UTILIZATION BLUETOOTH TECHNOLOGY

AS A DIGITAL STETHOSCOPE RESEARCH

Angguh Gubawa, NIM 1806156084
Master of Biomedical Engineerig, Department of Electro Engineering, Faculty of Engineering
University of Indonesia

I. Introduction hear intestine and blood flow in arteries and veins.

The most famous medical symbol is a
stethoscope. Stethoscopes come from Greek,
namely stethos which means chest and skopeein
which means checking / listening. The stethoscope
was discovered in France in 1816 by scientist Rene
Theophile Hyacinthe Laennec. Stethoscope is used
for auscultation, which is the overall examination
of sounds in the body in the medical. Laennec used
the direct auscultation method until 1816, one day
he was examining a patient with general symptoms
of heart disease. Because the patient is fat, young,
and female, he feels that the usual method of
examination is inappropriate. Then he got an idea
with one end of a piece wood scratched with a
needle, the sound that rises will be heard clearly if
the other end of the wood is affixed to the ear.
Laennec immediately rolled several sheets of paper
into a cylinder and pressed one end to his ear and
the other to the patient's chest just above the heart.
The result were so dramatic and encouraged
Laennec to perfect the tool. Finally Laennec
created a hollow wooden cylinder with length
about 30 cm, an inner diameter about 1 cm, and an
outer diameter about 4 cm. He calls this tool a
stethoscope, which means "look at the chest".
Laennec reports his research about the stethoscope
and its interpretation of natural and pathological
sounds from the lungs, heart and sound.
Figure 1. The 18th century Laennec stethoscope is stored
in the British Museum
A stethoscope is an acoustic medical instrument for
checking sounds in the body. This unit is widely
used to hear heart and respiratory sounds and to
In the industry, a stethoscope is also used by
technicians or engineers to isolate certain sounds
from a machine for diagnosis. The way of
stethoscope works is by transferring sound waves
that produced by the body through a membrane, so
that it can be heard clearly by the examiner (Rizal
& Soegijoko, 2006). Stethoscope is a medical
device that is already familiar to the medical world
or the general public.
Eventhough a stethoscope is a common
medical device in the health sector, its does not
mean it have no problem. The challenging is when
auscultating the lungs or the heart using a
stethoscope in surrounding noise, ear sensitivity,
low frequency and amplitude, and relatively similar
sound patterns. Using stethoscope as a diagnostic
unit tends to be very subjective. The result of
doctor's diagnosis depend on the sensitivity of the
ear and theit experience. Another weakness that
occurred, the sound data that became the guideline
was never stored so that it could not be heard
together with other doctors as a object discussion.
The use of stethoscope by doctors is very
dependent on their personal experience of
auscultation, therefore, it is difficult to trace or
record. The rhythm of the heart's and the lungs
sound are simultaneously continuous, this sound
may disappear in the next minutes (Luo, 2008).
Konventional stethoscopes only have a listening
function without visual functions. If the heart or
lungs sound can be recorded and reproduced,
certainly it will be a breakthrough in the diagnosis
of heart and lung disease. Sound source from all
parts of the heart / lungs is one of the basic physical
signals of the human body, which contains physical
and pathological information. For cardiovascular
disease, before the explication of the symptoms of
a cardiogram abnormality and pain is present, heart
sounds are trusted information for diagnosis.
Moreover, to capture the bological sound
signal of the critical human body, its use will be
more difficult. Under certain conditions, for
example during traffic accident, busy / noisy
emergency rooms and when patients are taken by
ambulances, the noise from ambulance sirens is
almost impossible to make an effective diagnosis
with a konventional stethoscope. Doctors can’t
make accurate diagnoses, and their diagnoses are
only based on their hearing and medical
experience. You could say if this method has a bad
or unreliable accuracy, and there is a possibility of
misjudgment due to subjective factors.
II. Basic Teory
The following will explain the basic theories of the
medical aspects and techniques that will be used in
this reseach.
II.1. Lung Auscultation
Lung sounds occur due to air turbulence
when air enters the respiratory tract during the
breathing process. This turbulence occurs because
air flows from a wider airway to a narrower airway
or to the contrary. While on inspiration, the air
flows from the wide airways to the narrow airways
so that the turbulence that occurs is stronger, while
on expiration it is the opposite. This cause when the
sound inspiration sounds louder. In general, lung
sounds are divided into 3, normal sounds, abnormal
sounds and additional sounds. The voices are
divided into several categories based on the pitch,
intensity, location and inspiration and expiration
ratio.
Normal lung sounds are divided into 4
groups, tracheal, bronchial, bronchovesicular and
vesicular. Tracheal breathing sounds are very loud
and the pitch is relatively high. Inspiration and
expiration are relatively long. This sound can be
heard over the trachea which is rarely performed on
a routine examination. Vesicular breathing is the
most common normal respiratory sound and is
heard almost on all surfaces of the lungs. His voice
is soft and low pitch. The sound of inspiration is
longer than the sound of expiration. Vesicular
sounds can sound coarser and some may sound
longer if there is rapid and deep ventilation (eg
after exercise) or in children who have thinner
chest walls. Vesicular sounds can also be softer if
the patient is weak, old, fat or very muscular. The
bronchial sound is very loud, high pitch, and the
sound sounds close to the stethoscope. There is a
gap between the inspiration and expiration phases
of breathing, and expiratory sounds sound longer
than inspirational sounds. If this sound is heard
except in the manubrium, it usually indicates there
is a consolidation area that is usually contain air
and water. There is a respiratory sound with a
moderate level of intensity and pitch. His
inspiration and expansions are just as long. This
sound sounds very good at the 1st and 2nd ICS and
between the scapula. With the sound of the bronchi,
if it is heard everywhere other than in the main
stem of the bronchus, it usually indicates a
consolidated area
Figure 2. Lung Auscultation Location
In chase there are additional lung sounds
that arise due to abnormalities in the lungs caused
by disease. For example pleural rub, crackle,
wheezing, grunting, and ronchi. The voice must
still be analyzed with the results of other
examinations such as palpation, to decide the
diagnosis of lung disease (Rizal & Soegijoko,
2006)).
To do auscultation of the lungs there are
12 locations on the chest and 14 locations on the
back, beside usually only 6 locations are heard,
both on the chest or back. Lung auscultation is
carried out starting from the top down and also
comparing between the left and right sides
(Hendian R, Soegijoko, & Isdyanto, 2007).
II.2. Heart Auscultation
Heart is a muscular hollow organ, contains
into four chambers. The upper room is called the
atria and the lower chamber is called the ventricle.
Heart muscle pumps blood from space to space. At
each pumping, the valves open to let blood flow
into the next room. Then the valve closes to prevent
blood from moving backwards. One-way valve
regulation prevents blood flow going back, in this
way the valve keeps blood moving as efficiently as
possible through the heart and out into the body.
 In normal heart conditions, basicly there
are two heart sounds, S1 and S2 (figure 3). S1
sound associated with simultaneous closure of
mitral and tricuspid valves after blood returns from
the body and lungs (systole). S2 sound shows the
end of the systole and the beginning of the diastole,
obtained from the closure of the aortic and
pulmonary valves when blood exits the heart to the
body and lungs. Heart disease, stenosis, occurs
when the valve can not open completely. This
could happen if the valve being hard or becomes
stiff due to calcium deposits. Consequently, only
bit blood can flow between the heart chambers.
Otherwise regurgitation occurs if the valve could
not close properly, so that blood could flow into the
wrong chamber. These diseases are dangerous
because caused death from heart failure (Setiaji,
Santoso , & Susilo, 2011).
Figure 3. Ilustration of heart sound
(a) Normal heart
(b) Heart with a systolic and diastolic murmur
The place where the aortic valve sounds are
located above the aorta, because sound
transmission rises to the aorta (figure 4), the
pulmonary area is located above the pulmonary
artery, the tricuspid area is above the right
ventricle, and the mitral area above the heart apex,
which is the left ventricle is closest to the chest
wall, because the heart position in such a way that
most of the left ventricle is located behind the right
ventricle. In other words, the sound of the A-V
valves is delivered to the chest wall through the
relevant ventricle, while the sound of the
semilunary valves is delivered mainly along the
large vessels sourced from the heart (Hendian R,
Soegijoko, & Isdyanto, 2007).
Figure 4. Heart auscultation location
For abnormal conditions, this phase usually
shows a murmur. A murmur is a heart sound that
arises due to abnormal turbulence or blood flow. It
may be due to heart problems, or maybe a
condition that makes a person's heart beat fast and
forces the heart to handle more blood faster than
usual (Luo, 2008).
II.3. About Bluetooth
The bluetooth name comes from the king
of Denmark, Harald "Bluetooth" Blatand was a
Danish king who ruled in 958-986 AD. He was
famous because of united several tribes in Denmark
who were separated before becoming kingdoms.
Bluetooth technology is considered have
similarities because it can unite various devices
with various uses in a single network. Bluetooth
technology was discovered in 1994. An IT
company from Sweden named Ericsson is the
inventor of Bluetooth technology that can connect
different technologies using cheap and low-power
radio waves.
Ericsson then join in a partnership with
several companies, the result is the Special Interest
Group were established in 1998. SIG initially
consisted of Ericsson, Intel, IBM, Toshiba and
Nokia companies working to develop bluetooth in
ambitions of cross-device and manufactured, the
first bluetooth device released one year later.
Bluetooth was originally developed to
replace the role of cables in everyday devices such
as computer mouse, keyboards and others, but
finally Bluetooth functioned as a link developed
with other. Bluetooth technology continues
developed such as the previous effective distance
from only 10 meters to 100 meters.
 Figure 5. International symbol of Bluetooth

Today, bluetooth is not only used as a

media for sending data. Some devices such as
speakers, watches, tv, game consoles, PCs, and
Figure 6. The basic sensor of digital stethoscope.
headsets have used Bluetooth technology.
Bluetooth technology that is mostly used is A2DP
Digital stethoscope not only separate heart
(Advandced Audio Distribution Profile). This
sounds from lung sounds at the same time, but also
technology capability allows delivered of high
have realtime digital display features, voice
quality audio data (Stereo or Mono). This
recording/playback feature, could be connect to
technology supports audio with MPEG-1, MPEG-
smartphone or other gadget for sharing or send data
2, MPEG-4, AAC and ATRAC graphics and
via email or messager applications android or mac
several other codec. A2DP is the most commonly
as telemedicine.
used smartphone today.

Till now Bluetooth has many versions.

The first version is v1.0 and v1.0B. in this version,
many blutooth technologies fail because the
devices and technology at that period didn’t use
Bluetooth much, but still using Infrared. Version
1.0 continued to develop at the next phase to
version 2.0, version 3.0, until in 2010 bluetooth Stetoskop

issued version v4.0 using the Bluetooth Low

Energy (BLE) feature. Small power consumption,
allowing for longer usage times, lower production
costs, greater coverage and transfer speeds of up to
1 Mb/s. BLE is not used on all devices because
Bluetooth v4.0 use Dual Mode technology, which
activates two types of wireless. Classic Bluetooth
wireless connection that is still mostly used on
existing devices and BLE as the new standard for
using wireless connections.
II.4. Application in Biomedical Engineering
In this proposal will propose research the
Bluetooth technology used on electronic
stethoscopes with digital signal processing facilities
and for auscultation of lung and heart organs. The
new device concept research consist of membranes
and hoses from conventional stethoscopes coupled
with condenser microphone which are connected to
soundcard device based on embedded systems,
TCP/IP networks, Bluetooth wireless transmission
technology, display technology, and other needs.
Figure 7. Telemedicine Application
Other benefits of this unit are includes
making the patient's family listen together, for
example: Mother who want to hear their child's
asthma, patient who need to hear their lungs for
smoking cessation programs, heart surgery patients
who want to hear leak valve sounds, teaching
classes of medical students who want to show time
right from the third heart sound when that happen,
client of veterinary who want to hear the heart or
lung problem of their pet so can be convinced to do
the procedure according to the next
recommendation. So that user do not need to
describe the sound, or strange mimic sounds to try
to express the meaning, just connect it to bluetooth
active speaker.
 solution because it allows health care officer to do
auscultation even protected in an isolation
environment, and could be use with protective
cover in the Emergency Room to reduce
contamination when pre-screening. Digital
stethoscope could be use directly using earphone or
headphone, via a bluetooth transmitter in the
isolation room or to an outdoor consultant,
connected to loudspeaker, or sent the sound via e-
mail or smartphone messager application (Smith,
2015).

Figure 8. The basic concept of digital stethoscope.

In the academic and research, digital

stethoscope provide new solutions for teaching
medical students directly at the patient's bedside, in
the classroom and online (Smith, 2015). With
combinations of digital stethoscope, gadget and
sound software application, it will enable user to
recording, display the frequency spectrum, display Figure 10. Illustration of using a digital stethoscope with
waveform and spectrogram together to connect complete PPE.
time and frequency, editing and annotation process
that could be display during presentation, III. System Design
documentation or journal articles in auscultation
research for expert user. The digital stethoscope technology
developed will have the following features :

1. The volume of the heart and lung sound is

adjustable, making it easier heard from the
earphone. Strengthening up to 100x
original sound.
2. LCD display.
3. Multi-mode: heart sound mode, lung
sound mode and heart-lung sound mode.
Figure 9. Illustration of a digital stethoscope application
4. Wireless transmission smartphone with
on a smartphone effective distance 10 meters.
5. Wireless transmission with Bluetooth
For special cases, such as the Ebola earphone or active speaker.
outbreak, where the SOP required protection of the 6. Using 3.5mm audio jack.
whole body, how do doctors use a conventional 7. Rechargeable Lithium Ion battery.
stethoscope with tubing in the ear to hear 8. Realtime observation software application
auscultation at the patient's bedside? It is 9. Automatic OFF if the unit is not operating
impossible, this digital stethoscope will be the best in 3 minutes.
 10. Working temperature -10OC - + 50OC.
III.1. Hardware design
As well known, the passband of the heart
sound signal is 30-500Hz, and the lung sound
signal covers 100-1000Hz. The human ear could
hear these sound. So we can use a condenser
microphone as a sound sensor to get the desired
signal. Then three bandpass filters were designed to
separate the heart sounds from lung sounds (figure
11).
Figure 11. Diagram block digital stethoscope
Sound signals that come from the vibration
of the heart and lungs will be captured by a
microphone and turn it into an electrical signal.
Then the signal is sent to a low-noise preamplifier
circuit to be amplified which is then forwarded to
the filter array. After reading the user's commands
from the keyboard to select the mode, the MCU
controls the filter array to select the mode between
heart sound/ lung sound/ heart-lung sound
combination to get the required sound signal.
The signal will be divided into two parts.
One goes to the earphone drive circuit after getting
sound strengthtening, so that the user/ doctor can
heard the heart-lung sound clearly in real-time
mode. The other signal feed into the MCU via
analog/digital convereter circuits for digital data
requirement and heart rate calculation, and display
the heart rate on the LCD according to user
instruction.
The MCU controls the timing of the
Bluetooth circuit, and send heart-lung signals that
have been digitalized to the gadget/ PC via
Bluetooth technology for further processing. MCU
designed use ATmega16L type. For filters, the
fourth-order butterworth filter is chosen to have a
better effect. After being filtered by sound filter
circuit, normal human S1 and S2 heart sounds can
be heard clearly.
III.2. Software design
This digital stethoscope is controlled by the
AVR MCU, firmware is designed to make all
periphery equipment work effectively and regularly
in accordance with the instructions. The main
function of all firmware is to initialize A/D,
keyboard, LCD, Timer, UART first, then activate
timer interruption.
Timer interruptions occur every 250 us.
During interruption, the status of the button is
tested. If the mode button is pressed, the digital
stethoscope changes its working mode (heart sound
mode, lung sound mode, heart-lung sound mode
and Bluetooth mode). At the same time the MCU
changes the filter arrangement combination. So that
the sound of the heart, the sound of the lungs and
the sound of heart-lung are separated.
A/D converter conversion could be activate
on timer interrupt. After A/D conversion, the A/D
service function is triger. In this function, if the
stethoscope is not in heart sound mode, digitalized
sound data will be sent to the PC; otherwise, data
will not be sent. Firmware calculates heart rate.
Then the final heart rate is displayed on the LCD
display.
III.3. PC software / smartphone paltform design
After the Bluetooth maching function, the
PC creates a virtual UART. This software accepts
heart-lung sound data from a virtual UART. PC
software displays the data received in time which
composes a real-time heart sound curve. To realize
remote consultation based on thin client mode, PC
software must support TCP/IP to achieve website
services, so that expert in other places can be
consulted via the browser. The software used is
LabVIEW8.20 (virtual instrument software),
because it supports rapid and efficient prototypes.
IV. Limitations 2. Luo, Y. (2008). Portable Bluetooth Visual
Electrical Stethoscope Research. .
Limitations of existing digital stethoscope systems
3. Smith, C. (2015, 12 29). www.thinklabs.com.
The posibility limitations of the research system (thinklabs) Retrieved 12 30, 2018, from
are: www.thinklabs.com:
https://www.thinklabs.com/ebola-and-
• Slow data transfer rate. biocontainment
• Limited pairing distance of the device. 4. Hendian R, H., Soegijoko, S., & Isdyanto, E.
• Signal Interference. (2007). Perancangan dan Realisasi Prototip
• Battery consumption. Stetoskop Elektronik Berbasis PC. Kelompok
Keahlian Teknik Biomedika, Sekolah Teknik
Elektro dan Informatika, ITB .
Some of the main factors that allow the use of a 5. Setiaji, F. D., Santoso , D., & Susilo, D.
digital stethoscope as:
(2011). Rekayasa Stetoskop Elektronik
Dengan Kemampuan Analisis Bunyi jantung.
• Data transmission systems currently use
Seminar Nasional Teknologi Informasi dan
Bluetooth technology that will continue to
Komunikasi Terapan 2011 (Semantik 2011) .
develop.
• Patient data can be saved.
• Playback of voice-recording files.
• It is possible to develop again and connect
with other medical devices such as patient
monitor.
• Could be connect to a smartphone for medical

applications.
• Could be developed towards telemedicine.



Bibliography
1. Rizal, A., & Soegijoko, S. (2006). Stetoskop

Elektronik Sederhana Berbasis PC dengan
Fasillitas Pengolahan Sinyal Digital untuk
Auskultasi Jantung dan Paru. Seminar
Instrumentasi Berbasis Fisika .
 Table I. Feature Comparation

Analysis
Data Signal Auscultation Testing
Performance Stability Realibility
Transfer Rate Amplitude Mode Heart
Beat
Yi Luo (2008) √ √

R. Elgharably, E. Marzban √ √
(2008)
Smith C, (2010) √ √ √
J. Miguel Sanches, Bruno √ √
Pereira
(2010)
Rizal, A., & Soegijoko, S. √ √ √
(2006).
Gerwin Schalk, Eric C
Leuthardt
(2010)
Ali Moti Nasrabadi, Minoo √
Heidari Kani
(2011)
Hendian R, H., Soegijoko, S., √ √
& Isdyanto, E. (2007)
Setiaji, F. D., Santoso , D., & √ √
Susilo, D. (2011)
Wahyu Artha Bayu Murthi, √ √
Haryanto (2014)
Hendi Handian R, Soegijardjo √ √
Soegijoko, Erie Isdyanto
(2016)
Shilin Wang, Baochen jiang √ √ √
(2018)