Introduction to Pulse oximetry

Sagar G V
August 21, 2012

What is oximetry ?

The heart pumps blood to the lungs

where haemoglobin in the red blood
cells is oxygenated. This oxygenated
blood is then pumped to various parts
of the body via the arteries. Arterial blood gas saturation (SpO2 ) is
the percentage of haemoglobin in the
arteries that is oxygenated.
SpO2 =

[HbO2 ]
[Hb] + [HbO2 ]

(1)

where [Hb] and [HbO2 ] are the

concentrations of de-oxygenated and
oxygenated haemoglobin in the arteries respectively. SpO2 can be estimated by measuring the absorption of light as it passes through the
Figure 1: A pulse oximeter
body. Oximetry is the measurement
of blood gas saturation. Pulse oximetry is a non-invasive method of oximetry which involves flashing two LEDs
alternately. This article describes the principle behind pulse oximetry.

What does it tell us?

It tells us if the person is getting enough oxygen. Arterial oxygen saturation

of healthy people will be in the range 94%-99%. Anything below 90% indicates insufficient supply of oxygen. Low SpO2 can be due to problems in the
lungs causing insufficient perfusion of oxygen to the blood or in the blood cells
themselves as in the case of anaemia. In newborns, low SpO2 is indicative of
Septicemia (infection), Congenital heart defects, anaemia, respiratory distress
syndrome etc.

Beer-Lambert Law

Beer-Lambert law states that the absorbance of light as it passes through a

sample is proportional to the thickness of the sample and the concentration of
1

the absorbent.
dI I[C]dt
where dI is the infinitesimal change in light intensity as it passes through a
sample of concentration [C] and thickness dt. Thus, for a large sample,
I = I0 e[C]t
where I0 is the intensity of the incident light and is the absorption co-efficient,
t is the thickness of the sample.

Making measurements

Light from an LED is transmitted through the human body (usually finger or
ear lobe) and the intensity of the light that passes through is measured. Well
assume that the light intensity of the LED is proportional to the current through
it and that the current in a photodiode is directly proportional to the light that
falls on it.

Figure 2: System Description

4.1

Start with an LED

We shall now send light from a red LED through a finger and measure how
much light passes through. Beer-Lambert law tells us
IrxR = ItxR etissueR [tissue]l1 HbO2 R [HbO2 ]l1 HbR [Hb]l1

(2)

where symbols have their usual meaning and the R suffix indicates that
the quantity is corresponding to the red light. The absorption is divided into
absorption due to tissues, oxy haemoglobin and deoxy haemoglobin.
To obtain SpO2 , the ratio of [Hb] to [HbO2 ] is needed. Eq. 2 does not allow
us to compute this ratio by mere knowledge of the currents in the transmitting
LED and receiving photo diode.

4.2

Beating heart to the rescue

The thickness of the artery oscillates as the heart beats. Correspondingly, the
detected current also varies at the heart rate. This means that we can take the
ratio of the maximum and minimum received currents over the duration of a
heart beat to eliminate the effect of the surrounding tissues. This is because the
2

Figure 3: Thickness modulation in the arteries

ratio will depend on the arterial expansion and contraction while the background
gets subtracted away.
IrxRpeak
= eHbO2 R [HbO2 ](l2 l1 )+HbR [Hb](l2 l1 )
IrxRtrough

(3)

The required ratio of [HbO2 ] to [Hb] in Eq. (3) still depends on the amount by
which the arteries expand.

4.3

Use two LEDs !

The dependence on the expansion of the arteries as the heart beats can be
eliminated if we take measurements with two different LEDs, a red LED and an
IR LED. To keep the detected current separate and to lower power consumption,

Figure 4: Depiction of when the LEDs are flashed

neither LEDs are continuously turned on. They are flashed alternately and the
detected current is measured. The maximum heat rate is around 250 beats per
minute. Flashing the LEDs at a 100Hz keeps the sampling system well above
the nyquist rate. We first compute the ratio in Eq. 3, take the logarithm and
then compute the ratio of this quantity for two different LEDs as shown below.
IrxIRpeak
= eHbO2 IR [HbO2 ](l2 l1 )+HbIR [Hb](l2 l1 )
IrxIRtrough

IrxRpeak
= HbO2 R [HbO2 ](l2 l1 ) + HbR [Hb](l2 l1 )
IrxRtrough


IrxIRpeak
ln
= HbO2 IR [HbO2 ](l2 l1 ) + HbIR [Hb](l2 l1 )
IrxIRtrough

(4)

ln

(5)

(6)

From Eqs 5 and 6,



IrxRpeak
ln IrxRtrough

[HbO2 ] + HbR [Hb]

 = HbO2 R
R= 
IrxIRpeak
HbO2 IR [HbO2 ] + HbIR [Hb]
ln IrxIRtrough

(7)

Combining Eq. (7) and Eq. (1), we have,

SpO2 =

HbR HbO2 R R
HbR HbO2 R + (HbO2 R + HbIR )R

(8)

Substituting typical values[1] gives us,

SpO2 =

0.81 0.18R
100%
0.63 + 0.11R

Therefore, to compute SpO2 , we need to compute R which needs measurement

of the peak and trough of the detected current in the photo-diode as red and
IR LEDs are alternately flashed.

Accuracy needed of current measurement

We would like to have an idea of the required resolution of the current in the
photodiode given the required accuracy in estimating the SpO2 . From Eq. (8),
S =

0.2025
R
(0.63 + 0.11R)2

We are particularly interested in the accuracy of the SpO2 around 92% because 90% is usually the threshold below which doctors recommend support
for oxygenation. Also insurance companies usually require that the SpO2 level
fall below 88% for them to pay for artificial oxygenation. At this point, R =
0.8. If the maximum tolerated S is 1% around this point, the corresponding
worst-case error in computing R should be below 0.025. At other points such
as 60%, the accuracy is not as important and an error of even 3% is tolerable.
The peak and trough of the detected current are usually very close to each
other. We may write R as,
 R R
I +I
ln I R Iac
R
ac


R=
IR
I +I IR
ln I IR Iac
IR
ac

where I R and I IR are the dc currents in the photodiode due to the red and
infra red LEDs. We can approximate this as,
R=1+2

R
IR
Iac
Iac

2
IR
I IR

From this,

R = 2I

1
1
+ IR
R
I
I


I =

I R I IR
I R + I IR

R
2

(9)

if we make the simplifying assumption that I R I IR , we get

R
I
=
I
4
Although this assumption is not true, it gives us an idea of the resolution required of the current. For R = 0.025, this indicates that 8 bits of resolution
is necessary. If I R = I IR = 100nA, then these equations indicate that the
resolution in current measurement should be 0.625nA.

Calibration

We would like to calibrate the instrument and measure its accuracy over the
range of useful SpO2 for a large number of people. Accurate calibration is
difficult because a highly accurate measurement of blood gas saturation requires
drawing blood from people and directly measuring oxygen saturation. This is
quite inconvenient. So, in most commercial pulse oximeters, SpO2 is assumed
to follow a quadratic polynomial in R.
SpO2 = a + bR + cR2
where are a,b,c are best-fit co-efficients obtained by fitting a second order
polynomial to a graph of measured R of the instrument to be calibrated vs.
readings(SpO2 ) from a pre-calibrated pulse oximeter for different test subjects.

References
[1] M. Tavakoli, L. Turicchia, and R. Sarpeshkar, An Ultra-Low-Power Pulse
Oximeter Implemented with an Energy-Efficient Transimpedance Amplifier, IEEE Transactions on Biomedical Circuits and Systems, Vol. 4, No. 1,
pp. 27-38, Feb. 2010.