BIOMEDICAL TELEMETRY

AND TELEMEDICINE
Biotelemetry
Biotelemetry is wireless transmission of
automatically measured physiological data
from the point of sensing to a remote
location.
In practice the term also refers to bidirectional
wireless data transfer and remote powering.
It is a modification of existing methods of
measuring physiological variables to a method
of transmission of resulting data.
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The transmission of data from one point of generation
to the point of reception can be done in various ways.
Example: stethoscope
Simplest device which uses the principle of
biotelemetry.
It amplifies acoustically the heartbeats and transmit
their sound to the ears of the doctor through a hollow
tube suction.

Certain applications of biotelemetry use telephone
lines for transmission.
However biotelemetry mainly uses radio transmission
by suitably modifying the biological data.
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Earlier times, the telemetry could be applied to measure:
Temperature by rectal or oral thermistor
ECG by surface electrodes.
Indirect blood pressure by contact microphone and cuff
Respiration by impedance pneumograph

However it is possible now to apply biotelemetry to almost
all measurements such as
Bioelectrical variables such as ECG, EEG,EMG
Physiological variables that require transducers eg. Blood
pressure, blood flow, temperature.
The signal is obtained directly in electrical form in
bioelectrical measurements.




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Applications

Multi-electrode recording
Vital sign monitoring in critical and
ambulatory care
Vital sign monitoring of pilots and astronauts
Measurements like- temperature, pressure,
EMG, EEG, ECG.
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MODULATION SYSTEMS
The sub-modulator can be a FM or PM system,
whereas the final modulator is practically always an
FM system.
Frequency modulation:
In frequency modulation, information is
transmitted by varying the instantaneous
frequency in accordance with the signal to be
modulated, keeping the amplitude of the carrier
wave constant.
Usually an FM signal is produced by controlling
the frequency of an oscillator by the amplitude of
the modulating voltage.
Pulse width modulation: this has an advantage of
being less perceptive to distortion and noise.

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Single channel telemetry system
In majority of situations requiring monitoring
of patients by wireless telemetry, most
commonly studied parameter is ECG.

ECG telemetry system
Consists of a transmitter and a receiver.

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BD of single channel telemetry system
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For distortion-free transmission of ECG, the
following requirements must be met

The subject should be able to carry on his normal activities
whilst carrying the instruments without any discomfort.
Motion artifacts and muscle potential interference should be
kept minimum.
The battery life should be long enough so that complete
experimental procedure may be carried out.
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B.D of ECG telemetry transmitter

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B.D of ECG telemetry receiver

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Temperature telemetry system
Systems for transmission of alternating
potentials representing parameters as ECG,
EEG and EMG are relatively easy to construct.
Telemetry systems which are sufficiently
stable to telemeter direct current outputs
from temperature, pressure for long periods
present greater design problems.
A temperature telemetry system based on this
principle is shown in fig.
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Temperature telemetry system

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Multi-channel wireless telemetry
system
Medical measuring problems often involve the
simultaneous transmission of several parameters.
For this purpose, a multi-channel telemetry system is
employed.
Multi-channel telemetry is particularly useful in
athletic training programs as it offers the possibility of
simultaneously surveying several physiological
parameters of the person being monitored.
With appropriate pre-amplifiers, the multi-channel
systems permit the transmission of ECG and heart rate,
respiration rate, temperature, intravascular and intra-
cardiac blood pressure.

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Multi-channel wireless telemetry
system
In multi-channel telemetry, the number of
sub-carriers used are the same as the same as
the number of signals to be transmitted.
Each channel therefore has its own modulator.
The RF unit-the same for all channels-
converts the mixed frequencies into the
transmission band.
And demodulator contains the RF unit and
one demodulator for each channel.

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Multi-channel wireless telemetry
system
Pulse width modulation is better suited for multi-
channel biotelemetry systems.
Such systems are insensitive to carrier frequency shifts
and have high noise immunity.
FM-FM systems for similar use may have low power
consumption and high baseline stability, but they are
more complicated and turn out to be more expensive.
They can be troubled by interference between different
channels.
Pulse position amplitude modulation easily gets into
synchronization difficulties caused by noise and thus
result in loss of information transmitted.

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Telemetry of ECG and repiration
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Obstetrical telemetry system
This provides greater freedom of movements to
patients during labour while the patient is
continuously monitored through a wireless link.
In delivery room, telemetry reduces the number
of instrumentation cables at the bedside.
When an emergency occurs, there is no loss of
monitoring in the vital minutes needed for
patient transfer.
The patient carries a small pocket-sized
transmitter which is designed to pick up signals
for foetal heart rate and uterine activity

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Obstetrical telemetry system
The foetal heart rate is derived from foetal
ECG which is obtained via scalp electrode
attached to the foetus after the mothers
membrane are ruptured.
Uterine activity is measured via an intra-
uterine pressure transducer.
The receiver located away from the patient, is
connected to a conventional cardiotocograph.
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Telemetry in operating rooms
The use of telemetry in operating rooms offers
a means of achieving a high degree of patient
safety from electric shock as well as
elimination of the hanging inter-connecting
patient leads which are necessary in direct-
wired equipment.
The most common parameters of interest
while monitoring surgical patients are ECG,
blood pressure, peripheral pulse and EEG.
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Sports physiology studies through
telemetry
Monitoring of pulmonary ventilation, heart rate and
respiration rate is necessary for a study of energy
expenditure during physical work, particularly for
sports such as squash, handball, tennis etc.
For this purpose, the transmitter uses pulse duration
modulation, i.e. each channel is sampled sequentially
and a pulse is generated, the width of which is
proportional to the amplitude of the corresponding
signal.
The transmitter is designed to work in a range of 100m,
which can be extended by using a whip antenna.

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Sports physiology studies through
telemetry
For recording ECG, the electrodes are placed
at the sternum.
The pulmonary ventilation and respiration
rates are derived from a mass flow transducer.
At the receiving end the system contains an
FM tuner and circuitry to convert the pulse
width coded signals back to analog signals and
a multi-channel pen recorder to display the
physiological signals.
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Multi-patient telemetry
This provides a sort of intermediate stage of care that
smoothens the patients transition back to a normal
life.
Avoids the need of confining the patient to bed.
Transmitters of very small size and weighing less than
115g, including battery are available.
Data from different patients is received at the nurses
central station.
The station may have the facility of non-fade display
of received waveforms, an ECG recorder which gets
activated when the patient goes into alarm, loose
lead/loss of signal alarm.
The heart rate of each patient is derived and displayed
simultaneously with a digital display.







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Implantable telemetry systems
It allows the measurement of multiple
physiological variables over long periods of
time without any attachment of wires,
anesthesia to monitored subject.
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Implantable telemetry system for
blood pressure and blood flow

Used in case where information about the
blood flow over a period of several months is
required.
Electromagnetic flowmeters are not suitable
for implant purposes, as they consume a lot of
power.
Ultrasonic Doppler shift principle is the most
widely used technique for implantable blood
flowmeter.

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B.D of implantable blood flowmeter

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Transmission of analog physiological
signals over telephone
This method has an advantage that individual
patients can be managed in remote areas.
By sending ECG and other signals over the
telephone lines, a patient can communicate with
the doctor or specialist from his home while lying
on bed.
Another necessity for such transmission is to use
telephone lines for the collection of data for a
central computer, from anaesthetized patients
undergoing surgery in operating theatres and
from conscious patients in recovery rooms, for
maintenance of records for future reference.
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Transmission of analog signals over
telephone lines

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Multi-channel patient monitoring
telephone telemetry system
This is employed due to increasing need for
multi-channel parameter monitoring,
especially the simultaneous transmission of
ECG, blood pressure, respiration and also
temperature.
A frequency modulation system using 750Hz,
1750Hz, 2750Hz is employed.
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B.D of 3 channel telephone trasmitter

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B.D of 3 channel telephone receiver

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TELEMEDICINE
Telemedicine, as the name suggests, is the application of computer
technology and telecommunication to provide health care from one
place to another.

Telemedicine uses information technology to provide timely
treatments to those in need by telecommunication of the necessary
expertise, diagnosis and information among distant located parties.

Physicians, labs and patients can be distant located parties.
Telecommunication enables all parties to interact as they are at one
place, resulting in an improved patient care and management, cost
effectiveness and better utilization of expertise.

Telemedicine includes hardware, software, medical equipment and
communication link.
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Telemedicine supports a range of
applications

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Telemedicine Applications
Telepathology is used to obtain an expert opinion in biopsy reports and
microscopic photos of pathology slides.

Teleradiology is used for telecommunication of radiology images like
radiographs, CT scan, MRI and nuclear medicine from one place to
another for expert interpretation and consultation. The problem faced in
radiology is the vast data associated wit each image and lack of
standardization of data for transmission.

Telecardiology relates to telecommunication of ECG, echo cardiography
and color dopler of patients to experts for advice.

Teleconsultation is used by a hospital or a patient to consult specialist
doctors.

Tele-education can be used for providing medical education to junior
doctors working at smaller towns who are professionally isolated from
teaching hospitals.
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Telemedicine concepts can be:
Store and forward:
In this, information is compiled and stored.
The stored information can be in the form of video images
and clips or laboratory reports.
The information in digital form is stored and forwarded to
experts for interpretation and advice.
The experts can access the same whenever possible and
they can transmit back their advice.

Real time:
In this, real time exchange of information takes place
between two medical professionals or two centers.
The real time information may be in the form of video
conference or it may take place simultaneously with the
examination and imaging of the patient
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Telemedicine system

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TELEMEDICINE TECHNOLOGY
Transmission of medical images:
Includes transmission of X-rays, CT, MRI etc.
These images are first converted into digital form.

Types of diagnostic images used in telemedicine include:
Image stored on traditional film or print media and
converted into digital format by direct imaging or
scanning. CCD(charged coupled devices) and laser
based scanners are used for digitization of images.
Computer generated images (e.g. ultrasound, CT)
which are already in digital format does not require any
further digitization.

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Transmission of video images
Telemedicine applications usually require
video and individual still-frame images for
interactive visual communication and medical
diagnosis.
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Transmission of digital audio
Audio channels are usually provided for diagnostic
instruments such as an electronic stethoscope or
Doppler ultrasound.
To produce heart and lung sounds accurately, an
electronic stethoscope must have a uniform frequency
response from 20Hz to 2kHz, while Doppler ultrasound
requires a uniform frequency response from 100Hz to
10kHz.
Audio use for conversation and medical diagnosis in a
telemedicine system must be digitized and compressed
before it can be combined with digital video and other
information.
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Video conferencing
One of the essential components in a
telemedicine system is the video conferencing
facility, which permits real time transmission
of both audio and video information.
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Digital communication systems
Telemedicine primarily demands a continuous
and reliable communication link for the
exchange of information.
There are various digital communication
services available today for this purpose.
They are POTS (Plain Old Telephone Service),
DDS (Digital data system), ISDN (Integrated
services digital network), ATM (Asynchronous
transfer mode).

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Telemedicine using mobile
communication
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Use of internet resource for
telemedicine
The world wide web (WWW) is an internet
resource through which information producing
sites offer hyper-linked multi-media information
to the general public or in some cases restricted
access to a certain group of people.

Graphical browser programs are specially
designed to access WWW resources and view
their contents in text, graphics images and video.
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THANK YOU
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