ADVANCED PATIENTS MONITORING THROUGH CCTV CAMERA

PROJECT REPORT submitted in partial fulfillment of the requirements for the award of the degree of BACHELOR OF TECHNOLOGY in BIOTECHNOLOGY

by

PRASHANT ABRAHAM THOMAS (10904203) VINNY KOSHY (10904711) K. G. GAUTHAM (10904102) VIVEK. B (10904714) under the guidance of Mr.M.K.JAGANATHAN, B.Pharm, M.Tech (Lecturer, Department of Biotechnology)

DEPARTMENT OF BIOTECHNOLOGY SCHOOL OF BIOENGINEERING FACULTY OF ENGINEERING AND TECHNOLOGY SRM UNIVERSITY KATTANKULATHUR 603203
April 2008
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CERTIFICATE
Certified that the project report entitled ADVANCED PATIENTS MONITORING THROUGH CCTV CAMERA is a record of project work done by PRASHANT ABRAHAM THOMAS,VINNY KOSHY, K.G. GAUTHAM, VIVEK. B under my supervision. This project has not formed the basis for the award of any degree, diploma, associateship or fellowship.

INTERNAL GUIDE

HEAD OF THE DEPARTMENT

(Mr.M.K. JAGANATHAN) For the purpose of viva voce 1. 2.

DECLARATION
We do hereby declare that the project report entitled ADVANCED PATIENTS MONITORING THROUGH CCTV CAMERA is a record of original work carried out by us under , the supervision Department of of

Mr.M.K.JAGANATHAN,B.Pharm,M.Tech

Lecturer,

Biotechnology, SRM University, Kattankulathur. This project has not been submitted earlier in part or full for the award of any degree, diploma, associateship or fellowship.

KATTANKULATHUR DATE

PRASHANT ABRAHAM THOMAS VINNY KOSHY K.G. GAUTHAM VIVEK. B

ACKNOWLEDGEMENT

We express our deep sense of gratitude to Mr. .M.K.Jaganathan Department of Biotechnology, School of Bioengineering, S R M University, Chennai for his valuable guidance and support during our project work. We are obliged to Dr. K.Ramaswamy, Dean, School of Bioengineering, SRM University who have been an inspiration to us. We would like to mention our gratitude to the head of the department of biotechnology, SRM Dr.Kantha.D. Arunachalam, MA.Sc.,Ph.D. UNIVERSITY,

This dissertation could not have come to form without the help and support of Mr. Palanivel, Chief Technical Advisor, BLUECHIP TECHNOLOGIES PVT LTD who taught us the techniques and whose guidance enabled us to complete our work. We are very grateful to Mr. Vasu, Technical Advisor, BLUE CHIP TECHNOLOGIES for the constant support and assistance he provided in making this project successful. We fondly remember our parents for always standing with us when we needed moral support Thanks to the Lord Almighty for his blessings that strengthened us throughout our work. Prashant Abraham Thomas Vinny Koshy K. G. Gautham Vivek. B

LIST OF TABLES

TABLE NO: 1.

TITLE

PAGE NUMBER 34

Some positive results on use of CCTV cameras

LIST OF FIGURES
FIGURE NO: 1. 2. 3. 4. 5. 6. 7. 8. TITLE Advanced telemedicine products RF Transmitter RF Receiver LCD Block diagram of a basic power supply Block Diagram of transmitter section Block diagram of receiver section Monitoring signals through CCTV PAGE NUMBER 15 20 21 24 26 28 29 37

LIST OF ABBREVIATIONS

TITLE

ABBREVIATION

Intensive Care Unit Radio Frequency Liquid Crystal Display Electro Cardio Gram Personal Computer Light emitting diode Power Supply Unit Central Processing Unit Random Access Memory Closed Circuit Tele Vision

ICU RF LCD ECG PC LED PSU CPU RAM CCTV

CONTENTS
PAGE NO ABSTRACT 1. INTRODUCTION 2. OBJECTIVES 3. REVIEW OF LITERATURE 3.1 VITAL SIGNS TO BE MONITORED 3.2 PATIENT MONITORING SYSTEMS ON CLOSE WATCH 3.3 FALSE ALARMS 3.4SELECTION OF ELECTRONIC DEVICES USED FOR PATIENT MONITORING 3.5RECENT DEVELOPMENTS IN MONITORING 4. MATERIALS AND METHODS 4.1 HARDWARE COMPONENTS 4.2 SOFTWARE REQUIREMENTS 4.3 METHODOLOGY 5. RESULTS 5.1 CASE STUDY ON EPILEPTIC PATIENTS USING CCTV 6. DISCUSSION 6.1 OTHER DEVELOPMENTS IN FIELD OF BIOMEDICAL ENGINEERING 2 3 4 4 5 7 10 11 14 14 22 23 25

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7. SUMMARY 8.REFERENCES

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ABSTRACT
In recent years, Intelligent System has shown to be capable of providing strong solutions for the diagnosis of medical conditions. This is largely due to the lack of transparency in the method they use to reach a diagnosis for a given medical condition. A critical factor in medical diagnosis is the necessity to be able to explain how a diagnosis was reached. From these Medical applications the effectiveness of diagnosis Procedures medical tests combined to analyze the medical conditions from the remote system.

This Project is to monitor the condition of a patient in ICU. When the Patient Condition is said to be critical an alert message is given to the doctors and they can check out the patient informations in the PC. Monitoring is done with help of The monitoring sensors are connected along with RF

closed circuit cameras.

Transmitter unit placed in ICU. In addition, these records have to be transferred from the ICU to the RF Receiver which is connected along with the PC .The AI method which helps the doctors to analyses the disorder or to identify the normal condition of the Patients whether they are affected severely or not. From this it can be easily identified the disease name or the severity of the disease that can be identified by the remote system.

1.INTRODUCTION
Monitoring patients health is based upon the fact that, the patients suffering from critical and chronic illness require constant surveillance. A doctor or a nurse cannot spend their whole time on any one patient but its equally important that they be in constant touch with their patients round the clock. This is what we have achieved through this project where we make a model of such a biomedical equipment ,which acts as a boon for the doctors as well as the patients .The use of such biomedical instruments in various hospitals has proved a decrease in the mortality rates .The doctor can always be in touch with the general health of the patient. He need not worry about his critical patients as they are always being monitored .The nurse on duty can send the improvements of patients to the concerned doctor .These improvements send by her can be in form of images or data. Here we concentrate more on images as we use closed circuit cameras for capturing improvements of patients. Electronic components play a major role in functioning of this biomedical equipment .These components comprise of two parts hardware and the software .These both go hand in hand for the proper working of the equipment. These components will be discussed in detail in the coming pages .All the traditional intensive care units are making way for modern intensive care units, in other words paving way for electronic ICUs. All these modern ones, use these modern equipments .Vital signs of patients should be monitored by trained staff, because these equipments are of no use otherwise .Monitoring does help early diagnosis of a change in a physiological parameter and provides guidance for proper therapy. The patient monitoring requires proper guidelines and proper methods which should be satisfied, some are

Assignment of risk levels Grading of adverse effects Plans for reporting of adverse effects Plans for monitoring progress of trials

These four guidelines should be satisfied by the concerned staff to be in par with proper functioning of the equipment used.
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OBJECTIVE

To monitor the patient suffering from serious disorder through closed circuit cameras and monitoring sensors

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REVIEW OF LITERATURE
All patients on general wards are monitored with at least one piece of electronic patient monitoring(EPM)equipment either continuously with a stand alone electrocardiogram (ECG)machine ,for example, or intermittently with timely

observations using tympanic thermometers and pulse oximeters .correct monitoring by adequately trained users reduces the death rates.

3.1 VITAL SIGNS TO BE MONITORED

Despite a lack of appropriate evidence the practice of non invasive care has become standard care, particularly in theaters and critical care environments and has overflowed into general ward areas .vital signs are important component of monitoring a patients progress during hospitalization, because they allow prompt and early detection of delayed recovery or adverse events .These vital signs to be monitored are

Blood pressure Temperature Pulse rate Respiratory rate Oxygen saturation level

Monitoring vital signs is often viewed as one of the more mundane aspects of nursing care and is frequently devolved to health care assistants and nursing students .A study by Thornley (2000) found that 82 percent of health care assistants surveyed performed and recorded patients observations, the monitoring often goes wrong as they dont do procedures correctly. It has been found for example that accuracy of tympanic temperatures varies depending on skill of health worker using the technology. To take an accurate tympanic temperature, the pinna of the ear should be grasped and pulled posteriorly while the probe is inserted into auditory canal until ear canal is fully sealed off by lens cover and reading is taken while most health monitors place probe in ear with one hand and read out display in other which gives a wrong result .its often noticed that
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patients often show physiological changes before a critical event ,these changes or symptoms should be properly diagnosed .It should be remembered ,though, monitoring is not the same as treatment ,nor is it a substitute for treatment .Instituting even the most invasive of monitoring techniques cannot alter a patients outcome without modification of treatment .monitoring does help early diagnosis of a change in a physiological parameter and provides guidance for treatment

3.1.1 MONITORING SKILLS Monitoring a patients physiological responses not only allows assessment of the patients physiological reserve, but also gives a baseline against which the effectiveness of any applied treatment can be judged (ONeill and Le Grove 2003). Nurses and healthcare assistants need to be educated to assess and monitor patients to such a standard that they are able to identify those who are deteriorating or who are at risk, early enough to inform the appropriate staff. Nurse training should emphasize that airway, breathing and circulation are the prerequisites of life, and their dysfunction is the common denominator of death (Mc Quillan et al 1998). Nurses should, therefore, be constantly aware that the skills required to detect when an acutely ill patient is deteriorating are fundamental to nursing assessment (Ahern and Philpot 2002).

3.2 PATIENT MONITORING SYSTEMS ON CLOSE WATCH

An increase in demand for intensive care facilities has resulted in a growing number of critically ill patients being admitted to acute ward areas and has subsequently increased the use of electronic monitoring devices (Murch and Warren 2001). In a survey by Chellel et al (2002) in Kent of 1,873 ward patients from 82 wards in four trusts there were 229 patients (12 per cent) whose care needs went beyond what could normally be managed on the ward. They also found that fundamental nursing observations on the sickest ward patients were incomplete. Such omissions imply that crucial and easily obtainable indicators of impending critical illness and

deteriorating respiratory function are going undetected, creating a further risk to the critically ill ward patient The governments review of adult critical care services,

Comprehensive Critical Care (DoH 2000a),

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was underpinned by the importance of developing an integrated approach to the work of the clinical team, to enable the health care system to provide critical care based on patient need rather than place critical care without walls (DoH 2000a).appropriately trained and experienced nurses could provide the skills required by critically ill patients in critical care units; for example, the continuous observation and monitoring of critically ill patients including assimilation, interpretation and evaluation of information. It did recognise that nurses working in other areas, such as medical and surgical wards, would need to gain the appropriate knowledge, skills and competencies to care for critically ill patients, because all patients have the potential to become critically ill whether they have been admitted to a gynaecology ward or an intensive care unit (Scott 2003). However, from anecdotal evidence there still appears to be a skills gap .McQuillan et al (1998) in a UK study of 100 consecutive adult emergency admissions showed that the greatest impact on outcomes from ICUs maybe improvements in input, particularly in the quality of acute care. Gwinnutt et al (2000) showed that patients who arrested on general wards were three times more likely to have a poor outcome .The authors suggested that the results on the wards could be because of the lack of recognition patients may have a greater incidence of complications post-arrest. Hodgetts et al (2002) also found that potentially avoidable cardiac arrest was5.1 times greater for patients in general wards than critical care areas, and clinical signs of deterioration in the preceding 24 hours were not acted upon in 48 per cent of the studied cases .

3.2.1 FLAWS IN PATIENT MONITORING Even if patients are connected to multi-channel continuous physiological monitoring, important changes that could indicate a catastrophic decline may still go undetected, either because the pattern of decline is not recognised by the ward staff or because existing monitors alarm too frequently for clinically insignificant events, and nurses become impervious to their purpose (Buist et al 2002).

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3.2.2 MONITORING ISSUES IN CLINICAL ENVIRONMENT Multi parameter monitoring is meant to assist doctors and nurses in diagnosing and highlighting any deterioration in a patients condition but, because of the increasing number of over-sensitive monitors, it appears to be more of a hindrance than a help. This is resulting in an increasing number of nurses becoming de sensitized to the sound of the alarms and not paying attention to patients themselves. It has been reported by the MDA that there are four possible reasons for the failure of an alarm: It could be switched off malevolently and result in an untoward incident. It could fail because of incorrect use by staff and carers, i.e., staff become conditioned to false alarms and do not check the significance of them, and set inappropriate limits, such as to only alarm if heart rate deviates below 10 or above 200bpm for an adult patient. It may fail because the device was selected inappropriately for its intended use. It may fail because the monitoring device, or part of the device, has failed (MDA1995).

3.3 FALSE ALARMS

Most monitoring systems have alarms and the alarms are usually viewed as unhelpful by medical staff because of the high incidence of false alarms that is alarms with no clinical significance (Chambrin2001). A study of monitoring in the United States found that over a period of 298 hours there were 325 alarms that had to be silenced, of which more Than 90 per cent were false (Tsien and Fackler1997). False

alarms may actually harm the patient; each alarm challenges the nurse to decide whether it is caused by a clinically significant event or the result of artefact from, for example, patient movement .Misinterpretation of alarms can result in failure to treat a developing condition or unnecessary treatment.

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3.3.1 AREAS IN HOSPITALS WHERE ALARMS ARE USED

On a general ward, alarms can come from ECG monitors, pulse oximeters, central Venous pressure monitors, blood pressure monitors, respiration rate monitors, perfusion pumps, nutrition pumps and automatic syringe drivers .These alarms usually get triggered by patient movement ,equipment interference, drawing blood gases, suctioning, probes dropping off, cables being changed ,leads when disconnected ( Chambrin 2001) In 1999, more than 6,600 adverse incidents involving medical devices were reported to the Medical Devices Agency (MDA), including 87 deaths and 345 serious injuries (DoH 2000b). One piece of anecdotal evidence concerns an occasion when a healthcare professional was asked by a nurse to remove a continuously alarming multi parametric monitor from a post-surgical patient. The nurse had to be challenged. The monitor was alarming, but the patient attached to the monitoring was obviously finding it increasingly difficult to breathe and was sweating profusely. On closer examination of the traces displayed on the monitor, it was showing clear signs that the patient was in atrial fibrillation. The patient was immediately returned to bed, the doctors contacted and an ECG performed to confirm the diagnosis. The nurse had been so conditioned to the inability of the specific monitor to function effectively and to only alarm to clinically insignificant events that she had dismissed the possibility that the monitor might be working properly and raising the alarm for a clinically significant event. 3.3.2 FLAWS CORRECTED

Thus a specific and sensitive technique to alert the medical emergency team to important changes in a patients physiological state may also reduce the rate of unheralded cardiac arrests in hospital. To date, virtually all medical emergency teams (METs) have used scoring systems to trigger a call to the patients bedside. These scoring systems are usually based on five physiological variables (Subbe et al2001):

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Heart rate. Respiratory rate. Blood pressure. Temperature. A measure of alertness or coma.

The scores increase as the patient diverges from normal physiological parameters, and values above a Set threshold mandate a call to the patients primary doctors or the MET. The scoring systems in current use the Early Warning Score and the Modified Early Warning Score, for example have been derived empirically and tested with minimal scientific rigour (Goldhill 2001). No data exist to suggest that any particular scoring system or threshold has advantages over any other. In essence, these systems might work simply because they impose a system of regular observations of the patient and man dated responses on the clinical team. This assumes there are suitably trained people available to make the observations at appropriate intervals, which might not always be the case. It would seem an obvious step to use continuous physiological monitoring to make these observations and possibly even calculate a score and sound an alarm, there by freeing nursing staff from a repetitive task and allowing them to concentrate on other areas of care. Computers are more consistent than nurses, and are not subject to observer variation and level of nurse training (Cunningham et al 1996). The fundamentals of nursing are to look and touch. It seems that some nurses are dismissing their basic training of looking at the patient before looking at a machine. The recognition of breathing difficulties and the feel of a patients brow should alert a nurse to a patients deteriorating condition regardless of the technology. Part of the problem is the ease with which technical interventions become routine, and that all nursing actions are no longer subject to critical thinking in relation to individual patients .Technology has made lifesaving critical care possible and accessible to most people. It can help or disrupt effective order and functioning, or it can shore up disorder and breakdown. It takes good clinical judgment to decide what is doing what (Benner 2003). Although advances in biomedical technology will lead to sustained and improved health, technology will never duplicate nurses compassion and human touch (Hader 2003).

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3.4 SELECTION OF ELECTRONIC DEVICES USED FOR PATIENT MONITORING

A device used in patient care should be selected with the following in mind (MDA1995):

It should not be used unnecessarily, but if there is a need for a particular therapeutic or monitoring function, then the device used should be appropriate for the task and preferably no more elaborate than is essential for its intended function.

It must operate safely and reliably. It should give clear and informative readings to users who should understand how to operate the device and how to interpret its readings or indications. Alarms should be fitted to assist in ensuring the safety of patients and users. The device should generate a minimum number of false alarms but deliver alarms when necessary and in a manner that suits the environment where it is used

Smith et al (2003) concluded that electronic monitoring introduces new dimensions of understanding but also the potential for new ways of misunderstanding.

3.4.1 IMPROVED MONITORING Ideally, a monitor needs to have alarms with high specificity and sensitivity, that is, the ability to alarm and alert carers to only clinically significant events in patients. Monitors are currently being developed with alarms of different frequencies dependent on whether the alert signifies a clinical event or a fault with the equipment. Monitor displays also need to reflect the cause of an alarm clearly, and technologies are being developed that use more than one input parameter, such as a combination of heart and breathing rate, as the basis of their alarm systems. One important area that has yet to be addressed by medical technology companies is that of the role of advanced technology in vital sign measurement. Current devices can monitor a range of physiological parameters, can

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alarm for changing status and some can print reports or graphical trends of these parameters. These devices have the potential to produce significant changes to clinical practices. Many of these advanced technologies are now employed in some clinical areas, but this is based more on the availability of the equipment than on its demonstrated

usefulness or its ability to improve care delivery, patient outcomes or expense (Evans et al 2001).

3.5 RECENT DEVELOPMENTS IN MONITORING

Monitoring has gained new heights, where there is no requirement of skilled nurses or professional health care assistants .Telemedicine is one such term ,which relieves patient from problems faced in hospitals Many people live in a condition that makes them reasonably defined as remote patients or remote users. This particular situation ranges among widely different cases: Elderly or ill people , that can not move out of home People living in difficult environments, as mountains or remote villages People moving everywhere for holidays or job

Figure 1: Advanced telemedicine products

These two devices are, examples of products used by patients at home for self monitoring. Thus telemedicine is trying to minimize the flaws in monitoring.

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3.5.1 REMOTE PATIENT MONITORING

One of the recently developed branches under patient monitoring is remote monitoring. The field of remote patient monitoring, or biotelemetry, has developed modern technologies and techniques for the remote physiological monitoring of patients. The current modern communication infrastructure including, but not limited to, WIFI, cellular, TCP/IP, and VOIP platforms is suitable to support health care provider-patient communications. These platforms may be used individually or in combination to provide a medical treatment network supporting voice and data transmission. Therefore, it is desirable in the field of biotelemetry to provide a system that is capable of integrating these technologies to build a cohesive care delivery system that facilitates the provision of remote patient care. Remote patient care could be better supported through the use of modern communications infrastructure and monitoring devices that are combined with new forms of traditional diagnostic instrumentation and control. The provision of remote care is facilitated by integrating these technologies to build a cohesive care delivery system that better enables the monitoring of patient vital parameters, medication, and treatment while supporting full bidirectional communication. The communications network allows for the bidirectional transmission of voice and data information between the remote patient and the centralized network. The increased communication capability helps the health care provider to bridge the distance between the health care provider and the remote patient by providing the health care provider with a new means to confer with the patient and to confer the subtle observations that promote patient monitoring. A complex array of institutional and health care provider created rules within a patient treatment file is used to regulate the monitoring of patient vital parameters for signals that are outside of specified limits. The treatment of remote patients is facilitated by escalation levels that are associated with exceeding rule limits in addition to the use of more traditional and simplistic rate level or quantity triggers. In an embodiment of the present invention, multiple levels of escalation allow for a more controlled proactive

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response in kind to the level of escalation leading to a variety of anticipated conditions. The gradation of patient escalation facilitates the ability to queue, route, and triage patients for the efficient provision of treatment to patients at remote locations.

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MATERIALS AND METHODS

4.1 HARDWARE COMPONENTS
4.1.1 MICRO CONTROLLER A microcontroller is a computer-on-a-chip. It is a type of microprocessor emphasizing high integration, low power consumption, self-sufficiency and costeffectiveness, in contrast to a general-purpose microprocessor .In addition to the usual arithmetic and logic elements of a general purpose microprocessor, the microcontroller typically integrates additional elements such as read-write memory for data storage, readonly memory, such as flash for code storage, EEPROM for permanent data storage, peripheral devices, and input/output interfaces. At clock speeds of as little as a few MHz or even lower, microcontrollers often operate at very low speed compared to modern day microprocessors, but this is adequate for typical applications. They consume relatively little power and will generally have the ability to sleep while waiting for an interesting peripheral event such as a button press to wake them up again to do something. Power consumption while sleeping may be just nanowatts, making them ideal for low power and long lasting battery applications. Microcontrollers are frequently used in automatically controlled products and devices, such as automobile engine control systems, remote controls, office machines, appliances, power tools, and toys. By reducing the size, cost, and power consumption compared to a design using a separate microprocessor, memory, and input/output devices, microcontrollers make it economical to electronically control many more processes.

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4.1.2 RF TRANSMITTER AND RECEIVER

Figure 2: RF Transmitter

RF Tx

Functional block of TX section where 1,2,3,4 are the pins 1 - Antenna 2 - Data input 3 - Ground 4 - VCC

In this transmitting section the 1st pin is the antenna pin where we can able to fix the antenna for transmitting the data in the Radio Frequency, the 2nd pin is the data input pin in which the output of the encoder is given; the 3rd pin is the ground and the 4th pin is the VCC which is given to operate the transmitter section.

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4.1.3 RF RECEIVER MODULE: FIGURE 3: RF Receiver

RF Rx

Functional block of Rx section where 1,2,3,4 are the pins 1 - Antenna 2 - Data input 3 - Ground 4 - VCC In this receiving section the 1st pin is the antenna pin where we can able to fix the antenna to receive the data in the Radio Frequency, the 2nd pin is the data output pin to the decoder circuit, the 3rd pin is the ground and the 4th pin is the VCC which is given to operate the receiver section.

4.1.4 LCD A liquid crystal display (commonly abbreviated LCD) is a thin, flat display device made up of any number of color or monochrome pixels arrayed in front of a light source or reflector. It is often utilized in battery-powered electronic devices because it uses very small amounts of electric power.

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4.1.4.1 OVERVIEW Each pixel of an LCD typically consists of a layer of molecules aligned between two transparent electrodes, and two polarizing filters, the axes of transmission of which are (in most of the cases) perpendicular to each other. With no liquid crystal between the polarizing filters, light passing through the first filter would be blocked by the second (crossed) polarizer. The surfaces of the electrodes that are in contact with the liquid crystal material are treated so as to align the liquid crystal molecules in a particular direction. This treatment typically consists of a thin polymer layer that is unidirectionally rubbed using, for example, a cloth. The direction of the liquid crystal alignment is then defined by the direction of rubbing. Before applying an electric field, the orientation of the liquid crystal molecules is determined by the alignment at the surfaces. In a twisted nematic device (still the most common liquid crystal device), the surface alignment directions at the two electrodes are perpendicular to each other, and so the molecules arrange themselves in a helical structure, or twist. Because the liquid crystal material is birefringent, light passing through one polarizing filter is rotated by the liquid crystal helix as it passes through the liquid crystal layer, allowing it to pass through the second polarized filter. Half of the incident light is absorbed by the first polarizing filter, but otherwise the entire assembly is transparent. When a voltage is applied across the electrodes, a torque acts to align the liquid crystal molecules parallel to the electric field, distorting the helical structure (this is resisted by elastic forces since the molecules are constrained at the surfaces). This reduces the rotation of the polarization of the incident light, and the device appears gray. If the applied voltage is large enough, the liquid crystal molecules in the center of the layer are almost completely untwisted and the polarization of the incident light is not rotated as it passes through the liquid crystal layer. This light will then be mainly polarized perpendicular to the second filter, and thus be blocked and the pixel will appear

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black. By controlling the voltage applied across the liquid crystal layer in each pixel, light can be allowed to pass through in varying amounts thus constituting different levels of gray. The optical effect of a twisted nematic device in the voltage-on state is far less dependent on variations in the device thickness than that in the voltage-off state. Because of this, these devices are usually operated between crossed polarizers such that they appear bright with no voltage (the eye is much more sensitive to variations in the dark state than the bright state). These devices can also be operated between parallel polarizers, in which case the bright and dark states are reversed. The voltage-off dark state in this configuration appears blotchy, however, because of small thickness variations across the device. Both the liquid crystal material and the alignment layer material contain ionic compounds. If an electric field of one particular polarity is applied for a long period of time, this ionic material is attracted to the surfaces and degrades the device performance. This is avoided either by applying an alternating current or by reversing the polarity of the electric field as the device is addressed (the response of the liquid crystal layer is identical, regardless of the polarity of the applied field). When a large number of pixels is required in a display, it is not feasible to drive each directly since then each pixel would require independent electrodes. Instead, the display is multiplexed. In a multiplexed display, electrodes on one side of the display are grouped and wired together (typically in columns), and each group gets its own voltage source. On the other side, the electrodes are also grouped (typically in rows), with each group getting a voltage sink. The groups are designed so each pixel has a unique, unshared combination of source and sink. The electronics or the software driving the electronics then turns on sinks in sequence, and drives sources for the pixels of each sink.

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4.1.4.2 SPECIFICATIONS OF LCD

Figure 4: LCD

Resolution: The horizontal and vertical size expressed in pixels (e.g., 1024x768). Unlike CRT monitors, LCD monitors have a native-supported resolution for best display effect.

Dot pitch: The distance between the centers of two adjacent pixels. The smaller the dot pitch size, the less granularity is present, resulting in a sharper image. Dot pitch may be the same both vertically and horizontally, or different (less common).

Viewable size: The size of an LCD panel measured on the diagonal (more specifically known as active display area).

Response time: The minimum time necessary to change a pixel's color or brightness.

Matrix type: Active or Passive.

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4.1.5 CLOSED CIRCUIT CAMERAS These cameras are used to monitor patients. Patients are kept under close watch using CCTV cameras .They transmit signals to specific monitors. It differs from broadcast television in that the signal is not openly transmitted, though it may employ point to point wireless links. CCTV equipment may be used to observe parts of a process that are remote from a control room, or where the environment is not comfortable for humans. CCTV systems may operate continuously or only as required to monitor a particular event.

4.1.5.1 MODERN CLOSED CIRCUIT CAMERAS

The first CCTV cameras used in public spaces were crude, conspicuous, low definition black and white systems without the ability to zoom or pan. Modern CCTV cameras use small high definition colour cameras that can not only focus to resolve minute detail, but by linking the control of the cameras to a computer, objects can be tracked semi-automatically. For example, they can track movement across a scene where there should be no movement, or they can lock onto a single object in a busy environment and follow it. Being computerised, this tracking process can also work between cameras. 4.1.6 STEPPER MOTOR Stepper motors were developed in the early 1960's as a low cost alternative to position servo systems in the emerging computer peripheral industry. The main advantage of stepper motors is that they can achieve accurate position control without the requirement for position feedback. In other words, they can run "open-loop", which significantly reduces the cost of a position control system.

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Stepper motors utilize a doubly-salient topology, which means they have "teeth" on both the rotor and stator. Torque is generated by alternately magnetizing the stator teeth electrically, and the permanent magnet rotor teeth try to line up with the stator teeth. There are many different configurations of stepper motors, and even more diverse ways to drive them. The most common stator configuration consists of two coils (A and B). These coils are arranged around the circumference of the stator in such a way that if they are driven with square waves which have a quadrature phase relationship between them, the motor will rotate. To make the motor rotate in the opposite direction, simply reverse the phase relationship between the A and B signals. A transition of either square wave causes the rotor to move by a small amount, or a "STEP". Thus, the name "stepper motor".

4.1.7POWER SUPPLY

4.1.7.1 DEFINITION: A power supply (sometimes known as a power supply unit or PSU) is a device or system that supplies electrical or other types of energy to an output load or group of loads. The term is most commonly applied to electrical energy supplies, less often to mechanical ones, and rarely to others.

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Figure 5: Block diagram of a basic power supply

The transformer steps up or steps down the input line voltage and isolates the power supply from the power line.

The RECTIFIER section converts the alternating current input signal to a pulsating direct current. However, as you proceed in this chapter you will learn that pulsating dc is not desirable. For this reason a FILTER section is used to convert pulsating dc to a purer, more desirable form of dc voltage.

The final section, the REGULATOR, does just what the name implies. It maintains the output of the power supply at a constant level in spite of large changes in load current or input line voltages.

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4.2 SOFTWARE REQUIREMENTS 4.2.1 Embedded C

An embedded system is a special-purpose computer system designed to perform a dedicated function. It comprises of both hardware and software. Embedded technology uses PC or a controller to do the specified task. assembly language programming or embedded C. The programming is done using

4.2.2 Kiel Compiler

The Keil C51 compiler has been written to allow C programmers to get code running quickly on 8051 systems with little or no learning curve. However, to get the best from it, some appreciation of the underlying hardware is desirable. The most basic decision to be made is which memory model to use.

4.3 METHODOLOGY
The functional block of this system consists of two sections, transmitter and receiver section. Transmitter section is attached to patients room and receiver section is at doctors room.

4.3.1 TRANSMITTER SECTION Sensors (electrodes) will be connected to a signal conditioning unit which will process the signal and send to the microcontroller. Then the microcontroller will transmit the RF signal at 433.92MHz. Step down transformer is provided to give the power supply.

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Figure 6: Block Diagram of transmitter section

RF Transmitter

Calling Switches

Micro Controller

Signal Encoder

Power Supply

Stepper Motor

CCTV Camera with TX

4.3.2 RECEIVER SECTION

The transmitted RF signal is encoded and received by RF receiver and this signal will be decoded by signal decoder. It will again send to the microcontroller and displayed in the display unit. So that value can be monitored by doctor in a remote place. The alarm circuit is provided to indicate the abnormal condition of the patient.

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Figure 7: Block diagram of receiver section

Display Unit RF Receiver

Micro Controller

Buzzer Alert

Signal Decoder

Power Supply

Audio/video Rx Unit

Interface Unit

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RESULTS
The uses of CCTV cameras to monitor patients are used extensively now a days. Mostly patients suffering from serious disorders are monitored, because they need to be watched closely round the clock .We narrowed our studies on epileptic patients and got some very positive results on the use of CCTV cameras.

6.1 CASE STUDY ON EPILEPTIC PATIENTS USING CCTV

Epilepsy is a chronic neurological condition characterized by recurrent seizures that are caused by abnormal cerebral nerve cell activity. Epilepsy is classified as idiopathic or symptomatic. Idiopathic epilepsy has no known cause, and the person has no other signs of neurological disease or mental deficiency. Symptomatic epilepsy results from a known condition, such as stroke, head injury, poisoning, Lennox-Gastaut syndrome, and cerebral palsy.

6.1.1 SEIZURES DURING EPILEPSY A nerve cell transmits signals to and from the brain in two ways by (1) altering the concentrations of salts (sodium, potassium, calcium) within the cell and (2) releasing chemicals called neurotransmitters (gamma aminobutyric acid). The change in salt concentration conducts the impulse from one end of the nerve cell to the other. At the end, a neurotransmitter is released, which carries the impulse to the next nerve cell. Neurotransmitters either slow down or stop cell-to-cell communication (called inhibitory neurotransmitters) or stimulate this process (called excitatory neurotransmitters). Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical activity. Improper concentration of salts within the cell and over activity of either type of neurotransmitter can disrupt orderly nerve cell transmission and trigger seizure activity. Certain areas of the brain are more likely than others to be involved in seizure activity. The motor cortex, which is responsible for body movement, and the temporal

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lobes, including the hippocampus, which is involved in memory, are particularly sensitive to biochemical changes (e.g., decreased oxygen level, metabolic imbalances, infection) that provoke abnormal brain cell activity. Seizure PhasesA seizure often has three distinct phases: aura, ictus, and postictal state. The first phase involves alterations in smell, taste, visual perception, hearing, and emotional state. This is known as an aura, which is actually a small partial seizure that is often followed by a larger event. The seizure is known as ictus. There are two major types of seizure: partial and generalized. What happens to the person during the seizure depends on where in the brain the disruption of neural activity occurs. Following a seizure, the person enters into the postictal state. Drowsiness and confusion are commonly experienced during this phase. The postictal state is the period in which the brain recovers from the insult it has experienced.

6.1.1.1 TYPES OF SEIZURES The International Classification of Epileptic Seizure identifies seizure types by the site of origin in the brain. The two main categories of seizures include partial seizures and generalized seizures. A partial seizure can evolve to a generalized seizure. There are several subtypes of each. Only the most common are described here.

6.1.1.1.1 PARTIALSEIZURES The site of origin is a localized or discreet area in one hemisphere of the brain. The two most common types of partial seizure are simple partial and complex partial.

6.1.1.1.2 SIMPLE PARTIAL These produce symptoms associated with the area of abnormal neural activity in the brain: motor signs, sensory symptoms, autonomic signs and symptoms (involuntary activity controlled by autonomic nervous system), and psychic symptoms (altered states of consciousness). There is no impairment of consciousness in simple partial seizures.

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6.1.1.1.3 COMPLEX PARTIAL

Impairment of consciousness, characteristic of complex partial seizures (CPS), results in the inability to respond to or carry out simple commands or to execute willed movement, and a lack of awareness of one's surroundings and events. Automatisms may occur. An automatism is a more or less coordinated, involuntary motor activity. A simple complex seizure may begin as a simple partial seizure.

6.1.2 USE OF THE EQUIPMENT ON EPILEPTIC PATIENTS

Recently there has been a remarkable increase in the number of elderly people with epilepsy due to the growing size of this segment of the population.

6.1.2.1 PURPOSE

To examine the outcome of inpatient diagnostic closed circuit TV-EEG (CCTVEEG) monitoring in a consecutive series of elderly patients admitted to an adult epilepsymonitoring unit (EMU)

6.1.2.2 METHODS

Retrospective review of all admissions to a university hospital adult EMU. Those older than 60 years were identified. Patients who were monitored for status epilepticus were excluded. Data on duration of events, frequency of events, physical examination, medications, preadmission EEG, brain imaging, length of stay, and interictal and ictal EEG were obtained. RESULTS: Of the 18 patients admitted for monitoring only, mean age was 69.5 years (range, 60-90 years). Mean length of stay was 4.3 days (range, 2-9 days). Five patients had complex partial seizures recorded. Three patients, all treated with anti-epileptic drugs (AEDs), had no spells recorded, and no additional diagnostic

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information was gained from the admission. The other 10 patients, eight of whom had been treated with AEDs, were symptomatic during their admission, leading to a variety of neurologic but not epileptic, psychiatric, or other medical disorders, and allowing tapering of AEDs.

Table 1: Some positive results on use of CCTV cameras

TOTAL NO OF PATIENTS ADMITTED FOR MONITORING

RANGE OF THEIR AGE

AVERAGE AGE OF PATIENTS

RESULTS

18

60 TO 90

69.5

5 PATIENTS-COMPLEX PARTIAL SEIZURES

60 TO 90

69.5

3 PATIENTS HAD NO SPELLS RECORDED 1O-PATIENTS WERE FOUND TO HAVE NEUROLOGIC DISORDERS

6.1.2.3 CONCLUSION In elderly patients with suspected epilepsy, CCTV-EEG is a very useful diagnostic tool. In this series of 18, 10 patients were diagnosed with potentially treatable medical illnesses not responsive to AEDs.

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DISCUSSION
After the successful completion of this project ,there is a need of in depth knowledge, in the field of biomedical instrumentation .This project leads us to the role of biomedical science in the field of medicine .Many clinical and research departments use biomedical instrumentation for various uses .Biomedical instruments help these centers with diagnostic, monitoring and therapeutic studies. Some of the examples are ,in the area of biomedical digital signal processing ,wavelet analysis ,neural networks and pattern recognition methods are being developed for analysis of EMG signals (generated by the muscles) in neuromuscular disease and CTG (the cardiotocogram) signals during labour. These are traditionally very difficult signals to quantify and innovative approaches to analysis are required for clinical quantification Other developments are in the field of telemetry in the operating theatre, particularly in anaesthesia and the remote monitoring of patients before, during and after surgery so that their condition is monitored at all times.

7.1OTHER

DEVELOPMENTS

IN

FIELD

OF

BIOMEDICAL

ENGINEERING

7.1.1 IMPLANT DESIGN

The design of hearing implants and prosthesis, and instrumentation for ear surgery. Replacing the bones of the middle ear is a challenging problem because of size constraints and the need for good prosthesis-bone vibration coupling. An important area in orthopedic engineering is the development of new devices and instrumentation for fracture fixation. We have designed are evaluating new internal and external fixation devices for fractured long bones and have designed and are evaluating a capacitively coupled electrical stimulator to assist bone healing in cases where fractures are slow to heal or cannot heal at all.

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The modern surgical theatre will incorporate more robotic devices and intelligent surgical instruments. We are developing intelligent drills and thread tapping devices for automated machining of bones for inserting screws. For example, fuzzy logic is being used for analysing a range of parameters as the bone is being drilled, to minimise overheating, which can cause bone death. Image processing plays an important part in assessing the quality of the bone after drilling and tapping and we are developing algorithms for this purpose.

Figure 8: Monitoring signals through CCTV

7.1.2 DISCUSSION ON EPILEPSY PATIENTS

Epilepsy patients were monitored using cctv cameras and positive results were found. Epilepsy was diagnosed on these patients and proper medications were provided .This biomedical equipment thus helped the doctors in diagnosing and providing proper care for patients. CCTV cameras closely monitor these patients round the clock and send signals to monitors A nerve cell transmits signals to and from the brain in two ways by (1) altering the concentrations of salts (sodium, potassium, calcium) within the cell and (2) releasing chemicals called neurotransmitters (gamma amino butyric acid). The change in salt concentration conducts the impulse from one end of the nerve cell to the other. At the end, a neurotransmitter is released, which carries the impulse to the next nerve cell.

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Neurotransmitters either slow down or stop cell-to-cell communication (called inhibitory neurotransmitters) or stimulate this process (called excitatory neurotransmitters). Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical activity. Improper concentration of salts within the cell and over activity of either type of neurotransmitter can disrupt orderly nerve cell transmission and trigger seizure activity.

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SUMMARY
The present device is used for monitoring a patients general health. This system comprising a plurality transmitter, one for each patient to be monitored and single receiver for monitoring each of the transmitters separately. Each transmitter comprised of a sensor system for sensing patients any change of physiological parameters. Each transmitter also includes a transducer for generating signals corresponding to patients general health, and modulator for transforming the data signals to radio frequency signals. The receiver is comprised of a demodulator for sensing the radio frequency signals from a transmitter and for reproducing the data signals there from. The receiver also includes a signal processor for producing a visual display from the reproduced data signals. Signals send by transmitter is received by receiver and later converted to images or datas. The images are captured by CCTV and send to monitor on doctors desk.

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