BULETINUL INSTITUTULUI POLITEHNIC DIN IAI Publicat de Universitatea Tehnic Gheorghe Asachi din Iai Tomul LIV (LVIII),

Fasc. 1, 2008 Secia AUTOMATIC i CALCULATOARE

A WIRELESS ECG MODULE FOR PATIENT MONITORING NETWORK

BY

*,**CRISTIAN ROTARIU, *,**HARITON COSTIN, *DRAGO AROTRIEI and *BOGDAN DIONISIE

Abstract. The current common goal in medical information technology today is the design and implementation of telemedicine solutions, which provide to patients services that enhance their quality of life. Recent technological advances in sensors, low-power integrated circuits, and wireless communications have enabled the design of low-cost, miniature, and intelligent physiological sensor modules. These modules are capable of measuring, processing, communicating one or more physiological parameters, and can be integrated into a wireless personal area network. In this paper we present the realization of a wireless ECG module, as a part of a personal area network for patient monitoring, capable to measure and transmit two ECG leads. The use of wireless ECG is suitable for continuous long-time cardiac activity monitoring as a part of a diagnostic procedure, can achieve medical assistance of a chronic condition, or can be supervised during recovery from an acute event or surgical procedure. For instance, the computer-assisted rehabilitation involves unwieldy wires between sensors and monitoring device that are not very comfortable for normal activity. We propose a wireless module, based on low power microcontrollers and RF transceivers that perform the measurements and transmit the data to a Personal server. Personal server, in form of a Personal Digital Assistant (PDA) that running a heart monitor application, receives the information from wireless ECG module, activates the alarms when the measured parameters are above the limits, and communicates periodically a the central server (part of the telemedicine system) by using WiFi or GSM/GPRS connection. The heart monitor reacts to potential heart risks and records physiological information into a local database. Key words: patient monitoring, wireless ECG, personal area network, intelligent sensors, telemedicine. 2000 Mathematics Subject Classification: 94C99, 04C12.

1. Introduction The Telemedicine (also referred to as telehealth or e-health) allows health care professionals to use "connected" medical devices in the evaluation,

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diagnosis and treatment of patients in different locations. These devices are enhanced through the use of communications technology, network computing, video-conferencing systems, a.s.o. Specialized application software, data storage devices, database management software, and medical devices capable of electronic data collection, storage and transmission are all parts components of the telemedicine infrastructure. The task of patient monitoring may be achieved by telemedicine (enabling medical information-exchange as the support to distant-decisionmaking) and telemonitoring (enabling simultaneous distant-monitoring of a patient and his vital functions), both having many advantages over traditional practice. A telemonitoring network (Fig. 1) devoted to medical teleservices, will enable the implementation of complex medical teleservices for a broader range of patients and medical professionals, mainly for family doctors and those people living in rural or isolated regions [1].

Fig. 1 Telemonitoring network general structure.

Doctors can receive information that has a longer time span than a patient's normal stay in a hospital and this information has great long-term effects on home health care, including reduced expenses for health care. Physicians also have more accessibility to experts, allowing the physician to obtain information on diseases and provide the best health care available. Moreover, patients can thus save time, money and comfort. Wearable heart monitoring modules allows to continuous monitor changes in ECG signals and provides feedback to help maintain an optimal heart status. If integrated into a telemonitoring network, these modules can even alert medical personnel when ECG parameters are outside the limits. Long-term heart monitoring modules can measure the variations in ECG signals, useful as a recovery indicator in cardiac patients after myocardial infarction or help monitor effects of drug therapy. During the last few years there has been a significant increase in the number of various wearable hearth monitoring modules, ranging from simple pulse monitors, and heart activity monitors, to portable Holter monitors. Although Holter monitors are used only to collect data, it still remains the most used device. Data processing and analysis are performed offline, making the device impractical for continual monitoring and early detection of

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medical disorders. Devices with multiple sensors for rehabilitation had unwieldy wires between the sensors and the monitoring device which may limit the patient's activity and their comfort. As for patient monitoring, we propose the development of a flexible wireless ECG module for personal area network capable of measuring, preprocessing and transmission ECG information to a Personal server. 2. Materials and Methods Our wireless ECG module is realized by using a custom developed ECG amplifier and a low power microcontroller board (eZ430-RF2500 Board from Texas Instruments). The ECG module is wirelessly connected to a personal server (PDA - Fujitsu Siemens LOOX T830) that receives the information from ECG Module. The eZ430-RF2500 is a complete MSP430[2] wireless development tool providing all the hardware and software for the MSP430F2274 microcontroller and CC2500 2.4GHz wireless transceiver [3]. Fig. 2 shows a simplified block diagram of a wireless ECG module. The ECG module is powered by two AA batteries and has as the features an ultra low power Texas Instruments MSP430 microcontroller, a Chipcon CC2500 radio interface in the 2.4 GHz band, and an integrated onboard antenna with 50m range indoors/125m range outdoors.

Fig. 2 Wireless ECG module block diagram.

The MSP430F2274 microcontroller is based around a 16-bit RISC core integrated with RAM and flash memories, analog and digital peripherals, and a flexible clock subsystem. It supports several low-power operating modes and consumes as low as 1A in a standby mode. The 2-lead ECG amplifier (Fig. 3) [5] is custom made device. It has for each channel a gain of 500, is DC coupled and has a band limited to 100 Hz.

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The high common mode rejection (>90dB), high input impedance (>10 M), the fully floating patient inputs are other features of the ECG amplifier.
C1 Cap 1nF R1 Res1 1M VCCbat 7 1M R7 Res1 10K 10K R10 Res1 10M 2 3 4 5 8 6 1 U1 OPA336

CH1-

R2 Res1

100K Cap 100pF C2

R3 Res1

10K 1 2

R4 Res1 U2A RGA INAINA+ -V

100K

R5 Res1 11 13 12

100K

R6 Res1

INA2321 +V OUTA REFA EA

VCC VCC/2 C3 Cap 10uF VCC 8 U3A OPA2336 1

R9 Res1

R8 Res1 10K C4 Cap 100nF

OUTCH1

CH1+

R11 Res1 100K

R12 Res1 10K

3 4

GND GND 2 3 R17 Res1 10K VCC/2 R16 Res1 10K VCC 8

R13 Res1 10M

GND R14 Res1 10M

14 R15 Res1 330R VCC

GND U3B OPA2336 7

6 5 4

4 GND

VCC/2 VCC/2

GND C5 Cap 1nF R18 Res1 1M VCCbat 7 8 6 1 4 U4 OPA336

CH2-

R19 Res1 100K Cap 100pF R28 Res1 100K C6

R20 Res1 10K 7 6 R29 Res1 10K 5 4

R21 Res1 100K U2B RGB INBINB+ -V

R22 Res1 100K 11 9 10

R23 Res1 1M R24 Res1 10K R26 Res1 10K R27 Res1 10M 2 3 5

INA2321 +V OUTB REFB EB

VCC C7 Cap 10uF VCC U5A OPA2336 1 8

R25 Res1 10K

VCC/2

OUTCH2

CH2+

GND GND 2 3 R34 Res1 10K VCC/2 GND R33 Res1 10K VCC 8 U5B OPA2336 7

R30 Res1 10M

GND R31 Res1 10M

C8 Cap 100nF

R32 Res1 330R VCC

GND

6 5 4

SHIELD

R35 Res1 330R C9 Cap 1nF R36 Res1 VCC 4K7 8 U6B OPA2336 7 6 5 4 R42 Res1 10K VCC/2 GND U6A OPA2336 1 VCC 8

4 GND

VCC/2 VCC/2

C10 Cap 10nF R40 Res1 330K R41 Res1 10K C11 Cap 100pF VCC/2

R37 Res1 3K3

2 3 4 R38 Res1 33K R39 Res1 33K

RL

GND

Fig. 3 ECG amplifier schematic.

In order to have a good signal to noise ratio, differential amplifiers are used. Since the output is proportional to the difference between the two voltages, this circuit has a fairly good common mode rejection. Unfortunately, the differential amplifiers performance is limited due to low input impedance. This problem has been avoided by incorporating a dual Instrumentation amplifier in place of a differential amplifier. The instrumentation amplifier used (INA2321), is a microPower,

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single-supply CMOS dual device from Texas Instruments. The INA2321 provides low-cost, low-noise amplification of differential signals and boasts a micropower current consumption of just 40A/channel and a high CMRR > 90 dB, and it is suitable to use in physiological amplifiers, in particular ECGs. The impedance between pins 1, 12, and 13 (or 7, 9 and 10), determines the gain of the INA2321. With an internally set gain of 5 per amplifier, the INA2321 can be programmed for gains greater than 5 with gain error guaranteed to be less than 0.1%. Errors from external resistors will add directly to the guaranteed error, and may become dominant error sources. A gain of 10 was chosen for this stage of the circuit. The INA2321 inputs are protected by ESD diodes that will conduct if the input voltages exceed the power supplies by more than 500 mV. Momentary voltages greater than 500 mV beyond the power supply can be tolerated if the current through the input pins is limited to 10 mA. This is easily accomplished with input resistors (100 K). The second stage is a low pass filter with a gain of 10 and it is used to eliminate the high frequency noise above 100 Hz. The frequency response of the ECG amplifier (one lead) is represented in the Fig. 4.

Fig. 4 The frequency response of the ECG amplifier ORCAD simulation.

The operational amplifier used in the right-leg common-mode feedback circuit is the OPA2366, a dual amplifier. The circuit sends an inverted version of the common-mode interference to the patients right leg, with the aim of cancelling the interference and protecting the signals from the leads by shielding the signal cable.

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The ECG amplifier is powered by two AAA 1.5V batteries through the Voltage Regulator. The regulator in built around TPS60204 circuit and the schematic in represented in the Fig. 5.
VCCbat GND 5 3 2 7 U7 OPA336 1 6 8 VCC/2

R43 Res1 100K C12 Cap 100nF GND R44 Res1 100K

VCCbat GND

VCCbat R45 R46 Res1 390K C13 Cap Pol1 4.7uF C14 Cap 100nF R48 Res1 680K C17 Cap 1uF U8 IN LBI C1+ GND C1TPS60204 OUT LBO C2+ C2EN Res1 100K

VCC

7 1 4 3

5 10 6 8

R47 C18 Cap 1uF C19 Cap 10nF GND Res1 330R

LBW

C15 Cap Pol1 C16 Cap 4.7uF 100nF

GND

GND

GND

GND

GND

PWEN

GND

Fig. 5 Voltage regulator schematic.

The TPS60204 is a step-up, regulated charge pumps that generates a 3.3V4% output voltage from a 1.8 V to 3.6 V input voltage. The device is typically powered by two Alkaline, NiCd, or NiMH battery cells and operates down to a minimum supply voltage of 1.6 V. Minimum continuous supply current is 100 mA from a 2 V input. Only four external capacitors are needed to build a complete low-ripple dc/dc converter. The push-pull operating mode of two single-ended charge pumps assures the low output voltage ripple, as current is continuously transferred to the output. The TPS60204 circuit is programmed by using the EN pin. Setting the EN pin to low disables the device, shuts down all internal circuits, and disconnects the output from the input. Setting the EN pin to high enables the device and programs it to run. In the Fig. 6, it is represented the block diagram of the personal server. The personal heart monitor is responsible for a number of tasks, providing a transparent interface to the wireless medical sensors, an interface to the patient, and an interface to the central server. The USB interface (Fig. 7) is realized by using a serial to USB transceiver (FT232BL) from FTDI [4] and enables eZ430-RF2500 to remotely send and receive data through USB connection using the MSP430 Application

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UART. All data bytes transmitted are handled by the FT232BL chip. It also contains a voltage regulator (TPS77301) to provide 3.3 V to the eZ430-RF2500.

Fig. 6 Personal server block diagram.

VCC R1 Res1 470R C3 100nF 6 R2 27R Res1 R3 27R Res1 GND R5 Res1 4K7 1 8 7 R4 1K5 Res1 5 4 27 28 32 1 2 31 3V3OUT USBDM USBDP RSTOUT# RESET# XTIN XTOUT EECS EESK EEDATA TEST 30 3 26 13 GND GND J1 VBUS DD+ GND SHLD R6 USB CON Res1 33K GND 1 2 3 4 5 VCC 33nF C4 U1 C1 100nF GND FT232BL P1 TXD RXD RTS# CTS# DTR# DSR# DCD# RI# TXDEN TXLED# RXLED# AGND GND GND PWRCTL PWREN# SLEEP# 25 24 23 22 21 20 19 18 16 12 11 14 15 10 1 2 3 4 GND SERIAL POWER SUPPLY C2 100nF GND 3V3

AVCC VCC VCC VCCIO

3V3

DS1

R7 VCC Res1 1K

VCC

3 R8 Res1 10K 2

Y1 6MHz

GND

GND R9 Res1 250K

GND

3V3 R10 Res1 6K8

U2 8 7 2 1 OUT1 OUT2 RESET FB/SENSE TPS77301DGK IN1 IN2 GND EN 5 6 3 4 C8 100nF C7 Cap Pol1 10uF VCC

C6 100nF

C5 Cap Pol1 4.7uF

R11 Res1 3K3 GND GND GND GND

29 9 17 GND GND

GND

Fig. 7 Personal server USB transceiver and voltage regulator schematic.

3. Results On the personal server module, visualization and analysis software are implemented. This software has the following facilities: GUI (Graphic User

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Interface) for ECG waveforms; displays the patients parameters received from the sensors; sends the commands and medical decisions to the patient. PDA devices typically offer a larger screen area, which is an important feature for quicker reading. Their large screens offer higher resolution than other devices (such us Palm-based). Usually PDA devices have faster processors that, in combination with the larger screen, cause higher power consumption. Furthermore, the availability of Windows Mobile as operating system allows an easy redesign of an ECG viewer already available for Win32 PC platform. For example, the ECG amplifier samples the two leads each at a frequency of 250 Hz. The raw data is filtered with a low pas filter to eliminate high frequency and movement artifacts.
QRS complex R

RRint
R

T wave QRSon P wave Q Pon Poff S Tp Toff QRSoff

QRSdur

+ QRSamp

T wave QRSoff or J point P wave ST point ST elevation ST

slope Baseline

Tamp
Pamp
QRS amp

Pdur

PRint

QTpint

QTint

Fig. 8 PQRST waves and location important points.

The process of recognition of the ECG waves (Fig. 8) constitutes a significant part of the most ECG analysis systems. In applications were rhythm detection is performed, only the location of the R wave is required. In other applications it is necessary to find and recognize the features of the ECG signal, such as the P and T waves, or the ST segment, for the automated classification and diagnosis. Many algorithms for the extraction of the ECG features based on the digital filters have been reported in the literature [6], especially algorithms for the QRS complex recognition. The main effort in the ECG features extraction is for finding the exact location of the waves. After that, the determination of the waves amplitudes and shapes is much simpler. The strategy for finding the exact location of the waves is to first filter the ECG signal and then recognize the QRS complex, which has a sharper slope. T wave is recognized next and finally is recognized the P wave, which is usually the smallest wave in amplitude. The baseline and the ST segment features are also computed. In order to test the morphological analysis of the ECG signal, it was applied on the synthesized ECG, and on the synthesized ECG corrupted with 50Hz power line noise and electromyographic noise. A detection error rate below 10% was achieved. The same value was obtained by using MIT-BIH Arrhythmia Database records.

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The results obtained by applying the method described in [6] on the DII lead is presented in Fig. 9.

Fig. 9 Personal server software.

4. Conclusions The wireless personal area network focuses on the implementation and exploitation of a modular and ambulatory telemedicine platform, which is using easily wearable vital signs monitoring devices, causing minimal discomfort to patients, and which transfer the information and on-line critical vital parameters to central server and/or medical experts/consultants, regardless of their location, while getting feedback to increase their comfort in case of alarm. The interactive continuous monitoring promises cost effective health services, more active involvement of patients in their own care, and a new sense of realism in making a diagnosis. The proposed system could also be used as a warning system for monitoring during normal activity or physical exercise. In addition to monitoring of physiological signals, we plan to use the proposed environment for development of a high performance user interface. New user inputs, including correlates of the user's physiological and emotional states could significantly improve human-computer interface and interaction.
A c k n o w l e d g e m e n t s. This work is supported by a grant from the Ministry of Education and Research, within PNII programme (www.cnmp.ro), contract No. 11-067/18.09. 2007. Received: January 19, 2008 * Gr. T Popa University of Medicine and Pharmacy, Iai and **Institute for Theoretical Computer Science Romanian Academy, Iai e-mail: crotariu74@yahoo.com

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REFERENCES 1. Costin H., Puscoci S., Rotariu C., A Multimedia Telemonitoring Network for Healthcare, Enformatika, Transactions on Engineering Computing and Technology, Vol. 17, 113-118. 2. *** MSP430 datasheet at http://www.ti.com/MSP430. 3. *** CC2500 datasheet at http://www.ti.com/CC2500. 4. *** FT232 datasheet at http://www.ftdichip.com/FT232. 5. *** Heart rate and EKG monitor Using the MSP430FG439, application note at http://www.ti.com/. 6. Zigel Y, ECG Signal Compression. M.Sc. Degree Thesis, Ben Gurion University of Negev, Faculty of Engineering Sciences, 1998.

UN MODUL ECG FR FIR PENTRU REEA DE MONITORIZARE A PACIENILOR (Rezumat) Recentele descoperiri tehnologice n domeniul circuitelor integrate cu consum redus de putere i a comunicaiilor fr fir permit proiectarea senzorilor biomedicali inteligeni. Aceti senzori sunt capabili s msoare, prelucreze i s transmit unul sau mai muli parametri fiziologici i pot fi integrai cu uurin ntr-o reea personal de senzori. n aceast lucrare se prezint realizarea unui modul ECG fr fir care achiziioneaz, prelucreaz i transmite dou canale ECG i ritmul cardiac ctre un server de pacient. Pe serverul de pacient, reprezentat de un PDA, ruleaz o aplicaie de monitorizare a pacientului care activeaz alarmele cnd parametrii monitorizai depesc limitele i comunic periodic cu serverul central, situat la centrul de telemedicin, utiliznd conexiunea WiFi sau GSM.|