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ECE 296 Biomedical Instrumentation
Lecture 21
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Presidency University
Cardiography Planes
Heart is not in one plane. So ECG vector is resolved in three X, Y, and Z planes
(i) Frontal Plane

(ii) Transverse Plane
(iii) Sagittal Plane
In the frontal plane we have

• 3 standard lead according to Einthoven
• Lead – I
• Lead – II
• Lead – III
• 3 augmented leads according to Goldberger
• 𝑎𝑉𝑅
• 𝑎𝑉𝐿
• 𝑎𝑉𝐹
In transverse plane are situated:
• 6 precordial leads according to Wilson
Figure Courtesy: wiley-vch.e-bookshelf.de
• 𝑉1 , 𝑉2 , 𝑉3 , 𝑉4 , 𝑉5 , 𝑉6
4/6/2021 Mr. Tony Aby Varkey M., Dept. of ECE, Presidency University 2
Wilson Central Terminal
• The three standard limb leads are connected through equal –
valued resistors to a common point.
• The potential at this point is the average of the potentials at
each limb electrode and is used as a reference potential
• This reference is known as the Central Terminal Potential
(VCT) and is used by physicians as zero equivalent
• By linking the three limbs RA, LA and LL through large equal

resistors a relatively stable reference potential VCT is created
• The Central Terminal Potential will be
𝑉𝑅𝐴 + 𝑉𝐿𝐴 + 𝑉𝐿𝐿 Figure Courtesy: wiley-vch.e-bookshelf.de

𝑉𝐶𝑇 =
3
Precordial(Chest) Leads [Transverse Plane Leads]
• It is the second type of unipolar lead
• It employs an exploring electrode to record the potential of the
heart action on the chest at six different positions.
• These leads are designated by the capital letter ‘V’ followed by
a subscript numeral, which represents the position of the
electrode on the pericardium.
• The Wilson leads are
• Unipolar, since the measurement occurs with only one
exploring or probing electrode. (the negative pole of the
ECG machine is connected to the central terminal; the
reference point 𝑉𝐶𝑇 acts as a zero potential) Figure Courtesy: wiley-vch.e-bookshelf.de
• Chest leads or precordial leads since the electrodes are
placed on the chest around the heart
Precordial(Chest) Leads : Positions
• V1 - Fourth intercostal space on the right sternum

• V2 - Fourth intercostal space at the left sternum
• V3 - Midway between placement of V2 and V4
• V4 - Fifth intercostal space at the midclavicular line
• V5 - Anterior axillary line on the same horizontal level as V4
• V6 - Mid-axillary line on the same horizontal level as V4 and V5
Figure Courtesy: www.cablesandsensors.com/pages/12-

lead-ecg-placement-guide-with-illustrations
Precordial(Chest) Leads : Positions
• V1 - Fourth intercostal space on the right sternum

• V2 - Fourth intercostal space at the left sternum
• V3 - Midway between placement of V2 and V4
• V4 - Fifth intercostal space at the midclavicular line
• V5 - Anterior axillary line on the same horizontal level as V4
• V6 - Mid-axillary line on the same horizontal level as V4 and V5
Figure Courtesy: wiley-vch.e-bookshelf.de
The 12 Leads Group
• If you want to check the quality of an apple you have to look
for weak spots from many directions !
• The same principle applies to the heart !
• The 12 – lead ECG provides 12 different views of the electrical activity of the heart, each
view looking from the outside of the chest toward the reference point within the heart
• The 12 leads are
• Bipolar Limb Leads
• Lead – I
• Lead – II
• Lead - III
• Unipolar Limb Leads (Augmented Leads)
• 𝑎𝑉𝑅
• 𝑎𝑉𝐿 Figure Courtesy: wiley-vch.e-bookshelf.de
• 𝑎𝑉𝐹
• Precordial Lead (Chest Leads)
• 𝑉1 , 𝑉2 , 𝑉3 , 𝑉4 , 𝑉5 , 𝑉6
The 12 Leads Group
Figure Courtesy: https://www.cablesandsensors.com/pages/12-lead-ecg-placement-guide-

with-illustrations
Color Coding Standards For The 12-lead ECG
Figure Courtesy: https://www.cablesandsensors.com/pages/12-lead-ecg-placement-guide-

with-illustrations
Sagittal Plane ECG Measurement
• Sagittal plane ECG recording is rarely carried out.

• For a normal routine ECG, it is never carried out.
• The recording is done only in exceptional cases where a serious
disorder is suspected.
• It is carried out by introducing a catheter or a plastic tube
through the nostril of the patient. An electrode with a wire runs
through the catheter
• The catheter is inserted deep down through the trachea till the
Figure Courtesy: Electronics in Medicine and Biomedical
electrode reaches the back side of the heart Instrumentation, Nandini K Jog
• The esophageal lead goes to the inverting input of the amplifier
• An indifferent electrode 𝑅𝐴 , 𝐿𝐴 , 𝐿𝐿 goes to the non – inverting
input of the amplifier
ECG Paper
• The strip chart paper has vertical lines 1 mm apart, with a

thick line after every 5 mm interval.
• The routine recording speed is 25 mm per second
• One square thus corresponds to 0.2 seconds
• The sensitivity is generally 10 mm per millivolt
Lecture 22
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
ELECTROCARDIOGRAPH
• The electrocardiograph (ECG) is an instrument, which records the electrical activity of the heart
• Although the electric field generated by the heart can be best characterized by vector quantities, it is generally
convenient to directly measure only scalar quantities, i.e. a voltage difference of mV order between the given
points of the body.
• The diagnostically useful frequency range is usually accepted as 0.05 to 150 Hz. The amplifier and writing part
should faithfully reproduce signals in this range.
• A good low frequency response is essential to ensure stability of the baseline.
• High frequency response is a compromise of several factors like isolation between a useful ECG signal from other
signals of biological origin (myographic potentials) and limitations of the direct writing pen recorders due to
mass, inertia and friction.
• The interference of non biological origin can be handled by using modern differential amplifiers, which are
capable of providing excellent rejection capabilities.
• CMRR of the order of 100–120 dB in the leads is a desirable feature of ECG machines.
• It becomes necessary to include a notch filter tuned to 50 Hz to reject hum due to power mains.
• A minimum of two paper speeds is necessary (25 and 50 mm per sec) for ECG recording
Block diagram description of Electrocardiograph
Fig. Courtesy: Handbook of Biomedical Instrumentation R S Khandpur
• The potentials picked up by the patient electrodes are taken to the lead selector switch.
• In the lead selector, the electrodes are selected two by two according to the lead program.
• By means of capacitive coupling, the signal is connected symmetrically to the long-tail pair differential
preamplifier.
• The preamplifier is usually a three or four stage differential amplifier having a sufficiently large negative current
feedback, from the end stage to the first stage, which gives a stabilizing effect.
• The amplified output signal is picked up single-ended and is given to the power amplifier.
• The power amplifier is generally of the push-pull differential type.
• The base of one input transistor of this amplifier is driven by the preamplified unsymmetrical signal.
• The base of the other transistor is driven by the feedback signal resulting from the pen position and connected
via frequency selective network.
• The output of the power amplifier is single-ended and is fed to the pen motor, which deflects the writing arm on
the paper.
• A direct writing recorder is usually adequate since the ECG signal of interest has limited bandwidth.
• Frequency selective network is an R–C network, which provides necessary damping of the pen motor and is
preset by the manufacturer.
• The auxiliary circuits provide a 1 mV calibration signal and automatic blocking of the amplifier during a change
in the position of the lead switch.
• It may include a speed control circuit for the chart drive motor.
• A ‘stand by’ mode of operation is generally provided on the electrocardiograph.
• In this mode, the stylus moves in response to input signals, but the paper is stationary.
• This mode allows the operator to adjust the gain and baseline position controls without wasting paper.
• Electrocardiograms are almost invariably recorded on graph paper with horizontal and vertical lines at 1 mm
intervals with a thicker line at 5 mm intervals.
• Time measurements and heart rate measurements are made horizontally on the electrocardiogram.
• For routine work, the paper recording speed is 25 mm/s.
• Amplitude measurements are made vertically in millivolts.
• The sensitivity of an electrocardiograph is typically set at 10 mm/mV.
Interpretation of the ECG
The eight step method are as follows
• Rhythm
• Measure heart rate
• P Wave
• Measure PR Interval
• Measure QRS interval
• Examine T wave
• Measure QT interval
• Check for ectopic beats and other abnormalities
Bradycardia: Heart rate < 60 beats per minute

Tachycardia: Heart rate > 120 beats per minute
Normal Heart Rates in Children
Age Awake Asleep Exercise or Fear
Neonatal 100 – 160 80 – 140 <220
1 week – 3 months 100 – 220 80 – 200 <220
3 months – 2 Years 80 – 150 70 – 120 <200
2 Years – 10 Years 70 – 110 60 – 90 <200
>10 Years 55 – 100 50 – 90 <200
Normal Sinus Rhythm
• Normal sinus rhythm is defined as the rhythm of a
healthy heart.
• It means the electrical impulse from your sinus node
is being properly transmitted.
Fig. Courtesy: www.proacls.com/
1. The Heart Rhythm
• The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above
graphic, it's regular.
2. The Heart Rate
• Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast?
• Remember, to determine the patient's heart rate you'll want to observe the following areas on the ECG paper printout and perform the
following calculations.
• The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds.
Each larger square is 5mm in length and represents .2 seconds. Therefore a 6 second interval would be 30 large squares.
• To determine the heart rate, count the number of QRS complexes over this 6 second interval and multiply by 10.
• In the ECG above, the rate is 80 beats per minute, and this is normal. For an adult patient, the normal heart rate range is 60 to 100 beats
per minute.
Normal Sinus Rhythm
3. P-Wave
• After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions.
• Are the patient's P-waves present?
• Do they occur regularly?
• Is there one P-wave for each QRS complex?
• Are the P-waves smooth, rounded, and upright?
• Do all the P-waves have a similar shape?
• The answer to each of those questions is, yes, meaning the P-waves are normal.
Normal Sinus Rhythm
4. PR Interval
• Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions:
• Is the PR interval normal for an adult patient, meaning between .12 and .20 seconds, or is it contained within one large square
on the readout?
• Is the PR interval constant?
The answer to both questions is, yes.
Normal Sinus Rhythm
5. QRS Complex
• The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these
questions while you do:
• Is the QRS interval less than .12 seconds?
• Is the QRS complex wide or narrow? If it's narrow, such as on the ECG printout above, then that's considered normal.
• Are the QRS complexes similar in appearance or are there noticeable differences?
• For the above ECG readout, the answer is, they're similar in appearance and thus normal.
• PR Interval : 0.12 – 0.2 seconds

• QRS interval : 0.06 – 0.1 seconds
• QT interval : 0.36 – 0.44 seconds
Common Terms
1. Sinus Arrhythmia
• An irregular heartbeat is called an
arrhythmia.(Rhythm is irregular)
• A sinus arrhythmia is an irregular heartbeat
that’s either too fast or too slow.
• One type of sinus arrhythmia, called respiratory sinus arrhythmia, is when the heartbeat changes pace when you
inhale and exhale.
• In other words, your heartbeat cycles with your breath. When you breathe in, your heart rate increases. When you
exhale, it falls.
• This condition is benign. It’s a naturally occurring heartbeat variation, and it doesn’t mean you have a serious heart
condition. In fact, this condition is common in young, healthy adults and children.
• A respiratory sinus arrhythmia can occur in older individuals, but in these cases, it’s often associated with heart
disease or another heart condition.
• It can be due to some drugs like Digoxin, morphine
Common Terms
1. Sinus Bradycardia
• Bradycardia, or a slow heartbeat, is
diagnosed when your heart’s natural rhythm
is below 60 beats per minute.
• If the low heart rate produces lengthy pauses
between beats, you may have sinus
bradycardia with sinus arrhythmia.
• It can be due to drugs like beta blockers, calcium channel blockers, glaucoma, hyper kalemia, hypothyroidism,
myocardial ischemia, SA node disease
Common Terms
1. Sinus Tachycardia
• Sinus tachycardia (also colloquially known as sinus tach or sinus tachy) is a sinus rhythm with an elevated
rate of impulses, defined as a rate greater than 100 beats/min (bpm) in an average adult.
Common Terms
1. Sinus Arrest
• Sinoatrial arrest (also known as sinus arrest or sinus
pause) is a medical condition wherein the sinoatrial
node of the heart transiently ceases to generate the
electrical impulses that normally stimulate the
myocardial tissues to contract and thus the heart to
beat.
• It is defined as lasting from 2.0 seconds to several minutes.

• Since the heart contains multiple pacemakers, this interruption of the cardiac cycle generally lasts only a few seconds
before another part of the heart, such as the atrio-ventricular junction or the ventricles, begins pacing and restores the
heart action.
• This condition can be detected on an electrocardiogram (ECG) as a brief period of irregular length with no electrical
activity before either the sinoatrial node resumes normal pacing, or another pacemaker begins pacing.
Common Terms
1. Sinoatrial exit block
• Sinus Exit Block does looks very much the same as
Sinus Arrest with one important distinction.
• With SA Block the R-R interval measurement is within
plus or minus 2 small boxes.
• Larger pause in the regular rhythm
Lecture 23
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
NERVOUS SYSTEM
• The nervous system is the control and communication network for the body which coordinates the functions
of the various organs.
• Rapid communication between the various parts, the effective, integrated activity of different organs and
tissues and coordinated contraction of muscle are almost entirely dependent upon the nervous system.
• It is thus, the most highly developed and complex system in the body.
• The centre of all these activities is the brain (central information processor) with memory, computational
power, decision making capability and a host of input output channels.
• The nervous system consists of a central and a peripheral part.
• The central nervous system is made up of the encephalon (brain) and the spinal cord.
• The peripheral nervous system comprises all the nerves and groups of neurons outside the brain and the
spinal cord.
• The brain consists of three parts, namely, the cerebrum, cerebellum and the brain stem.
NERVOUS SYSTEM
Fig. Courtesy: Handbook of Biomedical Instrumentation R S Khandpur
THE HUMAN BRAIN
• The brain consists of three parts,
• The cerebrum,
• The cerebellum and
• The brain stem.
Cerebrum:
• The cerebrum consists of two well demarcated
hemispheres, right and left and each hemisphere is sub-
divided into two lobes:
• frontal lobe and temporal lobe in the left hemisphere
and
• parietal and occipital lobes in the right hemisphere
• The outer layer of the brain is called the cerebral cortex.

• All sensory inputs from various parts of the body eventually reach the cortex, where certain regions relate
specifically to certain modalities of sensory information.
• Various areas are responsible for hearing, sight, touch and control of the voluntary muscles of the body.
THE HUMAN BRAIN
Cerebral Cortex
• The cerebral cortex is also the centre of intellectual functions.
• The frontal lobes are essential for intelligence, constructive imagination and thought.
• Here, large quantities of information can be stored temporarily and correlated, thus making a basis for higher
mental functions.
• Each point in the motor centre in the cerebral cortex corresponds to a
certain body movement.
• In the anterior part of the parietal lobe lies the terminal station for the nerve
pathways conducting sensation from the opposite half of the body.
• The sensory centre contains counterparts of the various areas of the body in
different locations of the cortex.
• The visual pathways terminate in the posterior part of the occipital lobe. Fig. Courtesy: Handbook of Biomedical
• The rest of the occipital lobes store visual memories, by means of which we Instrumentation R S Khandpur
interpret what we see.
THE HUMAN BRAIN
Cerebellum:
• The cerebellum acts as a physiological microcomputer which intercepts various sensory and motor nerves to
smooth out the muscle motions which could be otherwise jerky.
• It also consists of two hemispheres which regulate the coordination of muscular movements elicited by the
cerebrum.
• The cerebellum also enables a person to maintain his balance.
THE HUMAN BRAIN
Brain Stem:
• The brain stem connects the spinal cord to the centre of the
brain just below the cerebral cortex.
• The essential parts of the brain stem are
(i) Medulla oblongata which is the lowest section of the
brain stem and contains centres for regulating the
work performed by the heart, the vasomotor
centres, which control blood distribution and
respiratory centre which controls the ventilation of
the lungs.
(ii) the pons located just above the medulla and
protruding somewhat in front of the brain stem.
(iii) midbrain which lies in the upper part of the brain
stem
(iv) the diencephalon is located above and slightly
forward of the mid brain.
THE HUMAN BRAIN
• The brain stem has one part, the thalamus, which acts as a relay
station for sensory pathways to the cortical sensory centre of
the cerebrum.
• In the lower part of the diencephalon is the hypothalamus
which has several vital centres for temperature regulation,
metabolism and fluid regulation.
• They include the centres for appetite, thirst, sleep and sexual
drive.
• The hypothalamus is important for subjective feelings and
emotions.
Lecture 24
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Electroencephalography
• Electroencephalography is the study and analysis of signal arising due to the electrical activity of brain
• The instrument which record this activity is called the electroencephalograph
• In 1924 the German psychiatrist Hans Berger succeeded in obtaining the first EEG tracings from the human
scalp
Electroencephalography
• The waveforms recorded are thought to reflect the activity of the surface of the brain, the cortex.
• This activity is influenced by the electrical activity from the brain structures underneath the cortex.
• The nerve cells in the brain produce signals that are called action potentials.
• These action potentials move from one cell to another across a gap called the synapse.
• Special chemicals called neurotransmitters help the signals to move across the gap.
• There are two types of neurotransmitters,
• one will help the action potential to move to the next cell,
• the other will stop it moving to another nerve cell.
• EEG activity is quite small, measured in microvolts (µV) with the main frequencies of interest up to
approximately 30 Hertz (Hz)
Electroencephalography - Electrodes
• Small metal discs called electrodes are placed on the scalp in special
positions.
• These positions are identified by the recordist who measures the head
using the International 10/20 System.
• This relies on taking measurements between certain fixed points on the
head.
• The electrodes are then placed at points that are 10% and 20% of these
distances.
• Each electrode site is labelled with a letter and a number.
• The letter refers to the area of brain underlying the electrode
• F : Frontal Lobe
• T : Temporal Lobe
• C : Central Lobe
• P : Parietal Lobe
• O : Occipital Lobe
10/20 System of electrode placement
• Even numbers denote the right side of the brain Figure Courtesy: https://www.ebme.co.uk/articles/clinical-
• Odd numbers denote the left side of the brain engineering/introduction-to-eeg
• There are a great variety of electrodes that can be used.
• The majority are small discs of stainless steel, tin, gold or silver covered
with a silver chloride coating.
• These normally have a lead attached.
• Alternative methods consist of a cap in which the electrodes are already
imbedded.
10/20 System of electrode placement

Figure Courtesy: https://www.ebme.co.uk/articles/clinical-
engineering/introduction-to-eeg
EEG cables showing the disc electrodes to which

electrode gel is applied and applied to the
subject's scalp.
Many recording systems use a cap into which electrodes are

embedded; this facilitates recordings when high density arrays of
electrodes are needed or when comparing recording sites. The image
to the right shows the inside of such a cap.
Figure Courtesy: https://www.medicine.mcgill.ca/physio/vlab/biomed_signals/eeg_n.htm

Electroencephalography – Electrode Gel
• Electrode gel acts as a malleable extension of the electrode, so that the

movement of the electrodes cables is less likely to produce artifacts.
• The gel maximizes skin contact and allows for a low-resistance recording
through the skin.
• The electrolytic gel is injected into each cavity until a small amount comes out
the hole in the mount.
• With a moderate amount of downward pressure, the syringe with a blunt
needle is rapidly rocked back and forth.
Figure Courtesy: https://www.medicine.mcgill.ca/physio/vlab/biomed_signals/eeg_n.htm

10/20 EEG Placement
Four skull landmarks:
• Nasion
• Inion
• Left pre – auricular point
• Right pre – auricular point
https://www.ers-education.org/lrmedia/2016/pdf/298830.pdf
10/20 EEG Placement
Measurement of Cz
• Measure the distance from pre‐auricular point to pre‐ auricular
point
• Mark the midpoint (50%) with a vertical line
• This cross represents Cz which has been correctly aligned in the
horizontal & vertical planes
10/20 EEG Placement
Measurements - T3, C3, Cz, C4, T4

• Reapply the tape transversally between the pre‐auricular points
• The midpoint (50%) should cross with previous point marking for
Cz, confirming its location.
• Mark 10%, 20%, 20%, 20%, 20%, 10% = T3,C3, Cz, C4, T4
10/20 EEG Placement
Measurements - Fpz, Fz, Cz, Pz, Oz

• Reapply the tape along the midline from nasion to inion
• Mark 10%, 20%, 20%, 20%, 20%, 10% = Fpz, Fz, Cz, Pz, Oz
10/20 EEG Placement
Measurements - Fp1, F7, T3, T5, O1, Oz

• Measure the distance between Fpz & Oz by applying the tape
around the head via T3.
• Mark at 10%, 20%, 20%, 20%, 20%, 10% = Fp1, F7, T3, T5, O1, Oz
10/20 EEG Placement
Measurement - F3
• Measure Fp1 to C3 and mark midpoint
• Measure Fz to F7 and mark midpoint
• Mark 50% = F3
Measurement – F4
• Measure Fp2 to C4 and mark midpoint
• Measure Fz to F8 and mark midpoint
• Mark 50% = F4
10/20 EEG Placement
Measurements M1 & M2
• M1 & M2 are the reference electrodes (formally known as A1 & A2)
• M1 & M2 are placed on the mastoid (M) process.
• These are the bony prominences behind the ears.
Lecture 25
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Electroencephalography – EEG Montages
• Montage means the placement of the electrodes.

• The EEG can be monitored with either a bipolar montage or a
referential one.
• Bipolar means that you have two electrodes per one channel, so
you have a reference electrode for each channel.
• The referential montage means that you have a common
reference electrode for all the channels.
• Common Reference Derivation/Unipolar Electrode: Common Reference Derivation
• Each amplifier records the difference between a scalp
electrode and a reference electrode.
• The same reference electrode is used for all channels.
• Electrodes frequently used as the reference electrode are
A1, A2, the ear electrodes, or A1 and A2 linked together.
• Average Reference Derivation/Average Electrode:
• Activity from all the electrodes are measured, summed together and
averaged before being passed through a high value resistor.
• The resulting signal is then used as a reference electrode and connected
to input 2 of each amplifier and is essentially inactive.
• All EEG systems will allow the user to choose which electrodes are to be
included in this calculation.
Average Reference Derivation
• Bipolar Derivation/Bipolar Electrode:

• These sequentially link electrodes together usually in straight
lines from the front to the back of the head or transversely
across the head.
• For example the first amplifier may have electrodes FP1 and F3
connected to it and the second amplifier F3 and C3 connected to
it.
Bipolar Derivation
Electroencephalography – Different Waves
• Different waves from different parts of the brain are

• Delta Waves : 0.5 Hz to 3 Hz
• Theta Waves : 4 Hz to 7 Hz
• Alpha Waves : 8 Hz to 13 Hz
• Beta Waves : 4 Hz to 30 Hz
• Gamma Waves : > 30 Hz
• Subdelta Waves : < 0.5 Hz
• Amplitude of the waves varies between 10 𝜇𝑉 to 200 𝜇𝑉
• ALPHA Waves:
• Mostly comes from parietal and occipital lobes and have an amplitude of 50 𝜇𝑉
• The amplitude of the waves from the right lobe is higher than those from the left lobe for a
right handed person
• Pathological disorder exists if the amplitude of the waves varies ±30% from the normal and if
the frequency difference is 2 Hz over a sufficiently longer period of time
• BETA Waves:
• Beta waves are predominant in the central region
• These waves become blocked when the fist is clenched but are less inhibited upon opening the
eyes.
• THETA Waves:
• Theta waves of frequencies 6 Hz to 7 Hz are found in parietal region and are 4 Hz to 6 Hz in
the basal, temporal and frontal region
• Their amplitudes does not exceed 40 𝜇𝑉
• They are pronounced when the person is in a state of fatigue
• DELTA Waves:
• Delta waves occur during sleep in normal adults and are seen in early part of night
• This is also a normal finding in infants and young children
• Disturbances in delta waves indicate disturbances of cerebral function
Lecture 26
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Electroencephalography – Electrodes
• Two type of electrodes are used

• Surface electrodes
• Inserted electrodes
• Scalp Electrodes: Made of Platinum or stainless steel and they are placed on the scalp after applying a
conductive gel
• Silver chloride wires fixed in a plastic cup gives larger area
• Adhesive electrodes : most commonly used
• Sphenoidal electrodes : hyperdermic insulated needles. Inserted through the muscular tissue in the nostrils.
Used for recording of waves from the parts of the brain which are inaccessible
• Electrocortographic electrodes : inserted on the underside of the brain. During a seizure they are free from
artifacts as there is no movement from these electrodes
Electroencephalography – Evoked Potentials
• If an external stimulus is applied to the a sensory area of brain, it responds by producing an electrical
potential known as the ‘evoked potential’.
• The most frequently used evoked potentials for clinical testing include brainstem auditory evoked
responses, visual evoked responses and somatosensory evoked potentials
• Evoked potential, recorded at the surface of the brain, is the integrated response of the action of many
cells.
• The amplitude of the evoked potential is of the order of 10 microvolts.
• The evoked potentials are generally superimposed with electroencephalograms. Therefore, it is necessary
to remove the EEG by an averaging technique while making evoked potential measurements
• Since many evoked potential components are of short duration, about 2 ms to 1 sec., rapid sampling rates
are needed to digitally record such low level potentials. Usually, the sampling rate is 1000/second.
Electroencephalography – Evoked Potentials
• The procedure used is
• Hyper Ventilation: The patients breathes deeply for 2 to 4 minutes at the rate of 20 breathes per minute. The
EEG record is then taken
• Photic Stimulation: Repetitive flashes of light are made incident on the patient at the rate of 1 to 50 flashes per
second and the EEG is recorded
• Induced Sleep: The patients EEG record is obtained with drug induced sleep or spontaneous sleep
• Other specific evocative techniques are
• Gas Inhalation
• Insulin Injection
• Hydration
• Auditory Stimulation
• Emotional Excitation
• Activation with the aid of drugs
Electroencephalography – Analyzing EEG records
• Not as simple as ECG
• When a pattern shows a sudden increase in amplitude it is known as paroxysm
• When there is a constant change of slow and fast waves of different amplitudes, it is known as dysrhythmia
• K complex, lambda wave, mu rhythm and spike are specific waveforms. The history of the patient is studies along
with the waveform
• The following features are generally studied
• Amplitude
• Frequency
• Rhythmic and transient features
• Spatial distribution
• Incidence of temporal variability
• Response to stimuli
Electroencephalography – EEG Amplifiers
• Instrumentation amplifier is used
• High input impedance to provide a minimal loading of the signal being measured
• Bandwidth is restricted to 100 Hz to avoid any high frequency noise
• Gain is variable in the range × 1, × 10, × 100, × 1000
• Output impedance is low
• CMRR is high since common mode noise is large and should be rejected
• Isolation is mandatory for all bioelectric potential measurements to prevent micro shock to the patient.
• There should be atleast 1012 Ω insulation between the patient connector and the ac mains cord.
• Fibre optic isolation is the best isolation as it responds only to light and is not subjected to
electromagnetic interference
Lecture 27
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Electromyography (EMG)
• Electromyograph is an instrument used for recording the electrical activity of the muscles to
determine whether the muscle is contracting or not
• It is also used to measure the nerve conduction velocity
• There are about 600 muscles in the human body
• While walking almost 200 muscles are in action
Human Muscular System:

• The human muscular system includes three different types of muscles:
• Cardiac muscle
• Smooth muscle
• Skeletal muscle
Skeletal Muscle:
• Skeletal muscle fibers occur in muscles which are attached to the skeleton
• They are also called striated or striped muscle, because the arrangement of
the fibres of the muscle give them a striped appearance
• They form 25% of the body weight
• They are also called voluntary muscles because, for the most part, we can
choose when we want them to act and what we want them to do—drive a
car, kick a football, turn a page, jump, ride a bicycle. Figure Courtesy: dreamstime.com
Smooth Muscle:
• Smooth muscle, also called involuntary muscle is the muscle that
shows no cross stripes under microscopic magnification.
• It consists of narrow spindle-shaped cells with a single, centrally
located nucleus.
• Smooth muscle tissue, unlike striated muscle, contracts slowly and
automatically.
• It constitutes much of the musculature of internal organs and the
digestive system.
• Responsible for movements such as the muscular action that moves
food and waste along the digestive tract, or the contraction and dilation
of the pupil of the eye.
• Involuntary muscle, because the brain does not voluntarily control its
Figure Courtesy: encyclopediabritanica
actions.( We don’t control its action)
Cardiac Muscle:
• Cardiac muscle, also called myocardium, in vertebrates, one of three
major muscle types, found only in the heart.
• Involved in the rhythmic beating and contractions of the heart, which
are not under conscious control, and cardiac muscle is therefore termed
involuntary
• Their fibres form a criss – cross pattern
How muscles work

• Muscles are a series of parallel fiber bundles which are made of protein
• The filament bundles are called myofibrins. In between them there are
deposits of glycogen or starch, i.e., carbohydrate fuel.
• Muscle fibers are the muscle cells with their nuclei along the outer
edge.
• These bundles are surrounded by a connective tissue like the insulation
of a electric cable
• A small muscle has a few bundles of fiber, while a large muscle has
hundreds of these bundles.
• Each muscle has a large belly and two tapering ends or tendons. Each
tendon is attached to a bone
How muscles work

• Skeletal or voluntary muscles are activated by the motor nerves in the
spinal cord
• Each nerve splits into several strands to enter different strands of the
muscle fiber
• An electrical signal runs down from the brain to the tip of the motor
nerve
• Between the nerve ending and the muscle, a small amount of chemical
called acetyl choline alights on special receptors on the surface of the
muscles.
• The muscle then contracts and remains in this state as long as acetyl
choline is in touch with the receptor
• For the muscle to relax an enzyme which neutralizes acetyl choline
comes into action
Figure Courtesy: sites.usc.edu/
How muscles work

• All conscious movement occur when signals from the brain are send
down the spinal cord to stimulate the particular motor nerve
• The process of contraction is started by the flow of Calcium into the
muscle cells through microtubules between myofibrils
• Individual muscles can only contract; they cannot push. For movement
in other direction, another muscles is activated
• A tendon is an inelastic cord that binds the muscle to the bone.
• Thus movements of bones are brought about by the contraction of
muscles
Figure Courtesy: depositphotos.com
Note:
• Contraction of cardiac muscles is not brought about by motor nerves, but by
the Sino Atrial Node
How muscles work

• The motor nerves can exist only in the polarized or
depolarized state
• Action potentials last only for a few milliseconds and can
be observed by placing surface electrodes on the skin
• For better accuracy needle electrodes can be inserted into
the muscles
• The set up is shown
• To study the functioning of a nerve, the patient is asked
to contract the muscle voluntarily and the muscle
Figure Courtesy: Nandini K Jog
potentials are recorded
• The potentials range from 50 𝜇𝑉 𝑡𝑜 2 𝑚𝑉 and lasts for 2
– 10 milliseconds
Lecture 28
By
Tony Aby Varkey M
Assistant Professor
Dept. of ECE
Electromyography (EMG): Myograph
Figure Courtesy: Nandhi K Jog
• The set up is shown in the figure

• The muscle under study is fitted with an elastic strip to which a strain gauge is attached
• The bonded strain gauge forms one arm of the Wheatstone bridge
• Muscle contractions cause the resistance of the strain gauge to change, resulting in imbalance in the bridge circuit
Electromyography (EMG): Myograph
• The voltage 𝑉𝐴
𝑅
𝑉𝐴 = ×𝐸
𝑅+𝑅
𝐸
𝑉𝐴 =
2
• The voltage 𝑉𝐵
𝑅
𝑉𝐵 = ×𝐸
𝑅 + 𝑅 + Δ𝑅 Figure Courtesy: Nandhi K Jog
𝑅
𝑉𝐵 = ×𝐸
2𝑅 + Δ𝑅
2𝑅 + Δ𝑅 − 2𝑅
𝑉𝑜 = 𝐸
• The voltage 𝑉𝑜 2 2𝑅 + Δ𝑅
𝑉𝑜 = 𝑉𝐴 − 𝑉𝐵
Δ𝑅
𝑉𝑜 = 𝐸
𝐸 𝑅 2 2𝑅 + Δ𝑅
𝑉𝑜 = − ×𝐸
2 2𝑅 + Δ𝑅
Change in resistance causes change in voltage
Electromyography (EMG): Electrodiagnostic Examination
• The primary concerns of clinical neurophysiology laboratories are twofold: assessment of the functional
state of the peripheral nervous system (PNS); and assessment of cerebral cortical function.
• PNS assessment entails the use of nerve conduction studies by stimulation of selected peripheral nerves
while recording the waveforms of their response, and of electromyography by recording the waveforms
generated by selected muscles during voluntary contraction.
• The combination of nerve conduction studies and electromyography is referred to as electrodiagnostic
examination
Electromyography (EMG): Nerve Conduction Velocity
• The nerve conduction velocity (speed) is calculated by measuring the

distance between electrodes and the time it takes for electrical
impulses to travel between electrodes.
• During the test, the nerve is stimulated, usually with surface
electrode patches attached to the skin.
• Two electrodes are placed on the skin over the nerve.
• One electrode stimulates the nerve with a very mild electrical
impulse and the other electrode records it.
• The resulting electrical activity is recorded by another electrode.
• This is repeated for each nerve being tested.
Figure Courtesy: www.ebme.co.uk
• Routine measurements of the final CMAP are shown in figure

• They include the latency (time interval) between stimulus and
depolarization onset, and the amplitude and duration of the
negative phase of the waveform.
Figure Courtesy: www.ebme.co.uk
• Tests of nerve conduction velocity are relatively simple to perform and give an
indication about the condition of the fastest sensory or motor fibres in the nerve.
• Electrical stimuli are applied through the skin overlying the median nerve in the
distal forearm, and again at the elbow.
• Distal stimulation causes and action potential in the small muscles of the thumb,
picked up by recording electrodes.
• The distal terminal latency is the time taken for the action potential to be
conducted from nerve underlying the cathodal stimulating electrode to the nerve
muscle junction plus the time taken to initiate the action potential in the muscles.
• Proximal stimulation initiates a similar series of events but the proximal latency
also includes the time taken for the nerve action potential to be conducted the
distance between the two stimulating electrodes (wrist and elbow)- which happens
Figure Courtesy:
to be approximately a straight line.
www. http://humanphysiology.academy/
• So the conduction velocity of the median nerve in the forearm can be calculated as
shown.
𝐷 𝑚𝑚
𝐶𝑉 =
𝑇1 − 𝑇2 𝑚𝑠
• For the set up shown in figure , the distance A is measured as

340 mm , while the distance B is measured as 40 mm. The
proximal latency is 10 ms and the distal latency is 4 ms. What is
the nerve conduction velocity in m/s ?
𝐷𝑖𝑠𝑡𝑎𝑛𝑐𝑒 𝐴 − 𝐵
𝐶𝑉 =
𝑇𝑖𝑚𝑒 𝐴 − 𝐵
340 𝑚𝑚 − 40 𝑚𝑚
𝐶𝑉 =
10 𝑚𝑠 − 4 𝑚𝑠
300 𝑚𝑚
𝐶𝑉 =
6 𝑚𝑠
𝐶𝑉 = 50 𝑚𝑚/𝑚𝑠 Figure Courtesy: www. clinicalgate.com
𝐶𝑉 = 50 𝑚/𝑠
Antidromic
• Anti: “against” or opposite. That is against natural conduction
• Stimulate proximal, and record distal
Orthodromic
• Ortho: “right” or correct. Natural direction of sensation
• Stimulate distal, and record proximal
Figure Courtesy: www. aanem.org
• If the motor conduction velocity (CV) of the fastest fibres is >40 metres/second then the result is taken as normal.
• However, if the CV is <40 m/sec, the result is considered to be low and abnormal.
• It is important to be sure that a low result is not because the temperature of the limb nerve being tested is cold, because
low temperature reduces the CV of peripheral nerves.
• If the temperature is normal, and the CV is <40 m/sec, then it can be concluded that the nerve is abnormal, possibly due
to neuropathies associated with disorders such as diabetes.
• The latency is measured at 4 different sites

• Wrist
• Elbow
• Armpit
• Neck
Figure Courtesy: www. jnnp.bmj.com

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ECE 296 Biomedical Instrumentation

Tony Aby Varkey M

(i) Frontal Plane

In the frontal plane we have

• By linking the three limbs RA, LA and LL through large equal

𝑉𝑅𝐴 + 𝑉𝐿𝐴 + 𝑉𝐿𝐿 Figure Courtesy: wiley-vch.e-bookshelf.de

• V1 - Fourth intercostal space on the right sternum

Figure Courtesy: www.cablesandsensors.com/pages/12-

• V1 - Fourth intercostal space on the right sternum

Figure Courtesy: wiley-vch.e-bookshelf.de

Figure Courtesy: https://www.cablesandsensors.com/pages/12-lead-ecg-placement-guide-

Figure Courtesy: https://www.cablesandsensors.com/pages/12-lead-ecg-placement-guide-

• Sagittal plane ECG recording is rarely carried out.

• The strip chart paper has vertical lines 1 mm apart, with a

Tony Aby Varkey M

Fig. Courtesy: Handbook of Biomedical Instrumentation R S Khandpur

Bradycardia: Heart rate < 60 beats per minute

Age Awake Asleep Exercise or Fear

Neonatal 100 – 160 80 – 140 <220

1 week – 3 months 100 – 220 80 – 200 <220

3 months – 2 Years 80 – 150 70 – 120 <200

2 Years – 10 Years 70 – 110 60 – 90 <200

>10 Years 55 – 100 50 – 90 <200

Fig. Courtesy: www.proacls.com/

Fig. Courtesy: www.proacls.com/

Fig. Courtesy: www.proacls.com/

• PR Interval : 0.12 – 0.2 seconds

• It is defined as lasting from 2.0 seconds to several minutes.

Tony Aby Varkey M

Fig. Courtesy: Handbook of Biomedical Instrumentation R S Khandpur

• The outer layer of the brain is called the cerebral cortex.

interpret what we see.

Tony Aby Varkey M

10/20 System of electrode placement

EEG cables showing the disc electrodes to which

Many recording systems use a cap into which electrodes are

Figure Courtesy: https://www.medicine.mcgill.ca/physio/vlab/biomed_signals/eeg_n.htm

• Electrode gel acts as a malleable extension of the electrode, so that the

Figure Courtesy: https://www.medicine.mcgill.ca/physio/vlab/biomed_signals/eeg_n.htm

Measurements - T3, C3, Cz, C4, T4

Measurements - Fpz, Fz, Cz, Pz, Oz

Measurements - Fp1, F7, T3, T5, O1, Oz

Tony Aby Varkey M

• Montage means the placement of the electrodes.

Average Reference Derivation

• Bipolar Derivation/Bipolar Electrode:

• Different waves from different parts of the brain are

Tony Aby Varkey M

• Two type of electrodes are used

Tony Aby Varkey M

Human Muscular System:

Figure Courtesy: encyclopediabritanica

How muscles work

Figure Courtesy: encyclopediabritanica

How muscles work

How muscles work

How muscles work

Tony Aby Varkey M

Figure Courtesy: Nandhi K Jog

• The set up is shown in the figure

• The nerve conduction velocity (speed) is calculated by measuring the

Figure Courtesy: www.ebme.co.uk

• Routine measurements of the final CMAP are shown in figure