by means of selecting proper pulse-space ratio. Using double square pulse defibrillator, efficient and quick recovery of the heart to beat in the normal manner without any side effect like burning of myocardium or inducement of ventricular or atrial fibrillation. The double square pulse with the required pulse-space ratio can be produced with the use of digital circuits similar to those digital pacemaker circuits.
6. Biphasic DC defibrillator Biphasic DC defibrillator is similar to the double square pulse defibrillator such that it delivers DC pulses alternatively in opposite directions. This type of waveform is found to be more efficient for defibrillation of the ventricular muscles.
Defibrillator Electrodes
The two defibrillator electrodes applied to the thoracic walls are called either Anterior-Anterior or Anterior-Posterior paddles. With anterior-anterior paddles, both paddles are applied to the chest. Anterior-posterior paddles are applied to both the patient's chest wall and back, so that the energy is delivered through the heart. This method of paddle application offers better control over arrhythmias that occur as a result of atrial activity. These two methods are shown in Figure below. To maintain good contact, the electrodes must be firmly placed against the patient. The posterior paddle is flat and has a larger disc (with a radial handle) than the anterior paddle (axial handle). The electrodes must be sufficiently well insulated, so that the operator holding the electrodes is safe.
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(a)

(b)
(c)
(d)
(a) Anterior-Anterior Electrode Placement on the Chest (b) Anterior-Posterior Electrode Placement on Chest & Back (c) Paddle-Type External Electrode which is Applied on Chest Wall (d) A Spoon-shaped Internal Electrode which is Applied Directly to the Heart Muscle
Two types of electrodes for defibrillation are shown in the above figure, and Figure (c) shows the type of electrode used for external defibrillation. This electrode consists of a large metal disc, approximately 100 mm in diameter, in an insulated housing. A control switch is located on the handle so that, once the electrodes are in place, the operator can push the switch to initiate the pulse. While being used, the electrodes surface is coated with a conducting gel of the type used with an ECG recording. Figure (d) shows an internal type of electrode which is spoon shaped, for applying directly on the myocardium (during open-chest surgery), or it may be applied to the chest of an infant. In these applications, the energy levels required for defibrillation may range from 10 to 50 watts. Special pediatric paddles are available with diameters ranging from 2 to 6 cm. The energy of a defibrillator is usually given in terms of watts/sec, referenced across a 50 ohm resistor. Most defibrillators today have a charging capacity of 400 watts.
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Typical defibrillating values used (in watt are as follows:
S.No 1 2 3 4
Patient Adult (external) Adult (internal) Pediatric (external) Pediatric (internal)
Defibrillating Value 200-400 35-75 100-200 25-50
Due to energy dissipation as heat in components inside the unit and to some extent at the electrode skin interface, there is usually a 20% loss of energy. Most defibrillators include watt meters to indicate the amount of energy stored in the capacitor prior to discharge.
PACEMAKER
INTRODUCTION:
Pacemaker is an electrical pulse generator for starting and/or maintaining the normal heart beat. The output of the pacemaker is applied either externally to the chest or internally to the heart muscle. In the case of cardiac stand still, the use of the pacemaker is temporary - just long enough to start a normal heart rhythm. But in the case requiring long term pacing, the pacemaker is surgically implanted in the body and its electrodes are in direct contact with the heart. In cardiac diseases, where the ventricular rate is too low, it can be increased to normal rate by using pacemaker. By fixing the artificial electronic pacemaker, the above defects in the heart can be eliminated.
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Energy requirements to excite the heart muscle: Like all muscle tissues, the heart muscle can be stimulated with an electric shock. The minimum energy required to excite the heart muscle is about 10 J. For better stimulation and safety purposes, a pulse of energy 100 J is applied on the heart muscle. i.e., a pulse of 5 V, 10 mA and 2 milli seconds duration is used. Too high a pulse energy may provoke ventricular fibrillation. Ventricular fibrillation is a dangerous condition. During that time, the ventricular muscle contracts so rapidly and irregularly that the ventricles fail to fill the blood and circulatory arrest follows. The patient loses consciousness in 10-15 seconds and the brain cells die within a few minutes from oxygen deficiency in the brain. This is caused by a pulse of energy 400 J.
The above figure shows the shape of the pacemaker pulses. These pulses should have the pulse to space ratio 1:10000 and that should be negatively going pulses to avoid the ionization of the muscles. The pulse voltage is made variable to allow adjustments in the energy delivered by the pacemaker to the heart during each pulse. During the pulse duration, the stimulus voltage drives energy into the heart muscles. The pulse repetition rate is usually 70 pulses/min but many pacemakers are adjustable in the range of 50-150 pulses/min. The duration of each pulse is between 1 and 2 milli seconds. Output pulses from the pacemaker appear at the pair of electrodes used for triggering the heart.
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The typical ranges of parameters of the pacemakers available today are, S.No Parameters 1 Pulse rate 2 Pulse width 3 4 5 6 7 8 9 Pulse amplitude Battery capacity Longevity End-of-life indicator Weight Size Encapsulization Ranges 25 - 155 pulses per minute 0.1 - 2.3 milliseconds 2.5 - 10 volts 0.44 - 3.2 amp-hours 3.5 - 18 years 2 - 10% dropin pulse rate 33 - 98 grams 22 - 80 cm3 Silicon rubber, stainless steel, titanium
Methods of Stimulation:
There are two types of stimulation 1. External Stimulation and 2. Internal Stimulation
1. External Stimulation:
External stimulation is employed to restart the normal rhythm of the heart in the case of cardiac stand still. Stand still can occur during open heart surgery or whenever there is a sudden physical shock or accident. The paddle shaped electrodes are applied on the surface of the chest Currents in the range of 20 - 150 mA are employed.
2. Internal Stimulation:
Internal stimulation is employed in cases requiring long term pacing because of permanent damage. The electrodes are in the form of fine wires of teflon coated stainless steel are used. In some cases, during restarting of the heart after open heart surgery, spoon like electrodes are used. The currents in the range of 2-15 mA are employed.
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Classification of Pacemakers based on placement:

Based on the placement of the pacemaker, there are two types 1. External pacemaker and 2. Internal (Implanted) pacemaker
S. External Pacemaker Internal Pacemaker No The pacemaker is placed outside The pacemaker is miniaturized and the body. It may be in the form of is surgically implanted beneath the 1 wrist watch or in the pocket, from skin near the chest or abdomen that one wire will go into the with its output leads are connected heart through the vein. The electrodes are called The electrodes are called directly to the heart muscle.
endocardiac electrodes and are applied to the heart by means of an 2 electrode catheter with
myocardiac electrodes and are in contact with the outer wall of the myocardium.
electrode's tip situated in the apex of the right ventricle. These are in contact with the inner surface of the heart chamber.
It does not need the open chest It requires a minor surgery to place 3 surgery The battery and can any be easily or the circuit. The battery can be replaced only by minor surgery. Further any defect or adjustment in the circuit cannot be easily attended. Doctor's' help is necessary to rectify the defect in the circuit.
replaced 4
defect
adjustment in the circuit can be easily attended without getting any help from a medical doctor.
During placement, swelling and During placement swelling and pain 5 pain do not arise due to arise due to foreign body reaction.
minimum foreign body reaction. 6
Here there is no safety for the Here there is a cent percent safety
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UNIT III pacemaker case
ASSIST DEVICES AND BIO - TELEMETRY particularly in the for the circuit from the external the disturbances.
of children carrying
pacemaker. Mostly 7 these are used for Mostly these are used for
temporary heart irregularities
permanent heart damages.
Different modes of Operation:

Based on the modes of operation of the pacemakers, they can be divided into five types, 1. Ventricular asynchronous pacemaker (fixed rate pacemaker) 2. Ventricular synchronous pacemaker 3. Ventricular inhibited pacemaker (demand pacemaker) 4. Atrial synchronous pacemaker 5. Atrial sequential ventricular inhibited pacemaker
1. Ventricular asynchronous pacemaker (fixed rate pacemaker)

This pacemaker is suitable for patients with either a stable, total AV block, a slow atrial rate or atrial arrhythmia. It is basically a simple astable multivibrator. This produces a stimulus at a fixed rate irrespective of the behaviour of heart rhythm. It consists of a square wave generator (first differential amplifier circuit) and a positive edge triggered monostable multivibrator (second differential amplifier circuit with diodes). The period of the square wave generator is given by T = -2RC ln
1 1+
Where is the feedback voltage fraction such that
R2 R1 + R2
The period of the oscillator can be changed by changing or the time constant RC. The maximum output voltage is always equal to the modulus of the saturation voltage |Vsat| of the voltage level detector.
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The square wave generator is an astable multivibrator which periodically switches between the output voltages |V sat| and -|Vsat|.
The output of the square wave generator is coupled to the positive edge triggered monostable multivibrator circuit. A step at the trigger input will pass through the capacitor Cc and the diode will raise the voltage at the lower node (non inverting terminal) of the second differential amplifier. The capacitor Cc is chosen so as to make five time constants equal to the pulse duration TD. Otherwise the trigger would still be present after TD has passed and a second pulse would be wrongly generated. Therefore TD is so chosen such that
R R R3 TD = 5Cc 3 4 = -R5 Cm ln R3 + R 4 R3 + R 4
Advantages:
1. It has the simplest mechanism and the longest battery life. 2. It is cheap. 3. It is least sensitive to outside interference.
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Disadvantages:
1. There may be competition between the natural heart beats and pacemaker beats 2. Using the fixed rate pacemaker, the heart rate cannot be increased to match greater physical effort. 3. Stimulation with a fixed impulse frequency results in the ventricles and atria beating at different rates. This varies the stroke volume of the heart causes some loss in the cardiac output. 4. Possibility for ventricular fibrillation will be more.
2. Ventricular Synchronous pacemaker (Standby Pacemaker)

Ventricular synchronised pacemaker can be used only for patients with short periods of AV block or bundle block. This pacemaker does not compete with the normal heart activity. The block diagram of ventricular synch pacemaker is as shown in the figure below. A single transverse electrode placed in the right ventricle senses both R wave as well as delivers the stimulation so, no separate sensing electrode is required.
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A R wave from an atrial generated ventricular contraction triggers the ventricular synchronised pacemaker which provides an impulse falling in the lower part of the normal QRS complex. This ensures that the pacemaker does not interfere with the sinus rhythm. If atrial generated ventricular contractions are absent then the pacemaker provides impulses at a basic frequency of 70 impulses/minute. Thus it provides impulses only when the atrial generated ventricular contractions are absent.
Working: Using the sensing electrode, the heart rate is detected and is given to the timing circuit in the pacemaker. If the detected heart rate is below a certain minimum level, the fixed rate pacemaker is turned on to pace the heart. The lead used to detect the R wave is now used to stimulate the heart. If a natural contraction occurs, the asynchronous pacer's timing circuit is reset so that it will time its next pulse to detect heart beat. Otherwise the asynchronous pacemaker produces pulses at its preset rate. The pacemaker may detect noise and interpret as its ventricular excitation so to eliminate this refractory period circuit or gate circuit is used. In heart blocks, P waves occur at random times with respect to ventricular excitation. However P and R waves have their principal energy in different frequency bands. A high pass filter with a lower cut off frequency at 20 Hz almost completely eliminates the P wave. The R wave is differentiated by such a filter and its peak to peak amplitude is increased using an input amplifier. Advantages: 1. To arrest the ventricular fibrillation, this circuit can be used. 2. If the R-wave occurs with its normal value in amplitude and frequency then it would not work. Therefore the power
consumption is reduced 3. There is no chance of getting side effects due to competition between natural and artificial pacemaker pulses.
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4. When the R wave is appearing with lesser amplitude, the circuit amplifies it and delivers it in proper form. If the R wave period is too low or too high, the asynchronous pacer in the circuit is working up to the returning of the heart into normal one.
Disadvantages: 1. Atrial and ventricular contractions are not synchronized. 2. In the olden type, the circuit is more sensitive to external electromagnetic interferences such as electric shavers, microwave ovens, car ignition systems, air port security metal detectors, and so on. Therefore the patients could not work in radio or T.V. stations. They could not undergo diathermy treatment and could not be exposed to airport security metal detector. Further they could not ride motor or scooters. But in the newer pacemakers, this is eliminated by connecting a low pass filter in the input circuit of the pacemaker
3. Ventricular Inhibited Pacemaker (Demand Pacemaker)

The R wave inhibited pacemaker allows the heart to pace at its normal rhythm when it is able to. However if the R wave is missing for a preset period of time, the pacemaker will supply a stimulus. Therefore if the heart rate falls below a predetermined level then pacemaker will turn on and provide the heart a stimulus. For this reason it is called as demand pacemaker. There is also a piezoelectric sensor shielded inside the pacemaker casing. When the sensor is slightly stressed or bent by the patient's body activity, pacemaker can automatically increase or decrease its rate. Thus it can match with the greater physical effort. The sensing electrode picks up R wave. The refractory circuit provides a period of time following an output pulse or a sensed R-wave during which the amplifier in the sensing circuit will not respond to outside signals. The sensing circuit detects the R wave and resets the oscillator.
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The reversion circuit allows the amplifier to detect R wave in low level signal to noise ratio. In the absence of R wave, it allows the oscillator in the timing circuit to deliver pulses at its preset rate. The timing circuit consists of an RC network, a reference voltage source and a comparator which determines the basic pulse rate of the pulse generator. The output of the timing circuit is fed into pulse width circuit which is also a RC network.
The pulse width circuit determines the duration of the pulse delivered to the heart. Then the output of the pulse width circuit is fed into the rate limiting circuit which limits the pacing rate to a maximum of 120 pulses per minute. The output circuit provides a proper pulse to stimulate the heart. Thus the timing circuit, pulse width circuit, rate limiting circuit and output circuit are used to produce the desired pacemaker pulses to pace the heart. There is a special circuit called voltage monitor which senses the cell depletion and signals the rate slow-down circuit and energy compensation circuit of this event.
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UNIT III
The rate slow-down circuit shuts off some of the current to the basic timing network to cause the rate to slow-down 83 beats per minute when cell depletion has occurred. The energy - compensation circuit produces an increase in the pulse duration as the battery voltage decreases to maintain constant stimulation energy to the heart.
4. Atrial Synchronous Pacemaker

This type of pacing is used for young patients with a mostly stable block. It can act as a temporary pacemaker for the atrial fibrillation. The block diagram for the atrial synchronous pacemaker is as shown below. The atrial activity is picked up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium. The detected P wave is amplified and a delay of 0.12 second is provided by the AV delay circuit. This is necessary corresponding to the actual delay in conducting the P wave to the AV node in the heart. The signal is then used to trigger the resetable multivibrator.
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UNIT III
The output of the multivibrator is given to the amplifier which produces the desired stimulus to be applied to the heart. The stimulus is delivered to the ventricle through the ventricular electrode. If the rate of atrial excitation becomes too fast as in atrial fibrillation or too slow or absent, a preset fixed rate pacemaker (resetable multivibrator) takes over until the abnormal situation is over. Normally pacemaker pulse is so large that it would be detected by the atrial pick up leads and cause the heart to beat. This problem has been eliminated by refractory period control circuit. i.e., any signal detected on the atrial lead within 400 milliseconds of a paced heart beat is ignored.
5. Atrial sequential ventricular inhibited pacemaker:

It has the capability of stimulating both the atria and ventricles and adopts its method of stimulation to the patients needs. If atrial function fails, this pacemaker will stimulate the atrium and then sense the subsequent ventricular beat. If it is working properly it will discontinue its ventricular stimulating function. However if atrial beat is not conducted to ventricle, the pacemaker on sensing this will fire the ventricle at a preset interval of 0.12 second.
41

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UNIT III

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

ASSIST DEVICES AND BIO-TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Principles of Design of Bio-Telemetry System:

Physiological parameters adaptable to biotelemetry

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Continuous monitoring of the patient can be obtained.

Radio Telemetry systems:

Classification of Telemetry Systems:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Elements of Biotelemetry Systems:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Single Channel Telemetry system:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Radio Telemetry with a subcarrier:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Multiple Channel telemetry Systems:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Time division multiplex System:

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

UNIT III 4. batteries.

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

temperature sensor, the pH ISFET sensor and the two-electrode 5x 10-4mm2

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Types of defibrillator based on operation or Voltage delivered:

ASSIST DEVICES AND BIO - TELEMETRY

2. Capacitive Discharge DC Defibrillators

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

Delay-Line Capacitive Discharge DC Defibrillator

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College

ASSIST DEVICES AND BIO - TELEMETRY

EC1006 MEDICAL ELECTRONICS / Panimalar Engg. College