AP07_4-5.vp 1 Introduction Electrocardiography is one of the most important diag- nostic methods to monitor proper heart function. Increas- ingly, it is not only used in a clinical environment but more and more applied to the “Personal Healthcare” scenario. In this application field, medical devices are intended to be used in the domestic environment and can communicate wirelessly [1]. Traditionally, for ECG measurement conductive elec- trodes have been applied which are directly attached to the skin. With the help of contact gel, they provide direct resistive contact to the patient. Unfortunately, these electrodes possess various disadvantages which are not optimal for long-term use in a “Personal Healthcare” scenario: as a result drying of the contact gel and surface degradation of the electrodes, the transfer resistance may change with time. Furthermore, metal allergies can cause skin irritations and may result in pressure necroses. Especially infant’s skin reacts sensitively to these kind of electrodes. Finally, as a single-use item, they are rather expensive. Capacitive (insulated) electrodes, which can obtain an ECG signal without conductive contact to the body, even through clothes, represent an alternative. This kind of elec- trodes were first described by Richardson [2]. Unlike conduc- tive electrodes, the surface of these electrodes is electrically insulated and remains stable in long-term applications. Inte- grated in objects of daily life, they seem ideal for the “Personal Healthcare” field. Preliminary work concerning the integra- tion of ECG measuring systems into objects of daily life was done by Ishijima [3]. In his work, conductive textile electrodes were used. These acted as underlay and pillow and could obtain an ECG during sleep. However, due to direct skin contact, the patient’s coupling was probably not exclusively capacitive. A group of Korean researchers around K. S. Park continued this work and integrated insulated electrodes into several objects, e.g. a toilet seat or a bath tub. Recently, two ECG applications with a chair have been presented [4, 5] that are somewhat similiar to the work decribed below. Thus, based on the measurement principles of insulated electrodes, we present a cable-free, battery-operated ECG measurement system, integrated into an off-the-shelf office chair. 2 Materials and Methods Fig. 1 gives an overview of the developed measurement system. The front-end part of the measurement system con- sists of components for analog processing, like the insulated electrodes, an instrumental amplifier and analog filters plus in-between amplifiers. A/D conversion is followed by the di- gital part, with a radio transmitter as a data source and a receiver as a data drain. For demonstation and validation purposes, the receiver may be connected either with a stan- dard ICU patient monitor via a D/A converter and magnitude adjustment, or with a PC via serial interface. 2.1 Analog Signal Processing The front-end features two active electrodes with an effec- tive surface area of A � 4 cm × 8 cm. In both cases, the elec- trode’s surface forms a coupling capacitance (C1,2) between the subject’s body and the input of the unity gain amplifiers A1 and A2, respectively (Fig. 1). The integrated unity gain amplifiers assure the required high input impedance of the 68 © Czech Technical University Publishing House http://ctn.cvut.cz/ap/ Acta Polytechnica Vol. 47 No. 4–5/2007 Wireless and Non-contact ECG Measurement System – the “Aachen SmartChair” A. Aleksandrowicz, S. Leonhardt This publication describes a measurement system that obtains an electrocardiogram (ECG) by capacitively coupled electrodes. For demonstration purposes, this measurement system was integrated into an off-the-shelf office chair (so-called “Aachen SmartChair”). Whereas in usual clinical applications adhesive, conductively-coupled electrodes have to be attached to the skin, the described system is able to measure an ECG without direct skin contact through the cloth. A wireless communication module was integrated for transmitting the ECG data to a PC or to an ICU patient monitor. For system validation, a classical ECG with conductive electrodes and an oxygen saturation signal (SpO2 ) were obtained simultaneously. Finally, system-specific problems of the presented device are discussed. Keywords: electrocardiography, ECG, non-contacting, monitoring, capacitive electrodes, chair. Fig. 1: Block diagram of the measurement system measurement system. The electrode’s surface is covered by a very thin isolation layer (here: approx. 20 �m clear-transpar- ent insulating lacquer). Hence, the coupling capacitance de- pends mainly on the thickness d and the dielectric constant �r of the cloth located between the electrode and the subject’s skin. Assumed values like d � 0 3. mm and �r � 1 result in a ca- pacitance of C A dr12 0 92, � �� � pF (1) To suppress the interference due to the changing electro- magnetic fields in the environment, the electrodes have to be actively shielded [6]. Any static charges on the coupling capacitances and/or on the subject’s clothing must be dis- charged over the resistance RBias. Note that C1,2 and RBias form a high-pass filter. A compromise between the discharg- ing time constant and the attenuation of important ECG spectral fractions needs to be found by adjusting the resis- tor RBias properly. In this application, RBias was selected to 100 G� . Thus, the cut-off frequency of the electrodes can be calculated to f C RC � � � � 1 2 17 3 12, . Bias mHz � (2) In practice, any 50 Hz voltages from the power supply line that are capacitively coupled into the patient’s body may cause a common mode voltage (VCM ) between the subject’s body and the insulated circuit common ground VCM of ap- prox. 1 V, see Fig. 2. In this figure, CS represents the isolation capacitance between the circuit common ground and the po- tential earth, and CB as well as CP the stray coupling with the 220-V-powerline and potential earth, respectively. Due to the finite common mode rejection ratio (CMRR) of the instru- mental amplifier, these common mode voltages on the body cause interferences in the output signal Vout and have to be supressed. For this reason, a so-called “driven-right-leg” cir- cuit with an additional reference electrode is used in most conventional (conductive) ECG measurements [7]. By anal- ogy, Kim et al. [4] introduced a so-called “driven-ground- -plane” circuit for non-contacting ECG measurements which was also implemented in the application presented here. The sum of the electrodes’ output signals is fed back via inverting amplifier A3 to a conductive plane (C3), as shown in Fig. 2. This plane is also insulated and capacitively coupled to the subject. Resistors RA and RF adjust the amplifier’s gain to G R RA F A 3 2 � (3) Besides the limited CMRR of the instrumental amplifier, another reason for needing to reduce VCM is the possible transformation to a differential signal at the instrumental amplifier’s input VD, see Fig. 3. In the case of capacitive ECG measurements, this may occur due to different coupling capacitances C C1 2� , e.g. as a result of inhomogeneities in clothing. With Z jwC1 11� and Z jwC2 21� and the input imped- ance ZC of A1 and A2 (here: OPA124, Burr Brown Corp., Dal- las, USA), Eq. (4) shows the relation between VD and VCM: V V Z Z Z Z Z ZD CM B B � � � � � � � � � 2 2 1 1 (4) with ZC � 10 3 14 � pF (5) and Z Z R Z RB C C � � � Bias Bias . (6) Furthermore, Eq. (4) illustrates that to minimize interfer- ences at the instrumental amplifier’s input, either both cou- pling capacitances must be identical or VCM must be as low as possible. A “driven-ground-plane” circuit supports the sec- ond option. The resulting common mode voltage suppres- sion was found to be V V CM P f ( )220 118 50 V � � � Hz dB (7) using a gain of G A3 1000� (compare with [4]). Finally, the measurement chain for analog processing of the ECG signal consists of the following elements: � Instrumentation amplifier (INA 114, Texas Instruments Inc., Dallas, U.S.A.) � 4th order Butterworth high-pass filter with a cut-off fre- quency f C HP, .� 0 5 Hz � An in-between amplifier � 6th order Butterworth low-pass filter with cut-off frequency fC LP, � 200 Hz � 50 Hz Notch-filter with cut-off frequencies fL � 40 Hz and fH � 60 Hz In the version presented here, the overall gain in forward direction (i.e. from the capacitive electrodes to the A/D con- verter, see Fig. 1) was set to 950. © Czech Technical University Publishing House http://ctn.cvut.cz/ap/ 69 Acta Polytechnica Vol. 47 No. 4–5/2007 Fig. 2: The “driven-ground-plane” circuit Fig. 3: Equivalent circuit for common mode voltages at the input of the measurement system 2.2 Integration of the measurement system The capacitive ECG measurement system was integrated into an off-the-shelf office chair. Fig. 4 shows the electrodes on the backrest and the position of the insulated reference electrode hidden under the cover (copper meshes as “driven- -ground”, area: 34 cm×23 cm). The chair’s backrest is vertically adjustable, in order to adapt the position of the electrodes to the subject’s torso. 2.3 Wireless data transmission The analog signal processing block is followed by a 12 bit A/D converter and a ZigBeeTM radio transmission module (ZEBRA module from senTec Elektronik Corp., Ilmenau, Germany). Low-power consumption and a data transmis- sion rate sufficient for the specific application (unidirectional transmission of a one channel ECG) makes the ZEBRA mod- ule particularly attractive. A second ZEBRA module was used as a receiver. At the receiver’s output, two interfaces were implemented. Either an ICU patient monitor can be con- nected via D/A-conversion and magnitude adjustment, allowing standard ECG clamp leads to be applied, or a simple wired serial interface to a PC can be realized. In this second case, digital processing and the ECG data display may be done by a LabVIEW® application. Due to the wireless ECG data communication and the use of an accumulator for the power supply, the “Aachen SmartChair” possesses a mobility which is limited only by the transmission range. 3 Results Fig. 5 shows an ECG signal obtained with our measure- ment system. All given measurements were recorded from the same subject (male, 26 yr., healthy) during normal breathing conditions and without further deliberate body movements. For further validation purposes, a classical, conductive Einthoven ECG and an oxygen saturation signal (SpO2) were recorded in parallel to the capacitive ECG signal. These sig- nals were displayed on an ICU monitor MP70 in combination with an “IntelliVue”-module (both produced by Philips Medi- cal Inc., Boeblingen, Germany). As an example, a screenshot (inverted for better visibility) visually demonstrates the good correlation of the three vital signals (Fig. 6). In addition, Fig. 7 shows three capacitive ECG signals, ob- tained with our system, with different cotton wool shirt thickness. 70 © Czech Technical University Publishing House http://ctn.cvut.cz/ap/ Acta Polytechnica Vol. 47 No. 4–5/2007 Fig. 4: The “Aachen SmartChair”, front view Fig. 5: Capacitively measured ECG while the subject is wearing a cotton wool shirt of 0.3 mm in thickness Fig. 6: Comparison between a synchronously measured SpO2 sig- nal (above), a capacitive ECG signal (center) and classical (conductive) ECG derivation after Einthoven (below). The ECG measurement was performed under normal breath- ing conditions, wearing a cotton wool shirt 0.3 mm in thickness. Fig. 7: Comparison of the ECG signals with different a cotton wool shirt thicknesses 4 Discussion With our measurement system, it is possible to monitor an ECG without resistive skin contact. The QRS complex and the T wave were clearly identified, and often the p wave was also seen (see Fig. 5). However, typically a negative subsi- dence right after the T-wave, atypical in comparison to the Einthoven ECG, was observed by the authors, and this is in coincidence with the findings of Kim [5]. A possible reason for this could be the nontypical position of the insulated elec- trodes, compared to the classical ECG position. Also, this negative wave could be caused by a body movement, due to the mechanical activity of the heart. In the application pre- sented here, the ECG electrodes are not fixed to the body. Thus, movement artifacts cannot be prevented in principle. A conductive ECG measurement may be less sensitive to movement artifacts, due to the use of electrodes glued to the body. To reduce movement artifacts, Kim et al. suggest rais- ing the high-pass cut-off frequency from 0.5 to 8 Hz [5]. This method smoothes the base line, but may remove diag- nostically important fractions of the ECG signal (like the P or T-wave). Fig. 6 shows that the ECG signal quality of the presented measurement device is comparable to a conductive ECG mea- surement under certain clothing conditions: a subject’s shirt thickness of approx. 0.3 mm or lower. Due to possible static charging of the clothes, a cotton wool material is preferred. After Searle [6], a general increase of the coupling impedance between body and measurement systems leads to an increased difference and, referring to Eq. (4), to increasing interfer- ences in the ECG signal. As a result, Fig. 7 shows increasing 50-Hz hum. A reduced corner frequency of the low-pass filter to 35 Hz, also applied by Kim [5], could decrease this 50-Hz-noise. In any case, even with clothes thickness of 2.5 mm, at least the QRS-complex was clearly identified. 5 Conclusion With the capacitively coupled ECG measurement system presented here, an ECG can be obtained without direct skin contact and, thus, without causing skin irritations. Compared to a conventional, conductive measurement system, it is more sensitive to moving artifacts. Furthermore, the quality of the capacitive ECG is strongly dependent on the subject’s clothing, i.e. an adequate distance between the surface of the electrodes and subject’s body is necessary for a high-quality ECG measurement. Taking these disadvantages into consid- eration, our system seems useful for heart rate detection in long-term applications. However, further research is needed before the diagnostic potential of capacitive ECG measure- ment can be finally evaluated. Acknowledgments The research described in this paper was supervised by Prof. Dr. S. Leonhardt, Philips Chair for Medical Information Technology at RWTH Aachen University. Thanks to all col- leagues from the Chair for valuable discussions and technical assistance. Reference [1] Leonhardt, S.: Personal Healthcare Devices. In S. Mukherjee et al. (eds.), AmIware: Hardware Technology Drivers of Ambient Intelligence. Chapter 6.1, Springer Ver- lag, Dordrecht, NL, 2006, p. 349–370. [2] Richardson, P. C.: The Insulated Electrode. In Proceed- ings of the 20th Annual Conference on Engineering in Medi- cine and Biology. Boston, MA (USA), 1967, p. 157. [3] Ishijima, M.: Monitoring of Electrocardiograms in Bed without Utilizing Body Surface Electrodes. IEEE Trans- actions on Biomedical Engineering, Vol. 40 (1993), No. 6, p. 593–594. [4] Kim, K. K., Lim, Y. K., Park, K. S.: Common Mode Noise Cancellation for Electrically Non-Contact ECG Mea- surement System on a Chair. In Proceedings of the 27th Annual Conference of the IEEE EMBS. Shanghai (China), Sept. 2005, p. 5881–5883. [5] Lim, Y. G., Kim, K. K., Park, K. S.: ECG Measurement on a Chair without Conductive Contact. IEEE Transac- tions on Biomedical Engineering, Vol. 53 (2006), No. 5, p. 956–959. [6] Searle, A., Kirkup, L.: A direct Comparison of Wet, Dry and Insulating Bioelectric Recording Electrodes. Physio- logical Measurement, Vol. 21 (2000), p. 271–283. [7] Winter, B. B., Webster, J. G.: Reduction of Interference Due to Common Mode Voltage in Biopotential Amplifi- ers. IEEE Transactions on Biomedical Engineering, Vol. 30 (1983), No. 1, p. 58–61. Adrian Aleksandrowicz e-mail: medit@hia.rwth-aachen.de Prof. Dr. Steffen Leonhardt, Ph.D. Philips Chair for Medical Information Technology RWTH Aachen University Pauwelsstr. 20 52074 Aachen, Germany © Czech Technical University Publishing House http://ctn.cvut.cz/ap/ 71 Acta Polytechnica Vol. 47 No. 4–5/2007