BIOTELEMETRY AND TELEMEDICINE

By Kedar.N.Raje Ojas.V.Kulkarni

What is Biotelemetry??
Biotelemetry is the wireless transmission of automatically measured physiological data from the point of sensing to a remote location.

Why use Biotelemetry ??

Patient monitoring under normal conditions and in natural surroundings. Vital sign monitoring in critical situations. Research on unrestrained, unanesthetized animals in their natural habitat. To monitor astronauts in space.

Components of a Biotelemetry System

A typical biotelemetry system comprises: Sensors appropriate for the particular signals to be monitored Battery-powered, patient worn transmitters A Radio Antenna and a Receiver A display unit capable of displaying information from multiple patients.

Transmitter
DIRECT BIOPOTENTIAL

SUBJECT

OR

AMPLIFIER

TRANSDUCER

PROCESSOR

EXCITER

MODULATOR

CARRIER

Receiver

Receiver

CHART RECORDER

TUNER

DEMODULATOR

OR OSCILLOSCOPE

TAPE RECORDER

Types of Telemetry Systems

Single Channel (One parameter is measured) ECG Telemetry system Temperature Telemetry system Multi Channel (More than one parameter is measured) Telemetry of ECG and Respiration Obstetrical Telemetry system

ECG Telemetry System

Telemetry of ECG and Respiration

Implantable Telemetry Systems

Transducers are implanted surgically in the body. Allow measurement of multiple physiological variables over long periods of time without any attachment of wires, restraint or anesthesia to the monitored subjects. Generally used in animal research.

Problems encountered with implantable systems

Limited battery life. Restricts the range of signal transmission. Encapsulation of the unit.

Sometimes, partially implanted systems are Used Eg. Monitoring of EEG Electrodes implanted into the brain and telemetry unit mounted within and on top of the skull.

Telemetry system for monitoring animal activity

EEG Implantable Unit

Applications of Biotelemetry
Telemetry of ECGs from Cardiac Patients Sports Physiology studies Telemetry for Emergency Patient Monitoring Research with experimental animals Neurostimulation

Telemetry of ECGs from Cardiac patients

ECG electrodes taped securely to the chest of the patient Electrodes connected to a small transmitter unit which also contains signal conditioning equipment (amp + filters) Transmitter unit (containing batteries) fastened to a special belt worn around the patients waist Telemetry receiver o/p connected to one of the ECG channels of the patient monitor

Problems encountered
We cannot pinpoint the location of the patient Patients may move out of range of the telemetry transmitter Area in which the patients are allowed to move is limited

ECG Telemetry Transmitter Unit and Electrode Placement

Sports Physiology studies

Heart rate, respiration rate etc. of athletes are monitored for studying energy expended during sports activities Analysis of these results enables us to improve the performance of the athletes

Monitoring athletes using telemetry system

Telemetry for Emergency Patient Monitoring

Ambulances and emergency rescue teams equipped with telemetry equipment to allow transmission of physiological data like ECG to a nearby hospital Two-way voice transmission used simultaneously to provide instructions for treatment Sometimes emergency rescue squad transmits data from portable transmitter to portable receiver in a moving vehicle The data is then retransmitted using the transmitter of the moving vehicle which is more powerful

Research with experimental animals

Eg.1 EEG electrodes implanted into the brain of a chimpanzee Leads were brought out of the animals head and the EEG was transmitted Eg.2 Pressure transducer implanted into the body of a dog Lead from the transducer brought out through the dogs back and connected to telemetry transmitter mounted on a jacket worn by the dog

Neurostimulation
An electrical impulse can trigger the firing of nerves and cause them to function properly in case of any disability Eg. Treatment of Dropfoot (Inability of patient to lift his foot) An external transmitter - Pulse modulated carrier of 450khz Implanted receiver demodulates the signal and delivers it to the nerve The nerve when stimulated causes muscles in the lower forepart of the leg to contract and raises the foot A switch is present to turn the transmitter on/off in order to synchronize with the normal activity

References
BIOMEDICAL INSTRUMENTATION AND MEASUREMENTS by Leslie Cromwell, Fred Weibell, Erich Pfeiffer BIOMEDICAL INSTRUMENTATION by R.S.Khandpur BIOTELEMETRY: A REVIEW OF THE ART AND SOME INTERESTING CIRCUITS FOR LOW POWER, LOW FREQUENCY SYNTHESIS by Ron Spencer, The Krasnow Institute BIOTELEMETRY Wikipedia BIOTELEMETRY SYSTEMS, Open Technologies, Switzerland

What is Telemedicine ??
It is the application of telecommunications and computer technology to deliver health care from one location to the other In general, the telemedicine technology includes : a) Hardware ( High end camera, Video conferencing equipment, etc. ) b) Software c) Medical Equipment ( medical monitors ) d) Communications link ( Broadband communication media )

Types of Telemedicine
There are two concepts on the basis of which telemedicine is practiced: Store and forward concept Real time monitoring concept

Store and Forward concept

a) Acquiring medical data and transmitting it to an expert or medical specialist for interpretation and review at his/her convenience b) The experts opinion can be transferred back without any immediate compulsion c) It does not require presence of both parties at the same time d) Eg. Radiology, Pathology

Real time monitoring

a) Real time exchange of information between two centres simultaneously b) It requires presence of both parties at the same time c) A communications link that allows realtime interaction to take place is also required d) Eg. Video conferencing, Interviewing and examining the patients, robotic surgery

Essential parameters for Telemedicine

a) b) c) d) e) f) A detailed EPR (Electronic Patient Record) is required so that patient information can be accessed and sent for expert opinion when desired. The following components are also essential: Primary patient data : Name, age, sex, address, etc. Patient history: Personal and family health history Clinical information: Signs and symptoms obtained from direct or indirect patient observations Investigations: Complete analysis of blood tests, urine and stool tests, etc. Data and reports: Radiographs, ECG, MRI (Magnetic Resonance Imaging) Video conferencing facility for online consultation

A typical telemedicine system

A telemedicine system setup

Telemedicine Technology
Transmission of Medical Images: Acquisition and transmission of medical images such as Xrays, CT, MRI Images on traditional film or print media are converted into digital format by direct imaging or scanning Images in digital format (eg. Ultrasound, CT) are available in formats like TIF and SVGA The following table gives the storage requirements for various imaging techniques:

Transmission of Video Images: The NTSC (National Television System Committee) format is used which has a frame rate of 30 frames/sec Due to communication and storage limitations a codec ( coder/decoder ) is used to compress and decompress the transmitted video signal

Transmission of Digital audio: Audio used for conversation and medical diagnosis in a telemedicine system must be digitized and compressed before combining it with digital video and other information Typical data rates include 16 to 64kbps but sometimes 120kbps is used for applications requiring higher data rates

Digital Communication systems used for telemedicine

POTS ( Plain Old Telephone Service) It uses a modem (modulator/demodulator) Digital signals at data rates upto 30kbps (kilo bits per sec) can be transmitted Adequate for data file transfers of still images

DDS (Digital Data System) Eg. Switched-56 which produces data rates of 56kbps To obtain increased data communication capacity, a number of lines can be combined into a single channel and many channels into larger units by time division multiplexing of digital voice data. Data rates of upto 1536 kbps can be achieved (T-1 system)

ISDN (Integrated Services Digital Network) It is most commonly used nowadays for transmission of voice and data ATM (Asynchronous Transfer Mode) It is a high capacity communication link between widely dispersed sites Employs fibre optic communication channels such as OC-3 (155mpbs) and OC-2(622mbps) Well suited for transmitting digital video and audio

Telemedicine using mobile communication

Color images, audio signals and physiological signals are obtained from the patient in a moving vehicle Images and signals multiplexed and transmitted to a fixed station In the fixed station, signals are de multiplexed and presented to medical specialist Instructions from specialist are then transmitted back to the mobile station through the communication link

Principle of telemedicine using mobile and satellite communication

Use of Internet Resource for Telemedicine

There is a dedicated link for telemedicine applications It offers high security to the data, is more reliable, is better tuned for real-time applications and is ideal for image processing applications, video conferencing, video-microscopy, etc.

Telemedicine Applications
Tele radiology Tele cardiology Medical Consultations Tele surgery Tele education

Teleradiology
Radiological images such as X-rays, CTs, MRIs are transferred from one location to the other for the purpose of interpretation and/or consultation Teleradiology network is performed using standard network technologies such as the internet, telephone lines, wide area network (WAN), or over a local area network (LAN) Highly specialized software is used to transmit the images and enable the Radiologist to effectively analyze what can be 100's of images for a given study.

Telecardiology
Transmission of ECG, echocardiography, color Doppler, etc. for experts opinion

Medical consultations
Specialist doctors can be consulted by the patient either directly or by the local medical staff using telemedicine technology When patient is not present, his EPR (Electronic Patient Record) is used as a substitute Depending on the level of interaction required, the equipment varies from a normal telephone to video conferencing equipment

Tele consultation between a patient and an expert

Tele consultation in surgery between AIMS (Amrita Institute of Medical Sciences) and SGPGIMS (Sanjay Gandhi Post Grad Institute of Medical Sciences)

Tele surgery
Surgery, procedure or technique performed on a patient in which the surgeon in not at the immediate site of the subject being operated upon Visualization and manipulation of the tissues and equipment is performed using electronic devices

Concerns about Tele surgery

Cost of installing and maintaining a robotic system Safety of the procedure Complications in surgery Tele surgeons mistake or technical failure Legal issues

Tele Education
It involves delivery of medical education programmes to the physicians and paramedics located at smaller towns and who are professionally isolated from major medical centres Virtual classrooms through satellite links enable students to attend classes from near home It has tremendous potential for rural areas as it provides opportunity for higher education to those who are unable to attend on-campus classes

ISROs Telemedicine Program

ISRO's Telemedicine pilot project was started in the year 2001 with the aim of introducing the Telemedicine facility to the grass root level population The Telemedicine facility connects the District Hospitals/Health Centres with Super Speciality Hospitals for providing expert consultation to the needy and underserved population. Currently ISROs telemedicine network contains 130 hospitals (102 dist/rural hospitals and 28 super speciality hospitals)

Future
ISRO's Telemedicine Project is gaining more acceptability and has potential to open up new frontiers for the rural health care in India States of Karnataka, Kerala and Chhattisgarh have initiated the establishment of SatCom Based Telemedicine facility in all their district hospitals which will be connected to different Speciality Hospitals in the major cities. With the steady growth of Telemedicine application, it is also envisaged to develop an exclusive "HEALTHSAT" for meeting the health care needs of the country at large.

References
BIOMEDICAL INSTRUMENTATION, TECHNOLOGY AND APPLICATIONS by R.S.Khandpur ISRO (Indian Space Research Organization) website TELEMEDICINE IS THE FUTURE by Joe Attokaren TELESURGERY AND TELEMEDICINE ACTIVITIES IN INDIA by Prof. S. K. Mishra SGPGIMS, Lucknow. TELEMEDICINE IN EMERGENCY CARE by James. P. Marcin, University of California, Davis TELEMEDICINE Wikipedia TELEMEDICINE AND TELE EDUCATION by Dr. P. Jothimani and Dr. A. P. Subudhi

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