Handbook of Biomedical Telemetry
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Preface xxi
Acknowledgments xxiii
Contributors xxv
1 Introduction to Biomedical Telemetry 1
Konstantina S. Nikita
1.1 What is Biomedical Telemetry? 1
1.2 Significance of Area 3
1.3 Typical Biomedical Telemetry System 4
1.4 Challenges in Biomedical Telemetry 5
1.5 Commercial Medical Telemetry Devices 14
1.6 Overview of Book 19
References 23
Part I Biomedical Telemetry Devices 27
2 Design Considerations of Biomedical Telemetry Devices 29
Dominik Cirmirakis and Andreas Demosthenous
2.1 Introduction 29
2.2 Energy Transfer Types 30
2.3 Architecture of Inductively Coupled Biomedical Telemetry Devices 31
2.4 Data Transmission Methods 39
2.5 Safety Issues 44
2.6 Conclusion 51
References 51
3 Sensing Principles for Biomedical Telemetry 56
Athanasios Lioumpas, Georgia Ntouni, and Konstantina S. Nikita
3.1 Introduction 56
3.2 Biosensor Structure 57
3.3 Electrochemical Biosensors 59
3.4 Optical Biosensors 63
3.5 Thermal/Calorimetric Biosensors 67
3.6 Piezoelectric Biosensors 69
3.7 Other Types of Biosensors 71
3.8 Conclusions 72
References 73
4 Sensing Technologies for Biomedical Telemetry 76
Toshiyo Tamura
4.1 Introduction 76
4.2 Noninvasive Sensors and Interfaces 77
4.3 Invasive and Implantable Sensors 92
4.4 Conclusion 101
References 101
5 Power Issues in Biomedical Telemetry 108
Manos M. Tentzeris, Rushi Vyas, Wei Wei, Yoshihiro Kawahara, Li Yang, Stavros Georgakopoulos, Vasileios Lakafosis, Sangkil Kim, Hoseon Lee, Taoran Le, Sagar Mukala, and Anya Traille
5.1 Introduction and Powering Mechanisms 108
5.2 Motion-Powered Radio Frequency Identification (RFID) Wireless Sensors 109
5.3 Noninvasive Wireless Methods for Powering on Sensors 112
5.4 Conclusion 129
References 129
Part II Propagation and Communication Issues for Biomedical Telemetry 131
6 Numerical and Experimental Techniques for Body Area Electromagnetics 133
Asimina Kiourti and Konstantina S. Nikita
6.1 Introduction 133
6.2 Electrical Properties of Human Body Tissues 135
6.3 Numerical Modeling 139
6.4 Physical Modeling 154
6.5 Safety Issues 164
6.6 Conclusion 167
References 168
7 Inductive Coupling 174
Maysam Ghovanloo and Mehdi Kiani
7.1 Introduction 174
7.2 Induction Principles 175
7.3 Wireless Power Transmission 178
7.4 Inductive Coupling for Biomedical Telemetry 186
7.5 Inductive Data Transmission 192
7.6 Broader Applications 201
7.7 Future Research Directions 202
7.8 Conclusion 202
References 203
8 Antennas and RF Communication 209
Asimina Kiourti and Konstantina S. Nikita
8.1 Introduction 209
8.2 Background Information 211
8.3 On-Body Antennas 212
8.4 Implantable Antennas 223
8.5 Ingestible Antennas 235
8.6 Conclusion and Future Research Directions 245
References 246
9 Intrabody Communication 252
Laura M. Roa, Javier Reina-Tosina, Amparo Callejón-Leblic, David Naranjo, and Miguel Á. Estudillo-Valderrama
9.1 Introduction 252
9.2 Intrabody Communication Transmission Methods 256
9.3 Dielectric Properties of Human Body 259
9.4 Experimental Characterization of IBC Channel 265
9.5 Introduction to IBC Models 273
9.6 IBC Propagation Channel 282
9.7 Conclusion 292
Acknowledgments 294
References 294
10 Optical Biotelemetry 301
Koichi Shimizu
10.1 Introduction 301
10.2 Optical Technology for Optical Biotelemetry 303
10.3 Communication Technology for Optical Telemetry 306
10.4 Propagation of Optical Signal 309
10.5 Multiplexing in Optical Telemetry 313
10.6 Applications of Optical Telemetry 316
10.7 Conclusion 327
References 328
11 Biosensor Communication Technology and Standards 330
Lars Schmitt, Javier Espina, Thomas Falck, and Dong Wang
11.1 Introduction 330
11.2 Biosensor Application Scenarios 332
11.3 Biosensor Communication Technologies 335
11.4 Conclusion 364
References 365
12 Context-Aware Sensing and Multisensor Fusion 368
Stefan Hey
12.1 Introduction 368
12.2 Context-Aware Sensing 368
12.3 Multisensor Fusion 373
12.4 Example Application: Stress Measurement 378
12.5 Conclusion and Future Research Directions 379
References 379
13 Security and Privacy in Biomedical Telemetry: Mobile Health Platform for Secure Information Exchange 382
Nikolaos Bourbakis, Alexandros Pantelopoulos, and Raghudeep Kannavara
13.1 Introduction 382
13.2 Digital Security 383
13.3 Wearable Health Monitoring Systems (WHMS) Platform 390
13.4 Processing of Physiological Data 394
13.5 Secure Information Exchange 400
13.6 Conclusion and Future Research Directions 414
Acknowledgment 415
References 415
14 Connection Between Biomedical Telemetry and Telemedicine 419
Emmanouil G. Spanakis, Vangelis Sakkalis, Kostas Marias, and Manolis Tsiknakis
14.1 Introduction 419
14.2 Biomedical Instrumentation 420
14.3 Biomedical Telemetry and Telemedicine: Related Work 421
14.4 Theory and Applications of Biomedical Telemetry 423
14.5 Integration of Biomedical Telemetry with Telemedicine 423
14.6 Wireless Communication Protocols and Standards 425
14.7 Cross-Layer Design of Wireless Biomedical Telemetry and Telemedicine Health Networks 425
14.8 Telecommunication Networks in Health Care for Biomedical Telemetry 428
14.9 Future Research Directions and Challenges 437
14.10 Conclusion 440
References 442
15 Safety Issues in Biomedical Telemetry 445
Konstantinos A. Psathas, Asimina Kiourti, and Konstantina S. Nikita
15.1 Introduction 445
15.2 Operational Safety 446
15.3 Product and Device Hazards 450
15.4 Patient and Clinical Safety 454
15.5 Human Factor and Use Issues 458
15.6 Electromagnetic Compatibility and Interference Issues 461
15.7 Applicable Guidelines 464
15.8 Occupational Safety 471
15.9 Future Research Directions 472
15.10 Conclusion 473
References 474
Part III Example Applications of Biomedical Telemetry 479
16 Clinical Applications of Body Sensor Networks 481
Richard M. Kwasnicki and Guang-Zhong Yang
16.1 Introduction 481
16.2 Healthcare Paradigm Shift for Pervasive Sensing 483
16.3 Usage Scenarios 484
16.4 Opportunities and Future Challenges 494
16.5 Conclusion 501
Acknowledgment 502
References 502
17 Wearable Health Care System Paradigm 505
Yang Hao and Robert Foster
17.1 Introduction 505
17.2 Wireless Wearable Technology in Health Care 506
17.3 Methods and Design Approach for Wireless Wearable Systems 509
17.4 Example Wireless Body Area Network (WBAN) Applications in Health Care 516
17.5 Conclusion 521
References 521
18 Epidermal Sensor Paradigm: Inner Layer Tissue Monitoring 525
Dimitris Psychoudakis, Chi-Chih Chen, Gil-Young Lee, and John L. Volakis
18.1 Introduction 525
18.2 Review of Electromagnetic Properties of Human Body 526
18.3 Propagation Modes for Body-Centric Wireless Communications 531
18.4 Human Torso Model for Body-Centric Wireless Communication 537
18.5 Two-Layer Model for Internal Organ Monitoring 542
18.6 Epidermal RF Sensor for Inner Layer Tissue Monitoring 542
18.7 Extraction of Dielectric Constant 544
18.8 Conclusion 546
References 547
19 Implantable Health Care System Paradigm 549
Masaharu Takahashi and Koichi Ito
19.1 Introduction 549
19.2 Multilayered Model Simulating Human Body 550
19.3 Cardiac Pacemaker Embedded in Multilayered Models 554
19.4 Implantable Health Care System Paradigm 562
19.5 Conclusion and Future Research Directions 568
References 570
20 Ingestible Health Care System Paradigm for Wireless Capsule Endoscopy 572
Nikolaos Bourbakis and Alexandros Karargyris
20.1 Introduction 572
20.2 WCE and Endoscopic Imaging 576
20.3 Diagnostic Methods and Challenges 585
20.4 Future Directions: Design New Generation of WCE 586
20.5 Conclusion and WCE Global Health Care 591
References 591
21 Stimulator Paradigm: Artificial Retina 593
Carlos J. Cela, Keyoor C. Gosalia, Anil Kumar RamRakhyani, Gianluca Lazzi, Shruthi Soora, Gerard J. Hayes, and Michael D. Dickey
21.1 Introduction 593
21.2 Telemetry for Artificial Retina 594
21.3 Intraocular Telemetry Antennas 595
21.4 Multicoil Telemetry 611
21.5 Future Research Directions: Flexible and Liquid Antennas 618
21.6 Conclusion 620
References 620
22 mHealth-Integrated System Paradigm: Diabetes Management 623
Alessio Fioravanti, Giuseppe Fico, Alejandro González Patón, Jan-Paul Leuteritz, Alejandra Guillén Arredondo, and María Teresa Arredondo Waldmeyer
22.1 Clinical Treatment 623
22.2 Diabetes Treatment through Telemetry 624
22.3 Problems Related to Current Treatments 625
22.4 Assessment: State of the Art 625
22.5 Technological Solution 626
22.6 METABO System 627
22.7 Evaluation Methodology: Data Collection and System Testing 629
22.8 Results 631
22.9 Conclusion 631
Acknowledgments 632
References 632
23 Advanced Material-Based Sensing Structures 633
Manos M. Tentzeris, Sangkil Kim, Vasileios Lakafosis, Hoseon Lee, Taoran Le, Rushi Vyas, Sagar Mukala, and Anya Traille
23.1 Introduction 633
23.2 Human-Body-Wearable Antennas 634
23.3 Carbon-Nanotube-Based Ammonia Detection for Medical Diagnosis 656
23.4 Graphene-Based Ammonia Detection for Medical Diagnosis 670
23.5 Integrated Wireless Modules 679
23.6 Conclusion 685
References 686
Index 691
Chapter 1
Introduction to Biomedical Telemetry
Konstantina S. Nikita
School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
1.1 What Is Biomedical Telemetry?
The word telemetry is derived from the Greek words tele = “remote” and metron = “measure” and allows data measurements to be made at a distance. In other words, data are measured in situ and further transmitted remotely to a receiving station. Typically, telemetry systems have been used in the testing of moving vehicles such as cars, aircraft, and missiles.
Biomedical telemetry permits the measurement of physiological signals at a distance. Physiological signals are obtained by means of appropriate transducers, postprocessed, and eventually transmitted to an exterior monitoring and/or control device. The exterior device can be placed onto the patient's body or at a close distance next to the patient but can also further communicate with a distant hospital or physicians' station with the help of telemedicine technologies and infrastructure.
The principal purpose of biomedical telemetry is to take advantage of the recent advances in wired and wireless communication technologies in order to address the growing demands of the health care community. The goal is to take advantage of the recent improvements in electronics and communications in order to develop a new generation of medical devices with incorporated biomedical telemetry functionalities. Medical devices can be defined as any physical device which is useful for preventive, diagnostic, monitoring, or therapeutic functions. Such devices are expected to support an expanding variety of medical applications and have the potential to revolutionize medicine. Even though prevention is perhaps the most desirable goal for medical devices, early diagnosis, effective treatment, and accurate monitoring of diseases can also be considered as the cornerstones of an effective biomedical telemetry system.
There exist three categories of medical devices, according to their location on or inside the patient's body:
- Wearable devices can be worn by the patient as an accessory or embedded into clothing with the help of textile and flexible technologies (e.g., Figure 1.1a). They can be used to monitor several physiological parameters (e.g., glucose or cardiac events), assist the movement of artificial limbs, and work as receivers for the collection and retransmission of various vital signals.
- Implantable devices can be implanted inside the patient's human body by means of a surgical operation (e.g., Figure 1.1b) (Kiourti and Nikita, 2012a,b, 2013). Example applications are heart rate control, artificial retina, cardiac pacemakers, cochlear implants, hypertension monitoring, functional electrical stimulation, and intracranial pressure monitoring.
- Ingestible devices are integrated into capsules or pills and can be swallowed by the patient (e.g., Figure 1.1c). Main focus is on their use for gastrointestinal track and drug use monitoring.
Figure 1.1 (a) Wearable [advanced care and alert portable telemedical monitor, AMON (Anliker et al., 2004)], (b) implantable [epiretinal prosthesis (Sivaprakasam et al., 2005)], and (c) ingestible [PillCam (Mc Caffrey et al., 2008)] medical devices.
Since medical devices are used on human beings, with at least a theoretical potential for misuse or harmful side effects, they must first meet the criteria established by government-operated regulations before they can be designated as medical devices and enter the market. For example, in the United States, medical devices are primarily regulated via the Department of Health and Human Services (HHS) of the Food and Drug Administration (FDA).
Historically, wired links have been the most prevalent method of biomedical telemetry. To overcome the inherent drawbacks of restricted communication range as well as patient discomfort and limited activity level, research is nowadays mostly oriented toward wireless technologies. Wireless biomedical telemetry offers the advantage of obtaining accurate physiological signal measurements from freely moving patients and has significantly risen in the last decades thanks to the explosive growth in Internet traffic, the commercial success of digital cellular communication systems, and the scaling of integrated circuits (ICs) at a manageable cost, power, and size (Rappaport et al., 2002).
Recent global focus on health care issues has stimulated research and development of innovative technologies which address many unsustainabilities of the current health care provision models. Several health care organizations are seeking new techniques to deliver quality health care in a timely, cost-effective, and efficient manner. Biomedical telemetry can be considered as an important technological innovation toward freeing hospital resources, improving patient care, and rendering health care affordable for all. The utmost aim is to enhance the patients' quality of life by encouraging and maintaining their independence. With rising health care costs, an increasing average age of populations in the occidental world, a significant presence of wireless communications in our daily lives, and recent advances in electronics and information and communication technologies (ICTs), biomedical telemetry devices are attracting significant scientific interest in both academia and industry.
1.2 Significance of Area
Exploitation of ICT assists in a fundamental redesign of the health care processes based on the use and integration of communication technologies at all levels. Recent advances in ICT enable cost-effective and efficient health care delivery in home, hospital, assisted-living, and nursing home settings to promote disease management and wellness (Nikita et al., 2012).
Disease management programs aim to support patient-specific care plans and the provider–patient relationship via evidence-based guidelines while focusing on prevention of deteriorations and/or complications. Aiming at citizen empowerment, the paradigm of disease management can be extended to wellness management, where the focus is on disease prevention, maintenance, and improvement of the health status of any individual.
Continuous and remote monitoring of patients in the comfort of their own home rather than inside a hospital or clinic environment offers a number of benefits, including continuous medical monitoring of the disease progression or fluctuation, patient convenience, sophisticated monitoring capabilities, and lower health care costs (Lin and Nikita, 2010; Nikita et al., 2011). Example applications are:
- Monitoring of patients with chronic diseases (e.g., diabetes or hypertension) by means of a single medical device
- Development of “smart” body sensor networks where physiological data are collected from multiple on/in body sensors, preferably with context-aware sensing capabilities
- Drug delivery feedback loops which continuously monitor a drug's effect and adjust its delivery from drug pumps
- Rehabilitation for the elderly
- Measuring medical parameters at the scene of an accident and providing surveillance during transport to the hospital
A top 10 list for conditions and diseases that are already benefiting from wireless health services or soon will is shown (in alphabetical order) in Table 1.1 (Topol, 2012).
Table 1.1 Ten Targets for Wireless Medicine
Disease Number Affected (millions) Monitoring Alzheimer's 5 Vital signs, location, activity, balance Asthma 23 Respiratory rate (RR), peak-flow breathing volume (FEV1), air quality, oximetry, pollen count Breast cancer 3 Ultrasound, self-examination Chronic obstructive pulmonary disease (COPD) 10 RR, FEV1, air quality, oximetry Depression 21 Medicine compliance, activity, communication Diabetes 24 Glucose, hemoglobine A1C, activity Heart failure 5 Cardiac pressures, weight, BP, fluid status Hypertension 74 Continous BP, medical compliance Obesity 80 Smart scales, glucose, caloric in/out, activity Sleep disorder 40 Sleep phases, quality, apnea, vital signsBiomedical telemetry has the potential to empower patients and support a transition from a role in which the patient is the passive recipient of care services to an active role in which the patient is informed, has choices, and is involved in the decision-making process. However, these modern healthcare systems set some additional critical requirements and challenges compared to traditional networks.
1.3 Typical Biomedical Telemetry System
A schematic of a typical biomedical telemetry system is shown in Figure 1.2. A number of medical devices are worn on, implanted into, or ingested by the patient to perform measurements of the intended physiological signals to...
