Department of Electrical and Computer Engineering UTEP

EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
1
Biopotential Amplifiers

These are very important part of modern medical
instrumentation

We need to amplify biopotentials which are generated in the
body at low levels with a high source impedance

Biopotentials amplifiers are required to increase signal strength
while maintaining fidelity


Basic Requirements of Biopotential Amplifiers
Essential functions of a bioamplifier are:
To take a weak biopotential and increase its amplitude so that it
can be processed, recorded or displayed

To amplify voltage, but it could be considered as a power
amplifier as well

To amplify current since in some cases a biopotential amplifier
is used to isolate the load from the source current gain only


Input Impedance (Z
in
)
All biopotential amplifiers must have high input impedance
minimize loading (remember the characteristics of biopotential
electrodes resulting into loading and distortion if input
impedance of the amplifier is not high enough) typical values
of Z
in
over the frequency range of the measurand = 10 M
(remember the loading rule)




Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
2
Protection & Isolation
The input circuit of a biopotential amplifier must provide
protection to the live measurand



V
bio





Any potential or current at amplifiers input terminals can affect
V
bio


Electric currents produced by the biopotential amplifier can
result in microshock and macroshock

The bioamplifier must have isolation and protection circuitry so
that the current through the electrodes can be kept at safe levels
and any artifact generated by such current can be minimized

Output Impedance (Z
out
)
The output circuit does not present any critical problems, all it
needs to do is to drive the load
Output impedance must be low with respect to the load
impedance and it must be capable of satisfying the power
requirements of the load


R
out


V
in
R
in
A
.
V
in
R
load



Bioamplifier


Bioamplifier
~
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
3
Bandwidth (BW)
Frequency response requirements
The biopotential amplifier must be sensitive to important
frequency components of the biosignal
Since biopotentials are low level signals, it is important to limit
bandwidth optimize signal-to-noise ratio

Gain (G)
Biopotential amplifiers have a gain of 1000 or greater


Mode of Operation
Very frequently biosignals are obtained from bipolar electrodes

Electrodes symmetrically located with respect to ground need
differential amplification

High CMRR required because:
1. Common mode signals much greater than the biosignal appear
on bipolar electrodes

2. Symmetry with respect to ground is not perfect (mismatch
between electrode impedances) more on this later


Calibration Signal
Medical and clinical equipment require quick calibration
The gain of the biopotential amplifier must be calibrated to
provide us with an accurate indication of the signals amplitude
Push button to apply standard signal to the input of the
biopotential amplifier
Adjustable gain switch carefully selects calibrated fixed gains
(in microprocessorbased systems, gain adjustment can be
achieved by software setting)
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
4
Electrocardiography
A very widely used medical instrument, which is utilized to
diagnose and monitor cardiac beat abnormalities is the
electrocardiograph
It measures the electrical activity of the heart (more precisely
biopotential differences arising from the electrical activity of
myocardium). Weve already talked about the genesis of the
ECG signal.
The ECG machine uses surface electrodes and high input
impedance
Differential amplifiers with good common mode rejection ratio
to record the electrocardiogram
Normal ECG amplitude ranges between 0.5-4 mV. Normal
frequency content of ECG (for diagnostic purposes) is 0.05-100
Hz. A typical ECG waveform is shown below:


Obviously all human hearts are not the same and this leads into
variability in different parts of the ECG signal
Significant diagnostic features of the ECG signal are:
Duration of component parts of the signal
Polarities and magnitudes
The details of the ECG signal and the degree of variability in different
parts of the ECG signal is shown below:
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
5
The QRS amplitude, polarity, time duration, the RR interval
(indicator of heartbeat per min.) and the T-wave amplitude are
some very important and distinctive features of the ECG signal.
The heart rate in BPM = Beats Per Minute) is simply = 60
(RR interval in seconds)
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
6
Some ECG waveform abnormalities that may indicate illness are:
An extended PR interval may be diagnosed as AV node block

A widening of the QRS complex may indicate conduction
problems in the bundle of His

An elevated ST segment may indicate occurrence of myocardial
Infarction (MI)

A negative polarity in the T wave may be due to coronary
insufficiency


ECG Leads
Normal ECG recordings for the standard lead connections
leads I, II and III (Lead II provides the strongest signal)

Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
7
Obviously, all human hearts are not the same and this results
into a high degree of variability
Note the degree of variability of different parts of the ECG
signal
Some abnormalities that may indicate illness:
An extended P-R interval may be diagnosed as AV node
block
Widening of the QRS complex conduction problems in the
bundle of His
Elevated ST segment may indicate occurrence of MI
Negative polarity T wave may be due to coronary insufficiency
QRS amplitude, polarity, time domain, PR interval (indicator of
heat beat per min. & T-wave amplitude are some very important
distinctive features.
1. Loss of P-wave (un-coordinated twitching)
2. Atria undergoing very rapid regular flapping movement
3. An irritable focus discharge in the ventricle (Extrasystole)
4. Loss of QRS blood circulation, severely impaired lots of ectopic
foci
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
8
Origin of the ECG signal
We have already covered this concept extensively in the
previous lectures (The Dipole filed of the heart, the Eindhovens
Triangle, the electrical circuit model for the electrocardiographic
problem, etc.)

Standard Limb Leads (I, II, III)

The lead wires are color-coded according to some conventions.
One example is: White RA (Right Arm), Black LA (Left Arm),
Green RL (Right Leg), Red LL (Left Leg), and Brown C
(Chest)
Note: There is a CM (common mode) amplifier connected to the
right leg. We will discuss this in detail later.
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
9
Augmented Limb Leads
These leads offer a free 50% increase over leads VR, VL, and VF
connections (unipolar leads) with respect to Wilson terminal
AV
R
= -I III/2, AV
L
= I II/2, aV
F
= II I/2

Note: Each measurement is made from the reflected limb and the
average of the other two limbs.
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
10
Chest Leads (Precordial)
Chest Lead Anatomical Positions
V
1
- 4
th
intercostal space Right sternal margin
V
2
- 4
th
intercostal space Left sternal margin
V
3
Midway between V
2
& V
4

V
4
5
th
intercostal space on mid-clavicular line
V
5
Same as V4, on the anterior axillary line
V
6
Same as V5, on the mid-axillary line










Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
11
12 Lead Clinical Electrocardiography



Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
12
The ECG Machine
Most representative Specs:
Z
in
= 10 M
Frequency response = 0.05 100 Hz
Strip Chart Recorder Speed = 25 mm/sec.
Fast Speed = 100 mm/sec.
For detailed Specs. Refer to the Table in your text Summary of
performance requirements for electrocardiographs
















































Block Diagram of a modern electrocardiograph
Sensing
Electrodes
Lead-fail
Detector
Amplifier
Protection
Circuit
A
Lead
Selector
Driven
Right-leg
Circuit
Right leg
Electrode

Isolation
Circuit

Driver
Amplifier
Recorder
Printer
Auto-
Calibration
Baseline
Restoration
Isolated
Power
Supply

ADC
Memory

Microcomputer
Control
Program

ECG Analysis
Program

Operator
Display

Keyboard
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
13
Problems frequently encountered in electrocardiography
There are many factors that must be considered in the design &
application of the ECG machine

These considerations should address the common problems in
electrocardiography

The more common problems are:
Frequency distortion
Saturation or cut-off distortion
Ground loops
Open lead wires
Artifact from large electric transients
Interference from electric devices
Other sources of electric interference
Lets go through these problems carefully and focus on some of
their causes.

Frequency distortion
If the ECG machine does not meet the frequency response
requirements for amplification of the ECG signal, frequency
distortion occurs
a. True ECG
b. High frequency distortion due to inadequate gain of ECG amplifier at high
frequencies
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
14
c. Low frequency distortion due to inadequate gain of ECG amplifier at low
frequencies
Note:
In high frequency distortion, the corners are rounded off and the
amplitude of the QRS is diminished
In low frequency distortion, the baseline gets distorted and
monophasic waves appear to be more biphasic

Saturation or cutoff distortion
This type of distortion occurs if there are high offset voltages at
the electrodes or the amplifiers in the ECG machine are improperly
adjusted.

a. Undistorted ECG recording
b. Clipping of peak of the ECG due to positive saturation effects in
amplifier
c. Clipping of lower voltages in the ECG due to negative saturation
or cutoff effects in amplifier

Note:
In saturation distortion, the combination of the ECG signal and
offset voltages drives the amplifier into saturation. As a result the
QRS peaks are cutoff because the output of the amplifier can not
exceed the saturation voltage
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
15
In cutoff distortion, the lower portions of the ECG are cutoff
(clipped).
Ground loops

Ground loops can arise when patients having their ECGs taken
on either a clinical ECG machine or on a cardiac monitor are also
connected to other pieces of apparatus

Each electric device has its own ground connection either
through the power line or in some cases through a heavy ground
wire attached to some ground point in the room
Ground loop currents may present a safety problem
Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
16
They elevate the patients body potential to some voltage
above the lowest ground to which the instrumentation is attached
(ground A in the figure)

This potential produces common mode voltages that may
increase the amount of interference seen if the CMRR of the
device is not high enough

In electrocardiographs the ground leads usually run alongside
the ECG signal leads, magnetic fields caused by the grounding
circuit can induce small voltages in the signal lead wires
interference on the tracing

Ground loops represent closed current paths. They subtend some
geometrical areas within the loop. If this area is large and is in a
strong time varying magnetic filed, a current can be induced in the
ground loop, the current flows through the patient and common
mode voltages are generated

Open lead wires
A frequently occurring problem in electrocardiography is one of
the lead wires becoming disconnected as a result of rough handling

This results in relatively high potentials being induced on the
open lead wire due to electric fields emanating from the power
lines or other electrical devices in the vicinity of the ECG machine

This in turn leads to a big constant-amplitude deflection of the
ECG pen at 50 or (60) Hz. Such an electrode is not making good
contact with the patient. Therefore, this phenomena translates into
having a circuit for detecting poor electrode contact



Department of Electrical and Computer Engineering UTEP
EE 4385 Biomedical Instrumentation 1

BI1 Lecture Series Prepared by Homer Nazeran PhD
Please read carefully and check for typos!
17
Artifacts from large electric transients

These transients occur during the following situations:

Defibrillating the patient with a high-current high-voltage
electric pulse called the defibrillating pulse (more on this in BI)

Motion artifacts

The patient encountering a build-up of electric charges that can
be partially discharged through the body

Switching leads manually in older ECG machines (not a
problem in new machines)
Note: These effects can be alleviated by reducing the source of the
artifact.

Include an electronic protection circuitry to limit max. Input
voltage across ECG amp. To minimize saturation during
defibrillation
Reduce the build up of charge on personnel by having them use
conductive clothing, shoes, etc and touch the bed frame before
touching the patient