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The Biomedical Engineering Handbook
Third Edition

Medical Devices
and Systems
Bronz: “2122_c000” — 2006/2/24 — 11:31 — page ii — #2
The Electrical Engineering Handbook Series
Series Editor
Richard C. Dorf
University of California, Davis

Titles Included in the Series

The Handbook of Ad Hoc Wireless Networks, Mohammad Ilyas
The Avionics Handbook, Cary R. Spitzer
The Biomedical Engineering Handbook, Third Edition, Joseph D. Bronzino
The Circuits and Filters Handbook, Second Edition, Wai-Kai Chen
The Communications Handbook, Second Edition, Jerry Gibson
The Computer Engineering Handbook, Vojin G. Oklobdzija
The Control Handbook, William S. Levine
The CRC Handbook of Engineering Tables, Richard C. Dorf
The Digital Signal Processing Handbook, Vijay K. Madisetti and Douglas Williams
The Electrical Engineering Handbook, Third Edition, Richard C. Dorf
The Electric Power Engineering Handbook, Leo L. Grigsby
The Electronics Handbook, Second Edition, Jerry C. Whitaker
The Engineering Handbook, Third Edition, Richard C. Dorf
The Handbook of Formulas and Tables for Signal Processing, Alexander D. Poularikas
The Handbook of Nanoscience, Engineering, and Technology, William A. Goddard, III,
Donald W. Brenner, Sergey E. Lyshevski, and Gerald J. Iafrate
The Handbook of Optical Communication Networks, Mohammad Ilyas and
Hussein T. Mouftah
The Industrial Electronics Handbook, J. David Irwin
The Measurement, Instrumentation, and Sensors Handbook, John G. Webster
The Mechanical Systems Design Handbook, Osita D.I. Nwokah and Yidirim Hurmuzlu
The Mechatronics Handbook, Robert H. Bishop
The Mobile Communications Handbook, Second Edition, Jerry D. Gibson
The Ocean Engineering Handbook, Ferial El-Hawary
The RF and Microwave Handbook, Mike Golio
The Technology Management Handbook, Richard C. Dorf
The Transforms and Applications Handbook, Second Edition, Alexander D. Poularikas
The VLSI Handbook, Wai-Kai Chen
The Biomedical Engineering Handbook
Third Edition
Edited by
Joseph D. Bronzino

Biomedical Engineering Fundamentals

Medical Devices and Systems

Tissue Engineering and Artificial Organs

The Biomedical Engineering Handbook
Third Edition

Medical Devices
and Systems

Edited by
Joseph D. Bronzino
Trinity College
Hartford, Connecticut, U.S.A.

Boca Raton London New York

A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
2122_Discl.fm Page 1 Wednesday, December 14, 2005 4:52 PM

Published in 2006 by
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2006 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group

No claim to original U.S. Government works

Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1

International Standard Book Number-10: 0-8493-2122-0 (Hardcover)

International Standard Book Number-13: 978-0-8493-2122-1 (Hardcover)
Library of Congress Card Number 2005056892

This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with
permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish
reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials
or for the consequences of their use.

No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or
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storage or retrieval system, without written permission from the publishers.

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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
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Library of Congress Cataloging-in-Publication Data

Medical devices and systems / edited by Joseph D. Bronzino.

p. cm. -- (The electrical engineering handbook series)
Includes bibliographical references and index.
ISBN 0-8493-2122-0
1. Medical instruments and apparatus--Handbooks, manuals, etc. I. Bronzino, Joseph D., 1937- II.
Title. III. Series.

R856.15.B76 2006
610.28--dc22 2005056892

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Taylor & Francis Group and the CRC Press Web site at
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 Introduction and Preface

During the past five years since the publication of the Second Edition — a two-volume set — of the
Biomedical Engineering Handbook, the field of biomedical engineering has continued to evolve and expand.
As a result, this Third Edition consists of a three volume set, which has been significantly modified to
reflect the state-of-the-field knowledge and applications in this important discipline. More specifically,
this Third Edition contains a number of completely new sections, including:

• Molecular Biology
• Bionanotechnology
• Bioinformatics
• Neuroengineering
• Infrared Imaging

as well as a new section on ethics.

In addition, all of the sections that have appeared in the first and second editions have been significantly
revised. Therefore, this Third Edition presents an excellent summary of the status of knowledge and
activities of biomedical engineers in the beginning of the 21st century.
As such, it can serve as an excellent reference for individuals interested not only in a review of funda-
mental physiology, but also in quickly being brought up to speed in certain areas of biomedical engineering
research. It can serve as an excellent textbook for students in areas where traditional textbooks have not
yet been developed and as an excellent review of the major areas of activity in each biomedical engineering
subdiscipline, such as biomechanics, biomaterials, bioinstrumentation, medical imaging, etc. Finally, it
can serve as the “bible” for practicing biomedical engineering professionals by covering such topics as a his-
torical perspective of medical technology, the role of professional societies, the ethical issues associated
with medical technology, and the FDA process.
Biomedical engineering is now an important vital interdisciplinary field. Biomedical engineers are
involved in virtually all aspects of developing new medical technology. They are involved in the design,
development, and utilization of materials, devices (such as pacemakers, lithotripsy, etc.) and techniques
(such as signal processing, artificial intelligence, etc.) for clinical research and use; and serve as members
of the health care delivery team (clinical engineering, medical informatics, rehabilitation engineering,
etc.) seeking new solutions for difficult health care problems confronting our society. To meet the needs
of this diverse body of biomedical engineers, this handbook provides a central core of knowledge in those
fields encompassed by the discipline. However, before presenting this detailed information, it is important
to provide a sense of the evolution of the modern health care system and identify the diverse activities
biomedical engineers perform to assist in the diagnosis and treatment of patients.

Evolution of the Modern Health Care System

Before 1900, medicine had little to offer the average citizen, since its resources consisted mainly of
the physician, his education, and his “little black bag.” In general, physicians seemed to be in short

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supply, but the shortage had rather different causes than the current crisis in the availability of health
care professionals. Although the costs of obtaining medical training were relatively low, the demand for
doctors’ services also was very small, since many of the services provided by the physician also could be
obtained from experienced amateurs in the community. The home was typically the site for treatment
and recuperation, and relatives and neighbors constituted an able and willing nursing staff. Babies were
delivered by midwives, and those illnesses not cured by home remedies were left to run their natural,
albeit frequently fatal, course. The contrast with contemporary health care practices, in which specialized
physicians and nurses located within the hospital provide critical diagnostic and treatment services, is
dramatic.
The changes that have occurred within medical science originated in the rapid developments that took
place in the applied sciences (chemistry, physics, engineering, microbiology, physiology, pharmacology,
etc.) at the turn of the century. This process of development was characterized by intense interdis-
ciplinary cross-fertilization, which provided an environment in which medical research was able to
take giant strides in developing techniques for the diagnosis and treatment of disease. For example,
in 1903, Willem Einthoven, a Dutch physiologist, devised the first electrocardiograph to measure the
electrical activity of the heart. In applying discoveries in the physical sciences to the analysis of the
biologic process, he initiated a new age in both cardiovascular medicine and electrical measurement
techniques.
New discoveries in medical sciences followed one another like intermediates in a chain reaction. How-
ever, the most significant innovation for clinical medicine was the development of x-rays. These “new
kinds of rays,” as their discoverer W.K. Roentgen described them in 1895, opened the “inner man” to
medical inspection. Initially, x-rays were used to diagnose bone fractures and dislocations, and in the pro-
cess, x-ray machines became commonplace in most urban hospitals. Separate departments of radiology
were established, and their influence spread to other departments throughout the hospital. By the 1930s,
x-ray visualization of practically all organ systems of the body had been made possible through the use of
barium salts and a wide variety of radiopaque materials.
X-ray technology gave physicians a powerful tool that, for the first time, permitted accurate diagnosis
of a wide variety of diseases and injuries. Moreover, since x-ray machines were too cumbersome and
expensive for local doctors and clinics, they had to be placed in health care centers or hospitals. Once
there, x-ray technology essentially triggered the transformation of the hospital from a passive receptacle
for the sick to an active curative institution for all members of society.
For economic reasons, the centralization of health care services became essential because of many other
important technological innovations appearing on the medical scene. However, hospitals remained insti-
tutions to dread, and it was not until the introduction of sulfanilamide in the mid-1930s and penicillin in
the early 1940s that the main danger of hospitalization, that is, cross-infection among patients, was signi-
ficantly reduced. With these new drugs in their arsenals, surgeons were able to perform their operations
without prohibitive morbidity and mortality due to infection. Furthermore, even though the different
blood groups and their incompatibility were discovered in 1900 and sodium citrate was used in 1913 to
prevent clotting, full development of blood banks was not practical until the 1930s, when technology
provided adequate refrigeration. Until that time, “fresh” donors were bled and the blood transfused while
it was still warm.
Once these surgical suites were established, the employment of specifically designed pieces of med-
ical technology assisted in further advancing the development of complex surgical procedures. For
example, the Drinker respirator was introduced in 1927 and the first heart-lung bypass in 1939. By
the 1940s, medical procedures heavily dependent on medical technology, such as cardiac catheterization
and angiography (the use of a cannula threaded through an arm vein and into the heart with the injection
of radiopaque dye) for the x-ray visualization of congenital and acquired heart disease (mainly valve
disorders due to rheumatic fever) became possible, and a new era of cardiac and vascular surgery was
established.
Following World War II, technological advances were spurred on by efforts to develop superior weapon
systems and establish habitats in space and on the ocean floor. As a by-product of these efforts, the

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development of medical devices accelerated and the medical profession benefited greatly from this rapid
surge of technological finds. Consider the following examples:
1. Advances in solid-state electronics made it possible to map the subtle behavior of the fundamental
unit of the central nervous system — the neuron — as well as to monitor the various physiological
parameters, such as the electrocardiogram, of patients in intensive care units.
2. New prosthetic devices became a goal of engineers involved in providing the disabled with tools to
improve their quality of life.
3. Nuclear medicine — an outgrowth of the atomic age — emerged as a powerful and effective
approach in detecting and treating specific physiologic abnormalities.
4. Diagnostic ultrasound based on sonar technology became so widely accepted that ultrasonic studies
are now part of the routine diagnostic workup in many medical specialties.
5. “Spare parts” surgery also became commonplace. Technologists were encouraged to provide
cardiac assist devices, such as artificial heart valves and artificial blood vessels, and the artifi-
cial heart program was launched to develop a replacement for a defective or diseased human
heart.
6. Advances in materials have made the development of disposable medical devices, such as needles
and thermometers, as well as implantable drug delivery systems, a reality.
7. Computers similar to those developed to control the flight plans of the Apollo capsule were used
to store, process, and cross-check medical records, to monitor patient status in intensive care units,
and to provide sophisticated statistical diagnoses of potential diseases correlated with specific sets
of patient symptoms.
8. Development of the first computer-based medical instrument, the computerized axial tomography
scanner, revolutionized clinical approaches to noninvasive diagnostic imaging procedures, which
now include magnetic resonance imaging and positron emission tomography as well.
9. A wide variety of new cardiovascular technologies including implantable defibrillators and
chemically treated stents were developed.
10. Neuronal pacing systems were used to detect and prevent epileptic seizures.
11. Artificial organs and tissue have been created.
12. The completion of the genome project has stimulated the search for new biological markers and
personalized medicine.
The impact of these discoveries and many others has been profound. The health care system of today
consists of technologically sophisticated clinical staff operating primarily in modern hospitals designed
to accommodate the new medical technology. This evolutionary process continues, with advances in the
physical sciences such as materials and nanotechnology, and in the life sciences such as molecular biology,
the genome project and artificial organs. These advances have altered and will continue to alter the very
nature of the health care delivery system itself.

Biomedical Engineering: A Definition

Bioengineering is usually defined as a basic research-oriented activity closely related to biotechnology and
genetic engineering, that is, the modification of animal or plant cells, or parts of cells, to improve plants
or animals or to develop new microorganisms for beneficial ends. In the food industry, for example, this
has meant the improvement of strains of yeast for fermentation. In agriculture, bioengineers may be
concerned with the improvement of crop yields by treatment of plants with organisms to reduce frost
damage. It is clear that bioengineers of the future will have a tremendous impact on the qualities of
human life. The potential of this specialty is difficult to imagine. Consider the following activities of
bioengineers:
• Development of improved species of plants and animals for food production
• Invention of new medical diagnostic tests for diseases

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 The world of biomedical engineering
Biomechanics

Medical & Prosthetic devices

biological analysis & artificial organs

Biosensors Medical imaging

Clinical Biomaterials
engineering

Biotechnology
Medical &
bioinformatics Tissue engineering

Rehabilitation Neural
engineering engineering

Physiological Biomedical
modeling instrumentation

Bionanotechnology

FIGURE 1 The World of Biomedical Engineering.

• Production of synthetic vaccines from clone cells

• Bioenvironmental engineering to protect human, animal, and plant life from toxicants and
pollutants
• Study of protein–surface interactions
• Modeling of the growth kinetics of yeast and hybridoma cells
• Research in immobilized enzyme technology
• Development of therapeutic proteins and monoclonal antibodies

Biomedical engineers, on the other hand, apply electrical, mechanical, chemical, optical, and other
engineering principles to understand, modify, or control biologic (i.e., human and animal) systems, as
well as design and manufacture products that can monitor physiologic functions and assist in the diagnosis
and treatment of patients. When biomedical engineers work within a hospital or clinic, they are more
properly called clinical engineers.

Activities of Biomedical Engineers

The breadth of activity of biomedical engineers is now significant. The field has moved from being
concerned primarily with the development of medical instruments in the 1950s and 1960s to include a
more wide-ranging set of activities. As illustrated below, the field of biomedical engineering now includes
many new career areas (see Figure 1), each of which is presented in this handbook. These areas include:

• Application of engineering system analysis (physiologic modeling, simulation, and control) to

biologic problems
• Detection, measurement, and monitoring of physiologic signals (i.e., biosensors and biomedical
instrumentation)
• Diagnostic interpretation via signal-processing techniques of bioelectric data
• Therapeutic and rehabilitation procedures and devices (rehabilitation engineering)
• Devices for replacement or augmentation of bodily functions (artificial organs)

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 • Computer analysis of patient-related data and clinical decision making (i.e., medical informatics
and artificial intelligence)
• Medical imaging, that is, the graphic display of anatomic detail or physiologic function
• The creation of new biologic products (i.e., biotechnology and tissue engineering)
• The development of new materials to be used within the body (biomaterials)
Typical pursuits of biomedical engineers, therefore, include:
• Research in new materials for implanted artificial organs
• Development of new diagnostic instruments for blood analysis
• Computer modeling of the function of the human heart
• Writing software for analysis of medical research data
• Analysis of medical device hazards for safety and efficacy
• Development of new diagnostic imaging systems
• Design of telemetry systems for patient monitoring
• Design of biomedical sensors for measurement of human physiologic systems variables
• Development of expert systems for diagnosis of disease
• Design of closed-loop control systems for drug administration
• Modeling of the physiological systems of the human body
• Design of instrumentation for sports medicine
• Development of new dental materials
• Design of communication aids for the handicapped
• Study of pulmonary fluid dynamics
• Study of the biomechanics of the human body
• Development of material to be used as replacement for human skin
Biomedical engineering, then, is an interdisciplinary branch of engineering that ranges from theoretical,
nonexperimental undertakings to state-of-the-art applications. It can encompass research, development,
implementation, and operation. Accordingly, like medical practice itself, it is unlikely that any single
person can acquire expertise that encompasses the entire field. Yet, because of the interdisciplinary nature
of this activity, there is considerable interplay and overlapping of interest and effort between them.
For example, biomedical engineers engaged in the development of biosensors may interact with those
interested in prosthetic devices to develop a means to detect and use the same bioelectric signal to power
a prosthetic device. Those engaged in automating the clinical chemistry laboratory may collaborate with
those developing expert systems to assist clinicians in making decisions based on specific laboratory data.
The possibilities are endless.
Perhaps a greater potential benefit occurring from the use of biomedical engineering is identification
of the problems and needs of our present health care system that can be solved using existing engineering
technology and systems methodology. Consequently, the field of biomedical engineering offers hope in
the continuing battle to provide high-quality care at a reasonable cost. If properly directed toward solving
problems related to preventive medical approaches, ambulatory care services, and the like, biomedical
engineers can provide the tools and techniques to make our health care system more effective and efficient;
and in the process, improve the quality of life for all.

Joseph D. Bronzino
Editor-in-Chief

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Bronz: “2122_c000” — 2006/2/24 — 11:31 — page x — #10
 Editor-in-Chief

Joseph D. Bronzino received the B.S.E.E. degree from Worcester Polytechnic Institute, Worcester, MA,
in 1959, the M.S.E.E. degree from the Naval Postgraduate School, Monterey, CA, in 1961, and the Ph.D.
degree in electrical engineering from Worcester Polytechnic Institute in 1968. He is presently the Vernon
Roosa Professor of Applied Science, an endowed chair at Trinity College, Hartford, CT and President
of the Biomedical Engineering Alliance and Consortium (BEACON) which is a nonprofit organization
consisting of academic and medical institutions as well as corporations dedicated to the development and
commercialization of new medical technologies (for details visit www.beaconalliance.org).
He is the author of over 200 articles and 11 books including the following: Technology for Patient
Care (C.V. Mosby, 1977), Computer Applications for Patient Care (Addison-Wesley, 1982), Biomedical
Engineering: Basic Concepts and Instrumentation (PWS Publishing Co., 1986), Expert Systems: Basic Con-
cepts (Research Foundation of State University of New York, 1989), Medical Technology and Society: An
Interdisciplinary Perspective (MIT Press and McGraw-Hill, 1990), Management of Medical Technology (But-
terworth/Heinemann, 1992), The Biomedical Engineering Handbook (CRC Press, 1st ed., 1995; 2nd ed.,
2000; Taylor & Francis, 3rd ed., 2005), Introduction to Biomedical Engineering (Academic Press, 1st ed.,
1999; 2nd ed., 2005).
Dr. Bronzino is a fellow of IEEE and the American Institute of Medical and Biological Engineering
(AIMBE), an honorary member of the Italian Society of Experimental Biology, past chairman of the
Biomedical Engineering Division of the American Society for Engineering Education (ASEE), a charter
member and presently vice president of the Connecticut Academy of Science and Engineering (CASE),
a charter member of the American College of Clinical Engineering (ACCE) and the Association for the
Advancement of Medical Instrumentation (AAMI), past president of the IEEE-Engineering in Medicine
and Biology Society (EMBS), past chairman of the IEEE Health Care Engineering Policy Committee
(HCEPC), past chairman of the IEEE Technical Policy Council in Washington, DC, and presently Editor-
in-Chief of Elsevier’s BME Book Series and Taylor & Francis’ Biomedical Engineering Handbook.
Dr. Bronzino is also the recipient of the Millennium Award from IEEE/EMBS in 2000 and the Goddard
Award from Worcester Polytechnic Institute for Professional Achievement in June 2004.

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Bronz: “2122_c000” — 2006/2/24 — 11:31 — page xii — #12
 Contributors

Joseph Adam Raymond Balcerak G. Faye Boudreaux-Bartels

Premise Development Defense Advanced Research University of Rhode Island
Corporation Projects Agency Kingston, Rhode Island
Hartford, Connecticut Arlington, Virginia
Bruce R. Bowman
D.C. Barber EdenTec Corporation
P.D. Ahlgren
University of Sheffield Eden Prairie, Minnesota
Ville Marie Multidisciplinary
Sheffield, United Kingdom
Breast and Oncology Center Joseph D. Bronzino
St. Mary’s Hospital Khosrow Behbehani Trinity College
McGill University The University of Texas at Biomedical Engineering Alliance
Montreal, Quebec, Canada Arlington and Consortium (BEACON)
and Arlington, Texas Harford, Connecticut
London Cancer Centre and
London, Ontario The University of Texas Mark E. Bruley
Canada Southwestern Medical Center ECRI
Dallas, Texas Plymouth Meeting, Pennsylvania
William C. Amalu Richard P. Buck
N. Belliveau
Pacific Chiropractic and
Ville Marie Multidisciplinary University of North Carolina
Research Center
Breast and Oncology Center Chapel Hill, North Carolina
Redwood City, California
St. Mary’s Hospital
McGill University
P. Buddharaju
Kurt Ammer Montreal, Quebec, Canada Department of Computer Science
Ludwig Boltzmann Research and University of Houston
Institute for Physical London Cancer Centre Houston, Texas
Diagnostics London, Ontario, Canada
Vienna, Austria Thomas F. Budinger
and Anna M. Bianchi University of California-Berkeley
Medical Imaging Research Group St. Raffaele Hospital Berkeley, California
School of Computing Milan, Italy
Robert D. Butterfield
University of Glamorgan
Carol J. Bickford IVAC Corporation
Pontypridd, Wales
American Nurses Association San Diego, California
United Kingdom
Washington, D.C.
Joseph P. Cammarota
Dennis D. Autio Jeffrey S. Blair Naval Air Warfare Center
Dybonics, Inc. IBM Health Care Solutions Aircraft Division
Portland, Oregon Atlanta, Georgia Warminster, Pennsylvania

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Paul Campbell Steven Conolly Gary Drzewiecki
Institute of Medical Science Stanford University Rutgers University
and Technology Stanford, California Piscataway, New Jersey
Universities of St. Andrews
and Dundee Derek G. Cramp Edwin G. Duffin
and City University Medtronic, Inc.
Ninewells Hospital London, United Kingdom Minneapolis, Minnesota
Dundee, United Kingdom
Barbara Y. Croft Jeffrey L. Eggleston
Ewart R. Carson National Institutes of Health Valleylab, Inc.
City University Kensington, Maryland Boulder, Colorado
London, United Kingdom
David D. Cunningham Robert L. Elliott
Sergio Cerutti Abbott Diagnostics Elliott-Elliott-Head Breast Cancer
Polytechnic University Process Engineering Research and Treatment Center
Milan, Italy Abbott Park, Illinois Baton Rouge, Louisiana

A. Enis Çetin Ian A. Cunningham K. Whittaker Ferrara

Bilkent University Victoria Hospital Riverside Research Institute
Ankara, Turkey The John P. Roberts Research New York, New York
Institute
Christopher S. Chen and J. Michael Fitzmaurice
Department of Bioengineering The University of Western Ontario Agency for Healthcare Research
Department of Physiology London, Ontario, Canada and Quality
University of Pennsylvania Rockville, Maryland
Philadelphia, Pennsylvania Yadin David
Texas Children’s Hospital Ross Flewelling
Wei Chen Houston, Texas Nellcor Incorporation
Center for Magnetic Resonance Pleasant, California
Research Connie White Delaney
and School of Nursing and Medical Michael Forde
The University of Minnesota School Medtronic, Inc.
Medical School The University of Minnesota Minneapolis, Minnesota
Minneapolis, Minnesota Minneapolis, Minnesota
Amir H. Gandjbakhche
Victor Chernomordik Mary Diakides Laboratory of Integrative and
Laboratory of Integrative and Advanced Concepts Analysis, Inc. Medical Biophysics
Medical Biophysics Falls Church, Virginia National Institute of Child Health
National Institute of Child Health and Human Development
and Human Development Nicholas A. Diakides Bethesda, Maryland
Bethesda, Maryland Advanced Concepts Analysis, Inc.
Falls Church, Virginia Israel Gannot
David A. Chesler Laboratory of Integrative and
Massachusetts General Hospital C. Drews-Peszynski Medical Biophysics
Harvard University Medical Technical University of Lodz National Institute of Child Health
School Lodz, Poland and Human Development
Boston, Massachusetts Bethesda, Maryland
Ronald G. Driggers
Vivian H. Coates U.S. Army Communications and Leslie A. Geddes
ECRI Electronics Research, Purdue University
Plymouth Meeting, Pennsylvania Development and Engineering West Lafayette, Indiana
Center (CERDEC)
Arnon Cohen Night Vision and Electronic Richard L. Goldberg
Ben-Gurion University Sensors Directorate University of North Carolina
Be’er Sheva, Israel Fort Belvoir, Virginia Chapel Hill, North Carolina

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Boris Gramatikov David Hattery Millard M. Judy
Johns Hopkins School Laboratory of Integrative and Baylor Research Institute and
of Medicine Medical Biophysics MicroBioMed Corp.
Baltimore, Maryland National Institute of Child Health Dallas, Texas
and Human Development
Barton M. Gratt Bethesda, Maryland Philip F. Judy
School of Dentistry Brigham and Women’s Hospital
University of Washington Jonathan F. Head Harvard University Medical
Seattle, Washington Elliott-Elliott-Head Breast Cancer School
Research and Treatment Center Boston, Massachusetts
Walter Greenleaf Baton Rouge, Louisiana
Greenleaf Medical G.J.L. Kaw
Palo Alto, California Department of Diagnostic
William B. Hobbins
Radiology
Women’s Breast Health Center
Tan Tock Seng Hospital
Michael W. Grenn Madison, Wisconsin
Singapore
U.S. Army Communications and
Electronics Research, Stuart Horn J.R. Keyserlingk
Development and Engineering U.S. Army Communications and Ville Marie Multidisciplinary
Center (CERDEC) Electronics Research, Breast and Oncology Center
Night Vision and Electronic Development and Engineering St. Mary’s Hospital
Sensors Directorate Center (CERDEC) McGill University
Fort Belvoir, Virginia Night Vision and Electronic Montreal, Quebec, Canada
Sensors Directorate and
Eliot B. Grigg Fort Belvoir, Virginia London Cancer Centre
Department of Plastic Surgery
London, Ontario
Dartmouth-Hitchcock Medical Xiaoping Hu Canada
Center Center for Magnetic Resonance
Lebanon, New Hampshire Research C. Everett Koop
and Department of Plastic Surgery
Warren S. Grundfest The University of Minnesota Dartmouth-Hitchcock Medical
Department of Bioengineering Medical School Center
and Electrical Engineering Lebanon, New Hampshire
Minneapolis, Minnesota
Henry Samueli School of
Engineering and Applied Hayrettin Köymen
T. Jakubowska
Science Bilkent University
Technical University of Lodz
and Ankara, Turkey
Lodz, Poland
Department of Surgery
David Geffen School Luis G. Kun
of Medicine
G. Allan Johnson
Duke University Medical Center IRMC/National Defense
University of California University
Los Angeles, California Durham, North Carolina
Washington, D.C.

Michael L. Gullikson Bryan F. Jones

Phani Teja Kuruganti
Texas Children’s Hospital Medical Imaging Research Group
RF and Microwave Systems Group
Houston, Texas School of Computing Oak Ridge National Laboratory
University of Glamorgan Oak Ridge, Tennessee
Moinuddin Hassan Pontypridd, Wales
Laboratory of Integrative and United Kingdom Kenneth K. Kwong
Medical Biophysics Massachusetts General Hospital
National Institute of Child Health Thomas M. Judd Harvard University Medical
and Human Development Kaiser Permanente School
Bethesda, Maryland Atlanta, Georgia Boston, Massachusetts

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Z.R. Li Susan McGrath Michael R. Neuman
South China Normal University Department of Plastic Surgery Michigan Technological
Guangzhou, China Dartmouth-Hitchcock Medical University
Center Houghton, Michigan
Richard F. Little Lebanon, New Hampshire
E.Y.K. Ng
National Institutes of Health College of Engineering
Bethesda, Maryland
Matthew F. McKnight
Department of Plastic Surgery School of Mechanical and
Dartmouth-Hitchcock Medical Production Engineering
Chung-Chiun Liu Nanyang Technological University
Center
Electronics Design Center and Singapore
Lebanon, New Hampshire
Edison Sensor Technology
Center Paul Norton
Yitzhak Mendelson
Case Western Reserve University U.S. Army Communications and
Worcester Polytechnic Institute
Cleveland, Ohio Electronics Research,
Worcester, Massachusetts Development and Engineering
Center (CERDEC)
Zhongqi Liu James B. Mercer
Night Vision and Electronic
TTM Management Group University of Tromsø
Sensors Directorate
Beijing, China Tromsø, Norway
Fort Belvoir, Virginia
Arcangelo Merla Antoni Nowakowski
Jasper Lupo
Department of Clinical Sciences Department of Biomedical
Applied Research Associates, Inc.
and Bioimaging Engineering,
Falls Church, Virginia
University “G.d’Annunzio” Gdansk University of Technology
and Narutowicza
Albert Macovski
Institute for Advanced Biomedical Gdansk, Poland
Stanford University
Technology
Stanford, California Banu Onaral
Foundation “G.d’Annunzio”
and Drexel University
Luca T. Mainardi Istituto Nazionale Fisica della Philadelphia, Pennsylvania
Polytechnic University Materia David D. Pascoe
Milan, Italy Coordinated Group of Chieti Auburn University
Chieti-Pescara, Italy Auburn, Alabama
C. Manohar
Department of Electrical & Evangelia Micheli-Tzanakou Maqbool Patel
Computer Engineering Rutgers Unversity Center for Magnetic Resonance
University of Houston Piscataway, New Jersey Research
Houston, Texas and
Robert L. Morris The University of Minnesota
Joseph P. McClain Dybonics, Inc. Medical School
Walter Reed Army Medical Center Portland, Oregon Minneapolis, Minnesota
Washington, D.C. Robert Patterson
Jack G. Mottley
University of Rochester The University of Minnesota
Kathleen A. McCormick Rochester, New York Minneapolis, Minnesota
SAIC
Falls Church, Virginia
Jeffrey L. Paul
Robin Murray Defense Advanced Research
University of Rhode Island Projects Agency
Dennis McGrath Kingston, Rhode Island Arlington, Virginia
Department of Plastic Surgery
Dartmouth-Hitchcock Medical Joachim H. Nagel A. William Paulsen
Center University of Stuttgart Emory University
Lebanon, New Hampshire Stuttgart, Germany Atlanta, Georgia

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John Pauly E. Francis Ring Joyce Sensmeier
Stanford University Medical Imaging Research Group HIMSS
Stanford, California School of Computing Chicago, Illinois
University of Glamorgan
I. Pavlidis David Sherman
Pontypridd, Wales
Department of Computer Science Johns Hopkins School of Medicine
United Kingdom
University of Houston Baltimore, Maryland
Houston, Texas Richard L. Roa
Robert E. Shroy, Jr.
Baylor University Medical Center
Picker International
P. Hunter Peckham Dallas, Texas
Highland Heights, Ohio
Case Western Reserve University Peter Robbie
Cleveland, Ohio Stephen W. Smith
Department of Plastic Surgery
Duke University
Joseph G. Pellegrino Dartmouth-Hitchcock Medical
Center Durham, North Carolina
U.S. Army Communications and
Electronics Research, Lebanon, New Hampshire Nathan J. Sniadecki
Development and Engineering Gian Luca Romani Department of Bioengineering
Center (CERDEC) Department of Clinical Sciences University of Pennsylvania
Night Vision and Electronic and Bioimaging Philadelphia, Pennsylvania
Sensors Directorate University “G. d’Annunzio” Wesley E. Snyder
Fort Belvoir, Virginia and ECE Department
Institute for Advanced North Carolina State University
Philip Perconti Biomedical Technology Raleigh, North Carolina
U.S. Army Communications and Foundation “G.d’Annunzio”
Electronics Research, and
Orhan Soykan
Development and Engineering Istituto Nazionale Fisica della Corporate Science and
Center (CERDEC) Materia Technology
Night Vision and Electronic Coordinated Group of Chieti Medtronic, Inc.
Sensors Directorate Chieti-Pescara, Italy and
Fort Belvoir, Virginia Department of Biomedical
Joseph M. Rosen Engineering
Athina P. Petropulu Department of Plastic Surgery Michigan Technological
Drexel University Dartmouth-Hitchcock Medical University
Philadelphia, Pennsylvania Center Houghton, Michigan
Lebanon, New Hampshire
Tom Piantanida Primoz Strojnik
Greenleaf Medical Eric Rosow Case Western Reserve University
Palo Alto, California Hartford Hospital Cleveland, Ohio
and
T. Allan Pryor Premise Development M. Strzelecki
University of Utah Corporation Technical University of Lodz
Salt Lake City, Utah Hartford, Connecticut Lodz, Poland

Subrata Saha Ron Summers

Ram C. Purohit
Clemson University Loughborough University
Auburn University
Clemson, South Carolina Leicestershire, United Kingdom
Auburn, Alabama
John Schenck Christopher Swift
Hairong Qi General Electric Corporate Department of Plastic Surgery
ECE Department Research and Development Dartmouth-Hitchcock Medical
The University of Tennessee Center Center
Knoxville, Tennessee Schenectady, New York Lebanon, New Hampshire
Pat Ridgely Edward Schuck Willis A. Tacker
Medtronic, Inc. EdenTec Corporation Purdue University
Minneapolis, Minnesota Eden Prairie, Minnesota West Lafayette, Indiana

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Nitish V. Thakor Wolf W. von Maltzahn Christopher M. Yip
Johns Hopkins School of Medicine Rensselaer Polytechnic Institute Departments of Chemical
Baltimore, Maryland Troy, New York Engineering and Applied
Chemistry
Roderick Thomas Gregory I. Voss Department of Biochemistry
Faculty of Applied Design and IVAC Corporation Institute of Biomaterials and
Engineering San Diego, California Biomedical Engineering
Swansea Institute of Technology
University of Toronto
Swansea, United Kingdom Alvin Wald
Columbia University Toronto, Ontario, Canada
P. Tsiamyrtzis New York, New York
Department of Statistics E. Yu
University of Economics and Chen Wang Ville Marie Multidisciplinary
Business Athens TTM International Breast and Oncology Center
Athens, Greece Houston, Texas St. Mary’s Hospital
McGill University
Benjamin M.W. Tsui Lois de Weerd
Montreal, Quebec, Canada
University of North Carolina University Hospital of
Chapel Hill, North Carolina and
North Norway
Tromsø, Norway London Cancer Centre
Tracy A. Turner London, Ontario, Canada
Private Practice Wang Wei
Minneapolis, Minnesota Radiology Department Wen Yu
Beijing You An Hospital Shanghai RuiJin Hospital
Kamil Ugurbil
Beijing, China Shanghai, China
Center for Magnetic Resonance
Research B. Wiecek
and Technical University of Lodz Yune Yuan
The University of Minnesota Lodz, Poland Institute of Basic Medical Science
Medical School China Army General Hospital
Minneapolis, Minnesota M. Wysocki Beijing, China
Technical University of Lodz
Michael S. Van Lysel
Lodz, Poland Jason Zeibel
University of Wisconsin
Madison, Wisconsin U.S. Army Communications and
Martin J. Yaffe Electronics Research,
Henry F. VanBrocklin University of Toronto Development and Engineering
University of California-Berkeley Toronto, Ontario, Canada Center (CERDEC)
Berkeley, California Night Vision and Electronic
Robert Yarchoan
Sensors Directorate
Jay Vizgaitis HIV and AIDS Malignancy
Fort Belvoir, Virginia
U.S. Army Communications and Branch
Electronics Research, Center for Cancer Research
Development and Engineering National Cancer Institute (NCI) Yi Zeng
Center (CERDEC) Bethesda, Maryland Central Disease Control of China
Night Vision and Electronic Beijing, China
Sensors Directorate M. Yassa
Fort Belvoir, Virginia Ville Marie Multidisciplinary Xiaohong Zhou
Breast and Oncology Center
Duke University Medical Center
Abby Vogel St. Mary’s Hospital
Durham, North Carolina
Laboratory of Integrative and McGill University
Medical Biophysics Montreal, Quebec, Canada
National Institute of Child Health and Yulin Zhou
and Human Development London Cancer Centre Shanghai RuiJin Hospital
Bethesda, Maryland London, Ontario, Canada Shanghai, China

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 Contents

SECTION I Biomedical Signal Analysis

Banu Onaral
1 Biomedical Signals: Origin and Dynamic Characteristics;
Frequency-Domain Analysis
Arnon Cohen . . . . . . . . . . . . . . . . . . . . . 1-1

2 Digital Biomedical Signal Acquisition and Processing

Luca T. Mainardi, Anna M. Bianchi, Sergio Cerutti . . . . 2-1

3 Compression of Digital Biomedical Signals

A. Enis Çetin, Hayrettin Köymen . . . . . . . . . . . . 3-1

4 Time-Frequency Signal Representations for

Biomedical Signals
G. Faye Boudreaux-Bartels, Robin Murray . . . . . . . . 4-1

5 Wavelet (Time-Scale) Analysis in Biomedical

Signal Processing
Nitish V. Thakor, Boris Gramatikov, David Sherman . . . 5-1

6 Higher-Order Spectral Analysis

Athina P. Petropulu . . . . . . . . . . . . . . . . . . 6-1

7 Neural Networks in Biomedical Signal Processing

Evangelia Micheli-Tzanakou . . . . . . . . . . . . . . 7-1

8 Complexity, Scaling, and Fractals in Biomedical Signals

Banu Onaral, Joseph P. Cammarota . . . . . . . . . . . 8-1

9 Future Directions: Biomedical Signal Processing and

Networked Multimedia Communications
Banu Onaral . . . . . . . . . . . . . . . . . . . . . 9-1

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SECTION II Imaging

Warren S. Grundfest
10 X-Ray
Robert E. Shroy, Jr., Michael S. Van Lysel,
Martin J. Yaffe . . . . . . . . . . . . . . . . . . . . 10-1

11 Computed Tomography
Ian A. Cunningham, Philip F. Judy . . . . . . . . . . . 11-1

12 Magnetic Resonance Imaging

Steven Conolly, Albert Macovski, John Pauly, John Schenck,
Kenneth K. Kwong, David A. Chesler, Xiaoping Hu,
Wei Chen, Maqbool Patel, Kamil Ugurbil . . . . . . . . 12-1

13 Nuclear Medicine
Barbara Y. Croft, Benjamin M.W. Tsui . . . . . . . . . . 13-1

14 Ultrasound
Richard L. Goldberg, Stephen W. Smith, Jack G. Mottley,
K. Whittaker Ferrara . . . . . . . . . . . . . . . . . 14-1

15 Magnetic Resonance Microscopy

Xiaohong Zhou, G. Allan Johnson . . . . . . . . . . . . 15-1

16 Positron-Emission Tomography (PET)

Thomas F. Budinger, Henry F. VanBrocklin . . . . . . . . 16-1

17 Electrical Impedance Tomography

D.C. Barber . . . . . . . . . . . . . . . . . . . . . 17-1

18 Medical Applications of Virtual Reality Technology

Walter Greenleaf, Tom Piantanida . . . . . . . . . . . 18-1

SECTION III Infrared Imaging

Nicholas A. Diakides
19 Advances in Medical Infrared Imaging
Nicholas Diakides, Mary Diakides, Jasper Lupo,
Jeffrey L. Paul, Raymond Balcerak . . . . . . . . . . . 19-1

20 The Historical Development of Thermometry

and Thermal Imaging in Medicine
E. Francis Ring, Bryan F. Jones . . . . . . . . . . . . . 20-1

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21 Physiology of Thermal Signals
David D. Pascoe, James B. Mercer, Lois de Weerd . . . . . 21-1

22 Quantitative Active Dynamic Thermal IR-Imaging and

Thermal Tomography in Medical Diagnostics
Antoni Nowakowski . . . . . . . . . . . . . . . . . 22-1

23 Thermal Texture Maps (TTM): Concept, Theory, and

Applications
Zhongqi Liu, Chen Wang, Hairong Qi, Yune Yuan, Yi Zeng,
Z.R. Li, Yulin Zhou, Wen Yu, Wang Wei . . . . . . . . . 23-1

24 IR Imagers as Fever Monitoring Devices: Physics,

Physiology, and Clinical Accuracy
E.Y.K. Ng, G.J.L. Kaw . . . . . . . . . . . . . . . . . 24-1

25 Infrared Imaging of the Breast — An Overview

William C. Amalu, William B. Hobbins, Jonathan F. Head,
Robert L. Elliott . . . . . . . . . . . . . . . . . . . 25-1

26 Functional Infrared Imaging of the Breast:

Historical Perspectives, Current Application, and
Future Considerations
J.R. Keyserlingk, P.D. Ahlgren, E. Yu, N. Belliveau,
M. Yassa . . . . . . . . . . . . . . . . . . . . . . . 26-1

27 Detecting Breast Cancer from Thermal Infrared Images by

Asymmetry Analysis
Hairong Qi, Phani Teja Kuruganti, Wesley E. Snyder . . . 27-1

28 Advanced Thermal Image Processing

B. Wiecek, M. Strzelecki, T. Jakubowska, M. Wysocki,
C. Drews-Peszynski . . . . . . . . . . . . . . . . . . 28-1

29 Biometrics: Face Recognition in Thermal Infrared

I. Pavlidis, P. Tsiamyrtzis, P. Buddharaju, C. Manohar . . . 29-1

30 Infrared Imaging for Tissue Characterization and Function

Moinuddin Hassan, Victor Chernomordik, Abby Vogel,
David Hattery, Israel Gannot, Richard F. Little,
Robert Yarchoan, Amir H. Gandjbakhche . . . . . . . . 30-1

31 Thermal Imaging in Diseases of the Skeletal and

Neuromuscular Systems
E. Francis Ring, Kurt Ammer . . . . . . . . . . . . . . 31-1

32 Functional Infrared Imaging in Clinical Applications

Arcangelo Merla, Gian Luca Romani . . . . . . . . . . 32-1

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 33 Thermal Imaging in Surgery
Paul Campbell, Roderick Thomas . . . . . . . . . . . . 33-1

34 Infrared Imaging Applied to Dentistry

Barton M. Gratt . . . . . . . . . . . . . . . . . . . 34-1

35 Use of Infrared Imaging in Veterinary Medicine

Ram C. Purohit, Tracy A. Turner, David D. Pascoe . . . . 35-1

36 Standard Procedures for Infrared Imaging in Medicine

Kurt Ammer, E. Francis Ring . . . . . . . . . . . . . . 36-1

37 Infrared Detectors and Detector Arrays

Paul Norton, Stuart Horn, Joseph G. Pellegrino,
Philip Perconti . . . . . . . . . . . . . . . . . . . . 37-1

38 Infrared Camera Characterization

Joseph G. Pellegrino, Jason Zeibel, Ronald G. Driggers,
Philip Perconti . . . . . . . . . . . . . . . . . . . . 38-1

39 Infrared Camera and Optics for Medical Applications

Michael W. Grenn, Jay Vizgaitis, Joseph G. Pellegrino,
Philip Perconti . . . . . . . . . . . . . . . . . . . . 39-1

SECTION IV Medical Informatics

Luis G. Kun
40 Hospital Information Systems: Their Function and State
T. Allan Pryor . . . . . . . . . . . . . . . . . . . . 40-1

41 Computer-Based Patient Records

J. Michael Fitzmaurice . . . . . . . . . . . . . . . . . 41-1

42 Overview of Standards Related to the Emerging Health Care

Information Infrastructure
Jeffrey S. Blair . . . . . . . . . . . . . . . . . . . . 42-1

43 Introduction to Informatics and Nursing

Kathleen A. McCormick, Joyce Sensmeier,
Connie White Delaney, Carol J. Bickford . . . . . . . . . 43-1

44 Non-AI Decision Making

Ron Summers, Derek G. Cramp, Ewart R. Carson . . . . . 44-1

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 45 Medical Informatics and Biomedical Emergencies: New
Training and Simulation Technologies for First Responders
Joseph M. Rosen, Christopher Swift, Eliot B. Grigg,
Matthew F. McKnight, Susan McGrath, Dennis McGrath,
Peter Robbie, C. Everett Koop . . . . . . . . . . . . . 45-1

SECTION V Biomedical Sensors

Michael R. Neuman
46 Physical Measurements
Michael R. Neuman . . . . . . . . . . . . . . . . . . 46-1

47 Biopotential Electrodes
Michael R. Neuman . . . . . . . . . . . . . . . . . . 47-1

48 Electrochemical Sensors
Chung-Chiun Liu . . . . . . . . . . . . . . . . . . . 48-1

49 Optical Sensors
Yitzhak Mendelson . . . . . . . . . . . . . . . . . . 49-1

50 Bioanalytic Sensors
Richard P. Buck . . . . . . . . . . . . . . . . . . . 50-1

51 Biological Sensors for Diagnostics

Orhan Soykan . . . . . . . . . . . . . . . . . . . . 51-1

SECTION VI Medical Instruments and Devices

Wolf W. von Maltzahn

52 Biopotential Amplifiers
Joachim H. Nagel . . . . . . . . . . . . . . . . . . . 52-1

53 Bioelectric Impedance Measurements

Robert Patterson . . . . . . . . . . . . . . . . . . . 53-1

54 Implantable Cardiac Pacemakers

Michael Forde, Pat Ridgely . . . . . . . . . . . . . . . 54-1

55 Noninvasive Arterial Blood Pressure and Mechanics

Gary Drzewiecki . . . . . . . . . . . . . . . . . . . 55-1

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56 Cardiac Output Measurement
Leslie A. Geddes . . . . . . . . . . . . . . . . . . . 56-1

57 External Defibrillators
Willis A. Tacker . . . . . . . . . . . . . . . . . . . 57-1

58 Implantable Defibrillators
Edwin G. Duffin . . . . . . . . . . . . . . . . . . . 58-1

59 Implantable Stimulators for Neuromuscular Control

Primoz Strojnik, P. Hunter Peckham . . . . . . . . . . 59-1

60 Respiration
Leslie A. Geddes . . . . . . . . . . . . . . . . . . . 60-1

61 Mechanical Ventilation
Khosrow Behbehani . . . . . . . . . . . . . . . . . . 61-1

62 Essentials of Anesthesia Delivery

A. William Paulsen . . . . . . . . . . . . . . . . . . 62-1

63 Electrosurgical Devices
Jeffrey L. Eggleston, Wolf W. von Maltzahn . . . . . . . . 63-1

64 Biomedical Lasers
Millard M. Judy . . . . . . . . . . . . . . . . . . . . 64-1

65 Instrumentation for Cell Mechanics

Nathan J. Sniadecki, Christopher S. Chen . . . . . . . . 65-1

66 Blood Glucose Monitoring

David D. Cunningham . . . . . . . . . . . . . . . . 66-1

67 Atomic Force Microscopy: Probing Biomolecular

Interactions
Christopher M. Yip . . . . . . . . . . . . . . . . . . 67-1

68 Parenteral Infusion Devices

Gregory I. Voss, Robert D. Butterfield . . . . . . . . . . 68-1

69 Clinical Laboratory: Separation and Spectral Methods

Richard L. Roa . . . . . . . . . . . . . . . . . . . . 69-1

70 Clinical Laboratory: Nonspectral Methods and Automation

Richard L. Roa . . . . . . . . . . . . . . . . . . . . 70-1

71 Noninvasive Optical Monitoring

Ross Flewelling . . . . . . . . . . . . . . . . . . . . 71-1

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 72 Medical Instruments and Devices Used in the Home
Bruce R. Bowman, Edward Schuck . . . . . . . . . . . 72-1

73 Virtual Instrumentation: Applications in Biomedical

Engineering
Eric Rosow, Joseph Adam . . . . . . . . . . . . . . . 73-1

SECTION VII Clinical Engineering

Yadin David
74 Clinical Engineering: Evolution of a Discipline
Joseph D. Bronzino . . . . . . . . . . . . . . . . . . 74-1

75 Management and Assessment of Medical Technology

Yadin David, Thomas M. Judd . . . . . . . . . . . . . 75-1

76 Risk Factors, Safety, and Management of Medical Equipment

Michael L. Gullikson . . . . . . . . . . . . . . . . . 76-1

77 Clinical Engineering Program Indicators

Dennis D. Autio, Robert L. Morris . . . . . . . . . . . . 77-1

78 Quality of Improvement and Team Building

Joseph P. McClain . . . . . . . . . . . . . . . . . . . 78-1

79 A Standards Primer for Clinical Engineers

Alvin Wald . . . . . . . . . . . . . . . . . . . . . 79-1

80 Regulatory and Assessment Agencies

Mark E. Bruley, Vivian H. Coates . . . . . . . . . . . . 80-1

81 Applications of Virtual Instruments in Health Care

Eric Rosow, Joseph Adam . . . . . . . . . . . . . . . 81-1

SECTION VIII Ethical Issues Associated with

the Use of Medical Technology

Subrata Saha and Joseph D. Bronzino

82 Beneficence, Nonmaleficence, and Medical Technology
Joseph D. Bronzino . . . . . . . . . . . . . . . . . . 82-1

83 Ethical Issues Related to Clinical Research

Joseph D. Bronzino . . . . . . . . . . . . . . . . . . 83-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-1

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Bronz: “2122_c000” — 2006/2/24 — 11:31 — page xxvi — #26
 I
Biomedical Signal
Analysis
Banu Onaral
Drexel University

1 Biomedical Signals: Origin and Dynamic Characteristics;

Frequency-Domain Analysis
Arnon Cohen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

2 Digital Biomedical Signal Acquisition and Processing

Luca T. Mainardi, Sergio Cerutti, Anna M. Bianchi . . . . . . . . . . . . . . . . . . . . 2-1

3 Compression of Digital Biomedical Signals

A. Enis Çetin, Hayrettin Köymen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

4 Time–Frequency Signal Representations for Biomedical Signals

G. Faye Boudreaux-Bartels, Robin Murray . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

5 Wavelet (Time-Scale) Analysis in Biomedical Signal Processing

Nitish V. Thakor, Boris Gramatikov, David Sherman . . . . . . . . . . . . . . . . . . . 5-1

6 Higher-Order Spectral Analysis

Athina P. Petropulu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

7 Neural Networks in Biomedical Signal Processing

Evangelia Micheli-Tzanakou . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

8 Complexity, Scaling, and Fractals in Biomedical Signals

Banu Onaral, Joseph P. Cammarota . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

I-1

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I-2 Medical Devices and Systems

9 Future Directions: Biomedical Signal Processing and Networked

Multimedia Communications
Banu Onaral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

B
IOMEDICAL SIGNAL ANALYSIS CENTERS on the acquisition and processing of information-
bearing signals that emanate from living systems. These vital signals permit us to probe the state of
the underlying biologic and physiologic structures and dynamics. Therefore, their interpretation
has significant diagnostic value for clinicians and researchers.
The detected signals are commonly corrupted with noise. Often, the information cannot be readily
extracted from the raw signal, which must be processed in order to yield useful results. Signals and systems
engineering knowledge and, in particular, signal-processing expertise are therefore critical in all phases of
signal collection and analysis.
Biomedical engineers are called on to conceive and implement processing schemes suitable for biomed-
ical signals. They also play a key role in the design and development of biomedical monitoring devices
and systems that match advances in signal processing and instrumentation technologies with biomedical
needs and requirements.
This section is organized in two main parts. In the first part, contributing authors review contemporary
methods in biomedical signal processing. The second part is devoted to emerging methods that hold the
promise for major enhancements in our ability to extract information from vital signals.
The success of signal-processing applications strongly depends on the knowledge about the origin and
the nature of the signal. Biomedical signals possess many special properties and hence require special
treatment. Also, the need for noninvasive measurements presents unique challenges that demand a clear
understanding of biomedical signal characteristics. In the lead chapter, entitled, “Biomedical Signals:
Origin and Dynamic Characteristics; Frequency-Domain Analysis,” Arnon Cohen provides a general
classification of biomedical signals and discusses basics of frequency domain methods.
The advent of digital computing coupled with fast progress in discrete-time signal processing has led to
efficient and flexible methods to acquire and treat biomedical data in digital form. The chapter entitled,
“Digital Biomedical Signal Acquisition and Processing,” by Luca T. Mainardi, Anna M. Bianchi, and Sergio
Cerutti, presents basic elements of signal acquisition and processing in the special context of biomedical
signals.
Especially in the case of long-term monitoring, digital biomedical signal-processing applications gen-
erate vast amounts of data that strain transmission and storage resources. The creation of multipatient
reference signal bases also places severe demands on storage. Data compression methods overcome these
obstacles by eliminating signal redundancies while retaining clinically significant information. A. Enis
Cetin and Hayrettin Köymen provide a comparative overview of a range of approaches from conventional
to modern compression techniques suitable for biomedical signals. Futuristic applications involving long-
term and ambulatory recording systems, and remote diagnosis opportunities will be made possible by
breakthroughs in biomedical data compression. This chapter serves well as a point of departure.
Constraints such as stationarity (and time invariance), gaussianity (and minimum phaseness), and the
assumption of a characteristic scale in time and space have constituted the basic, and by now implicit,
assumptions upon which the conventional signals and systems theories have been founded. However,
investigators engaged in the study of biomedical processes have long known that they did not hold under
most realistic situations and hence could not sustain the test of practice.
Rejecting or at least relaxing restrictive assumptions always opens new avenues for research and yields
fruitful results. Liberating forces in signals and systems theories have conspired in recent years to create
research fronts that target long-standing constraints in the established wisdom (dogma?) of classic signal
processing and system analysis. The emergence of new fields in signals and system theories that address
these shortcomings and aim to relax these restrictions has been motivated by scientists who, rather

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Biomedical Signal Analysis I-3

than mold natural behavior into artificial models, seek methods inherently suited to represent reality.
Biomedical scientists and engineers are inspired by insights gained from a deeper appreciation for the
dynamic richness displayed by biomedical phenomena; hence, more than their counterparts in other
disciplines, they more forcefully embrace innovations in signal processing.
One of these novel directions is concerned with time–frequency representations tailored for non-
stationary and transient signals. Faye Boudreaux-Bartels and Robin Murray address this issue, provide an
introduction to concepts and tools of time–frequency analysis, and point out candidate applications.
Many physiologic structures and dynamics defy the concept of a characteristic spatial and temporal
scale and must be dealt with employing methods compatible with their multiscale nature. Judging from
the recent success of biomedical signal-processing applications based on time-scale analysis and wavelet
transforms, the resolution of many outstanding processing issues may be at hand. The chapter entitled,
“Time-Scale Analysis and Wavelets in Biomedical Signals,” by Nitish V. Thakor, familiarizes the reader
with fundamental concepts and methods of wavelet analysis and suggests fruitful directions in biomedical
signal processing.
The presence of nonlinearities and statistics that do not comply with the gaussianity assumption and
the desire for phase reconstruction have been the moving forces behind investigations of higher-order
statistics and polyspectra in signal-processing and system-identification fields. An introduction to the
topic and potential uses in biomedical signal-processing applications are presented by Athina Petropulu
in the chapter entitled, “Higher-Order Spectra in Biomedical Signal Processing.”
Neural networks derive their cue from biologic systems and, in turn, mimic many of the functions of
the nervous system. Simple networks can filter, recall, switch, amplify, and recognize patterns and hence
serve well many signal-processing purposes. In the chapter entitled, “Neural Networks in Biomedical
Signal Processing,” Evangelia Tzanakou helps the reader explore the power of the approach while stressing
how biomedical signal-processing applications benefit from incorporating neural-network principles.
The dichotomy between order and disorder is now perceived as a ubiquitous property inherent in the
unfolding of many natural complex phenomena. In the last decade, it has become clear that the common
threads shared by natural forms and functions are the “physics of disorder” and the “scaling order,” the
hallmark of broad classes of fractal entities. Biomedical signals are the global observables of underlying
complex physical and physiologic processes. “Complexity” theories therefore hold the potential to provide
mathematical tools that describe and possibly shed light on the internal workings of physiologic systems.
In the next to last chapter in this section, Banu Onaral and Joseph P. Cammarota introduce the reader
to basic tenets of complexity theories and the attendant scaling concepts with hopes to facilitate their
integration into the biomedical engineering practice.
The section concludes with a brief chapter on the visions of the future when biomedical signal pro-
cessing will merge with the rising technologies in telecommunication and multimedia computing, and
eventually with virtual reality, to enable remote monitoring, diagnosis, and intervention. The impact of
this development on the delivery of health care and the quality of life will no doubt be profound. The
promise of biomedical signal analysis will then be fulfilled.

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 1
Biomedical Signals:
Origin and Dynamic
Characteristics;
Frequency-Domain
Analysis

1.1 Origin of Biomedical Signals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

1.2 Classification of Biosignals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
1.3 Stochastic Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
1.4 Frequency-Domain Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
1.5 Discrete Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
1.6 Data Windows. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
1.7 Short-Time Fourier Transform . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
1.8 Spectral Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
The Blackman–Tukey Method • The Periodogram •
Time-Series Analysis Methods
1.9 Signal Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
1.10 Optimal Filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16
Minimization of Mean Squared Error: The Wiener Filter •
Maximization of the Signal-to-Noise Ratio: The Matched
Filter
1.11 Adaptive Filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18
Arnon Cohen 1.12 Segmentation of Nonstationary Signals . . . . . . . . . . . . . . . . 1-21
Ben-Gurion University References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

A signal is a phenomenon that conveys information. Biomedical signals are signals, used in biomedical
fields, mainly for extracting information on a biologic system under investigation. The complete process
of information extraction may be as simple as a physician estimating the patient’s mean heart rate by
feeling, with the fingertips, the blood pressure pulse or as complex as analyzing the structure of internal
soft tissues by means of a complex CT machine.
Most often in biomedical applications (as in many other applications), the acquisition of the signal is
not sufficient. It is required to process the acquired signal to get the relevant information “buried” in it.

1-1

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1-2 Medical Devices and Systems

This may be due to the fact that the signal is noisy and thus must be “cleaned” (or in more professional
terminology, the signal has to be enhanced) or due to the fact that the relevant information is not “visible”
in the signal. In the latter case, we usually apply some transformation to enhance the required information.
The processing of biomedical signals poses some unique problems. The reason for this is mainly the
complexity of the underlying system and the need to perform indirect, noninvasive measurements. A large
number of processing methods and algorithms is available. In order to apply the best method, the user
must know the goal of the processing, the test conditions, and the characteristics of the underlying signal.
In this chapter, the characteristics of biomedical signals will be discussed [Cohen, 1986]. Biomedical
signals will be divided into characteristic classes, requiring different classes of processing methods. Also
in this chapter, the basics of frequency-domain processing methods will be presented.

1.1 Origin of Biomedical Signals

From the broad definition of the biomedical signal presented in the preceding section, it is clear that
biomedical signals differ from other signals only in terms of the application — signals that are used in the
biomedical field. As such, biomedical signals originate from a variety of sources. The following is a brief
description of these sources:
1. Bioelectric signals. The bioelectric signal is unique to biomedical systems. It is generated by nerve cells
and muscle cells. Its source is the membrane potential, which under certain conditions may be excited
to generate an action potential. In single cell measurements, where specific microelectrodes are used
as sensors, the action potential itself is the biomedical signal. In more gross measurements, where, for
example, surface electrodes are used as sensors, the electric field generated by the action of many cells,
distributed in the electrode’s vicinity, constitutes the bioelectric signal. Bioelectric signals are probably
the most important biosignals. The fact that most important biosystems use excitable cells makes it
possible to use biosignals to study and monitor the main functions of the systems. The electric field
propagates through the biologic medium, and thus the potential may be acquired at relatively convenient
locations on the surface, eliminating the need to invade the system. The bioelectric signal requires a
relatively simple transducer for its acquisition. A transducer is needed because the electric conduction in
the biomedical medium is done by means of ions, while the conduction in the measurement system is by
electrons. All these lead to the fact that the bioelectric signal is widely used in most fields of biomedicine.
2. Bioimpedance signals. The impedance of the tissue contains important information concerning its
composition, blood volume, blood distribution, endocrine activity, automatic nervous system activity,
and more. The bioimpedance signal is usually generated by injecting into the tissue under test sinusoidal
currents (frequency range of 50 kHz–1 MHz, with low current densities of the order of 20–20 mA). The
frequency range is chosen to minimize electrode polarization problems, and the low current densities are
chosen to avoid tissue damage mainly due to heating effects. Bioimpedance measurements are usually
performed with four electrodes. Two source electrodes are connected to a current source and are used
to inject the current into the tissue. The two measurement electrodes are placed on the tissue under
investigation and are used to measure the voltage drop generated by the current and the tissue impedance.
3. Bioacoustic signals. Many biomedical phenomena create acoustic noise. The measurement of this
acoustic noise provides information about the underlying phenomenon. The flow of blood in the heart,
through the heart’s valves, or through blood vessels generates typical acoustic noise. The flow of air
through the upper and lower airways and in the lungs creates acoustic sounds. These sounds, known as
coughs, snores, and chest and lung sounds, are used extensively in medicine. Sounds are also generated
in the digestive tract and in the joints. It also has been observed that the contracting muscle produces
an acoustic noise (muscle noise). Since the acoustic energy propagates through the biologic medium, the
bioacoustic signal may be conveniently acquired on the surface, using acoustic transducers (microphones
or accelerometers).
4. Biomagnetic signals. Various organs, such as the brain, heart, and lungs, produce extremely weak
magnetic fields. The measurements of these fields provides information not included in other biosignals

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Biomedical Signals 1-3

(such as bioelectric signals). Due to the low level of the magnetic fields to be measured, biomagnetic signals
are usually of very low signal-to-noise ratio. Extreme caution must be taken in designing the acquisition
system of these signals.
5. Biomechanical signals. The term biomechanical signals includes all signals used in the biomedicine
fields that originate from some mechanical function of the biologic system. These signals include motion
and displacement signals, pressure and tension and flow signals, and others. The measurement of bio-
mechanical signals requires a variety of transducers, not always simple and inexpensive. The mechanical
phenomenon does not propagate, as do the electric, magnetic, and acoustic fields. The measurement
therefore usually has to be performed at the exact site. This very often complicates the measurement and
forces it to be an invasive one.
6. Biochemical signals. Biochemical signals are the result of chemical measurements from the living
tissue or from samples analyzed in the clinical laboratory. Measuring the concentration of various ions
inside and in the vicinity of a cell by means of specific ion electrodes is an example of such a signal.
Partial pressures of oxygen (pO2 ) and carbon dioxide (pCO2 ) in the blood or respiratory system are other
examples. Biochemical signals are most often very low frequency signals. Most biochemical signals are
actually dc signals.
7. Biooptical signals. Biooptical signals are the result of optical functions of the biologic system, occur-
ring naturally or induced by the measurement. Blood oxygenation may be estimated by measuring the
transmitted and backscattered light from a tissue (in vivo and in vitro) in several wavelengths. Important
information about the fetus may be acquired by measuring fluorescence characteristics of the amniotic
fluid. Estimation of the heart output may be performed by the dye dilution method, which requires the
monitoring of the appearance of recirculated dye in the bloodstream. The development of fiberoptic
technology has opened vast applications of biooptical signals.

Table 1.1 lists some of the more common biomedical signals with some of their characteristics.

1.2 Classification of Biosignals

Biosignals may be classified in many ways. The following is a brief discussion of some of the most
important classifications.

1. Classification according to source. Biosignals may be classified according to their source or physical
nature. This classification was described in the preceding section. This classification may be used when
the basic physical characteristics of the underlying process is of interest, for example, when a model for
the signal is desired.
2. Classification according to biomedical application. The biomedical signal is acquired and processed
with some diagnostic, monitoring, or other goal in mind. Classification may be constructed according to
the field of application, for example, cardiology or neurology. Such classification may be of interest when
the goal is, for example, the study of physiologic systems.
3. Classification according to signal characteristics. From point of view of signal analysis, this is the most
relevant classification method. When the main goal is processing, it is not relevant what is the source of
the signal or to which biomedical system it belongs; what matters are the signal characteristics.

We recognize two broad classes of signals: continuous signals and discrete signals. Continuous signals
are described by a continuous function s(t ) which provides information about the signal at any given
time. Discrete signals are described by a sequence s(m) which provides information at a given discrete
point on the time axis. Most of the biomedical signals are continuous. Since current technology provides
powerful tools for discrete signal processing, we most often transform a continuous signal into a discrete
one by a process known as sampling. A given signal s(t ) is sampled into the sequence s(m) by

s(m) = s(t )|t =mTs m = . . . , −1, 0, 1, . . . (1.1)

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1-4 Medical Devices and Systems

TABLE 1.1 Biomedical Signals

Classification Acquisition Frequency range Dynamic range Comments

Bioelectric
Action potential Microelectrodes 100 Hz–2 kHz 10 µV–100 mV Invasive measurement of cell
membrane potential
Electroneurogram (ENG) Needle electrode 100 Hz–1 kHz 5 µV–10 mV Potential of a nerve bundle
Electroretinogram (ERG) Microelectrode 0.2–200 Hz 0.5 µV–1 mV Evoked flash potential
Electro-oculogram (EOG) Surface electrodes dc–100 Hz 10 µV–5 mV Steady-corneal-retinal potential
Electroencephalogram (EEG)
Surface Surface electrodes 0.5–100 Hz 2–100 µV Multichannel (6–32) scalp
potential
Delta range 0.5–4 Hz Young children, deep sleep and
pathologies
Theta range 4–8 Hz Temporal and central areas
during alert states
Alpha range 8–13 Hz Awake, relaxed, closed eyes
Beta range 13–22 Hz
Sleep spindles 6–15 Hz 50–100 µV Bursts of about 0.2–0.6 sec
K-complexes 12–14 Hz 100–200 µV Bursts during moderate and deep
sleep
Evoked potentials (EP) Surface electrodes 0.1–20 µV Response of brain potential to
stimulus
Visual (VEP) 1–300 Hz 1–20 µV Occipital lobe recordings,
200-msec duration
Somatosensory (SEP) 2 Hz–3 kHz Sensory cortex
Auditory (AEP) 100 Hz–3 kHz 0.5–10 µV Vertex recordings
Electrocorticogram Needle electrodes 100 Hz–5 kHz Recordings from exposed surface
of brain
Electromyography (EMG)
Single-fiber (SFEMG) Needle electrode 500 Hz–10 kHz 1–10 µV Action potentials from single
muscle fiber
Motor unit action Needle electrode 5 Hz–10 kHz 100 µV–2 mV
potential (MUAP)
Surface EMG (SEMG) Surface electrodes
Skeletal muscle 2–500 Hz 50 µV–5 mV
Smooth muscle 0.01–1 Hz
Electrocardiogram (ECG) Surface electrodes 0.05–100 Hz 1–10 mV
High-frequency ECG Surface electrodes 100 Hz–1 kHz 100 µV–2 mV Notchs and slus waveforms
superimposed on the ECG

where Ts is the sampling interval and fs = 2π/Ts is the sampling frequency. Further characteristic
classification, which applies to continuous as well as discrete signals, is described in Figure 1.1.
We divide signals into two main groups: deterministic and stochastic signals. Deterministic signals are
signals that can be exactly described mathematically or graphically. If a signal is deterministic and its
mathematical description is given, it conveys no information. Real-world signals are never deterministic.
There is always some unknown and unpredictable noise added, some unpredictable change in the para-
meters, and the underlying characteristics of the signal that render it nondeterministic. It is, however, very
often convenient to approximate or model the signal by means of a deterministic function.
An important family of deterministic signals is the periodic family. A periodic signal is a deterministic
signal that may be expressed by

s(t ) = s(t + nT ) (1.2)

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Biomedical Signals 1-5

Signal

Deterministic Stochastic

Periodic Nonperiodic
Stationary Nonstationary

Sino-
Complex
soidal
Almost Tran-
periodic sient

Non-
Ergodic
ergodic Special
type

FIGURE 1.1 Classification of signals according to characteristics.

where n is an integer and T is the period. The periodic signal consists of a basic wave shape with a duration
of T seconds. The basic wave shape repeats itself an infinite number of times on the time axis. The simplest
periodic signal is the sinusoidal signal. Complex periodic signals have more elaborate wave shapes. Under
some conditions, the blood pressure signal may be modeled by a complex periodic signal, with the heart
rate as its period and the blood pressure wave shape as its basic wave shape. This is, of course, a very rough
and inaccurate model.
Most deterministic functions are nonperiodic. It is sometimes worthwhile to consider an “almost
periodic” type of signal. The ECG signal can sometimes be considered “almost periodic.” The ECG’s RR
interval is never constant; in addition, the PQRST complex of one heartbeat is never exactly the same
as that of another beat. The signal is definitely nonperiodic. Under certain conditions, however, the RR
interval is almost constant, and one PQRST is almost the same as the other. The ECG may thus sometimes
be modeled as “almost periodic.”

1.3 Stochastic Signals

The most important class of signals is the stochastic class. A stochastic signal is a sample function of a
stochastic process. The process produces sample functions, the infinite collection of which is called the
ensemble. Each sample function differs from the other in it fine details; however, they all share the same
distribution probabilities. Figure 1.2 depicts three sample functions of an ensemble. Note that at any given
time, the values of the sample functions are different.
Stochastic signals cannot be expressed exactly; they can be described only in terms of probabilities which
may be calculated over the ensemble. Assuming a signal s(t ), the N th-order joint probability function

P[s(t1 ) ≤ s1 , s(t2 ) ≤ s2 , . . . , s(tN ) ≤ sN ] = P(s1 , s2 , . . . , sN ) (1.3)

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1-6 Medical Devices and Systems

s1(t )

s2(t )

t =t2–t1
Sj(t )

t1 t2

FIGURE 1.2 The ensemble of the stochastic process s(t ).

is the joint probability that the signal at time ti will be less than or equal to Si and at time tj will be less
than or equal to Sj , etc. This joint probability describes the statistical behavior and intradependence of the
process. It is very often useful to work with the derivative of the joint probability function; this derivative
is known as the joint probability density function (PDF):

∂N
p(s1 , s2 , . . . , sN ) = [P(s1 , s2 , . . . , sN )] (1.4)
∂s1 ∂s2 L∂sN

Of particular interest are the first- and second-order PDFs.

The expectation of the process s(t ), denoted by E{s(t )} or by ms , is a statistical operator defined as

∞
E{s(t )} = sp(s) ds = m (1.5)
−∞

The expectation of the function s n (t ) is known as the nth-order moment. The first-order moment is thus
the expectation of the process. The nth-order moment is given by

∞
E{s n (t )} = s n p(s) ds (1.6)
−∞

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Biomedical Signals 1-7

Another important statistical operator is the nth central moment:

∞
µn = E{(s − ms )n } = (s − ms )n p(s) ds (1.7)
−∞

The second central moment is known as the variance (the square root of which is the standard deviation).
The variance is denoted by σ 2 :

∞
σ 2 = µ2 = E{(s − ms )2 } = (s − ms )2 p(s) ds (1.8)
−∞

The second-order joint moment is defined by the joint PDF. Of particular interest is the autocorrelation
function rss :

∞
∞
rss (t1 , t2 ) = E{s(t1 )s(t2 )} = s(t1 )s(t2 )p(s1 , s2 ) ds1 ds2 (1.9)
−∞ −∞

The cross-correlation function is defined as the second joint moment of the signal s at time t1 , s(t1 ), and
the signal y at time t2 , y(t2 ):

∞
∞
rsy (t1 , t2 ) = E{s(t1 )y(t2 )} = s(t1 )y(t2 )p(s1 , y2 ) ds1 dy2 (1.10)
−∞ −∞

Stationary stochastic processes are processes whose statistics do not change in time. The expectation and
the variance (as with any other statistical mean) of a stationary process will be time-independent. The
autocorrelation function, for example, of a stationary process will thus be a function of the time difference
t = t2 − t1 (one-dimensional function) rather than a function of t2 and t1 (two-dimensional function).
Ergodic stationary processes possess an important characteristic: Their statistical probability distribu-
tions (along the ensemble) equal those of their time distributions (along the time axis of any one of its
sample functions). For example, the correlation function of an ergodic process may be calculated by its
definition (along the ensemble) or along the time axis of any one of its sample functions:

T
1
rss (τ ) = E{s(t )s(t − τ )} = lim s(t )s(t − τ ) dt (1.11)
T →∞ 2T −T

The right side of Equation 1.11 is the time autocorrelation function.

Ergodic processes are nice because one does not need the ensemble for calculating the distributions;
a single sample function is sufficient. From the point of view of processing, it is desirable to model the
signal as an ergodic one. Unfortunately, almost all signals are nonstationary (and hence nonergodic). One
must therefore use nonstationary processing methods (such as, for e.g., wavelet transformation) which
are relatively complex or cut the signals into short-duration segments in such a way that each may be
considered stationary.
The sleep EEG signal, for example, is a nonstationary signal. We may consider segments of the signal,
in which the subject was at a given sleep state, as stationary. In order to describe the signal, we need to
estimate its probability distributions. However, the ensemble is unavailable. If we further assume that the
process is ergodic, the distributions may be estimated along the time axis of the given sample function.
Most of the standard processing techniques assume the signal to be stationary and ergodic.

1.4 Frequency-Domain Analysis

Until now we have dealt with signals represented in the time domain, that is to say, we have described
the signal by means of its value on the time axis. It is possible to use another representation for the

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1-8 Medical Devices and Systems

same signal: that of the frequency domain. Any signal may be described as a continuum of sine waves
having different amplitudes and phases. The frequency representation describes the signals by means of
the amplitudes and phases of the sine waves. The transformation between the two representations is given
by the Fourier transform (FT):

∞
S(ω) = s(t )e−jωt dt = F {s(t )} (1.12)
−∞

where ω = 2π f is the angular frequency, and F { ∗ } is the Fourier operator.

The inverse Fourier transform (IFT) is the operator that transforms a signal from the frequency domain
into the time domain:

∞
1
s(t ) = S(ω)ejωt dw = F −1 {S(ω)} (1.13)
2π −∞

The frequency domain representation S(ω) is complex; hence

S(ω) = |S(ω)|ejθ (ω) (1.14)

where |S(ω)|, the absolute value of the complex function, is the amplitude spectrum, and θ (ω), the phase
of the complex function, is the phase spectrum. The square of the absolute value, |S(ω)|2 , is termed the
power spectrum. The power spectrum of a signal describes the distribution of the signal’s power on the
frequency axis. A signal in which the power is limited to a finite range of the frequency axis is called a
band-limited signal. Figure 1.3 depicts an example of such a signal.
The signal in Figure 1.3 is a band-limited signal; its power spectrum is limited to the frequency range
−ωmax ≤ ω ≤ ωmax . It is easy to show that if s(t ) is real (which is the case in almost all applications), the
amplitude spectrum is an even function and the phase spectrum is an odd function.
Special attention must be given to stochastic signals. Applying the FT to a sample function would
provide a sample function on the frequency axis. The process may be described by the ensemble of
spectra. Another alternative to the frequency representation is to consider the correlation function of the
process. This function is deterministic. The FT may be applied to it, yielding a deterministic frequency
function. The FT of the correlation function is defined as the power spectral density function (PSD):

∞
PSD[s(t )] = Sss (ω) = F {rss (τ )} = rss (τ )e−jωτ dτ (1.15)
−∞

S(v)

s(t )
v
vmax

t
u(v)

FIGURE 1.3 Example of a signal described in the time and frequency domains.

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Biomedical Signals 1-9

The PSD is used to describe stochastic signals; it describes the density of power on the frequency axis.
Note that since the autocorrelation function is an even function, the PSD is real; hence no phase spectrum
is required.
The EEG signal may serve as an example of the importance of the PSD in signal processing. When
processing the EEG, it is very helpful to use the PSD. It turns out that the power distribution of the EEG
changes according to the physiologic and psychological states of the subject. The PSD may thus serve as a
tool for the analysis and recognition of such states.
Very often we are interested in the relationship between two processes. This may be the case, for example,
when two sides of the brain are investigated by means of EEG signals. The time-domain expression of
such relationships is given by the cross-correlation function (Equation 1.10). The frequency-domain
representation of this is given by the FT of the cross-correlation function, which is called the cross-power
spectral density function (C-PSD) or the cross-spectrum:

Ssy (ω) = F {rsy (τ )} = |Ssy (ω)|e jθsy (ω) (1.16)

Note that we have assumed the signals s(t ) and y(t ) are stationary; hence the cross-correlation function
is not a function of time but of the time difference t . Note also that unlike the autocorrelation function,
rsy (τ ) is not even; hence its FT is not real. Both absolute value and phase are required.
It can be shown that the absolute value of the C-PSD is bounded:

|Ssy (ω)|2 ≤ Sss (ω)Syy (ω) (1.17)

The absolute value information of the C-PSD may thus be normalized to provide the coherence function:

|Ssy (ω)|2
γsy2 ≤1 (1.18)
Sss (ω)Syy (ω)

The coherence function is used in a variety of biomedical applications. It has been used, for example, in
EEG analysis to investigate brain asymmetry.

1.5 Discrete Signals

Assume now that the signal s(t ) of Figure 1.3 was sampled using a sampling frequency of fs = ωs /2π =
2π/Ts . The sampled signal is the sequence s(m). The representation of the sampled signal in the frequency
domain is given by applying the Fourier operator:

Ss (ω) = F {s(m)} = |Ss (ω)|ejθs (ω) (1.19)

The amplitude spectrum of the sampled signal is depicted in Figure 1.4. It can easily be proven that the
spectrum of the sampled signal is the spectrum of the original signal repeated infinite times at frequencies
of nωs . The spectrum of a sampled signal is thus a periodic signal in the frequency domain. It can
be observed, in Figure 1.4, that provided the sampling frequency is large enough, the wave shapes of
the spectrum do not overlap. In such a case, the original (continuous) signal may be extracted from
the sampled signal by low-pass filtering. A low-pass filter with a cutoff frequency of ωmax will yield at
its output only the first period of the spectrum, which is exactly the continuous signal. If, however, the
sampling frequency is low, the wave shapes overlap, and it will be impossible to regain the continuous
signal.
The sampling frequency must obey the inequality

ωs ≥ 2ωmax (1.20)

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1-10 Medical Devices and Systems

s(m)

Ss(v)

–vs vmax vs

Ss(v)

–vs vs vs

FIGURE 1.4 Amplitude spectrum of a sampled signal with sampling frequency above the Nyquist frequency (upper
trace) and below the Nyquist frequency (lower trace).

Equation 1.20 is known as the sampling theorem, and the lowest allowable sampling frequency is called
the Nyquist frequency. When overlapping does occur, there are errors between the sampled and original
signals. These errors are known as aliasing errors. In practical applications, the signal does not possess a
finite bandwidth; we therefore limit its bandwidth by an antialiasing filter prior to sampling.
The discrete Fourier transform (DFT) [Proakis and Manolakis, 1988] is an important operator that
maps a finite sequence s(m), m = 0, 1, . . . , N − 1, into another finite sequence S(k), k = 0, 1, . . . , N − 1.
The DFT is defined as


N −1
S(k) = DFT{s(m)} = s(m)e−jkm (1.21)
m=0

An inverse operator, the inverse discrete Fourier transform (IDFT), is an operator that transforms the
sequence S(k) back into the sequence s(m). It is given by


N −1
s(m) = IDFT{S(k)} = − s(k)ejkm (1.22)
k=0

It can be shown that if the sequence s(m) represents the samples of the band-limited signal s(t ), sampled
under Nyquist conditions with sampling interval of Ts , the DFT sequence S(k) (neglecting windowing
effects) represents the samples of the FT of the original signal:

S(k) = Ss (ω)|ω=k(ωs /N ) k = 0, 1, . . . , N − 1 (1.23)

Figure 1.5 depicts the DFT and its relations to the FT. Note that the N samples of the DFT span the
frequency range one period. Since the amplitude spectrum is even, only half the DFT samples carry the
information; the other half is composed of the complex conjugates of the first half.

Bronz: “2122_c001” — 2006/2/9 — 21:41 — page 10 — #10

Biomedical Signals 1-11

s(m)

N–1

Ss(v)

–vs vmax vs

S(k )

N–1 k

FIGURE 1.5 The sampled signal s(m) and its DFT.

The DFT may be calculated very efficiently by means of the fast (discrete) Fourier transform (FFT)
algorithm. It is this fact that makes the DFT an attractive means for FT estimation. The DFT provides an
estimate for the FT with frequency resolution of

2πfs 2π
f = = (1.24)
N T

where T is the duration of the data window. The resolution may be improved by using a longer window.
In cases where it is not possible to have a longer data window, for example, because the signal is not
stationary, zero padding may be used. The sequence may be augmented with zeroes:

sA (m) = {s(0), s(1), . . . , s(N − 1), 0, . . . , 0} (1.25)

w(t ) = 0 ∀|t | > T /2 (1.25a)

The zero padded sequence sA (m), m = 0, 1, . . . , L − 1, contains N elements of the original sequence and
L − N zeroes. It can be shown that its DFT represents the samples of the FT with an increased resolution
of f = 2π fs L − 1.

1.6 Data Windows

Calculation of the various functions previously defined, such as the correlation function, requires know-
ledge of the signal from minus infinity to infinity. This is, of course, impractical because the signal is
not available for long durations and the results of the calculations are expected at a reasonable time. We
therefore do not use the signal itself but the windowed signal.
A window w(t ) is defined as a real and even function that is also time-limited:
The FT of a window W (ω) is thus real and even and is not band-limited.

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1-12 Medical Devices and Systems

Multiplying a signal by a window will zero the signal outside the window duration (the observation
period) and will create a windowed, time-limited signal sw (t ):

sw (t ) = s(t )w(t ) (1.26)

In the frequency domain, the windowed signal will be

Sw (ω) = S(ω) ∗ W (ω) (1.27)

where (∗) is the convolution operator. The effect of windowing on the spectrum of the signal is thus the
convolution with the FT of the window. A window with very narrow spectrum will cause low distortions.
A practical window has an FT with a main lobe, where most of its energy is located, and sidelobes, which
cover the frequency axis. The convolution of the sidelobes with the FT of the signal causes distortions
known as spectral leakage. Many windows have been suggested for a variety of applications.
The simplest window is the rectangular (Dirichlet) window; in its discrete form it is given by w(m) = 1,
m = 0, 1, . . . , N − 1. A more useful window is the Hamming window, given by
 
2π
w(m) = 0.54 − 0.46 cos m m = 0, 1, . . . , N − 1 (1.28)
N

The Hamming window was designed to minimize the effects of the first sidelobe.

1.7 Short-Time Fourier Transform

The Fourier analysis discussed in preceding sections assumed that the signal is stationary. Unfortunately,
most signals are nonstationary. A relatively simple way to deal with the problem is to divide the signal
into short segments. The segments are chosen such that each one by itself can be considered a windowed
sample of a stationary process. The duration of the segments has to be determined either by having some
a priori information about the signal or by examining its local characteristics. Depending on the signal
and the application, the segments may be of equal or different duration.
We want to represent such a segmented signal in the frequency domain. We define the short-time
Fourier transform (STFT):

∞
STFTs (ω, τ ) = F {s(t )w(t − τ ) = s(t )w(t − τ )e−jωt dt (1.29)
−∞

The window is shifted on the time axis to t = t so that the FT is performed on a windowed segment in the
range t − (T /2) ≤ t ≤ t + (T /2). The STFT describes the amplitude and phase-frequency distributions
of the signal in the vicinity of t = t .
In general, the STFT is a two-dimensional, time-frequency function. The resolution of the STFT on
the time axis depends on the duration T of the window. The narrower the window, the better the time
resolution. Unfortunately, choosing a short-duration window means a wider-band window. The wider
the window in the frequency domain, the larger the spectral leakage and hence the deterioration of the
frequency resolution. One of the main drawbacks of the STFT method is the fact that the time and
frequency resolutions are linked together. Other methods, such as the wavelet transform, are able to better
deal with the problem.
In highly nonstationary signals, such as speech signals, equal-duration windows are used. Window
duration is on the order of 10–20 msec. In other signals, such as the EEG, variable-duration windows are
used. In the EEG, windows on the order of 5–30 sec are often used.

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Biomedical Signals 1-13

fs

0.5fs

2T 4T 6T t (sec)

FIGURE 1.6 A spectrogram.

A common way for representing the two-dimensional STFT function is by means of the spectrogram.
In the spectrogram, the time and frequency axes are plotted, and the STFT PSD value is given by the
gray-scale code or by a color code. Figure 1.6 depicts a simple spectrogram. The time axis is quantized to
the window duration T . The gray scale codes the PSD such that black denotes maximum power and white
denotes zero power. In Figure 1.6, the PSD is quantized into only four levels of gray. The spectrogram
shows a signal that is nonstationary in the time range 0 to 8 T . In this time range, the PSD possesses a peak
that is shifted from about 0.6fs to about 0.1fs at time 0.7T . From time 0.8T , the signal becomes stationary
with a PSD peak power in the low-frequency range and the high-frequency range.

1.8 Spectral Estimation

The PSD is a very useful tool in biomedical signal processing. It is, however, impossible to calculate, since
it requires infinite integration time. Estimation methods must be used to acquire an estimate of the PSD
from a given finite sample of the process under investigation. Many algorithms for spectral estimation
are available in the literature [Kay, 1988], each with its advantages and drawbacks. One method may be
suitable for processes with sharp spectral peaks, while another will perform best for broad, smoothed
spectra. An a priori knowledge on the type of PSD one is investigating helps in choosing the proper
spectral estimation method. Some of the PSD estimation methods will be discussed here.

1.8.1 The Blackman–Tukey Method

This method estimates the PSD directly from its definition (Equation 1.15) but uses finite integration time
and an estimate rather than the true correlation function. In its discrete form, the PSD estimation is


M
Ŝxx (ω) = Ts r̂xx (m)e−jωmTs
m=−M
(1.30)
N −i−1
1 
r̂xx (m) = x(m + i)x(i)
N
i=0

where N is the number of samples used for the estimation of the correlation coefficients, and M is
the number of correlation coefficients used for estimation of the PSD. Note that a biased estimation of
the correlation is employed. Note also that once the correlations have been estimated, the PSD may be
calculated by applying the FFT to the correlation sequence.

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1-14 Medical Devices and Systems

1.8.2 The Periodogram

The periodogram estimates the PSD directly from the signal without the need to first estimate the
correlation. It can be shown that
  2 
 1 
T  
 
Sxx (ω) = lim E  x(t )e −jωt dt  (1.31)
T →∞  2T  −T  

The PSD presented in Equation 1.31 requires infinite integration time. The periodogram estimates the
PSD from a finite observation time by dropping the lim operator. It can be shown that in its discrete form,
the periodogram estimator is given by

Ts
Ŝxx (ω) = |DFT{x(m)}|2 (1.32)
N

The great advantage of the periodogram is that the DFT operator can very efficiently be calculated by the
FFT algorithm.
A modification to the periodogram is weighted overlapped segment averaging (WOSA). Rather than
using one segment of N samples, we divide the observation segment into shorter subsegments, perform a
periodogram for each one, and then average all periodograms. The WOSA method provides a smoother
estimate of the PSD.

1.8.3 Time-Series Analysis Methods

Time-series analysis methods model the signal as an output of a linear system driven by a white source.
Figure 1.7 depicts this model in its discrete form. Since the input is a white noise process (with zero mean
and unity variance), the PSD of the signal is given by

Sss (ω) = |H (ω)|2 (1.33)

The PSD of the signal may thus be represented by the system’s transfer function. Consider a general
pole-zero system with p poles and q zeros [ARMA(p, q)]:
q −i
i=0 bi z
H (z) = p (1.34)
1+ −i
i=1 ai z

Its absolute value evaluated on the frequency axis is


|
q −i 2 
2 i=0 bi z | 
|H (ω)| =  (1.35)
|
p −i 2 
i=1 ai z | z=e −jωTs

Several algorithms are available for the estimation of the model’s coefficients. The estimation of the ARMA
model parameters requires the solution of a nonlinear set of equations. The special case of q = 0, namely,
an all-pole model [AR(p)], may be estimated by means of linear equations. Efficient AR estimation

u(m) s(m)
H(z)

U(w) s(w) = H(v)U(w)

FIGURE 1.7 Time-series model for the signal s(m).

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Biomedical Signals 1-15

50 100 Hz
Freq.

PSD

50 100 Hz
Freq.

FIGURE 1.8 PSD of surface EMG. (Upper trace) Blackman–Tukey (256 correlation coefficients and 256 padding
zeroes). (Middle trace) Periodogram (512 samples and 512 padding zeroes). (Lower trace) AR model (p = 40).

algorithms are available, making it a popular means for PSD estimation. Figure 1.8 shows the estimation
of EMG PSD using several estimation methods.

1.9 Signal Enhancement

The biomedical signal is very often a weak signal contaminated by noise. Consider, for example, the
problem of monitoring the ECG signal. The signal is acquired by surface electrodes that pick up the
electric potential generated by the heart muscle. In addition, the electrodes pick up potentials from other
active muscles. When the subject is at rest, this type of noise may be very small, but when the subject
is an athlete performing some exercise, the muscle noise may become dominant. Additional noise may
enter the system from electrodes motion, from the power lines, and from other sources. The first task
of processing is usually to enhance the signal by “cleaning” the noise without (if possible) distorting the
signal.
Assume a simple case where the measured signal x(t ) is given by

x(t ) = s(t ) + n(t ) X (ω) = S(ω) + N (ω) (1.36)

where s(t ) is the desired signal and n(t ) is the additive noise. For simplicity, we assume that both the signal
and noise are band-limited, namely, for the signal, S(ω) = 0, for ωmax ≤ ω, ωmin ≥ ω. Figure 1.9 depicts
the PSD of the signal in two cases, the first where the PSD of the signal and noise do not overlap and the
second where they do overlap (for the sake of simplicity, only the positive frequency axis was plotted). We
want to enhance the signal by means of linear filtering. The problem is to design the linear filter that will

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1-16 Medical Devices and Systems

(a) PSD

Signal Noise

f
fmin fmax

(b) PSD

Signal
Noise

FIGURE 1.9 Noisy signal in the frequency domain (a) nonoverlapping case and (b) overlapping case.

provide best enhancement. Assuming we have the filter, its output, the enhanced signal, is given by

y(t ) = x(t ) ∗ h(t ) Y (ω) = X (ω)H (ω) (1.37)

where y(t ) = ŝ(t ) + no (t ) is the enhanced output, and h(t ) is the impulse response of the filter. The
solution for the first case is trivial; we need an ideal bandpass filter whose transfer function H (ω) is

1, ωmin < ω < ωmax

H (ω) = (1.38)
0, otherwise

Such a filter and its output are depicted in Figure 1.10.

As is clearly seen in Figure 1.10, the desired signal s(t ) was completely recovered from the given noisy
signal x(t ). Practically, we do not have ideal filters, so some distortions and some noise contamination
will always appear at the output. With the correct design, we can approximate the ideal filter so that the
distortions and noise may be as small as we desire. The enhancement of overlapping noisy signals is far
from being trivial.

1.10 Optimal Filtering

When the PSD of signal and noise overlap, complete, undistorted recovery of the signal is impossible.
Optimal processing is required, with the first task being definition of the optimality criterion. Different
criteria will result in different solutions to the problem. Two approaches will be presented here: the Wiener
filter and the matched filter.

1.10.1 Minimization of Mean Squared Error: The Wiener Filter

Assume that our goal is to estimate, at time t + ξ , the value of the signal s(t + ξ ), based on the observations
x(t ). The case x = 0 is known as smoothing, while the case ξ > 0 is called prediction.

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Biomedical Signals 1-17

X(t ) = s(t ) + n(t ) H(v) y(t ) = s(t ) + no(t )

X(v) = S(v) + N(v) Y(v) = X(v) + H(v)

PSD

Signal Noise

H(v)

f
fmin fmax

Y(v)
Enhanced signal

FIGURE 1.10 (a) An ideal bandpass filter. (b) Enhancement of a nonoverlapping noisy signal by an ideal bandpass
filter.

We define an output error ε(t ) as the error between the filter’s output and the desired output. The
expectation of the square of the error is given by

E{e 2 (t )} = E{[s(t + ξ ) − y(t + ξ )]2 }


∞ 2 
= E s(t + ξ ) − h(τ )x(t − τ ) dτ (1.39)
−∞

The integral term on the right side of Equation 1.39 is the convolution integral expressing the output of
the filter.
The minimization of Equation 1.39 with respect of h(t ) yields the optimal filter (in the sense of
minimum squared error). The minimization yields the Wiener–Hopf equation:

∞
rsx (τ + ξ ) = h(η)rxx (τ · −η) dη (1.40)
−∞

In the frequency domain, this equation becomes

Ssx (ω)ejωξ = Hopt (ω)Sxx (ω) (1.41)

from which the optimal filter Hopt (ω) can be calculated:

Ssx (ω) jωξ Ssx (ω)

Hopt (ω) = e = ejωξ (1.42)
Sxx (ω) Sss (ω) + Snn (ω)

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Exploring the Variety of Random
Documents with Different Content
The Project Gutenberg eBook of Nos frères
farouches
This ebook is for the use of anyone anywhere in the United States
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you are located before using this eBook.

Title: Nos frères farouches

Ragotte, Les Philippe

Author: Jules Renard

Release date: January 13, 2024 [eBook #72702]

Language: French

Original publication: Paris: Gallimard, 1921

Credits: Laurent Vogel and the Online Distributed Proofreading Team

at https://www.pgdp.net (This file was produced from
images generously made available by The Internet
Archive/Canadian Libraries)

*** START OF THE PROJECT GUTENBERG EBOOK NOS

FRÈRES FAROUCHES ***
 JULES RENARD

NOS FRÈRES
FAROUCHES

5e Édition

GALLIMARD
 Copyright by Librairie Gallimard, Paris

Tous droits de reproduction, de traduction et d’adaptation réservés

pour tous pays.
RAGOTTE
 RAGOTTE

I
MŒURS DE RAGOTTE

Elle est si naturelle que, d’abord, elle a l’air un peu simple. Il faut
longtemps la regarder pour la voir.

A l’école.

Elle est allée à l’école huit mois, chez ce vieil ours de Varneau.
On payait trente sous par mois et, en hiver, chaque élève
apportait le matin sa bûche.
Il y avait deux partis en classe : les écriveux et ceux qui
n’écrivaient pas. Ses sœurs ont eu le temps d’apprendre. Comme
elle était l’aînée, elle a dû tout de suite se mettre au ménage avec sa
mère, et elle n’a rien appris.
 Elle connaît la lettre P, la lettre J et la lettre L, parce que ces
lettres lui ont servi à marquer le linge de ses petits, qui s’appellent
Paul, Joseph et Lucienne. Elle reconnaît aussi le chiffre 5, on ne sait
pas pourquoi.

Elle ne peut rendre la monnaie que sur dix sous. Par exemple, si
on lui achète un sou de lait, elle redoit neuf sous. A partir de dix
sous, elle s’embrouille, et elle aime mieux dire :
— Vous me paierez une autre fois !

Elle se passe bien d’écrire, mais elle regrette encore de ne pas

savoir lire. On a beau lui faire lentement la lecture d’une lettre, elle
se méfie. Si elle savait, elle pourrait lire la lettre à son aise, la relire
toute seule, en cachette, souvent.
— J’ai soixante ans, madame, dit-elle à Gloriette, c’est trop tard ;
si j’en avais vingt de moins, je vous ferais une prière, je vous prierais
de m’apprendre à lire !

Elle observe Mademoiselle penchée sur sa table de travail.

— Je viens voir, dit-elle, si vous ne vous trompez pas dans vos
écritures !
Et elle ajoute, fine, haussant les épaules pour se moquer d’elle-
même :
— C’est bien à moi !…

Quand son homme, Philippe, est absorbé par la lecture du Petit

Parisien, elle a envie de lui arracher le journal et de le jeter au feu.
— Qu’est-ce qu’il trouve donc de si curieux là-dessus ?
 Si elle reçoit une lettre à son nom, ce qui ne lui arrive presque
jamais, elle l’apporte à Philippe.
— Ah ! mon Dieu ! fait-elle, troublée, dépêche-toi !
— Tu as le temps, peut-être ! répond Philippe.
— Écoute, dit Ragotte, tu vas me la lire d’abord une première
fois, vite, pour que je sache si c’est une bonne ou une mauvaise
nouvelle. Ensuite, tu me la liras une deuxième fois, sans te presser,
pour que je comprenne, comme il faut, ce qu’ils me veulent.

Elle ne sait pas encore que le timbre des lettres est à deux sous.

Elle explique ainsi ce que fait un employé de bureau :

— Toute la journée, dit-elle, il écrit dans une chambre.

Louée.

A douze ans, elle était déjà en maître, c’est-à-dire au service des

autres, chez une vieille dame ayant les moyens, mais si avare
qu’elle ne pouvait pas garder une servante.
A l’arrivée de Ragotte, les voisines se dirent :
— Elle est fraîche, cette petite-là ! Elle n’aura pas longtemps sa
bonne mine !
La vieille dame taillait elle-même la soupe pour qu’elle fût claire
de pain.
— Quand on ne travaille pas beaucoup, disait-elle, on n’a pas
besoin de beaucoup manger.
Jamais on ne veillait. Hiver comme été, il fallait se coucher à la
nuit tombante et ne pas user de chandelle.
Dès que la vieille dormait, Ragotte allait prendre le pain dans
l’arche et se coupait une tranche mince sur toute la longueur de la
miche. Elle mangeait sous ses draps, sans bruit, au risque de
s’étouffer, et sans plaisir, parce que, demain, la vieille s’apercevrait
sûrement de quelque chose.
La vieille ne s’aperçut de rien, et Ragotte, contente de gagner
quelques sous, qu’elle devait donner à sa mère, ne se plaignait pas.
Au bout de trois mois, sa mère, la voyant maigrir, la retira à
cause des voisines, par fierté.
*
* *

Elle dit à propos de tout ce qui a précédé sa naissance :

— En ce temps-là, je n’étais pas faite !

— Quand mon père se fâchait, il me disait : « Si tu n’es pas

contente, passe par où les maçons n’ont pas maçonné. »
— Qu’est-ce qu’il voulait dire ?
— Par la porte !
— De mon temps, les jeunes filles rentraient toutes à la tombée
de la nuit.

Mariée.

— Ce n’était pas pour ma beauté, dit Ragotte, ce n’était pas non

plus pour ma fortune, mais à l’âge de me marier, j’en avais cinq
autour de moi ! Le premier m’a fait la cour trois ans. Las de
m’attendre, il s’est marié avec une autre ; puis, une fois veuf, il m’a
redemandée. Je ne voulais pas. Quand il était trop près de moi,
j’avais de l’ennui. Il me disait :
« Si votre mariage avec Philippe manque, vous me donnerez sa
place et je lui rembourserai tous ses frais. »
J’ai mieux aimé Philippe.
 — Vous ne regrettez rien ?
— Ma foi non, dit-elle, après avoir un peu hésité parce que
Philippe est là.

— Quand je pense, dit tout de même Ragotte, que je pouvais

choisir entre cinq garçons, et que j’ai choisi le plus laid !
— Quand je pense, dit Philippe, que je connaissais trois filles et
que j’ai pris la plus vieille !
— Et ce n’était pas malin de ta part, répond Ragotte ; si j’avais
été un homme, je n’aurais jamais voulu d’une femme plus âgée que
moi !
— Regardez-le, dit-elle, il ne voit plus clair !
C’est qu’en effet il plisse et ferme presque les yeux à force de
rire.

Elle s’est mariée en sabots ; elle avait acheté des souliers neufs,
mais par crainte de les salir, elle ne voulait les mettre que pour faire
son entrée à l’église. Arrivée sous le porche, elle voit que sa mère,
qui devait les porter à la main, ne les a pas.
— Et mes souliers, maman ?
— Ha, ma fille, je les ai oubliés ; ils sont sous l’armoire, mon
enfant !
Il fallut bien aller jusqu’au chœur avec les sabots qui tapaient le
moins possible sur les dalles.

— Tout s’est passé comme il faut la première nuit ?

— Oh ! oui, dit Ragotte, Philippe avait une chemise bien propre.
 Elle était encore si jeune de caractère qu’elle n’a pas pu, tout de
suite, s’empêcher de faire la partie avec les filles du village. Elle ne
s’arrêtait que lorsqu’une voisine de ses amies lui criait :
— Attention ! voilà ton homme !

Nouvelle mariée, elle habitait la même maison, c’est-à-dire la

même pièce que son beau-père. Cela ne devenait gênant que
lorsqu’elle accouchait ; mais le beau-père sortait par discrétion. Et
puis Ragotte n’était pas longue. Personne ne mettait moins de
temps qu’elle.

— Mon beau-père ne m’adressait pas la parole. Philippe croyait

qu’il boudait par ma faute et m’en voulait. Il aimait beaucoup son
père. Moi aussi, je l’aimais, le pauvre vieux, seulement, je n’étais
pas bicheuse, et je ne savais pas le mignoter à sa suffisance.

Amour.

Elle aime Philippe, mais comment oser dire qu’elle l’aime

d’amour ?
Quel nom faut-il que je donne au sentiment qui les tient liés ?
Elle l’aime : cela signifie qu’elle le préfère à tous. Elle a perdu sa
mère, Philippe lui restait. Elle perd son petit Joseph, Philippe reste.
Ses autres enfants peuvent mourir, Philippe vivant, elle ne sera pas
inconsolable.
Elle dit : « Pourvu que je l’aie ! » comme elle dirait : « Tant qu’on a
du pain, on ne meurt pas de faim ! »
Elle se passerait de tout, sauf de Philippe, et, pour cette raison,
elle l’appelle, sans se creuser la tête : « Mon principal ! »
 Philippe l’appelle bonnement : la vieille demoiselle !

— Aujourd’hui, dit-elle, il aime mieux se faire lécher par son chien

que par moi ; mais qu’il ne vienne pas ensuite mettre sa figure contre
la mienne, je n’ai pas besoin qu’il me rende les bicheries du chien !

— A cause de son nez, je le reconnaîtrais entre cent cochons.

Philippe a le nez un peu déformé.

En ménage.

— Moi aussi, madame Gloriette, j’étais ambitieuse ! J’ai voulu

longtemps mettre des chaussettes à mes petits. Ils possédaient tous
trois chacun leur paire. Je la lavais le soir, pour la faire sécher la
nuit, et j’en coiffais les chenets. Un matin, j’ai retrouvé les
chaussettes mangées par les grillons. Je me suis rendu compte, ce
jour-là, que mes petits marcheraient aussi bien pieds nus.

— Quand un petit commence à pouvoir rester assis sur ses

fesses, madame, ça prouve qu’il n’a pas le cul trop rond.

Philippe ne lui donne jamais un sou. Il fait sa vie de son côté, elle
fait la sienne du sien. Loin de se plaindre, elle blâme certaines
femmes :
— Il y en a, dit-elle, qui gardent le porte-monnaie et qui ne
remettent de l’argent à leur homme que vingt sous par vingt sous.
Moi, je ne pourrais pas.
Toutefois, elle pense qu’à la rigueur la femme peut vivre sur son
homme, et même le mari sur sa femme : c’est compagne et
compagnon ! Mais un père et une mère ne doivent pas rester à la
charge de leurs enfants. Dès qu’elle ne pourra plus, aidée de son
principal ou seule, faire sa vie, elle voudra mourir.

— Dans un ménage, dit-elle, quand il pleut sur l’un, il fait mou sur
l’autre.
Ce qui veut dire que, si l’un gagne des sous, l’autre en profite.

Elle ne dépense pas dix francs par an à son entretien, et dans les
vieilles culottes qu’on passe à Philippe et qu’il use, elle trouve
encore de bonnes pièces pour se faire des chaussons tout neufs.

Elle n’a pas adopté le pantalon des femmes ; on ne marche à

l’aise que si les cuisses se touchent.

Toujours propre, décente et modeste dans sa tenue, il faut qu’il

fasse bien chaud pour qu’elle dénoue et relève sur le cou les brides
de son bonnet blanc. C’est presque du libertinage.

Ce qui l’a flattée, un jour qu’elle s’achetait un petit manteau pour

une noce, c’est que Tapin, le marchand de nouveautés, ait dit, en lui
mettant sur le dos la première jaquette venue :
— Vous êtes bien plaisante à habiller !

Comme Tapin faisait miroiter un caraco de satinette :

— Oh ! non ! non ! dit-elle, c’est trop victorieux pour moi !
 — Un homme peut rester au lit quand il est malade, une femme
pas. Une femme n’a jamais le temps de s’écouter.

— Une femme doit manger moins qu’un homme.

Jadis, on mêlait des pommes de terre à la farine du pain. Ragotte

a mangé de ce pain-là, et elle fait la grimace au souvenir du
morceau de pomme de terre froide qu’on sentait tout à coup sous la
dent.

Elle a été longue à s’habituer au pain de monsieur, qui est le pain

blanc. Elle aime toujours le pain de ménage, et parfois elle fait avec
sa cousine, qui cuit encore elle-même, des échanges au goût et au
profit de chacune.

Elle est allée, ce matin, au marché de la ville, et elle dit :

— Autrefois, il y avait un boucher ; aujourd’hui, il y en a cinq ! Le
monde devient carnassier.

— Autrefois, il fallait courir jusqu’à la ville acheter deux sous de

sel. On prenait ses précautions le dimanche. Aujourd’hui, pour notre
argent, ils nous apportent tout à la maison.

— Manger ! Est-ce drôle que tout le monde s’enferme dans les

maisons, à la même heure, pour faire la même chose !

Ils mangent, Philippe, Ragotte, le Paul, à une petite table où ne

peut tenir que la grande écuelle commune.
 — Vous êtes bien là, dit Gloriette, serrés coude à coude.
— Oui, madame, répond Ragotte, on se donne appétit les uns
aux autres.

— En veux-tu, toi, du pain ? lui demande Philippe.

— Je ne peux pas déjeuner sans ça !
— Est-ce que je sais, moi ?

Habile à avaler sa soupe proprement et nettement, elle n’aime

pas les tables mal torchées.

— Vous avez déjà fini votre soupe, Ragotte ?

— Oh ! madame, quand on l’attaque à pleine cuiller, ça va vite.
— C’est bien propre, Philippe, une toile cirée comme celle de
madame. Il n’en faudrait pas grand sur notre petite table ! si un jour,
à la ville, tu en voyais un morceau ?…
— Mange donc ! lui dit Philippe.

Elle se chauffe mal, si elle ne voit pas le feu ; elle aime les beaux
feux de bois dont la braise ardente fait pleurer des larmes cuites ;
mais elle trouve que rien ne vaut le gentil feu d’une paire de sabots
qu’elle a portés, qu’elle brûle quand ils ne sont plus mettables, et
qu’elle regarde flamber, toute songeuse.

Le son du cor de chasse l’émeut au point qu’elle ose dire à

Philippe :
— Pourquoi n’as-tu jamais appris à flûter comme ça ?
 Il y avait à la cuisine un reste de gâteau.
— Avez-vous mangé ce gâteau ? dit Gloriette.
— Non, madame, je n’ai fait que laver la vaisselle.

Elle dit à Gloriette qui surveille du bœuf à la mode :

— Votre fricot sent si bon que je mangerais bien mon pain sec à
côté.

— Avez-vous goûté à votre pot de confitures ?

— Oh ! non, madame !
— Qu’est-ce que vous attendez ?
— Toute seule, j’aurais honte ; il me viendra peut-être de la
compagnie !

Quelquefois, la bouchère, dont elle a élevé un des petits, lui fait

présent d’un morceau de viande. Cette générosité cause à Ragotte
plus d’embarras que de plaisir. Elle montre la viande à Gloriette :
— Voilà, madame, un brave goûter ! Mais je ne sais pas le faire
cuire ; vous allez bien m’expliquer, dites ?

C’est malheureux de ne pas être dame ! Elle mangerait de la

crème au chocolat tous les jours.

— Un rien me suffit pour ma nourriture, mais quand j’ai quelque

chose de bon, je me laisse faire comme les autres.
— Toute la journée et toute la vie, dit-elle, on ne travaille que
pour la gueule !
Le rocking-chair.

Philippe, qui désherbe, accroupi, les oignons du jardin, reçoit une

motte de terre sur le dos. Il ne sait pas d’abord d’où ça lui tombe,
mais il aperçoit Ragotte dans le rocking-chair. Elle lui sourit avec
tendresse.
— Regarde comme je me balance ! dit-elle.
Philippe hausse les épaules.
Il a tort.
Il faut voir Ragotte dans cette petite voiture sans roue. Elle
s’amuse comme une fillette, émerveillée par cette nouvelle invention
des hommes qui ne savent plus quoi imaginer.
*
* *

— Madame, dites, pour une pièce de trois francs, on aurait bien

un bon fauteuil ?

Elle a pris d’abord le tub pour un ciel de lit et elle finit par trouver
que ces boules, que le monsieur appelle des haltères, pourraient
servir à écraser le sel.
C’est une des dernières paysannes qui ne veulent pas accepter
certains progrès et qui s’arrêtent et se baissent n’importe où.
— Quand je suis allée à Moulins, chez une cousine, comme
j’avais un petit besoin, elle m’a mise dans une chambre, oui, toute
seule, dans une vraie chambre ! Oh ! que j’avais peur ! je serais
morte si on était entré.

Il lui arrive de se croire si seule au monde qu’elle se mouche

dans ses doigts.
 Gloriette a mis, par jeu, sa voilette sur la figure de Ragotte. Ça lui
va comme à une dame et Philippe dit en riant :
— Elle se conserverait bien derrière ce petit grillage !

Elle vient s’asseoir dans la cuisine de Gloriette pour causer et

faire la dame.
Si Gloriette lui offre un reste, Ragotte apporte une assiette et dit :
— Mon assiette est peut-être trop creuse, mais vous n’êtes pas
obligée de la remplir. On met bien un veau dans une grange !
Gloriette lui passe un vieux plateau de bois où c’est l’habitude de
mincer le lard et de hacher le persil.
— Prenez-le, Ragotte, il ne me sert plus, et si vous n’aviez pas
été là, je le jetais au feu.
— Ne faites jamais ça, madame, je le jetterai bien moi-même.

— On souffre, madame, quand on voit les riches jeter quelque

chose.

— Oh ! madame, vous pensez donc toujours à moi ?

Elle dit à Gloriette qui compte sa monnaie :

— Vous en avez des jolis sous ! Il n’y a que ça qui débêtit le
monde !

Elle croit que nous sommes très riches, et si quelqu’un lui disait
que nous avons au moins mille francs, ça ne l’étonnerait pas.