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(ecg) monitoring system using pc thomas leong tze hsiun universiti

1. Private Sub btnEdit Click ByVal sender As System Object ByVal e As System EventArgs Handles btnEdit Click Dim LI As ListViewItem LI lvUsers SelectedItems 0 If Not FEditUser EditUser LI Text LI SubItems 1 Text Then Exit Sub LI Text FEditUser txtUsername Text LI SubItems 1 Text FEditUser txtPassword Text End Sub Private Sub btnRemove_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnRemove Click lvUsers Items Remove lvUsers SelectedItems 0 End Sub End Class CFMain Imports System IO Public Class CFMain Public With Events VidCl Public Peers As New Col Friend TheP Dim y 5 Dim Nex 64 APPENDIX B TELE ECG_CLIENT ln As bsVideoClientSDK VideoClient llection r SelPeer As CClient ECG declaration Dim grafik As System Drawing Graphics Dim pensil As New System Drawing Pen System Drawing Color DarkRed Dim gMyGraphics As Graphics Dim pMyPen As Pen Dim cLatar As Sol Dim PictureWidth As Single Const HI EARTRATE As lidBrush New SolidBrush Color White PictureHeight As ULong Dim xStep x xAwal As Single Dim incoming As Byte Dim graphed As Byte tStatus As Byte Dim oldgraphed As Byte Byte 2 Const NOTDATA As Byte 1 Const ISDATA As Byte 0 client declaration Dim FSettings As CFSettings Dim FConnect As CFConnect Dim FAlert As
2. Figure 4 13 ECG signal display sinus bradycardia 43 If the heart rate is more than 60 bpm and less than 100 bpm then this is called sinus rhythm In Figure 4 14 heart rate equal to 66 bpm means that this is a normal ECG waveform Jacky is healthy and his heart rate is normal It also can prove by observing the shape of the ECG waveform which is very normal 44 Heart Rate BPM cc PLOT Peers Name Time State Jacky 9 26 27 AM Connected Begin Talk EndTalk Send Alert Stat Chat Remove Call r Record Audio Voice Activation Frame Rate Local Play Audio J g Record Remot um Voice Compression viaeo Lompression RE 4 Play Video J l Log 9 26 27 AM Connected to the server 10 61 66 45 2222 9 26 27 AM New peer at Jacky 9 26 27 AM Session open Server 10 61 66 45 2222 User Thomas Figure 4 14 ECG signal display sinus rhythm However if the ECG waveform is appeared as shown in Figure 4 15 then it is an abnormal situation too named sinus tachycardia which R R interval smaller than 0 6 s The waveform has very high frequency and the signal is strong as it generates pulse frequently It means that Jacky also in a dangerous situation and has a high possibility of heart attack Immediate action should be taken 45 Heart Rate BPM 122 PLOT Peers i Name Time State Jacky 9 26 27 AM Connected
3. CFSettings Public Class CFSettings Public FMain As CFMain Private Sub SetMode radSecret Checked radSecret Checked frmSecret Enabled txtSecret Enabled frmKeypair Enabled radPublic Checked lblPublic Enabled radPublic Checked lblPrivate Enabled radPublic Checked lblFingerprint Enabled radPublic Checked btnGenerate Enabled radPublic Checked btnClear Enabled radPublic Checked 76 frmFingerprints Enabled radPublic Checked txtFingerprints Enabled radPublic Checked End Sub Private Sub btnGenerate_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnGenerate Click Dim Pub As String Dim Pri As String MsgBox This will take couple of seconds MsgBoxStyle OkOnly Key generation Pub Pri If FMain VidSrv GenerateKeypair Pub Pri Then txtPublic Text Pub txtPrivate Text Pri txtFingerprint Text FMain VidSrv TakeFingerprint Pub Else MsgBox Error generating Public Private keys Error End If End Sub Private Sub btnClear_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnClear Click txtPublic Text txtPrivate Text txtFingerprint Text End Sub Private Sub CFSettings Load ByVal sender As System Object ByVal e As System EventArgs Handles MyBase Load Call SetMode End Sub Private Sub radPlain_CheckedChanged ByVal
4. Private Sub chkRecordVideo CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles chkRecordVideo CheckedChanged If Not Me Visible Then Exit Sub VidCln RecordVideo chkRecordVideo Checked End Sub Private Sub chkPlayVideo_CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles chkPlayVideo CheckedChanged If Not Me Visible Then Exit Sub 75 VidCln PlayVideo chkPlayVideo Checked End Sub Private Sub trkVoiceActivation_Scroll ByVal sender As System Object ByVal e As System EventArgs Handles trkVoiceActivation Scroll VidCln VoiceActivation trkVoiceActivation Value End Sub Private Sub trkVoiceCompression Scroll ByVal sender As System Object ByVal e As System EventArgs Handles trkVoiceCompression Scroll VidCln VoiceCompression trkVoiceCompression Value End Sub Private Sub trkFrameRate Scroll ByVal sender As System Object ByVal e As System EventArgs Handles trkFrameRate Scroll VidCln FrameRate trkFrameRate Value End Sub Private Sub trkVideoCompression Scroll ByVal sender As System Object ByVal e As System EventArgs Handles trkVideoCompression Scroll VidCln VideoCompression trkVideoCompression Value End Sub Private Sub CFMain FormClosing ByVal sender As System Object ByVal e As System Windows Forms FormClosingEventArgs Handles MyBase FormClosing VidCln EndTalk End Sub End Class
5. EndTalk Send Alert Start Chat Remove Call Record Audio Voice Activation Frame Rate Local Play Audio J Record Video Remote i ES Voice Compression viaeo Lompression v Play Video I Loo 9 26 27 AM Connected to the server 10 61 66 45 2222 9 26 27 AM New peer at Jacky 9 26 27 AM Session open Server 10 61 66 45 2222 User Thomas Figure 4 15 ECG signal display sinus tachycardia 4 4 Teleconsultation Thomas can send an alert message to notify Jacky by clicking Send Alert button After that Thomas can type some message such as Attention and click Send button Peers Log Heart Rate BPM 60 End Talk Text Attention Time 9 26 27 AM Recipient User Jacky 9 26 27 AM Connected to the server 10 61 66 45 2222 8 26 27 AM New peer at Jacky 9 26 27 AM Session open Local Remote Server 10 61 66 45 2222 User Thomas Figure 4 16 Sending alert message 46 Then Jacky will receive the alert message Attention that sent by Thomas in his GUI 47 State Connected Ale End Taik fl Send Alert Start jes onn Call Record Audio Voice Activation Attention Play Audio 7 Remote E t V Play Video p Local Log 9 26 50 PM Connected to the server 10 61 66 45 2222 9 2
6. ByVal eventArgs As System EventArgs Handles MyBase Load ECG PictureBoxl BackColor Color White gMyGraphics PictureBoxl CreateGraphics PictureWidth PictureBoxl Width PictureHeight PictureBoxl Height Timerl Enabled True SerialPortl Open drawTemplate x 0 xStep 1 client VidCln New bsVideoClientSDK VideoClient FSettings New CFSettings create the settings form FSettings FMain Me FConnect New CFConnect create the connection form FAcceptCall New CFAcceptCall SetSettings FAlert New CFAlert create the alert form VidCln RecordingDevice 0 select default recording device VidCln PlaybackDevice 0 select default playback device VidCln FindCaptureCapabilities find capture devices VidCln CaptureDevice O0 select default capture device VidCln CaptureFormat O0 select default capture size VidCln RecordAudio chkRecordAudio Checked VidCln PlayAudio chkPlayAudio Checked VidCln RecordVideo chkRecordVideo Checked VidCln PlayVideo chkPlayVideo Checked En UpdateStatus d Sub Private Sub lvPeers_SelectedIndexChanged ByVal sender As System Object ByVal e As System EventArgs Handles lvPeers SelectedIndexChanged Up dateStatus 69 End Sub Connecting to the server Private Sub btnConnect_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnConnect Click If FConnect ShowDialog lt gt DialogResult OK Then
7. C Li C T C Zheng IEEE Trans Biomed Eng 42 1995 21 28 E Supriyanto I M H Satria and Putra E A NOVEL LOW COST TELEMEDICINE SYSTEM USING WIRELESS MESH NETWORK Ph D Thesis Faculty of Biomedical Engineering and Health Science Faculty of Electrical Engineering Universiti Teknologi Malaysia APPENDIX A TELE ECG SERVER CFMain Public Class CFMain Public WithEvents VidSrv As bsVideoServerSDK VideoServer Dim FSettings As CFSettings Dim FUsers As CFUsers Initializations Private Sub CFoMain_Load ByVal eventSender As System Object As System EventArgs Handles MyBase Load VidSrv New bsVideoServerSDK VideoServer FSettings New CFSettings FSettings FMain Me SetSettings FUsers New CFUsers create the users form FUsers LoadUsers btnStart PerformClick UpdateStatus End Sub Private Function GetUsername ByVal aHandle As Integer GetUsername VidSrv GetClientName aHandle If GetUsername Then GetUsername Guest End If End Function Update the status text Private Sub UpdateStatus If VidSrv Running Then StatusBar Panels Item 0 Text Started btnStart Enabled False btnStop Enabled True Else StatusBar Panels Item 0 Text Stopped btnStart Enabled True btnStop Enabled False End If If lvClients Items Count 0 Then 56 ByVal eventArgs create the settings form Start the server automatically As Strin
8. If Pr Handle aHandle Then PeerFromHandle Pr Exit For Exit loop End If Next End Function Public Function PickPeer ByVal aHandle As Long As Boolean ThePeer PeerFromHandle aHandle PickPeer Not ThePeer Is Nothing End Function Public Function SelectPeer As Boolean gMyGraphics DrawLine pMyPen x i i x i PictureBoxl Height 66 SelectPeer Fals If lvPeers SelectedItems Count 0 Then Exit Function SelPeer lvPeers SelectedItems 0 Tag SelectPeer Not SelPeer Is Nothing End Function Update the button state and the status text Private Sub UpdateStatus If VidCln GetSessionState SESSION STATE CONNECTED Then already connected btnConnect Enabled False btnCancel Enabled False btnDisconnect Enabled True Gl StatusBar Panels 0 Text Session open StatusBar Panels 1 Text Server VidCln ServerAddress Str VidCln ServerPort If VidCln Username gt Then StatusBar Panels 2 Text User VidCln Username Else StatusBar Panels 2 Text User not signed in End If Else StatusBar Panels 1 Text StatusBar Panels 2 Text nm If VidCln GetSessionState SESSION STATE CONNECTING Then now connecting btnConnect Enabled False btnCancel Enabled True btnDisconnect Enabled False StatusBar Panels 0 Text Con
9. Pr ListItem SubItems 1 Text Pr ListItem SubItems 2 Text FAcceptCall Text Call is requested from Pr Username If FAcceptCall ShowDialog DialogResult OK Then aOkay True End If End Sub Private Sub VidCln OnTalkBegan ByVal aHandle As Integer Handles VidCln OnTalkBegan Dim Pr As CClient Pr PeerFromHandle aHandle If Pr Is Nothing Then Exit Sub Pr ListlItem SubItems 2 Text Talking lblCaller Text Pr ListItem Text VidCln VoiceActivation trkVoiceActivation Value FLocCam Nothing FRemCam Nothing UpdateButtons LogMsg Call from Pr Username is taken End Sub Private Sub VidCln OnTalkRefused ByVal aHandle As Integer ByVal aCode As Integer Handles VidCln OnTalkRefused Dim Pr As CClient Pr PeerFromHandle aHandle If Pr Is Nothing Then Exit Sub Pr ListItem SubItems 2 Text Connected UpdateButtons MsgBox Call from Pr Username is rejected LogMsg Call from Pr Username is rejected End Sub Private Sub VidCln OnTalkEnded ByVal aHandle As Integer Handles VidCln OnTalkEnded Dim Pr As CClient Pr PeerFromHandle aHandle If Pr Is Nothing Then Exit Sub 73 lblCaller Text Pr ListItem SubItems 2 Text Connected UpdateButtons MsgBox Call from Pr Username is terminated LogMsg Call from Pr Username is terminated End Sub Private Sub Vid
10. institutionalized and less pervasive and less capable in terms of data transfer speed and quality They need to develop technically feasible medically valid reimbursable and institutionally supported applications in order to justify the value of telemedicine and engender consistent and frequent use by medical experts or physicians 10 Fixed communication network has been used in different telemedicine setup for some years and it has shown its values whereas wireless technologies within telemedicine have been developed only in the last few years One of the sole decisive factors that will cause a telemedicine system successful in urban and rural areas is the application of modern communication technology for information exchange between a homecare patient and the medical specialists providing care 11 2 6 Electrocardiogram ECG Electrocardiogram ECG is the recording of the heart s electrical activity over time via skin electrodes The deviations in the normal electrical patterns indicate various cardiac disorders and abnormalities Cardiac cells in the normal state are electrically polarized Their inner sides are negatively charged relative to their outer sides These cardiac cells can lose their normal negativity through a process called depolarization which is the fundamental electrical activity of the heart This process is propagated from cell to cell producing a wave of depolarization that can be transmitted across the entire he
11. military and space operations e remote monitoring or telemonitoring Telemedicine has a very big relationship with telemonitoring Telemonitoring is the remote monitoring of patients including the use of audio video and other telecommunications networks and electronic information processing technologies to monitor patient status at a distance Telemonitoring is still overshadowed by telediagnosis and teleconsulting A more restrictive term used for telemonitoring is biotelemetry which consists of the transmission of biologic or physiologic data from a remote location to another location for data interpretation further analysis and decision making 2 3 Telemedicine VS Telehealth Telemedicine is always used interchangeably with telehealth in common usage however they are not same The table below summarizes the salient features of both Table 2 1 Telemedicine VS Telehealth Telemedicine Telehealth Teleradiology Patient records Telepathodogy Disease Management Information access Teledermatology Remote monitoring Telepsychiatry Patient compliance Focus on discipline technology Billing access and focus on Patient 11 2 4 Telemedicine Concepts Telemedicine is practised on the basis of two concepts real time synchronous and store and forward asynchronous Real Time Telemedicine synchronous is referred to as two way interactive television IATV It another meaning it can be as simple as telephon
12. 0 End If End If ext VidCln PublicKey FSettings txtPublic Text VidCln PrivateKey FSettings txtPrivate Text VidCln Fingerprints FSettings txtFingerprints Text VidCln BindAddress FSettings txtAddr Text End Sub Sub DeletePeer ByVal aPeer As CClient If aPeer Is Nothing Then Exit Sub Peers Remove Str aPeer Handle VidCln DisconnectPeer aPeer Handle lv t nd Ini Peers Items Remove aPeer ListItem Sub tializations Private Sub Buttonl Click ByVal sender As System Object ByVal e As System EventArgs Handles Buttonl Click x 0 End Sub Private Sub Timerl_Tick ByVal sender As System Object ByVal e As System EventArgs Handles Timerl Tick If SerialPortl BytesToRead gt 0 Then incoming SerialPortl ReadByte If incoming lt gt 0 And incoming lt 246 And NextStatus ISDATA Then drawGraph incoming End If I If NextStatus HEARTRATE Then TextBoxl Text incoming NextStatus ISDATA End If If NextStatus NOTDATA Then NextStatus ISDATA End If 68 If incoming 250 Then FA then NextStatus HEARTRATE End If If incoming 249 Or incoming 251 Then F9 dan FB then NextStatus NOTDATA End If If SerialPortl BytesToRead gt PictureBoxl Width 1 5 Then SerialPortl DiscardInBuffer End If End If End Sub Private Sub fMain Load ByVal eventSender As System Object
13. Basic programming language will also be furthered discussed in this chapter 2 1 Telemedicine What is telemedicine Telemedicine is a branch of e health that uses communication networks or information technologies IT for delivery of healthcare services and medical education from one geographical location to another It is deployed to cope with issues like uneven distribution and shortage of infrastructural and human resources 6 In other ways telemedicine may be as simple as two health professionals discussing a case related to health care over the telephone or as complex as using satellite technology and video conferencing equipment to conduct a real time consultation between medical specialists in two different countries 7 2 2 Telemedicine Goals Concomitant advances in information technology and medical technology have led to the increasing focus development and use of telemedicine systems and services around the globe particularly in developed countries The goals of these systems are e increase the accessibility of and to caregivers 10 e increase the quality and continuity of care to patients as well as the person around us e increase the focus or awareness on preventive medicine through early intervention There is no meaning in comparing e reduce the overall cost of healthcare help the poor patient e education and training purpose e provide services to remote areas in case of natural calamities disasters and
14. CFAlert Dim FAcceptCall As CFAcceptCall Dim FLocCam As CFLocCam Dim FRemCam As CFRemCam Const SESSION STA E CONNECTING 1 Const SESSION STATE CONNECTED 2 Add a message to the log Private Sub LogMsg ByVal aText As String Dim Line As String If txtLog Text gt Then 65 Line Chr 13 amp Chr 10 Else Line End If Line Line amp amp Now ToLongTimeString amp Line Line amp aText txtLog SelectionStart Len txtLog Text txtLog SelectedText Lin Friend Function drawTemplate As Integer Dim height As UInt16 cLatar Color Color White gMyGraphics FillRectangle cLatar 0 0 PictureBoxl Width PictureBoxl Height height PictureHeight 2 pMyPen New Pen Color Red 1 5 gMyGraphics DrawLine pMyPen 0 height PictureBoxl Width height End Function Friend Function drawGraph ByVal graphed As Integer pMyPen New Pen Color White 1 Dim i As Single For i 0 To xStep gMyGraphics DrawLine pMyPen x i x PictureBoxl Height Next i pMyPen New Pen Color Blue 1 gMyGraphics DrawLine pMyPen x xStep 256 oldgraphed x 256 graphed xX x xStep oldgraphed graphed If x gt 625 Then x 0 End If End Function Friend Function PeerFromHandle ByVal aHandle As Long As CClient Dim Pr As CClient PeerFromHandle Nothing For Each Pr In Peers Iterate through elements
15. R wave 1 60 mV Q T interval 0 35 to 0 44 s Q wave 25 R wave S T interval 0 05 to 0 15 s T wave 0 1 to 0 5 mV P wave interval 0 11 s QRS interval 0 09 s The normal value of heart beat lies in the range of 60 to 100 beats per minute named as sinus rhythm Normal heart A slower rate than this is called bradycardia Slow heart in which the heart rate value is lower than 60 beats per minute while a higher rate is called tachycardia Fast heart in which the heart rate value is exceed 100 beats per minute If the cycles are not evenly spaced an arrhythmia may be indicated If the P R interval is greater than 0 2 seconds it may suggest blockage of the AV node e Certain disorders involving heart valves cannot be diagnosed from ECG Other diagnostic techniques such as angiography and echocardiography can provide information not available in ECG 15 e Each action potential in the heart originates near the top of the right atrium at a point called the pacemaker or sinoatrial SA node e The wave generated by action potential terminates at a point near the center of the heart called the atrioventricular AV node The horizontal segment of this waveform preceding the P wave is indicated as the baseline or the isopotential line The P wave represents depolarization of the atrial musculature and the QRS complex is the combined result of the repolarization of the atria and depolarization of the ventricles whi
16. might not able to make this so far Thanks for their love encouragement and emotional supports that they had given to me Last but not least my great appreciation dedicated to my friends SEL member s batch 2006 and those who had contributed to the success of this project which are not mentioned here Thomas Leong Tze Hsiun UTM ABSTRACT Nowadays the number of patient who needs constant assistance has been increased One key point of all critical care for patient is the continuous monitoring of their vital signs Among these the ECG signal is used for non invasive diagnoses of cardiovascular diseases This ECG signal can be monitored by the doctors by using medical monitoring There are many types of medical monitoring It depends on the type of disease Usually a doctor needs to monitor his patient for long duration such as abnormal heart rate or rhythm arrhythmia Electrodes and medical device are fitted to the patient in more than 24 hours while he or she is doing daily activities including sleeping at night The existed medical monitoring devices are wired restraint and unable to transmit data to the doctor in real time As a result immediate action cannot be taken by the doctor to the patient in an emergency case As a conclusion this project proposes a development of vital sign heart rate monitoring system by using PC to monitor the patient s ECG signal Besides an embedded GUI Graphical User Interface is developed in the
17. to Zigbee and then transmitted out The data is arranged in a frame as shown in Figure 2 8 It consists of device ID status length of frame data and checksum The Zigbee module is bidirectional MDIZ can receive the command through Zigbee module Medical Signal Processor lee ZigBee Sensor Conditioner Module and ADC Figure 2 7 Block diagram of MDIZ Device Status Length of Data Checksum ID Frame Figure 2 8 Data frame of MDIZ MDIZB coordinates the Zigbee network It decides which medical device will communicate to in that time and give them priority based on their status Figure 2 9 shows block diagram of MDIZB which consists of Zigbee module two processors D latch SRAM and Bluetooth module Data from MDIz is received by Zigbee module 21 and processed by processor 1 Delay may ignore the data To overcome this matter a 256kb SRAM is added as a data buffer The data is then sent to processor 2 to add a frame as shown in Figure 2 10 before transmitted out by Bluetooth module The Bluetooth module is bidirectional 15 es ZigBee Module Bluetooth Module Figure 2 9 Block diagram of MDIZB Start Status Device Length of Data Checksum End Byte ID Frame Byte Figure 2 10 Data frame of MDIZB 2 10 Microsoft Visual Studio Microsoft Visual Studio is an Integrated Development Environment IDE from Microsoft It can be used to develop cons
18. with the previous GUI shown in Figure 3 3 except it do not include the ECG signal and heart rate displaying region It is purposely for the use of client homecare patient Tele ECG Client n i Due ol I End Talk Record Audio Voice Activation Play Audio Record Video Voice lon 7 Play Video g Session closed Figure 3 3 Tele ECG Client GUI for medical expert Figure 3 4 Tele ECG Client GUI for client 5 LZ M nn CM OIN Peers Name Time State End Talk Call Record Audio Voice Activation Frame Rate B Local Play Audio J Record Video Remote Voice Compression viaeo Lompression v Play Video y Log l Session closed 27 28 3 6 Software Architecture Tele ECG Server is ON Key in IP address Port No Usemame and Tele ECG Client is ON Figure 3 5 Software algorithm 29 3 7 Algorithm In this program there are several major algorithms that had been developed and each of it will perform their specific functional tasks In Tele ECG Server GUI Start button is used to initialize a server network While Stop button is used to stop and disconnect the server immediately There is a Setting button which is used to set the security setting and other useful options Hub Settings Security Options i Encryption mode Plain text no encryption Shared sec
19. 7 28 PM New peer at Thomas 9 27 28 PM Session open ceea Figure 4 17 Receiving alert message Next Thomas can chat with Jacky by clicking Start Chat button Tele ECG_Client EE ee Heart Raj Chat with Jacky 9 31 12 AM Thomas hi Jacky 9 31 27 AM Jacky hi Thomas 9 31 38 AM Thomas how do you do 9 31 53 AM Jacky Tm fine thank you okay bye 9 26 27 AM Connected to the server 10 61 66 45 2222 9 26 27 AM New peer at Jacky 9 26 27 AM Sewer 1061 66 45 222 User Thomas Figure 4 18 Chatting After Thomas types the message click SEND button then the message will appear in Jacky GUI immediately It is quite convenient and fast Besides Thomas also can chat with more than 1 person 48 Apart from that this GUI has a very special function which is talking to others by using webcam For instance Thomas wants to talk with Jacky He just needs to click the Begin Talk button Then the State in Peers region will change from Connected to Calling Tele ECG Client State Calling End Talk Send Alert star Chat Remove Record Audio Voice Activation Frame Rate Play Audio L Fl eni den a oo v Play Video Log 9 26 27 AM Connected to the server 10 61 66 45 2222 9 26 27 AM New peer at Jacky 9 26 27 AM Session open Server 10 61 66 45 2222 User Thom
20. ACKNOWLEDGEMENT ABSTRACT ABSTRAK TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF ABBREVIATIONS LIST OF APPENDICES INTRODUCTION 1 1 Background 1 2 Problem Statement 1 3 Objectives 1 4 Scope 1 5 Work Flow 1 6 Gantt Chart 1 6 1 Gantt Chart Semester I 1 6 2 Gantt Chart Semester II 1 7 Work Breakdown 1 8 Block Diagram LITERATURE REVIEW 2 1 Telemedicine 22 Telemedicine Goals 2 3 Telemedicine VS Telehealth 2 4 Telemedicine Concepts 2 5 Current Situation of Telemedicine vii PAGE ii iii iv vi viii ix xi xii xiii ND AW WW ND e Oo 10 11 12 viii 2 6 Electrocardiogram ECG 12 2 7 ECG Interpretation 13 2 8 ECG Electrodes 16 2 9 MDIZ and MDIZB 19 2 10 Microsoft Visual Studio 21 2 11 Visual Studio NET 22 3 DESIGN AND IMPLEMENTATION 23 3 1 Design Specification 23 3 2 System Overview 25 3 3 Hardware 25 3 4 Software 25 3 5 Graphical User Interface GUI 26 3 6 Software Architecture 28 3 7 Algorithm 29 3 8 User Manual 34 4 RESULTS AND ANALYSIS 36 4 1 Tele ECG_Server GUI Testing 36 4 2 Tele ECG_Client GUI Testing 40 4 3 ECG Signal Displaying 41 4 4 Teleconsultation 45 4 5 Optimization 51 5 CONCLUSION AND RECOMMENDATION 52 5 1 Conclusion 52 5 2 Novelty 52 5 3 Limitation 52 5 4 Recommendation 53 REFERENCES 54 APPENDICES A B 56 64 TABLE NO 2 1 2 2 2 3 2 4 25 3 1 LIST OF TABLES TITLE Telemedicine VS Telehealth ECG waveform Electr
21. Cln OnLocalFrame ByRef aData As Object Handles VidCln OnLocalFrame If FLocCam Is Nothing Then FLocCam New CFLocCam FLocCam Show End If Dim buf As Byte buf aData Dim ms As MemoryStream ms New MemoryStream buf FLocCam PicBox Image New Bitmap ms If FLocCam Width lt gt FLocCam PicBox Image Width 8 Then FLocCam Width FLocCam PicBox Image Width 8 End If If FLocCam Height lt gt FLocCam PicBox Image Height 24 Then FLocCam Height FLocCam PicBox Image Height 24 End If End Sub Private Sub VidCln_OnRemoteFrame ByVal aHandle As Integer ByRef aData As Object Handles VidCln OnRemoteFrame If FRemCam Is Nothing Then FRemCam New CFRemCam FRemCam Show End If Dim buf As Byte buf aData Dim ms As MemoryStream ms New MemoryStream buf FRemCam PicBox Image New Bitmap ms If FRemCam Width lt gt FRemCam PicBox Image Width 8 Then FRemCam Width FRemCam PicBox Image Width 8 End If If FRemCam Height lt gt FRemCam PicBox Image Height 24 Then FRemCam Height FRemCam PicBox Image Height 24 End If End Sub Private Sub VidCln_OnStartRecording Handles VidCln OnStartRecording lblRecording Visible True End Sub Private Sub VidCln OnStopRecording Handles VidCln OnStopRecording lblRecording Visible False End Sub Private Sub trkTrigger ValueChanged ByVal sender As System Object 74 ByVal e As System EventArgs
22. Closing e Cancel True Hide End Sub End Class
23. DEVELOPMENT OF VITAL SIGN ECG MONITORING SYSTEM USING PC THOMAS LEONG TZE HSIUN UNIVERSITI TEKNOLOGI MALAYSIA PSZ 19 16 Pind 1 07 UNIVERSITI TEKNOLOGI MALAYSIA DECLARATION OF THESIS UNDERGRADUATE PROJECT PAPER AND COPYRIGHT THOMAS LEONG TZE HSIUN Author s full name Date of birth 6JULY 1987 _ Title DEVELOPMENT OF VITAL SIGN ECG MONITORING YSTEM USING P Academic Session 2009 2010 declare that this thesis is classified as CONFIDENTIAL Contains confidential information under the Official Secret Act 1972 RESTRICTED Contains restricted information as specified by the organisation where research was done OPEN ACCESS agree that my thesis to be published as online open access full text acknowledged that Universiti Teknologi Malaysia reserves the right as follows The thesis is the property of Universiti Teknologi Malaysia The Library of Universiti Teknologi Malaysia has the right to make copies for the purpose of research only The Library has the right to make copies of the thesis for academic exchange Certified by SIGNATURE SIGNATURE OF SUPERVISOR 870706 52 5933 EN ISMAIL BIN ARIFFIN NEW IC NO NOTES 2 If the thesis s CONFIDENTIAL or RESTRICTED please attach with the letter from the organisation with period and reasons for confidentiality or restriction I hereby declare that I have read this report and in my opinion this report is suffici
24. ECG signal display in picture box Then turn to the interesting part in this GUI that is teleconsultation GUI First is the alert notification sending by clicking Send Alert button User can type the alert message and then click Send button to single user or all user 32 Recipient Single user Allusers Figure 3 10 Sending an alert message Next is chatting function by clicking Start Chat button It will pop out a chatting window for user to type the message and click the Send button to send message to other user Recipient Single user Figure 3 11 Chat Besides that user also can talk to others by clicking Begin Talk This function is very amazing because user can speak and view the other user by using webcam Figure 3 12 will pop up at the other user s Tele ECG Client GUI to ask permission for a call requested from the user If Accept button is clicked they can start to talk to each other but other user also can reject the call by clicking Deny button 33 Figure 3 12 Call requested Once the user can talk with other user it will pop up 2 new windows local camera and remote camera that contain perform video conferencing from the webcam in the computer Figure 3 13 Local camera Local camera shows the video that capture from the user s webcam In other way it means user will see himself herself in this window 34 Figure 3 14 Remote camera Remote camera
25. Exit Sub If Not VidCln OpenSession FConnect txtSrvAddr Text Val FConnect txtSrvPort Text FConnect txtUsername Text FConnect txtPassword Text Then MsgBox Cannot initiate a new session Str VidCln LastError End If UpdateStatus End Sub Disconnect from the server Private Sub btnDisconnect Click ByVal sender As System Object ByVal e As System EventArgs Handles btnDisconnect Click VidCln CloseSession End Sub Private Sub btnCancel Click ByVal sender As System Object ByVal e As System EventArgs Handles btnCancel Click VidCln CloseSession End Sub Private Sub btnSettings Click ByVal sender As System Object ByVal e As System EventArgs Handles btnSettings Click If FSettings ShowDialog DialogResult OK Then Exit Sub SetSettings UpdateStatus End Sub Private Sub btnExit Click ByVal sender As System Object ByVal e As System EventArgs Handles btnExit Click Close End Sub Events Just connected to the server Private Sub VidCln_OnSessionOpen Handles VidCln OnSessionOpen UpdateStatus LogMsg Connected to the server VidCln ServerAddress Str VidCln ServerPort End Sub Unsuccessful connection to the server Private Sub VidCln_OnSessionRejected ByVal aCode As Integer Handles VidCln OnSessionRejected LogMsg Cannot open a session to FConnect txtSrvAddr Text FConnect txtSrv
26. Handles trkVoiceActivation ValueChanged If Not Me Visible Then Exit Sub If VidCln Is Nothing Then Exit Sub If VidCln GetTalkerCount 0 Then Exit Sub VidCln VoiceActivation trkVoiceActivation Value End Sub Private Sub trkQuality ValueChanged ByVal sender As System Object ByVal e As System EventArgs Handles trkVideoCompression ValueChanged If Not Me Visible Then Exit Sub If VidCln Is Nothing Then Exit Sub VidCln VideoCompression trkVideoCompression Value End Sub Private Sub btnLocalCam Click ByVal sender As System Object ByVal e As System EventArgs Handles btnLocalCam Click If Not FLocCam Is Nothing Then FLocCam Dispose End If FLocCam New CFLocCam FLocCam Show End Sub Private Sub btnRemoteCam Click ByVal sender As System Object ByVal e As System EventArgs Handles btnRemoteCam Click If Not FRemCam Is Nothing Then FRemCam Dispose End If FRemCam New CFRemCam FRemCam Show End Sub Private Sub chkRecordAudio_CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles chkRecordAudio CheckedChanged If Not Me Visible Then Exit Sub VidCln RecordAudio chkRecordAudio Checked End Sub Private Sub chkPlayAudio_CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles chkPlayAudio CheckedChanged If Not Me Visible Then Exit Sub VidCln PlayAudio chkPlayAudio Checked End Sub
27. Items 0 Tag UpdateStatus End Sub Clear the log Private Sub btnClear Click ByVal sender As System Object ByVal e As System EventArgs Handles btnClear Click txtLog Text 59 End Sub A list view item is clicked Private Sub lvPeers_SelectedIndexChanged ByVal sender As System Object ByVal e As System EventArgs Handles lvClients SelectedIndexChanged UpdateStatus End Sub xxx VidSrv events xxx A new peer is just connected Private Sub VidSrv OnClientConnected ByVal aHandle As Integer Handles VidSrv OnClientConnected Dim LI As ListViewItem LI lvClients Items Add GetUsername aHandle LI Tag aHandle LI SubItems Add VidSrv GetClientAddress aHandle LI SubItems Add Str VidSrv GetClientPort aHandle LI SubItems Add Now ToLongTimeString LI SubItems Add Connected UpdateStatus LogMsg New connection from LI SubItems 1 Text LI SubItems 2 Text End Sub A connection is broken Private Sub VidSrv_OnClientDisconnected ByVal aHandle As Integer ByVal aCode As Integer Handles VidSrv OnClientDisconnected Dim LI As ListViewItem LI ItemFromHandle aHandle If LI Is Nothing Then Exit Sub LogMsg Disconnected amp LI Text amp Str aCode lvClients Items Remove LI End Sub A connection is refused Private Sub VidSrv OnClientRejected ByVal aUsername As String ByVal aAddress As String ByVa
28. PC for displaying the ECG signal perform automatic heart rate calculation based on the ECG signal and teleconsultation purpose for medical expert s convenience to monitor patient s health in remote location vi ABSTRAK Pada masa kini bilangan pesakit yang memerlukan pengawasian semakin bertambah Isyarat yang paling penting and perlu diawasi adalah isyarat ECG denyutan jantung pesakit Isyarat ini dapat diawasi oleh doktor dengan menggunakan alat pegawasian Terdapat banyak jenis alat pengawasian ianya bergantung kepada jenis penyakit Biasanya doktor perlu mengawasi pesakitnya pada suatu jangka masa yang panjang Elektrod dan alat pengawasian perlu sentiasa dipakai dan berada pada badan pesakit dengan melebihi 24 jam semasa dia sedang membuat kerja sendiri termasuk tidur pada waktu malam Alat pengawasian yang terdapat sekarang adalah dilengkapi dengan banyak wayar dan tidak dapat menghantar maklumat kepada doktor dengan segera Oleh itu tindakan segera tidak dapat diambil sekiranya berlaku sesuatu kemalangan atau berada dalam keadaan kecemasan Kesimpulannya projek ini mencadangkan tentang pengawasian isyarat ECG denyutan jantung melalui komputer Selain itu suatu GUI Graphical User Interface telah dipancangkan untuk membekalkan isyarat ECG pesakit mengira bilangan denyutan jantung pesakit secara automatik dan dapat mengawasi kesihatan pesakit dari tempat yang jauh CHAPTER TABLE OF CONTENTS TITLE DECLARATION DEDICATION
29. Plain CheckedChanged Call SetMode End Sub Private Sub radSecret CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles radSecret CheckedChanged Call SetMode End Sub Private Sub radPublic CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles radPublic CheckedChanged Call SetMode CFUsers Imports System IO Public Class CFUsers Dim FEditUser As CFEditUser Look up the user list and return the assigned password Public Function FindPassword ByVal aUsername As String As String Dim Result As String Dim LI As ListViewItem Dim i As Integer For i 0 To lvUsers Items Count 1 LI lvUsers Items i If LI Text aUsername Then Result LI SubItems 1 Text Exit For End If Next i Return Result End Function Public Sub LoadUsers Dim LI As ListViewItem Dim Users Napa As String Dim Data As String Dim Path As String SpecialFolder ApplicationData Dim i As Integer bsusers dat lvUsers Items Clear Data LoadFile Path If Data Then Exit Sub Users Split Data For i 0 To UBound Users Napa Split Users i LI lvUsers Items Add Napa 0 LI SubItems Add Napa 1 Next i End Sub Private Sub SaveUsers Dim Path As String SpecialFolder ApplicationData Dim LI As ListViewItem Dim i As Integer Dim Data As Strin
30. Port Text Error ErrorText aCode MsgBox Cannot open the session Error ErrorText aCode UpdateStatus End Sub Just disconnected from the server Private Sub VidCln OnSessionClosed Handles VidCln OnSessionClosed UpdateStatus LogMsg Disconnected from the server End Sub xxx Alert Private Sub btnAlert_Click ByVal ByVal e As System EventArgs If Not SelectPeer T nen FAlert txtMsg Text 70 sender As System Object Handles Exit Sub btnAlert Click If lvPeers SelectedItems Count gt 0 Then FAlert radSingle Text User lvPeers SelectedItems 0 Text FAlert radSingle Enabled True FAlert radSingle Checked Tru Else FAlert radAll Checked True FAlert radSingle Text Single user FAlert radSingle Enabled False End If If FAlert ShowDialog lt gt DialogResult OK Then Exit Sub Checked Then SelP If FAlert radSingl VidCln SendAlertMessag Else For VidCln SendAlertMessag Next End If End Sub r Handle FAlert txtMsg Text Each Pr As CClient In Peers Pr Handle FAlert txtMsg Text xxx Chat Private Sub btnChat Click ByVal sender As System Object ByVal e As System EventArgs Handles btnChat Click If Not SelectPeer Then Exit Sub ShowForm SelPeer FChat End Sub Private Sub btnRemove Click ByVal sender As System Object ByVal e As System EventArg
31. Testing on ECG signal from MDIZB to PC Work Flow 1 6 Gantt Chart 1 6 1 Gantt Chart Semester I Based on the project s proposal my projects activities will be divided into several important milestones where the details are shown in Gantt chart below pw eee MIB Literature Review am EE Study ECG and medical SEE LLL LLL Mean E NN TELL Figure 1 2 Gantt Chart Semester I programming language Learning Visual Studio Visual Basic programming Microcontroller interface study programming Coding testing Part 2 Tele consultation between 2 or more PCs Specification Algorithm Coding testing Part 1 Medical interface gt i GUI on ECG display in PC Specification Algorithm 1 6 3 Gantt Chart Semester II The work flow of the projects activities for the second semester was planned and shown in below The planning of the project activities for the semester II is integration of Part and Part 2 Basically it is focused on software algorithm development to develop a Week 2 3 4 5 7 12 13 14 15 Plan Integration of Part 1 and Part 2 Specification Algorithm Coding testing II III A Optimization and eres Up a eee ka NENAS i Checking and improve thesis III II III b gg gt s Thesis seminar and LILLE EL Se eee Figure 1 3 Gantt Chart Semester II graphical user interfaces or GUI for ECG signal analysis calculation for the patient s heart rate and private secure com
32. al care and exploiting the provision of health care services at rural health centres ambulance vehicles ships trains and airplanes as well as for home monitoring With this wide range of technologies available telemedicine programs are no longer about proving that telemedicine works but are about choosing the right communication mode to deploy a cost effective telemedicine network Currently ECG Electrocardiograph monitoring is the most widely used technique for providing ambulatory cardiac monitoring for capturing rhythm disturbances Traditional ECG monitor can record up to 24 hours of ECG signals and the recorded data is subsequently retrieved and analysed by a clinician Due to the short duration involved and the unknown context within which the ECG signal is captured reliable interpretation of the recorded data is always a challenge 5 Electrical signals from the heart characteristically precede the normal mechanical function and monitoring of these signals has the great clinical significant and it is very valuable for the experts or physician to determine type of diagnosis However the accurate ECG interpretation is essentially required in order to evaluate the valuable information inside the ECG signal 1 2 Problem Statement Current type of medical devices for vital sign monitoring use very expensive components and not design for multi patients Consequently patients are unaffordable to buy that particular medical monitoring
33. al software component used in this project included Microsoft Visual Studio 2008 and Microsoft Visual Basic NET 26 3 5 Graphical User Interface GUI The GUI is developed using Microsoft Visual Studio 2008 and Microsoft Visual Basic NET The development of the GUI includes on how to read data from the microcontroller ATMEGA162 16PU and displayed it in the GUI There are two main GUI first is Tele ECG Server act as a server while second GUI named Tele ECG Client act as client to that server and also includes the plotting graph of the ECG signal in real time calculation of patient s heart rate automatically chatting and webcam interface Tele ECG server OMNES 8 v E stop J settings f users f wir wj Name P Port Time State Log 10 54 13 PM Server is started Clear Started No active connection i Figure 3 2 Tele ECG Server GUI Tele ECG Server contains 6 main buttons Peers region shows the users that connected to server while Log region shows the detail and flow of process of this program with timing This type Tele ECG Client Figure 3 3 is mainly for medical expert or physician because it contains a region purposely for ECG signal and heart rate displaying in real time Others features contain send alert chatting talking by using webcam and adjustment on voice activation voice compression video frame rate and video compression On the other hand GUI in Figure 3 4 is almost same
34. art This wave of depolarization produces a flow of electric current and it can be detected by keeping the electrodes on the surface of the body skin Once the depolarization is complete the cardiac cells are able to restore their normal polarity by another process named re polarization This process also sensed by the electrodes 12 In additions ECG simulator is a tool that simulates or recreates an ECG 13 2 7 ECG Interpretation The ECG records the electrical activity of the heart over time where each heart beat is displayed as a series of electrical waves characterized by peaks and valleys Any ECG gives two kinds of information First the duration of the electrical wave is crossing the heart which in turn decides whether the electrical activity is normal or slow or irregular while the second is the amount of electrical activity passing through the heart muscle which enables to find whether the parts of the heart are too large or overworked Normally the frequency range of an ECG signal is of 0 05C100 Hz and its dynamic range of 1C10 mV P Wave Depolarization of atria in response to SA node triggering Delay of AV node ae Beginning of Depolarization of to allow filling of ides tr ventricle ventricles nenu ggers repolarization main pumping contractions aad decas Figure 2 1 The normal ECG waveform The ECG signal is normally characterized by five peaks and valleys labeled by the letters P Q R S T The pe
35. as Figure 4 19 Calling Next Jacky will receive a call request from Thomas He can either choose Accept or Deny If he press Accept button a call is started and 2 new windows will pop up as shown in Figure 4 21 and Figure 4 22 On the other hand the call is terminated if Deny button is pressed instead nn a Peers Name Time State Thomas 9 27 28 PM Connected a Call is requested from Thomas Al _ X A Begin Talk End Talk Call Record Ado E Play Audio v Record Video emote 2 Voice Compression viaeo Lompression V Play Video p Log 9 26 50 PM Connected to the server 10 61 66 45 2222 9 27 28 PM New peer at Thomas 9 27 28 PM 9 34 34 PM Call is requested from Thomas 9 27 28 PM Connected Server 10 61 66 45 2222 User Jacky Figure 4 20 Receiving call request 49 Log 9 35 36 AM Connected to the server 10 61 66 45 2222 9 35 36 AM New peer at Jacky 9 35 36 AM 9 36 08 AM Call from Jacky is taken Session open Server 10 61 66 45 2222 User Thomas Figure 4 21 Video conferencing medical expert Noticed that the State column in Peers region will change from Calling to Talking It means that Thomas and Jacky can talk to each other by using webcam Local camera shows Thomas s live video and audio while remote shows Jacky s live video and audio D
36. ch occur almost simultaneously The T wave is the wave of ventricular repolarization Consequently the duration amplitude and morphology of the QRS complex is useful in diagnosing cardiac arrhythmias conduction abnormalities ventricular hypertrophy myocardial infection and other disease or abnormalities 14 0 02 04 06 08 1 1 2 1 4 16 1 8 2 Figure 2 2 Normal sinus rhythm 16 34 3 2 2 8 p 2 6 2 4 2 2 0 02 04 06 0 8 1 1 2 1 4 1 6 1 8 2 Figure 2 3 Sinus tachycardia 2 8 ECG Electrodes Basically there are three of these leads I II and III Lead I is between the right arm and left arm electrodes the left arm being positive Lead II is between the right arm and left leg electrodes the left leg being positive Lead III is between the left arm and left leg electrodes the left leg again being positive 1 8 1 64 1 4 1 2 0 8 0 6 0 4 0 2 0 2 0 4 06 08 1 12 1 4 Figure 2 4 Sinus bradycardia Figure 2 5 ECG electrodes 1 6 1 8 17 V1 V2 V3 V4 V5 V6 18 Chest Electrode Placement Fourth intercostal space to the right of the sternum Fourth intercostal space to the Left of the sternum Directly between leads V2 and V4 Fifth intercostal space at midclavicular line Level with V4 at left anterior axillary line with V5 at left midaxillary line Directly under the midpoint of the armpit Limb f Umb Electrode Electrode outer aspect of imb C2 Fig
37. d ECG waveform will display and heart rate will calculated automatically Click Send Alert button to send alert message Click Start Chat button to chat Click Begin Talk to request a call Click End Talk to end a call There are other options that you can try such as play and record audio and video voice activation and compression video frame rate and compression Click Disconnect button to disconnect to the server Click Exist button to exist the program CHAPTER 4 RESULTS AND ANALYSIS This chapter described the hardware and software testing result and further analysis for the GUI design Three BPM values are tested in this experiment to determine the relationship between heart rate and the ECG waveform 4 1 Tele ECG Server GUI Testing Let says Thomas is doctor while Jacky is patient First Thomas opens Tele ECG Server GUI to create a private secure server as shown in Figure 4 1 Log 10 54 13 PM Server is started g 2 No active connection Figure 4 1 Tele ECG Server Then IP address is checked by clicking My IP button Example Figure 4 2 shows that the IP address is 10 50 38 11 37 State My IP address 1050 38 11 Log 10 54 13 PM Server is started No active connection Figure 4 2 Checking IP address Then click the Users button to add users BI F Peers P Port Time State Name Access contro
38. device Besides that some of the monitoring devices are wire restraint It is not practice for patient s mobility Moreover some of them do not have connection to communication network It causes data from the medical devices are not able to be transferred through the network to provide fast health service Apart from that current medical monitoring devices just record the data do not transmit the data in real time Thus it causes the immediate action cannot be taken if abnormality is found 1 3 Objectives The main objective of this project is to develop a software application for wireless intensive ECG monitoring system Besides that a development on ECG monitoring system with teleconsultation purpose is implemented In another say a graphical user interface GUI will be developed to carry out the whole process by displaying the ECG signal in real time calculation of patient s heart rate automatically and able to perform teleconsultation by video conferencing in real time sending live audio and live video information as well as chatting message between medical experts and clients 1 4 Scope Basically my project will focus on the setup for software configuration to capture the ECG data by using a low cost Medical Data Interface Zigbee MDIZ and Medical Data Interface Zigbee Bluetooth MDIZB by using Zigbee and Bluetooth wireless connection Then will concentrate on the development of a GUI to display the signal heart rate calcu
39. e calls or as complex as sophisticate virtual reality VR robotic surgery or tele surgery In it providers patients at different locations interact with each other using communication technology in the form of audiovisual and wireless or microwave signals Apart from video conferencing peripheral sensing devices can also be attached to the patient to aid in interactive examination Besides that it can also be used for long term monitoring for home care patients In fact due to the high cost constraints quality and continuity of care issues mal distribution of physicians in different geographic regions and scarcity of the same remote home care of chronically ill patients and of long term care patients is the fastest emerging use of telemedicine Specialities for which it is used most frequent are psychiatry internal medicine rehabilitation cardiology paediatrics obstetrics and gynaecology neurology Store and Forward asynchronous technology involves acquiring medical data images bio signals and transmitting this data to a medical specialist for consultation evaluation or other related purposes It does not require simultaneous communication between both persons in real time Tele radiology and tele dermatology is the fastest emerging branches that use such kind of services Overall radiology pathology and dermatology are most tending for utilizing this mechanism These basic telemedicine technologies as mentioned previously are ut
40. emented with the hardware and software approaches The hardware approach is using the entire prepared component to build the system Then for the software approach is use the relevant programming skill Visual Basic programming language to implement the microprocessor to configure the GUI display Then the analysis coding and testing will be done on the overall system to ensure the output of the system is under consideration and expected Finally the improvement is done to enhance the system performance 1 8 Block Diagram First ECG signal is produced by using an ECG simulator which can connect the output directly to MDIZ Medical Device Interface Zigbee by wired Then the signal is transmitted to MDIZB Medical Device Interface Zigbee Bluetooth through Zigbee connection because MDIZ has a Zigbee transmitter Again MDIZB will transmit the signal to personal computer PC through Bluetooth connection MDIZB is unique because it contains a Zigbee receiver and Bluetooth transmitter Then the signal will display in the GUI developed on the PC screen Finally other PC also can communicate with this GUI through LAN Local Area Network or Wi Fi connection Zigbee PC e Bluetooth MDIZB LN PC Figure 1 5 Block Diagram CHAPTER 2 LITERATURE REVIEW In this chapter a review in knowledge of telemedicine and the electricity of the heart or more commonly called electrocardiogram ECG will be look over Besides Microsoft Visual
41. ent in terms of scope and quality for the award of the degree of Bachelor of Engineering Electrical Electronics Signature Name En Ismail Ariffin Date April 2010 Signature Name Issoc Prof Ir Dr Ing Eko Supriyanto Date April 2010 DEVELOPMENT OF VITAL SIGN ECG MONITORING SYSTEM USING PC THOMAS LEONG TZE HSIUN A report submitted in partial fulfilment of the requirements for the award of the degree of Bachelor of Engineering Electrical Electronics Faculty of Electrical Engineering Universiti Teknologi Malaysia April 2010 ii I declare that this report entitled Development of Vital Sign ECG Monitoring System using PC is the result of my own research except as cited in the references The report has not been accepted for any degree and is not concurrently submitted in candidature of any other degree Signature Name THOMAS LEONG TZE HSIUN Date April 25 2010 iii Dedicated in thankful appreciation for support encouragement and understandings to my beloved mother father and sisters iv ACKNOWLEDGEMENT First and foremost I would like to express my heartily gratitude to my project supervisor En Ismail Arrifin and my co supervisor Issoc Prof Ir Dr Ing Eko Supriyanto for the advice aid guidance and enthusiasm given throughout the progress of this project My appreciation also goes to my beloved family s support tolerant and assistance because without them I
42. g For i 0 To lvUsers Items Count 1 LI lvUsers Items i If Data Length gt 0 Then Data bsusers dat Data LI Text LI SubItems 1 Text Next i SaveFile Path Data LoadUsers End Sub System EventArgs Handles MyBase Load FEditUser New CFEditUser LoadUsers End Sub Private Sub btnOk Click ByVal sender As System Object System EventArgs Handles btnOk Click SaveUsers DialogResult End Sub DialogResult OK Private Sub UpdateButtons Private Sub CFUsers Load ByVal sender As System Object 62 Environment GetFolderPath Environment Environment GetFolderPath Environment ByVal e As ByVal e As 63 btnEdit Enabled lvUsers SelectedItems Count gt 0 btnRemove Enabled lvUsers SelectedItems Count gt 0 End Sub Private Sub lvUsers_SelectedIndexChanged ByVal sender As System Object ByVal e As System EventArgs Handles lvUsers SelectedIndexChanged UpdateButtons End Sub Private Sub CFUsers_Shown ByVal sender As System Object ByVal e As System EventArgs Handles MyBase Shown UpdateButtons End Sub Private Sub btnAdd Click ByVal sender As System Object ByVal e As System EventArgs Handles btnAdd Click Dim LI As ListViewItem If Not FEditUser EditUser Then Exit Sub LI lvUsers Items Add FEditUser txtUsername Text LI SubItems Add FEditUser txtPassword Text End Sub
43. g 57 StatusBar Panels Item 1 Text No active connection Else StatusBar Panels Item 1 connection s End If ext Str lvClients Items Count btnRemove Enabled lvClients SelectedItems Count gt 0 End Sub Set the component properties Private Sub SetSettings VidSrv ListeningPort Val FSettings txtPort Text If FSettings radSecret Checked Then VidSrv SecurityMode 1 Else If FSettings radPublic Checked Then VidSrv SecurityMode 2 Else VidSrv SecurityMode 0 End If End If VidSrv SecretKey FSettings txtSecret Text VidSrv PublicKey FSettings txtPublic Text VidSrv PrivateKey FSettings txtPrivate Text VidSrv Fingerprints FSettings txtFingerprints Text End Sub Add a message to the log Private Sub LogMsg ByVal aText As String Dim Line As String If txtLog Text Then Line Chr 13 amp Chr 10 Else Line End If Line Line amp amp Now ToLongTimeString amp Line Line amp aText txtLog SelectionStart Len txtLog Text txtLog SelectedText Lin End Sub Private Function ItemFromHandle ByVal aHandle As Long As ListViewItem iterate on the list Dim i As Integer For i 0 To lvClients Items Count 1 If lvClients Items i Tag aHandle Then ItemFromHandle lvClients Items i Exit Function End If Next i ItemFromHandle Nothing End Function Start the server Pri
44. gramming language because of its graphical development features and BASIC heritage CHAPTER 3 DESIGN AND IMPLEMENTATION This chapter described the design methodology for the ECG signal capturing by using PC The design system will be described according to the block diagram hardware and software approach 3 1 Design Specification Table 3 1 Design Specification Specification Detail Dimension MDIZ 4 5 X 2 56 X 1 18 MDIZB 6 X 4 65 X 2 5 Power MDIZ Battery 9V MDIZB Built in LiPo rechargeable 11 1V Performance Display PC Trace 3 leads selectable ECG Parameter Heart Rate BPM Feature ECG display in real time Heart rate calculation automatically Teleconsultation Instant alert and chat message sending live video conferencing using webcam Communication Zigbee Bluetooth LAN Wi Fi 24 25 3 2 System Overview ECG Simulator GUI on PC MDIZ MDIZB Figure 3 1 System Overview 3 3 Hardware The hardware approach for this project included ECG simulator medical data interface MDIZ and MDIZB both medical data interface devices contain microcontroller ATMEGA162 16PU and the implementation of the GUI display General hardware component included Zigbee transmitter Zigbee receiver Bluetooth 2 microcontrollers type ATMEGA162 16PU 3 4 Software The software approach for this project included the coding design for Microcontroller ATMEGA162 16PU and the GUI development Gener
45. ilized for providing various health care services that spawns numerous specialties and can be broadly categorized as telehome Home Health Care telepsychiarty teleradiology general telemedicine telecardiology telemedicine consulting teleconsultation teledermatology emergency telemedicine telepathology teledentistry telesurgery telediagnostic telemonitoring telecare and teleeducation Among these specialties teleconsultation is one of the most significant applications as it uses multimedia telecommunication through networks for medical consultation It can either use ordinary telephone email or video conferencing equipments Real time consultations use the video conferencing technology and permit the interaction and communication between medical experts and clients 8 12 2 5 Current Situation of Telemedicine Telemedicine is a growing field which has a high potential for improving accessibility to services quality and continuity of care and significant savings in the overall cost of healthcare However the use of telemedicine applications has not spread as extensively as other as other commonly used engineering techniques such as medical imaging 9 Although telemedicine applications have proliferated in recent years their diffusion has remained low in terms of the volume of consultations especially in Malaysia This is not because telemedicine is less important but because supporting technologies have been traditionally costly
46. istItem LI LI Tag Pr LI SubItems Add Now ToLongTimeString LI SubItems Add Connected If lvPeers SelectedItems Count 0 Then LI Selected Tru End If UpdateStatus LogMsg New peer at LI Text LI SubItems 1 Text End Sub A peer is just disconnected Private Sub VidCln OnPeerDisconnected ByVal aHandle As Integer Handles VidCln OnPeerDisconnected Dim Pr As CClient Pr PeerFromHandle aHandle If Pr Is Nothing Then Exit Sub LogMsg Disconnected peer Pr ListItem Text Pr ListItem SubItems 1 Text Pr ListItem SubItems 2 Text DeletePeer Pr End Sub An alert message is available 72 Private Sub VidCln OnAlertMessage ByVal aHandle As Integer ByVal aText As String Handles VidCln OnAlertMessage An alert message is available If Not PickPeer aHandle Then Exit Sub MsgBox aText Alert from ThePeer Username End Sub A chat message is available Private Sub VidCln OnChatMessage ByVal aHandle As Integer ByVal aText As String Handles VidCln OnChatMessage If Not PickPeer aHandle Then Exit Sub ThePeer FChat HaveChatMessage aText End Sub Private Sub VidCln OnTalkInvited ByVal aHandle As Integer ByRef aOkay As Boolean Handles VidCln OnTalkInvited Dim Pr As CClient Pr PeerFromHandle aHandle If Pr Is Nothing Then Exit Sub LogMsg Call is requested from Pr Username
47. l Usemame 10 54 13 PM Sq Edit Remove ae No active connection Figure 4 3 Add Users For example key in username as his patient s name Jacky password as 1234 then click OK button Then key in another username Thomas and password 1122 The result is shown in Figure 4 5 After add the users in this step it will automatically save the username and password of the users Thus user no need to type his name or password again next time when he open this GUI 38 Tele ECG Sen J EN Bee X Lew orn Dome e e Started No active connection d Figure 4 4 Enter username and password Figure 4 5 Adding 2 Users Optionally user can adjust the setting of the GUI For instance no encryption symmetric encryption or asymmetric encryption 39 Security Options Start Encryption mode Plain text no encryption Shared secret keys symmetric encryption Name P C Public Private keys asymmetric encryption Secret key Key pair Public key i Generate Remove Clear Private key 10 54 13 PM Server Fingerprint of the public key Valid peer fingerprints optional j Ok Cancel 65 0 KB ied 3 29 2010 10 31 PM Figure 4 6 No encryption Key pair Public key Generate Clear Private key Fingerprint of the public key Valid peer fingerprin
48. l aPort As Integer ByVal aCode As Integer Handles VidSrv OnClientRejected LogMsg Rejected client aUsernam aAddress Str aPort End Sub A request from a new peer Private Sub VidSrv_OnConnectionRequest ByVal aHandle As Integer ByVal aUsername As String ByRef aPassword As String ByRef aAccept As Boolean Handles VidSrv OnConnectionRequest aAccept True If aUsername lt gt Then not a Guest user look for the password aPassword FUsers FindPassword aUsername End If End Sub Access control Private Sub btnUsers Click ByVal sender As System Object ByVal e As System EventArgs Handles btnUsers Click FUsers ShowDialog End Sub 60 End Class CFEditUser Public Class CFEditUser Public Function EditUser ByVal aUsername As String ByVal aPassword As String As Boolean txtUsername Text aUsernam txtPassword Text aPassword Return ShowDialog DialogResult OK End Function Private Sub btnOk Click ByVal sender As System Object ByVal e As System EventArgs Handles btnOk Click If Trim txtUsername Text Or Trim txtPassword Text Then sgBox There are empty fields Exit Sub End If DialogResult DialogResult OK End Sub Private Sub CFEditUser Load ByVal sender As System Object ByVal e As System EventArgs Handles MyBase Load End Sub End Class CFSettings Public Class CFSettings Pub
49. lation and then communicate with other same GUI in other PC via LAN or wireless network All of these tasks will be done by using Microsoft Visual Studio 2008 and Visual Basic programming language In additions the ECG used is type of 3 leads selectable ECG 1 5 Work Flow The work flow of the project s activities was divided into different stages as shown in the flow diagram below Firstly the project requires a literature study on basic analysis of ECG signal Then will proceed to the study of Visual Basic programming language by using Microsoft Visual Studio 2008 After that a study on using MDIZ device and MDIZB device will be carry out Then experiments on ECG signal capturing and transmitting from ECG simulator to MDIZ to MDIZB and then display it on the GUI that developed in the PC will be tested Next a GUI will be developed for monitoring purpose and heart rate calculation Finally a secure communication network for teleconsultation purpose is developed for chatting and webcam application Planning on schedule Literature Review on ECG Literature review on Visual Basic programming language Testing on ECG signal from ECG simulator to MDIZ Testing on ECG signal from MDIZ to MDIZB Figure 1 1 Presentation demo journal and thesis Writing GUl on tele consultation part development of a secure communication network for chatting and webcam application GUI on ECG signal display and heart rate calculation
50. lic FMain As CFMain Private Sub SetMode frmSecret Enabled radSecret Checked txtSecret Enabled radSecret Checked frmKeypair Enabled radPublic Checked lblPublic Enabled radPublic Checked lblPrivate Enabled radPublic Checked lblFingerprint Enabled radPublic Checked btnGenerate Enabled radPublic Checked btnClear Enabled radPublic Checked frmFingerprints Enabled radPublic Checked txtFingerprints Enabled radPublic Checked End Sub Private Sub btnGenerate_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnGenerate Click Dim Pub As String Dim Pri As String 61 MsgBox This will take couple of seconds MsgBoxStyle OkOnly Key generation Pub Pri If FMain VidSrv GenerateKeypair Pub Pri Then txtPublic Text Pub txtPrivate Text Pri txtFingerprint Text FMain VidSrv TakeFingerprint Pub Else MsgBox Error generating Public Private keys Error End If End Sub Private Sub btnClear_Click ByVal sender As System Object ByVal e As System EventArgs Handles btnClear Click txtPublic Text txtPrivate Text txtFingerprint Text End Sub Private Sub CFSettings_Load ByVal sender As System Object ByVal e As System EventArgs Handles MyBase Load Call SetMode End Sub Private Sub radPlain CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles rad
51. munication network between 2 or more PCs The final developed software will further convert as standalone execution file or exe format so that it able to be run outside the Microsoft Visual Studio software environment or others computer Undoubtedly this will make the software more friendly user and having high flexibility to implement the software in other computers 1 7 Work Breakdown The flow of the work breakdown chart is shown at figure 1 2 above The main process in completing the project is basically divided as study design and implementation Study is the process that is continuous throughout the project from the beginning till the end At the beginning of the project a lot of study has been done which include study on the concepts of ECG signals analysis signal Visual Basic programming language microcontroller and GUI display Meanwhile in the design phase the project system will be developed according MAIN PROCESS Implementation Concepts of ECG System block diagram Concepts of Visual C programming Algorithm and Hardware TIE E Software language specification Analysis coding Concepts of GUI development and testing microcontroller and GUI display Improvement Figure 1 4 Work Breakdown to the system block diagram Then it also includes the system s algorithm and specification and finally is GUI design for displaying the output signal In the implementation phase the project will be impl
52. ncy action can be taken if problems arise 2 Telemedicine is widely considered to be part of the future of the modern practice of medicine It is gaining more momentum as a new approach for patients surveillance outside of hospitals at home to encourage public safety and to facilitate early diagnosis treatment and increased convenience Defined as the use of advanced telecommunication technologies or information technologies to exchange health information and provide health care services across geographic time social and cultural barriers telemedicine is currently being used by doctors physicians hospitals and other healthcare providers around the world 3 Telemedicine provides a medical care by expert to any place where patient is needed in emergency Telemedicine has been introduced for more than 30 years ago when telephone and fax machines were used as first telecommunication system Nowadays telemedicine applications have been implemented over wired and wireless communication technologies Telemedicine applications reflect the spectrum of clinical specialties and subspecialties found in conventional clinical medicine Besides that telemedicine has been applied in practical education Hence telemedicine is represented in the vast majority of medical specialties although the stages of development and maturity vary substantially by specialty 4 In addition health telematics applications is enabling the availability of expert medic
53. nd optimization is to make the software more flexible user friendly and easier to be use in any computers without installation of Microsoft Visual Studio 2008 or other versions Thus the embedded program needs to convert as standalone execution file in exe format CHAPTER 5 CONCLUSION AND RECOMMENDATION 5 1 Conclusion As a conclusion here ECG monitoring system and teleconsultation for medical purpose is very important and required in telemedicine purposes Thus a software application GUI was successfully developed for wireless intensive ECG monitoring system with the various useful functions such as ECG signal displaying in real time heart rate calculation automatically and teleconsultation purpose Normal Heart rate which is more than 60 bpm and less than 100 bpm Heart rate which is out of this range is consider abnormal 5 20 Novelty The system configuration and communication technology combination are novel which is the integration of Zigbee and Bluetooth Besides that integration between ECG display GUI and video conferencing is another novelty 5 3 Limitation There are some limitations in my project First is alarm system If the heart rate is abnormal but at that time the doctor is busy and do not notice it then the patient may will in a very dangerous condition and any accident may happen Thus alarm system is needed Next is PC problem It is better the ECG signal can display in mobile phone instead of PC becau
54. necting to the hub Else not connected btnConnect Enabled True btnCancel Enabled False btnDisconnect Enabled False StatusBar Panels 0 Text Session closed End If End If UpdateButtons End Sub Private Sub UpdateButtons btnAlert Enabled lvPeers SelectedItems Count gt 0 btnChat Enabled lvPeers SelectedItems Count gt 0 btnRemove Enabled lvPeers SelectedItems Count gt 0 btnBeginTalk Enabled False If lvPeers SelectedItems Count gt 0 Then If VidCln GetCaller 0 And VidCln GetTalkerCount 0 Then btnBeginTalk Enabled True nd If If Eri El B Q btnEndTallk Enabled VidCln GetTalkerCount gt 0 chkRecordAudio Enabled btnEndTallk Enabled chkPlayAudio Enabled btnEndTallk Enabled a btnLocalCam btnRemoteCam Enabled btnEndTal 67 Enabled btnEndTallk Enabled k Enabled I pi trkVoiceActivation Enabled btnEndTallk Enabled trkVideoCompression Enabled btn T ndTallk Enabled End Sub Set the component properties Private Sub SetSettings If FSettings radSecret Checked Then VidCln SecretKey FSettings txtSecret 1 Else VidCln SecurityMode 1 If FSettings radPublic Checked Then VidCln SecurityMode 2 Else VidCln SecurityMode
55. odes Positions MDIZ Characteristic MDIZB Characteristic Design Specification 1X PAGE 10 14 19 19 20 24 FIGURE NO 1 1 1 2 1 3 1 4 1 5 2 1 2 2 2 3 2 4 2 5 2 6 2d 2 8 2 9 2 10 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 3 10 3 11 3 12 3 13 LIST OF FIGURES TITLE Work Flow Gantt Chart Semester I Gantt Chart Semester II Work Breakdown Block Diagram The normal ECG waveform Normal sinus rhythm Sinus tachycardia Sinus bradycardia ECG electrodes Electrodes positions Block diagram of MDIZ Data frame of MDIZ Block diagram of MDIZB Data frame of MDIZB System Overview Tele ECG Server GUI Tele ECG Client GUI for medical expert Tele ECG_Client GUI for client Software algorithm Hub Setting Access control Edit username password New connection Sending an alert message Chat Call requested Local camera PAGE o N QV tA NA 13 15 16 17 17 18 20 20 21 21 25 26 27 27 28 29 30 30 31 32 32 33 33 3 14 4 1 4 2 4 3 44 4 5 4 6 4 7 4 8 4 9 4 10 4 11 4 12 4 13 4 14 4 15 4 16 4 17 4 18 4 19 4 20 4 21 4 22 4 23 Remote camera Tele ECG Server Checking IP address Add Users Enter username and password Adding 2 Users No encryption Symmetric encryption Asymmetric encryption Connect to Server medical expert Connect to Server client Jacky is connected Thomas is connected ECG signal display sinus bradycardia ECG
56. ole and graphical user interface applications along with Windows Forms applications and web services in both native code together with managed code for all platforms supported by Microsoft Windows Windows Mobile Windows CE NET Framework NET Compact Framework and Microsoft Silverlight Visual Studio includes a code editor supporting IntelliSense as well as code refactoring The integrated debugger works both as a source level debugger and a machine level debugger Other built in tools include a forms designer for building GUI applications web designer class designer and database schema designer Visual Studio supports languages by means of language services which allow the code editor and debugger to support to varying degrees nearly any programming language provided a language specific service exists Built in languages include C C via Visual C VB NET via Visual Basic NET and C via Visual C 22 2 11 Visual Studio NET Visual Basic NET VB NET is an object oriented computer programming language that can be viewed as an evolution of Microsoft s Visual Basic VB which is generally implemented on the Microsoft NET Framework Microsoft currently supplies Visual Basic Express Edition free of charge Visual Basic VB is the third generation event driven programming language and integrated development environment IDE from Microsoft for its COM programming model VB is also considered a relatively easy to learn and use pro
57. ret keys symmetric encryption Public Private keys asymmetric encryption Secret key Kn EE Private key Fingerprint of the public key Valid peer fingerprints optional Figure 3 6 Hub Setting Users can either using default mode that is no encryption or using encryption mode by key in shared secret keys symmetric encryption or public private keys asymmetric encryption Next is Users button Its function is used to add the users whose can connect to this server Of course it also can remove user By clicking the Add or Edit button a window will pop up to key in the username and password of the user Next user can check the IP address by clicking My IP button Finally is Exit button to exit the whole program Figure 3 7 Access control Figure 3 8 Edit username password 30 31 Once Tele ECG_Server is ON Tele ECG Client can start to use to connect to the server that created by Tele ECG Server By clicking Connect button it will pop up a new window as shown below New connection Sa Server Address Server Port 127 0 0 1 2222 Username Password Connect Cancel Figure 3 9 New connection User has to enter the IP address port number while username and password are optional unless user already set it in the Tele ECG Server previously as shown in Figure 3 7 While Disconnect button is disconnect the user from server Next is the most important part
58. rformance of ECG analyzing system depends mainly on the accurate and reliable detection of the QRS complex as well as T and P waves The P wave represents the activation of the upper chambers of the heart the atria while the QRS complex and T wave represent the excitation of the ventricles or the lower chamber of the heart The detection of the QRS complex is the most important part in automatic ECG signal analysis Once the QRS complex has been identified a 14 more detailed examination of ECG signal including the heart rate the ST segment and others can be performed In the normal sinus rhythm normal state of the heart the P R interval is in the range of 0 12 to 0 2 seconds The QRS interval is from 0 04 to 0 12 seconds The Q T interval is less than 0 42 seconds and the normal rate of the heart beat is from 60 to 100 beats per minute So from the recorded shape of the ECG we can conclude whether the heart activity is normal or abnormal The electrocardiogram is a graphic recording or display of the time variant voltages produced by the myocardium during the cardiac cycle The P QRS and T waves reflect the rhythmic electrical depolarization and repolarization of the myocardium associated with the contractions of the atria and ventricles and very useful in diagnosing various abnormalities and conditions associated with the heart 13 Table 2 2 ECG waveform Amplitude Duration P wave 0 25 mV P R interval 0 12 to 0 20 ss
59. s Handles btnRemove Click If Not SelectPeer Then Exit Sub DeletePeer SelPeer End Sub Private Sub btnClear Click ByVal sender As System Object ByVal e As System EventArgs Handles btnClear Click txtLog Clear End Sub Private Sub btnBeginTalk Click ByVal sender As System Object ByVal e As System EventArgs Handles btnBeginTalk Click If Not SelectPeer Then Exit Sub If VidCln BeginTalk SelPeer Handle Then lvPeers SelectedItems 0 SubItems 2 Text Calling Else MsgBox Cannot make a call code Str VidCln LastError End If UpdateButtons 71 End Sub Private Sub btnEndTalk Click ByVal sender As System Object ByVal e As System EventArgs Handles btnEndTallk Click VidCln EndTalk end the conversation lbbpgcaller Tesxt Dim i As Long For i 0 To lvPeers Items Count 1 lvPeers Items Item 0 SubItems 2 Text Connected Next i UpdateButtons End Sub A new peer is just created Private Sub VoiCln OnPeerConnected ByVal aHandle As Integer Handles VidCln OnPeerConnected Dim Pr As New CClient Dim LI As ListViewItem Pr Handle aHandle Peers Add Pr Str Pr Handle Pr Username NiceName VidCln GetPeerName Pr Handle create the chat form Pr FChat New CFChat Pr FChat FMain Me Pr FChat Peer Pr Pr FChat Text Chat with Pr Username LI lvPeers Items Add Pr Username Pr L
60. s started J Local 1 01 54 PM New connection from 10 50 38 11 51190 Play Audio 11 0400 BU New connection from 10 50 37 59 49330 eed Wen Remote T Voice Compression viaeo vonpresson Play Video Log 1 01 16 PM Connected t the server 10 50 38 11 2222 11 01 22 PM Disconnected from the server 1 01 54 PM Connected b the server 10 50 38 11 2222 i 11 0401 BI New peer at Thomas 1 0401 PM Stated 2comections Vid Date modified 3 29 2010203 PM Datecrested Se pen Soe Eze ena Figure 4 12 Thomas is connected From figure 4 13 noticed that the heart rate is equal to 30 bpm From the graph it is obviously show that the ECG waveform is very weak and low frequency Thus this is an abnormal ECG waveform named sinus bradycardia because R R interval more than 1 It means that Jacky now is in a very dangerous situation and emergency action is needed immediately 42 rs es NLIONS NON j End Talk l Heart Rate BPM 30 PLOT Peers I Name Time State Jacky 9 26 27 AM Connected Send Alert Start Chat Remove Call I Record Audio Voice Activation Frame Rate i Play Audio p ri Mes Voice Compression viaeo Lompression 4 Play Video p I Log 9 26 27 AM Connected to the server 10 61 66 45 2222 9 26 27 AM New peer at Jacky 9 26 27 AM Local Remote j Session open i Server 10 61 66 45 2222 User Thomas
61. se mobile phone is portable and more convenient Furthermore this project only includes one vital sign signal that is ECG 53 5 4 Recommendation For further development of this project it is recommended to add some more vital sign signals such as detect SPO2 NIBP temperature and respiration to make this particular monitoring system more powerful flexible and accurate Besides that 6 leads or 12 leads selectable ECG can consider in this project instead of only using 3 leads selectable ECG to increase the accuracy of heart rate detection Furthermore an alarm system should be implemented into the GUI so that it will alert the doctor if an abnormality is found Moreover mobile phone can replace PC to display the ECG signal in real time as it is lighter smaller portable and more convenient 10 11 54 REFERENCES WHO Atlas of Heart Disease and Stroke September 2004 D Bottazzi A C and Montanari R Context aware middleware solutions for anytime and anywhere emergency assistance to elderly people IEEE Communications Magazine 2006 44 4 82 90 Y B Choi H S K E C J S Krause and Chung K Telemedicine in the USA standardization through information management and technical applications IEEE Communications Magazine 2006 44 4 41 48 Elizabeth Krupinski R P D E R S Michelle Nypaver and Sapci H Clinical Applications in Telemedicine Telehealth EEE Communications Magazine 2002 8 1 P S
62. sender As System Object ByVal e As System EventArgs Handles radPlain CheckedChanged Call SetMode 77 End Sub Private Sub radSecret_CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles radSecret CheckedChanged Call SetMode End Sub Private Sub radPublic_CheckedChanged ByVal sender As System Object ByVal e As System EventArgs Handles radPublic CheckedChanged Call SetMode End Sub End Class CFChat Public Class CFChat Public FMain As CFMain Public Peer As Globals CClient the peer associated with the form Sub HaveChatMessage ByVal aMessage As String Dim S As String ShowForm Me If txtLog Text Then S mu Else S Environment NewLin End If S S 4 Now ToLongTimeString S25 Peer Username S S aMessage txtLog AppendText S End Sub Private Sub btnSend Click ByVal sender As System Object 78 ByVal e As System EventArgs Handles btnSend Click Dim S As String FMain VidCln SendChatMessage Peer Handle txtMsg Text If txtLog Text Then Sg nN Else S Environment NewLin End If S S Now ToLongTimeString S S FMain VidCln Username S S txtMsg Text txtLog AppendText S txtMsg Text End Sub Private Sub CFoChat_Closing ByVal sender As Object ByVa le As System ComponentModel CancelEventArgs Handles MyBase
63. shows the video that capture from other user s webcam In other way it means user will see other user in this window When you click the End Talk button it will terminate the calling In additions there are other features such as play audio and video record audio and video adjust voice activation voice compression video frame rate and video compression 3 8 User Manual This GUI is user friendly There are several basic steps and cautions that need to pay attention Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Make sure you have one unit of 3 leads selectable ECG electrodes MDIZ MDIZB PC internet connection Bluetooth connection and webcam Install bsvidchatsdk free setup into your PC Copy 2 folders named Tele ECG Server and Tele ECG Client for medical expert while Tele ECG Client2 for client such as patient Fix the ECG electrodes to your body for client Turn on MDIZ and MDIZB Once the Bluetooth is connected you can open the exe file VidSrv exe in the folder Tele ECG_Server while VidCln exe in the folders Tele ECG Client and Tele ECG Client2 Step 7 Step 8 Step 9 Step 10 Step 11 Step 12 Step 13 Step 14 Step 15 Step 16 Step 17 Step 18 Step 19 35 Check IP address Enter correct IP address and Port number Enter username and password optionally but recommended Connect to the Tele ECG Server GUI Connect to the Tele ECG Client GUI Once both parties are connecte
64. signal display sinus rhythm ECG signal display sinus tachycardia Sending alert message Receiving alert message Chatting Calling Receiving call request Video conferencing medical expert Video conferencing client End call xi 34 36 37 37 38 38 39 39 40 40 4l 41 42 43 44 45 46 47 47 48 48 49 50 50 xii LIST OF ABBREVIATIONS ECG Electrocardiogram GUI Graphical User Interface PC Personal Computer Wi Fi Wireless Fidelity IP Internet Protocol LAN Local Area Network MDIZ Medical Data Interface Zigbee MDIZB Medical Data Interface Zigbee Bluetooth VB Visual Basic bpm beat per second xiii LIST OF APPENDICES APPENDIX NO TITLE PAGE A TELE ECG SERVER 56 B TELE ECG CLIENT 64 CHAPTER 1 INTRODUCTION This chapter gives an overview of the whole project starting with the project background and problem statement followed by the project objectives scopes and methodology 1 4 Background According to a World Health Organization WHO estimate cardiovascular disease kills almost seventeen million people around the world each year with around twenty million people at a risk of sudden heart failure 1 Some of these lives can often be saved if quick care and cardiac surgery are provided within the so called golden hour Therefore patients who are at risk require that their cardiac health to be monitored frequently whether they are indoors or outdoors so that emerge
65. tanding A C M Dent and Glenville B Changes in referral patterns to cardiac out patient clinics with ambulatory ECG monitoring in general practice The British Journal of Cardiology 2001 8 6 396 398 Sanjay Sood S J R D C R D N P R C M Victor Mbarika What is Telemedicine A Collection of 104 Peer Reviewed Perspectives and Theoretical Underpinnings Telemedicine and e Health 2007 13 5 573 590 Meystre S The Current State of Telemonitoring A Comment on the Literature Telemedicine and e Health 2005 11 1 Consultation W G Health Telematics Policy in support of the renewed Health for All Strategy in the 21st century Geneva 1997 Shimuzu K Telemedicine by Mobile Communication EEE Engineering in Medicine and Biology 1999 Tanriverdi H and Iacono C S Diffusion of Telemedicine A Knowledge Barrier Perspective Telemedicine Journal 1999 5 3 Jasemian N L Y Design and Implementation of a Telemedicine System Using Bluetooth Protocol and GSM GPRS Network for Real Time Remote Patient Monitoring Technology and HealthCare 13 2005 13 12 13 14 15 55 L Cromwell E P F J Weibell Design and Implementation of a Telemedicine System Using Bluetooth Protocol and GSM GPRS Network for Real Time Remote Patient Monitoring Technology and HealthCare 2005 13 C Saritha Y N M V Sukanya ECG Signal Analysis Using Wavelet Transforms Bulg J Phys 2008 35 68 77
66. ted from the server Session closed Figure 4 10 Connect to Server client EISE ETIN Jama oer aiti Peers Name Time State Jacky 11 03 38 PM Connected EndTalk Send Alert Start Chat Remove Cal Record Audio Voice Activation Frame Rate D Local Play Audio 9 nose Mc menter Wess UMEN I 7 Play Video g Log 11 03 37 PM Connected to the server 10 50 38 11 2222 11 03 38 PM New peer at Jacky 11 03 38 PM Server 10 50 38 11 2222 User Thomas Figure 4 11 Jacky is connected 4 3 ECG Signal Displaying Let says the ECG simulator acts as the ECG device places on Jacky s body It will produce ECG signal according to the input that we adjust on that device Then the signal is transmitted directly to MDIZ then to MDIZB through Zigbee connection finally to Thomas s PC Thus Thomas can observe his patient Jacky s ECG signal in real time in his GUI as shown in Figure 4 13 WO aw i J t Stop Settings Users myiP T Peers li sets ot Name P Pori Time State I J dediy 10503811 SVO OSA Comected Peers I Thomas 10503759 48030 THOKODPM Comedei Name Time State Thomas 1421 PM Connected l Begin Talk EndTalk Send Alert Stari Chat Remove Log Cal Record Audo Voice Activation Fame Rate 1 024 BI Server i
67. ts optional e 65 0 KB Figure 4 7 Symmetric encryption After that open Tele ECG Client to connect to the private server by entering the correct IP address Port number username and password Otherwise failure of connecting to server message will pop up secuty onina Encryption mode Plain text no encryption Shared secret keys symmetric encryption Public Private keys asymmetric encryption Key pair Public key Log 10 54 13 PM Server i Private key Fingerprint of the public key Valid peer fingerprints optional p fied 3 29 2010 10 31 PM Figure 4 8 Asymmetric encryption ete ES 7 Play Video Session closed Figure 4 9 Connect to Server medical expert 4 2 Tele ECG Client GUI Testing When both of them are successfully connected to the server that created by Thomas then Thomas can view his patient s name Jacky appear in the Peers region with name time and status stated as Connected in his Tele ECG Client GUI While Jacky also can note that Thomas is connected in his GUI 40 41 Name Time State New connection Server Address Server Port 10 50 38 11 2222 Call Username Password Jacky 1234 Local Remote Log 11 01 16 PM Connected to the server 10 50 38 11 2222 11 01 22 PM Disconnec
68. ure 2 6 Electrodes positions 19 Table 2 3 Electrodes Positions Chest Leads View V1 and V2 Right Ventricle V3 and V4 Septum Lateral Left Ventricle V5 and V6 Anterior Lateral Left Ventricle 2 9 MDIZ and MDIZB Medical Data Interface Zigbee MDIZ is a device which receives data from medical device and transmits it out through Zigbee network while MDIZB coordinates the Zigbee network as well as communicates with other devices through Bluetooth network MDIZ is able to send data up to 115200 bps The bandwidth is more than enough for vital sign data The network has a PAN ID to differ with the other Zigbee networks MDIZB has the same operational frequency as MDIZ but the modulation is slightly different Table 2 4 MDIZ Characteristic Parameter Value gain transmitter 1 dBi gain receiver 1dBi receiver sensitivity 92 dBm indoor coverage range 30m line of sight range 100m Zigbee channel frequency 2 411 GHz Zigbee bandwidth 1 359 MHz Zigbee data rate 115200bps 20 Table 2 5 MDIZB Characteristic Parameter Value gain transmitter 1 dBi gain receiver 1dBi average power 89 dBm line of sight range 100m Bluetooth channel frequency 2 411 GHz Bluetooth bandwidth 1 359 GHz Bluetooth data rate 723300bps From Figure 2 7 it shows that analog signal from medical sensor is conditioned digitized and processed by a processor The data from processor is converted
69. uring their conversation the ECG signal still display in the GUI so Thomas still can make observation in all time 50 9 35 57 PM Disconnected peer Thomas 9 27 28 PM Connected 9 36 36 PM New peer at Thomas 9 36 36 PM 9 36 59 PM Callis requested from Thomas 9 36 36 PM Connected 9 37 09 PM Call from Thomas is taken Session open Server 10 61 66 45 2222 User Jacky Figure 4 22 Video conferencing client Figure 4 22 shows Jacky s GUI which can also talk with Thomas by using webcam Now the local camera shows Jacky s live video and audio while Remote camera shows Thomas s live video and audio They can adjust some setting such as voice activation voice compression video frame rate or video compression At last the call can terminated if the End Talk is pressed by either side Heat Rate BPM 60 Peers Name Time Jacky 9 35 36 AM Begin Tam End Talk Call from Jacky is terminated Call al Record Audio ation e XH Play Audio L 7 Record Video Remote hr Voice Compression viaeo compression V Play Video g Log 9 35 36 AM Connected to the server 10 61 66 45 2222 9 35 36 AM New peer at Jacky 9 35 36 AM 9 36 08 AM Call from Jacky is taken Session open Server 10 61 66 45 2222 User Thomas Figure 4 23 End call 51 4 5 Optimization The approach of testing a
70. vate Sub btnStart Click ByVal sender As System Object 58 ByVal e As System EventArgs Handles btnStart Click If VidSrv Start Then LogMsg Server is started Else Call MsgBox Cannot start the server Error End If UpdateStatus End Sub Stop the server Private Sub btnStop Click ByVal eventSender As System Object ByVal eventArgs As System EventArgs Handles btnStop Click Dim i As Integer VidSrv Stop For i lvClients Items Count 1 To 0 Step 1 VidSrv DisconnectClient lvClients Items i Tag Next i UpdateStatus LogMsg Server is stopped End Sub Modify the settings Private Sub btnSettings Click ByVal eventSender As System Object ByVal eventArgs As System EventArgs Handles btnSettings Click If FSettings ShowDialog DialogResult OK Then Exit Sub SetSettings UpdateStatus nd Sub ral Show my IP address Private Sub btnIP Click ByVal sender As System Object ByVal e As System EventArgs Handles btnIP Click MsgBox VidSrv LocalIPList My IP address End Sub Private Sub btnExit Click ByVal sender As System Object ByVal e As System EventArgs Handles btnExit Click End End Sub Remove a client connection Private Sub btnRemove Click ByVal eventSender As System Object ByVal eventArgs As System EventArgs Handles btnRemove Click If lvClients SelectedItems Count 0 Then Exit Sub VidSrv DisconnectClient lvClients Selected

(ecg) monitoring system using pc thomas leong tze hsiun universiti

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