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Development of A Portable Linux-Based ECG Measurement and Monitoring System
Development of A Portable Linux-Based ECG Measurement and Monitoring System
Development of A Portable Linux-Based ECG Measurement and Monitoring System
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Yung-Fu Chen
National Cheng Kung University
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ORIGINAL PAPER
Received: 8 September 2009 / Accepted: 15 October 2009 / Published online: 14 November 2009
# Springer Science + Business Media, LLC 2009
reduce device cost and increase accessibility as PCs are Isolation amplifiers can be used to break ground loops,
now ubiquitous. A Windows-based client-server architec- eliminate source ground connections, and provide isolation
ture for measuring and monitoring ECG signals was protection to patient and electronic equipment [17]. In a
presented in [11]. In the system the client (the ECG unit) bio-potential amplifier, the main purpose of the isolation
extracts ECG signals, and the server imports or exports the amplifier is to protect the patient by eliminating the hazard
signals. A PC-based system that captures a patient’s ECG of electric shock resulting from the interaction among
signals via an acquisition card and displays them on a patient, amplifier and other electric devices in the patient’s
monitor was proposed in [12]. In that system, three environment, specifically defibrillators and electrosurgical
electrodes are utilized as sensors that detect ECG signals; equipment. It also has the capability to prevent line fre-
one electrode is placed on the left and one on the right quency interferences.
wrist, and the third electrode, the reference (ground), is In this work, we present a license-free portable Linux-
placed on an ankle. A graphical user interface (GUI) for based system for monitoring heart functions based on ECG
ECG monitoring was designed using a LabVIEW software signals. High usability, portability, ease-of-use and low cost
module developed by National Instruments to allow users are the design objectives of the proposed system. It can be
to monitor signal waveforms. Additionally, digitized ECG installed virtually anywhere (e.g., offices, homes, health-
data can be saved as a text file and then retrieved and care centers and ambulances). The system allows people
displayed. Furthermore, visual alert for the abnormal to self-monitor their heart conditions. Additionally, the
heartbeat is provided. A PC-based ECG measurement and data can be sent to a server at a distant hospital via
monitoring system employing Visual Basic 6.0 to perform Internet for remote diagnosis. Furthermore, the proposed
HRV analysis in the time and frequency domains was system has a 7-in. interactive TFT-LCD touch screen that
recently presented in [13]. That system uses the modified allows users to execute various functions, such as scaling
Tompkins QRS detection algorithm to determine HRV via single-lead or multiple-lead ECG waveforms. Also, an
ECG signals. A universal serial bus (USB) controller isolation circuit is added to prevent electrical shocks. The
employing Windows API was used to capture and deal effectiveness of the proposed system was verified by
with USB data. Furthermore, this system determines the employing a commercial 12-lead ECG signals simulator
HRV of users in real-time and provides the frequency [18] and in vivo experiments.
spectrum of ECG signals for diagnosis. The remainder of this paper is organized as follows.
Although these PC-based systems are useful for monitor- Section “System implementation” describes the implemen-
ing heart function based on ECG signals, they are not portable tation of the proposed portable Linux-based ECG measure-
and cannot monitor heart function anywhere at any time. ment and monitoring system. Section “Experimental
Several Windows-based portable systems have been devel- results” then illustrates experimental results and accuracy
oped in recent years [14–16]. For example, Kara [14] of the measured clinical ECG signals. Conclusions are
developed a compact ECG with graphic LCD screen and finally drawn in Section “Conclusions”.
phonocardiogram unit, enabling physicians and patients to
hear heart sounds simultaneously while examining ECG
signals. The system allows patients to understand their System implementation
personal health status directly by hearing heart sounds and
listening to the explanation provided by physician in a real- Hardware architecture
time manner. It implemented a receiver program by using
Microsoft Visual C++ programming language. In [15], a Figure 1 presents the hardware architecture of the proposed
portable ECG recorder with USB storage was used to system, which consists of an ECG front end and an
acquire ECG signals. In the system, ECG signals are embedded Linux platform (ELP). The ECG front end
collected from four electrodes via standard lead placement. consists of signal amplifiers, an analog-to-digital (A/D)
A six-lead EGG can be selected via the lead-selection circuit circuit and control circuit module, and the ELP is a modular
and the acquired EGG signals are then stored in the USB platform that composed of signal storage, signal processing
storage for subsequent processing by a PC. In [16], a and graphic display modules for a 12-lead ECG signals
portable ECG recording system integrating ECG signal measurement and monitoring system. The key features of
acquisition, Bluetooth modules and a LabVIEW software the proposed system are as follows:
module was proposed. In addition, ECG signals are analyzed
to determine HR, HRV and ECG spectrum. However, the 1. Low cost due to the utilization of license-free Linux
price of such monitoring devices is high due to licensing fees open-source code.
for the Microsoft Windows operating system and may incur 2. Easy to use due to the fully interactive TFT-LCD touch
a high economic burden for many people. screen.
J Med Syst (2011) 35:559–569 561
ECG ECG
Connector Simulator
USB
Interface
(b)
3. High portability due to a total weight of only 1.5 kg or so. 3. Derivation of the 12-lead ECG signals in the time-
4. Allowing people to monitor health status anytime and domain from signals acquired using 10 electrodes.
anywhere. 4. Derivation of frequency-domain spectrums of the
5. Enhancing safety by adding an isolation circuit to 12-lead ECG signals.
prevent electrical shocks. 5. Establishment of the base value of ECG signals using
6. Enabling remote diagnosis via wireless network interface. the determined HR by multiplying HR in beats/second
by a scaling quantity ranging from 3 to 7 (preferably 5).
6. Health evaluation of the heart status by dividing an area
The function of each part is described as follows:
obtained by conducting integration from 0 Hz to the base
1. ECG front end: This subsystem acquires ECG signals value in the frequency domain, by another area obtained
from electrodes and then delivers them to the ELP via a by performing integration from the base value to infinity.
USB interface. 7. Peaks analysis of the power spectrum in the frequency
2. Signal storage: The 12-lead ECG signals obtained are domain for diagnosing CVDs.
stored in the RAM disk and SD (Secure Disk) card of
the embedded Linux platform. Table 1 Twelve-lead time-domain ECG signals and their evaluation
3. Signal processing: This module performs time and equations
frequency domains analyses of the 12-lead ECG signals
Lead ECG signals
using the equations and the Discrete Fourier transform
(DFT) suggested by [19]. Table 1 lists these equations. I = LA-RA
4. Graphic display: This module demonstrates the mea- II = LL-RA
sured values and graphs of ECG signals in time and III = LL-LA
frequency domains on the ELP. aVR = RA-(RA + LA + LL)/3
5. ECG simulator: This module is used for testing the aVL = LA-(RA + LA + LL)/3
proposed system. aVF = LL-(RA + LA + LL)/3
In this study, a scheme proposed in [19] for detecting 12- V1 = C1-(RA + LA + LL)/3
lead ECG signals and diagnosing CVDs was adopted. The V2 = C2-(RA + LA + LL)/3
functions of this scheme are summarized as follows. V3 = C3-(RA + LA + LL)/3
V4 = C4-(RA + LA + LL)/3
1. Acquisition of ECG signals from a patient using 10 V5 = C5-(RA + LA + LL)/3
electrodes. V6 = C6-(RA + LA + LL)/3
2. Amplification and digitalization of acquired ECG signals.
562 J Med Syst (2011) 35:559–569
Acquisition of ECG signals much as possible. To this end, the power of all amplifiers is
supplied by the ELP, thereby decreasing device size and
All ECG signals are obtained by sensors placed at 10 avoiding the additional cost of any power supply circuits.
sampling points (Fig. 2) which are located on the right arm
(RA), left arm (LA), right leg (RL), left leg (LL) and the Design of amplifiers circuits Skin contact may result in
chest (C1–C6) close to the heart. A 12-lead ECG signals disturbance during ECG signal acquisition [22]. To sup-
connector (DB15 connector) is employed to transmit ECG press such disturbance meanwhile amplify the ECG signals
signals to the ECG front end. Figure 3 shows the pin extracted by eight ECG sensors, two precision instrumen-
assignment of DB15 connector. tation amplifier (AD8221) chips and one quad input and
output amplifiers (AD8604) chip [23] are integrated to
Design of ECG front end produce V1, V2, V3, V4, V5 and V6 signals, as illustrated
in the amplifiers block Fig. 4. Moreover, three amplifiers
The circuits proposed in [20] and [21] were adopted and depicted in blocks P10-RALL, P11-LALL and P12-RALL
improved in designing the ECG front end circuit. Since the (Fig. 4) are used to generate RA-LL, LA-LL and RA-LA
circuit layout presented in [20] requires a larger space than signals, respectively, such that the 12-lead ECG signals can
the proposed system can accommodate, a significant space be monitored and analyzed.
reduction is achieved by the proposed layout. Additionally,
the A/D converter (AD7888) in [21] does not fit the Design of analog-to-digital (A/D) circuit The A/D circuit
proposed system as the resolution of the AD7888 is not block is depicted as P06-MPU in Fig. 4. To achieve the design
compatible with the ELP; thus, the circuit layout was objectives, an A/D converter, the ADuC841 [23], which
redesigned. Figure 4 presents the block diagram of the integrates a high-performance self-calibrating multi-channel
improved 12-lead ECG front end circuit. analog-to-digital converter (ADC), a dual digital-to-analog
In addition to designing a highly portable and low-cost converter (DAC) and an optimized single-cycle 20-MHz 8-bit
system, another study goal is to achieve long-term ECG MCU on a single chip, is utilized as the main chip in the A/D
monitoring. Therefore, the circuit should be simplified as circuit. The output signals from nine amplifier circuits are
applied to the ADuC841 chip for digitization. Notably,
each digitized signal is represented by 12 bits. Moreover,
a program was designed on an 8051 built-in ADuC841
chip (speed = 20 MIPS) to extend a 12-bit signal to a
16-bit signal by filling the four most significant bits with
0s, and storing them in the flash ROM embedded in the
ADuC841 chip. Via this program, the ADuC841 chip can
output 16-bit data that comply with the data format to be
processed by the selected USB controller chip. Therefore, the
design complexity of the USB circuit is significantly reduced.
This ADuC841 chip is also powered by the ELP via a USB.
1
1
UPG UPG
P03-Laptop
P09-VIEW56
TXDN RXDN P07-AFE
NB_5V
RXDN TXDN
NB_GND V5L OUT0 IN0+ V5
V6L OUT1 IN1- V6
NB_RST REF D+ D5
USB_UPG 5VA 5VA D- D6
AGND LL
AGND IN-
NB_TRX4 5VD 5VD
NB_RX4 DGND DGND A/D converter
P10-RALL
P10-AFE1
Isolation RAL OUT IN+ RA RA
LL
circuit VCC29
REF IN-
VCC29
5VA 5VA COM COM0 COM0
AGND AGNDSHIELD SHD0 SHD0
P11-LALL
P10-AFE1
LA
LAL OUT IN+ LA
LL
REF IN-
VCC29 VCC29
5VA COM1
5VA COM COM1
AGND SHD1
AGNDSHIELD SHD1
P12-RALA
P10-AFE1
OUT IN+ RA
RALA
REF IN- LA
VCC29 VCC29 VCC29
5VA 5VA COM COM2
COM2
AGND AGNDSHIELD SHD2
SHD2
VCC29
VCC29
AGND
AGND
Amplifiers
Fig. 4 Block diagram of the improved circuit of the 12-lead ECG front end
564 J Med Syst (2011) 35:559–569
1
+IN +OUT
-IN -OUT
1
D
S
Design of isolation circuit The power for the amplifier chips Software structure
(AD8221 and AD8604) and A/D converter chip (ADuC841)
are supplied by the ELP via the USB port. Notably, users of Real-time operation system (RTOS)
the proposed ECG monitoring system may have CVD.
Therefore, one must account for risk of electrical shock The Real-time Operating System (RTOS) is a basic
caused by a static charge, a requirement of certified medical building block of most Embedded Systems (ESs). This
facilities. Thus, an isolation circuit block, the P04-isolation subsection describes the RTOS of the embedded system and
(Fig. 4), was added to prevent electrical shocks. structure of the real-time operating system [26]. The RTOS
Figure 5 shows details of the isolation circuit, in which is an operating system that schedules tasks in a real-time
the ADuM1401C digital isolator chip [23] functions as a manner. Additionally, the system manages system resources
DC/DC converter which transforms the input DC voltage efficiently and provides a consistent basis for application
into a lower DC value. The feature of the DC/DC converter
is adopted in the design to supply DC power to other chips Fig. 6 High-level view of an
in addition to achieving the purpose of isolation. Notably, it RTOS
has important features as follows:
1. 5 kV rms isolation rating with IEC-60601–1 [25]
medical safety approval.
2. Short-circuit protection for xD+ and xD− lines (USB
lines must automatically switch between actively
driving D+/D−, receiving data, and allowing external
resistors to set the idle state of the bus).
3. Class 3A (4,000 to <8,000 Voltage) contact Electro-
static Discharge (ESD) performance per ANSI/ESD
STM5.1–2007.
J Med Syst (2011) 35:559–569 565
development. A good RTOS should be scalable to various A feasible portable ECG monitoring system should have
applications. An RTOS can be a combination of various at least the following six functions.
modules, including the kernel, file system, networking
1. Extraction of ECG signals.
protocol stacks and other components required by a
2. Reading and saving of ECG signals.
particular application. In embedded systems, the Board
3. Domain transformation of ECG signals.
Support Package (BSP) is a collection of user-provided
4. Display of ECG signals.
facilities that interface an RTOS and application with a
5. Analysis of ECG signals for diagnosis and generation
specific hardware platform. The BSP is commonly built
of an alarm or alert.
with a bootloader containing minimal device support to
6. Execution of a remote medical diagnosis.
load the operating system and device drivers for all devices
on the board. Figure 6 presents a high-level view of an This study focuses on the first four functions as the
RTOS. remaining two require support from medical, telecommu-
∞
∫
566 J Med Syst (2011) 35:559–569
22. Carr, J. J., and Brown, J. M., Introduction to biomedical 26. Li, Q., and Yao, C., Real-time concepts for embedded systems,
equipment technology. Prentice Hall, Upper Saddle River, 2001. San Francisco: CMP, 2003.
23. Analog Devices, Inc., http://www.analog.com/. 27. Nokia Corporation, http://qt.nokia.com/.
24. Prolific Technology Inc., http://www.prolific.com.tw/. 28. Alfaouri, M., Daqrouq, K., Abu-Isbeih, I. N., and Khalaf, E. F.,
25. Marcus, M. L., and Biersach, B. R., Regulatory requirements for Quality evaluation of reconstructed biological signals. Am. J.Appl.
medical equipment. IEEE instrum. Meas. Mag. 6 (4)23–29, 2003. Sci. 6:187–193, 2009.