3.

BIOTELEMETRY

3.1 INTRODUCTION TO BIOTELEMETRY

Biotelemetry or biomedical telemetry is the measurement of biological parameters over

distance, and transmitting the data from point of generation to the point of reception.
Radio telemetry is the process in which biological data is used to modulate a RF carrier
so as to be radiated by an electromagnetic field (radio transmission).

3.2 PHYSIOLOGICAL PARAMETERS ADAPTABLE TO BIOTELEMETRY

The biotelemetry measurements can be applied to two categories:

1. Bioelectrical variables such as ECG, EMG and EEG. Here the signal is
obtained directly in electrical form.
2. Physiological variables that require transducers such as blood pressure,
gastrointestinal pressure, blood flow and temperatures. It requires excitation because the
physiological parameters are measured as variations of resistance, inductance or capacitance.

Biosignals that can be telemetered:

a. ECG telemetry:
The most widespread use of biotelemetry for bioelectric potentials is in the
transmission of ECG. Instrumentation at the transmitting end is simple because only electrodes
and amplification are needed.
Examples ECG telemetry:
1. Transmission of ECGs from an ambulance or site of emergency to a hospital. A
cardiologist in the hospital, immediately interprets the ECG, instructs emergency resuscitation
procedures to the trained rescue team and arranges for any special treatment that is necessary on
arrival of the patient at the hospital. The telemetry is also supplemented by two-way voice
communication.
2. For exercise ECGs in the hospitals so that the patient can run up and down
steps, unencumbered by wires.
3. The individuals with heart problems can wear ECG telemetry units always and
relay ECG data periodically to the hospital for checking.
4. Monitoring of athletes running a race for improving their performance
5. Human performance laboratories in college campuses.
The actual equipment worn by the subject is comfortable and usually does not impede
movement, since the electrodes are taped into place and the patient wears a belt around the waist
with a pocket for the transmitter. The transmitter is about the size of package of king-size
cigarettes. The wire antenna is incorporated in the belt or hung loosely. The clothing has opening
to allow the lead wires from the electrodes to come through the transmitter. The power for the
transmitter is from a battery usually a mercury cell with useful life of about 30hours.
For cardiovascular research performed with experimental animals, the electrodes are
needle type and animals interfere with equipment. Hence miniature transmitters are surgically
implanted subcutaneously.

b. EEG telemetry:
The applications are
 1. EEG electrodes are implanted in the brain of the chimpanzees in the Space
biology program in the Brain research institute at the University of California, Los Angeles. A
small transmitter installed on the animal’s head, transmits the EEG. Some times instead of this,
special helmets with surface electrodes are used.
2. Special helmets with surface electrodes are also used for collection of EEGs of football
players during the game.
2. For study of mentally disturbed children. The child wears specially designed “football
helmet” or “spaceman’s helmet” with built-in electrodes so that the EEG can be monitored
without traumatic difficulties during play.

c. EMG telemetry:
The third type of bioelectrical signal that can be telemetered is the
electromyogram (EMG). It is used for studies of muscle damage and partial paralysis problems
and human performance studies.

d. Treatment of dropfoot:
Studied under telestimulation

Physiological variables that can be measured using telemetry:

The transducer circuit is designed as a separate “plug-in” module to fit into the
transmitter so that one transmitter is used for different measurements.
a. **Skin or systemic body temperature Temperature by rectal or oral thermistor
b. Respiration by impedance pneumograph
c. Indirect blood pressure by contact microphone and cuff.
d. **Measurement of blood pressure and heart rate research in anaesthetized animals. The
transducers are surgically implanted with leads brought out through the animal’s skin. A male
plug attached to the leads, is connected to the female socket contained in the transmitter unit.
e. **Blood flow measurement using Doppler-type and electromagnetic type transducers.
f. **Monitoring of vaginal temperature for long-term studies of natural birth control in
obstetrics and gynecology
g. Use of radiopills for monitoring stomach pressure or pH. (Studied in detail as separate
topic)

3.3 COMPONENTS OF A BIOTELEMETRY SYSTEM

A radio-frequency (RF) carrier is a high frequency sinusoidal signal which is

propagated in the form of electromagnetic waves when applied to an appropriate transmitting
antenna. The range of the system is the distance for which the transmitted signal can be
received. The range depends on power and frequency of the transmitter, relative locations of the
transmitting and receiving antennas and the sensitivity of the receiver. Modulation is the process
of impressing the information to be transmitted on a carrier.
In continuous wave (CW) transmission, the transmitter is simply turned on and off to
correspond to some code. This cannot be used for transmission of physiological data but is useful
for remote control applications.
In amplitude modulation (AM), the amplitude of the carrier is varied according to the
information being transmitted. It is used in standard radio broadcast (AM) stations and video
(picture) signal for TV. It is more susceptible to natural and man-made electrical interference
because the interferences generally appear as vibrations in the amplitude of the signal.
 In frequency modulation (FM), the frequency of the carrier is varied according to the
information being transmitted. It is used in FM broadcast stations and sound signal for TV. It is
less susceptible to interference because the variations in the amplitude of the received signal
caused by the interference can be removed at the receiver before demodulation. Hence FM
transmission is used for telemetry. FM method consumes more energy than pulse modulation
but has greater range.
The biotelemetry system use two modulators. The physiological signals are used to
modulate a low-frequency carrier called sub-carrier in the audio frequency range. The RF
carrier is then modulated by the sub-carrier and transmitted. The double modulation gives
better interference free performance in transmission and enables the reception of low frequency
biological signals. The sub modulator can be FM or PWM but the final modulator is practically
always FM system.
If several physiological signals are to be transmitted simultaneously, each signal is placed
on a sub-carrier of a different frequency using FM or AM. The sub-carriers are added together to
give a composite signal in which none of the parts overlap in frequency. The composite signal
modulates the RF carrier by the same or different method. This process of transmitting many
channels of data on a single RF carrier is called frequency division multiplexing (FDM). This
is more efficient and less expensive than employing a separate transmitter for each channel.
At the receiver, a multiplexed RF carrier is first demodulated to recover each of the
separate sub-carriers which are then demodulated to retrieve the original physiological signals.
Both FM/AM (sub-carrier is frequency modulated and RF carrier is amplitude modulated) and
FM/FM systems are used in biotelemetry, the later more extensively.
The modulation system is selected based on the size, complexity, noise transmission and
other operational problems.
In pulse modulation the carrier is a series of short bursts or pulses. In PAM, the
amplitude of the pulse is varied according to the transmitted information. In PWM or PDM, the
width of the pulse is varied according to the transmitted information. The pulse duration
modulation has advantages such as lower sensitivity to temperature and battery voltage changes
and its adaptability to miniaturization due to availability of suitable ICs.
In PPM, the timing of a very narrow pulse is varied with respect to a reference pulse.
Most pulse modulated telemetry systems us a sub-carrier as well as RF carrier to achieve better
stability and greater accuracy.
The pulse interval modulation (PIM) and pulse interval ratio modulation (PIRM) are
illustrated in the figure below.
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The time durations are very short, usually in tens of microseconds. Thus sampling
frequency and hence frequency response can be very high. In PIM, the interval between
successive pulses (t1) is proportional to the input signal. It is best suited for acceleration and
biopotentials such as ECG. In PIRM, the ratio of two successive intervals in each sequential pair
of pulses is proportional to the input signal. This system is more complex than PIM but is less
dependent on battery voltage. It is best suited for temperature and pressure.
In time-multiplexing scheme, each of the physiological signal is sampled briefly and used
to control amplitude, width or position of one pulse depending on pulse modulation used. The
pulses representing the various channels of data are transmitted sequentially. Thus in a size-
channel system every sixth data pulse represents a channel. A reference pulse is included in each
set for identifying the data pulses. If the sampling rate is several times the highest frequency
component of each data signal, no loss of information occurs.
A biotelemetry system has transmitter for generating the carrier and modulating it and
receiver for receiving the transmitted signal and demodulating it to recover the information. The
physiological signals are obtained from the subject through appropriate transducers. The signal is
then passed through an amplifier, processor for generation of sub-carrier and modulator.
323,324crom

The receiver has a tuner to select the transmitting frequency, a demodulator to separate
the signal from the carrier wave and units for displaying or recording the signals. The signal is
stored in the tape recorder in modulated stage.

Blood pressure telemetry:

The blood pressure monitoring system uses FM/FM method. An exciter (Colpitts
transistor oscillator and RC coupled CE amplifier stage) excites a flush diaphragm type of
strain-gauge transducer bridge, with a constant ac voltage of frequency 5KHz inductively. The
bridge is balanced so that any change in resistance of the bridge due to the changes in pressure
on the transducer, changes the output voltage. This output voltage is coupled inductively to an
amplifier (CE amplifier stage and RC coupled class C amplifier).
328crom

The output of the class C amplifier is rectified and filtered and given to a FM sub-carrier
oscillator (UJT oscillator) for controlling the frequency of the audio sub-carrier. The sub-carrier
frequency range of 1 to 2KHz represents the range of 0 to 300mmHg (0 to 40kPa) pressure. The
modulated sub-carrier is then used to frequency modulate the main RF carrier. The carrier is
transmitted at low power on a frequency band specially designated for biotelemetry.
The transmitted signal is picked up by the receiver. The sub-carrier is removed from the
RF carrier and then demodulated to obtain the original data waveform. The signal is then
displayed or recorded on a chart.

PWM telemetry system:

The figure shows the block diagram of a biolink PWM transmitting system. It transmits
four channels of physiological data, simultaneously.
The sync pulse turns ON the first channel ring modulator or one-shot multivibrator. It
remains in the ON state for a time period t1 based on the level of physiological data fed into it at
that instant of time, so that its output pulse has time period t1. When the multivibrator is turned
OFF, it triggers the second channel multivibrator and so on down the line. Thus the outputs of
the four multivibrators are square signal pulses of time periods t1 – t4 and the position of each
pulse with respect to its neighbors is proportional to the corresponding physiological data.
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 The mixing network differentiates the square pulses, clips the positive part to obtain
negative pulses and forms a composite signal of positive synchronizing pulse and a series of
negative signal pulses. The FM transmitter transmits the composite signal.
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The figure shows the block diagram of a biolink PWM receiving system. The
synchronizing and signal pulses are separated. The synchronizing pulse is sent only to the first
channel flip flop while the signal pulses are sent to all channels flip flops. The synchronizing
pulse turns ON the first flip flop and the first signal pulse turns OFF the first flip flop. Thus the
width of the square wave output of the first flip-flop is same as the width (t1) of the first signal
pulse.
The second flip flop is turned ON when the first flip flop is OFF, and is turned OFF by
the subsequent signal pulse and so on down the line. The width of the square wave output of
each of the four flip-flops is equal to that of the corresponding signal pulse. The square wave
outputs are integrated to obtain the four physiological data.

Single channel telemetry system:

Under this we will study about ECG telemetry system and Temperature telemetry system.

ECG telemetry system: (khandpur)

The figure 3.4 shows the block diagram of a single channel telemetry system suitable for
transmission of ECG. There are two main parts - telemetry transmitter and telemetry receiver.

Fig 3.4
288khand

For distortion-free transmission of ECG for following requirements must be met.

1. The subject should be able to carry on with his normal activities while carrying
the instruments, without discomfort.
2. Motion artifacts and muscle potential interference should be minimum.
3. Long battery life.
4. ECG amplifiers in transmitters must have limited slew rate in order to reduce
the amplitude of artificial pacemaker pulses which are narrow pulses.
ECG telemetry systems operate in the 450 – 470MHz band. The circuit details of an ECG
telemetry system are described below.
The figure 3.5 shows the block diagram of ECG telemetry transmitter.

Fig 3.5
289khand

The ECG amplifier amplifies the ECG signal picked up by three pre-gelled electrodes
attached to the patient’s chest. The amplified signal modulates a 1KHz sub-carrier in a sub-
carrier oscillator (current controlled multivibrator) such that the deviation is + 320Hz from the
1KHz center frequency, for +5mV ECG signal respectively. The sub-carrier filter removes
square wave harmonics. The filtered signal is used to frequency modulate the 115MHz RF
carrier generated in the voltage controlled crystal oscillator.
The modulated signal is passed through two frequency doubler stages (class C transistor
doubler and series connected step recovery diode doubler). The signal is then transmitted through
RL electrode which also acts as antenna. The operating range is 60m if output power is 2mW.
The figure 3.6 shows the block diagram of the high frequency section of ECG telemetry
receiver.

Fig. 3.6
290khand

An omnidirectional antenna receives the transmitted signal. The RF amplifier provides

low noise figure, RF filtering and image frequency rejection. The mixer reduces interference
problems. The 8-pole crystal filter determines the receiver selectivity. The IF amplifier amplifies
the filter output. The AGC amplifier which reduces the mixer gain under strong signal conditions
to avoid overloading at the IF stages.
A quadrature detector demodulates the obtained signal and outputs the 1KHz sub-carrier.
The AFC circuit averages this output and feeds back it to the local oscillator for frequency
control. The 1KHz sub-carrier is demodulated to recover the original ECG waveform. The ECG
is then passed to a low pass filter having cut-off frequency 50Hz and then given to a monitoring
instrument.
The figure 3.7 shows the schematic diagram of ECG demodulation and “inoperate”
circuits in ECG telemetry receiver.

Fig. 3.7
291khand

If any of the electrodes fail, the frequency of the multi-vibrator in the transmitter shifts by
about 400Hz. This is sensed in the receiver and “electrode inoperative” alarm is turned ON. The
“inoperative” alarm lamp lights up if the amplitude of the 1kHz sub-carrier is not within preset
level i.e. it is satisfactory and valid signal is not received.

Temperature telemetry system:

The direct current outputs from temperature, pressure and other similar transducers are
conveyed as modulation of the mark/space ratio of a square wave. The figure 3.8 shows the
circuit diagram of a temperature telemetry system based on this principle.
Fig. 3.8
292khand

A thermistor having a resistance of 100ohms at 20˚C senses the temperature. A

multivibrator circuit (T1,T2) is timed by the thermistor, R1+R2 and C1. A 200Hz square wave
output by the multivibrator, is fed to the variable capacitance diode D2 in the tuned circuit of a
RF oscillator formed by T3. The value of R1 is adjusted to give 1:1 mark/space ratio at the
midscale temperature (35 - 41˚C). The mark/space ratio is changed by about 20% over a
temperature range of 5˚C. T4 is an untuned buffer stage between the oscillator and aerial.
On the receiver side, a vertical dipole aerial feeds a FM tuner. The 200Hz square wave
output by the tuner is fed to the demodulator.
 Multichannel wireless telemetry systems

Multichannel telemetry system is used for simultaneous transmission of several

parameters e.g. ECG, heart rate, respiration rate, temperature, intravascular and intra-cardiac
blood pressure.
PWM is better suited for multi-channel biotelemetry systems because they are insensitive
to carrier frequency shifts and have high noise immunity.
The FM/FM system cannot be used though they have advantages such as low power
consumption and high baseline stability, because
1. High cost because they use separate sub-carrier frequency for each data
channel.
2. They are affected by interference between different channels. Hence complex
and expensive filters are required.
The pulse-position amplitude modulation has synchronization problems caused by noise
and thus information loss occurs.
For multi-channel radio telemetry, various channels of information are combined into a
single signal by a technique called multiplexing. There are two basic methods fo multiplexing.
These are FDM and TDM. (already discussed).
318aru

PWM transmitting system:

Discussed earlier

Telemetry of ECG and respiration:

The figure shows the schematic diagram of FM-FM modulated radio telemetry
transmitter for detecting and transmitting ECG and respiration activity simultaneously on a
single carrier frequency. Same pair of electrodes E1 and E2 is used for detecting respiration and
ECG.

294khand

The amplifier A1 amplifies the respiration and ECG signal from the electrodes. The
amplifier filter A3 recovers the respiration signal and low-pass Butterworth filter A2 recovers the
ECG signal. The summer A4 sums the amplified ECG signal and the preprocessed respiration
signal, to generate composite signal. The composite signal modulates the subcarrier which then
modulates a RF carrier for transmission.

3.4 IMPLANTABLE UNITS or IMPLANTABLE TELEMETRY SYSTEMS

The transducers are implanted surgically in the position required for a particular
measurement such as in the aorta or other artery for blood pressure. The figure shows a typical
pressure transducer implantation in a dog. The transmitters and power units have to be placed in
a suitable body cavity close to the under surface of the skin and situated so that they give no
physical or psychological disturbance to the animal.
149crom
 In partial implantation systems, the lead from the transducer is brought out through the
dog’s back and connected to a telemetry transmitter which is kept in a pocket of the jacket worn
by the dog. The jacket is made of strong nylon mesh so that it is comfortable, permits air
circulation and not easily bitten by the do.

Implantable telemetry system for blood pressure and Blood flow:

Electromagnetic blood flow meter is suitable for implant purposes since they consume a
lot of power and give rise to baseline shift. Hence ultrasonic Doppler shift principle is the most
widely used technique for implantable blood flow meter.
The figure shows the block diagram of an implantable blood flow meter based on
ultrasonic Doppler shift principle.

298khand

Two ultrasonic transducers are mounted in a rigid cuff surrounding the vessel. One of the
transducers is drive n by a 6MHz oscillator and the other transducer receives the scattered energy
with shifted frequency. The 6MHz AM receiver converts the incoming ultrasonic signal to audio
frequency signal by synchronous detection. The demodulater estimates flow from Doppler shift
frequency.
Radar et al describes a miniature totally implantable FM/FM telemetry system to
simultaneously measure blood pressure and blood flow. The pressure is detected by a miniature
intravascular transducer comprising four semiconductor strain gauges bonded to the inner
surface of a small pressure sensing diaphragm. The blood flow is sensed by an extravascular
interferometric ultrasonic technique.

Power sources used:

Mercury and silver-oxide primary batteries, lithium battery are used. The implantable
telemetry batteries vary in size and electrical capacity depending on the application. They can
range from electrical capacity of 20mA-hr with a weight of 0.28gm and volume of 0.05cm3 to
1000mA-hr with weights of the order of 12gms and 3.2cm3.

Advantages:
The implantable telemetry systems allow the measurement of physiological variables
over long periods of time without any attachment of wires or sensors on body surface.

Disadvantages:
1. The telemetry transmitters have to be made as small as possible; at the same time they
must be reliable. This is possible by using transmitters in thin film circuits.
2. The weight and size of batteries must be minimal and operating life must be maximal.
The energy consumption is minimized by using micro-power operational amplifiers and CMOS
components for multiplexing, tuning and switching operations in multi-channel telemetry
systems, reducing the transmitter energy consumption and turning ON the transmitter only when
required.
3. The risk associated with surgery.
4. Once the unit is implanted it cannot be serviced and the life of the unit depends on how
long the battery can supply the necessary current.
 5. The distance of signal transmission is restricted because the body fluids and skin
attenuate the signal and the unit has low power as it is small. This is avoided by picking the
signal with a nearby antenna and retransmitting it.
6. The leakage of body fluids into equipment or chemical effects of the equipment on
body tissues result in malfunction or infection respectively. Hence, the outer case and wiring
must be impervious to the body fluids and moisture. This is achieved using plastic potting
compounds, plastic materials and silicon encapsulation.

Applications:
Single or multi-channel implantable systems are used to monitor ECG, EEG, blood
pressure, blood flow, temperature.
For study of effect of the hormone norepinephrine on blood pressure of dog.

3.5 TRANSMISSION OF ANALOG PHYSIOLOGICAL SIGNALS

OVER TELEPHONE

The physiological signals e.g. ECG can be sent through telephone lines. A telephone
telemetry technique for transmitting and receiving medical signals is shown below.
300khand

Multichannel patient monitoring telephone telemetry system:

The figure shows the block diagram of the three channel telephone transmitter. The
physiological signals are amplified. The three physiological signals frequency modulate three
different VCOs with center frequencies 750Hz, 1750Hz and 2750Hz. The three channels of data
are combined using FDM.

302khand

The figure shows the block diagram of the three channel telephone receiver. The
multiplexed signals are filtered using second order low pass filter. The three band-reject notch
filters are used for separating the frequencies 750Hz, 1750Hz and 2750Hz. The PLLs are used as
frequency demodulator. The low pass filter removes the carrier ripple noise.

302khand

3.6 APPLICATIONS OF TELEMETRY IN PATIENT CARE

1. Telemetry of ECGs from extended coronary care patients:

It is used for observing rhythm disturbances of cardiac patients for a period of time
following intensive coronary care. Each patent has ECG electrodes taped securely to his chest.
The electrodes are connected to a small transmitter unit fastened to a special belt worn around
the patient’s waist. The batteries are also included in the transmitter package.
 The area in which the patients are allowed to move must be limited because the location
of the patient cannot be identified. If the patient moves beyond the range of the system his ECG
cannot be monitored.

2. Telemetry for ECG measurements during exercise:

Telemetry can be used for patient monitoring where free movement is desired e.g. while
obtaining ECG while the patient is exercising on a treadmill or set of steps for diagnosis of
cardiac abnormalities such as ischemic coronary artery disease. If wired connection is used they
may interfere with the performance of the patient.
The transmitter unit used for this purpose is similar to that of the extended coronary care.
The receiver and other equipments for conditioning and playing the signals received from the
exercising patient are located very near the patient. Thus the transmitter can operate with low
power.
The electrodes and all wires must be securely fastened to the patient to prevent their
movement because it results in artifacts on the ECG tracing.

3. Telemetry for emergency patient monitoring:

Telemetry can also be used for patient monitoring and collection of medical data in
ambulance, emergency site and locations e.g. office or home away from hospital and transmitting
them to a hospital.
A cardiologist in the hospital, immediately interprets the ECG, instructs emergency
resuscitation procedures to the trained rescue team and arranges for any special treatment that is
necessary on arrival of the patient at the hospital. The telemetry is also supplemented by two-
way voice communication to provide instructions for treatment e.g. defibrillation. Hence
treatment can begun before the patient arrives at the hospital.
The transmitter used for this application must be powerful than the two applications
previously described because the data must be transmitted many miles or from a moving vehicle.
Also they must be capable of reliable reception and reproduction of transmitted signals
regardless of conditions.
If the emergency team is working in location where it is not possible to maintain direct
communication with the hospital, retransmission is used. Here the physiological information is
transmitted from a portable transmitter to a receiver in their vehicle. The vehicle which has more
powerful transmitter and better antenna system, retransmits the data to the hospital.

4. For monitoring astronauts in space.

5. Research on unrestrained anaesthetized animals in their natural habitat.
6. For special internal techniques such as tracing acidity or pressure through the gastrointestinal
tract.
7. Isolation of electrically susceptible patient from power-line operated ECG equibment to
protect him from accidental shock.
8. Physiological signals can be obtained from swimmers, riders, athletes, pilot or manual
labourers.

ADVANTAGES OF MODERN TELEMETRY

Advantages of wireless telemetry:

 1. Permits examination of physiological data of man or animal under normal conditions
and in natural surroundings without any discomfort or obstruction to the person or animal under
investigation. Hence factors influencing healthy and sick persons during the performance of their
daily tasks may thus be easily recognized and evaluated.
2. Allows study of active subjects.
3. Convenient for continuous monitoring of patient during transportation of patient.
4. Elimination of wires.
5. For detection of causes of symptoms such as pain and aches that give trouble for days
but disappears during medical examination. With telemetry and long-term monitoring, the cause
of these symptoms can be detected when they occur of analyzed later by recording them on
magnetic tape.

If analog signal such as ECG is converted into digital form before modulation, they can
be used in conjunction with computers.

Disadvantages of long term monitoring by telemetry:

Large amount of data is generated. The data can be recorded on tape and played back at a
higher speed that that at which data are recorded. Thus an hour’s data can be played back in half
minute. This rapid playback technique is effective only the observer is looking for a specific
voltage amplitude or frequency. When a discrimination circuit senses a certain voltage amplitude
or frequency, a light or sound is activated. The observer then stops the machine and records the
only the vital segment of the data on the paper.

Disadvantages of telemetry:
1. The signal is lost or of poor quality when patient with the telemetry transmitter moves
in area with concrete wall or conductive material because they are hinder, block or reflect the
radio waves.
2. Reception gets affected by RF wave effects that result in poor reception areas or null
spots under some patient location and carrier frequency.
3. Cross-talk or interference between telemetry channels. It can be minimized by careful
selection of transmitter frequencies, use of a suitable antenna system and by equipment design.
4. Problems caused by patient movement and interference from electrical equipment and
other radio systems.

CHOICE OF RADIO CARRIER FREQUENCY

The radio frequencies normally used for medical telemetry purposes are of the order of
37, 102, 153, 159, 220 and 450 MHz. In USA, two frequency bands (174-216MHz and 450-
470MHz) are used.