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Dept. of Mechatronics Engg.


Biomedical Amplifiers

Dr. Mohsin Tiwana
Feedback and stability

 A negative feedback system (left) with closed loop gain G1G2 > 1 and no
phase shift in the loop will always be stable since we are just
subtracting in-phase components from the input and amplifying.
 Q: What if we change the feedback to positive? (right)
 A: Now we are taking a signal from the output, ADDING it to the input
and amplifying it → UNSTABLE!!
Feedback and stability

 Q: What if we have NEGATIVE feedback, high closed loop gain G1G2, but
a phase shift of 180o in the amplifier?
 A: The negative feedback becomes POSITIVE feedback and we get
 Most modern opamps are stable when used as designed but if we are
creating our own feedback loops with RLD circuits we must be careful.
 Methods of preventing negative feedback instability:
 Reduce phase shift in the loop
 Reduce the loop gain at the frequency where the phase is 180o.
 The basic building block of amplifiers
used to measure biopotentials is the
operational amplifier (op-amp or
opamp) RL RL
 A simplified circuit of a BJT (bipolar
junction transistor) op-amp front end is
shown right, together with the op-amp’s IB1 IB2
circuit symbol
 Ideal opamp Q1 Q2
 A =  (infinite gain)
 v+ = v- (no offset voltage) Vs1 RC Vs2
 Rd =  (infinite input impedance)
 Ro = 0 (zero output impedance)
 BW = (infinite bandwidth) -VBB (a)
 Ф = 0 (zero phase shift)
 No opamp is ideal – we must design the -
circuit to account for the characteristics
of the opamp used v2 +
Non-ideal opamps
 Typically ~ 100,000 at dc.
 Several stages, each of which has stray or
junction capacitance → the gain falls off as
the frequency increases.
 As an amplifier, the op-amp is never used in
open-loop mode. It always has negative
feedback around it.
 Op-amps such as the 741 have a unity-gain
bandwidth of about 1 MHz, but for high
frequency applications op-amps with
bandwidths of >100 MHz are available.
 The two input voltages v+ and v- may differ
by a few mV.
 When amplifying small signals the offset
voltage may need to be nulled out.
 Alternatively you can use multiple gain
stages with AC coupling to remove the offset.
 Or find a precision op-amp
Non-ideal opamps
 The frequency response referred to above,
is for small signal inputs.
 For large signals, there is an additional
limitation. When rapid changes in
outputs are demanded, the compensation
capacitor must be charged up from an
internal source that has limited current
 The rate of change in voltage across the
capacitor is then limited, and as a
consequence the rate of change of the
output voltage is limited to a maximum
slew rate – often of the order of 1 volt per
 Slew rate is not normally an issue for
biological signals which have fairly long
rise times, even when using micropower
opamps (low slew rate)
Non-ideal opamps
 For the typical BJT op-amp, this is about 0.5 meg ohms. However,
the amplifier itself, because of feedback, will exhibit a much higher
input resistance.
 For a voltage follower, it is A times as great. For an inverting
amplifier, it is equal to the external input resistor value. In some
applications, where extremely high input resistances are required,
FET-input op-amps are useful.

 Typically, this is about 100 ohms, but because of feedback in the
overall amplifier, its value is reduced by a factor A and so becomes
negligible for most applications.
Non-ideal opamps

 Low frequency (drift) noise is generated when temperature
variations cause the offset voltage to vary.
 At more cost, op-amps with tighter drift specification (eg 0.1V/C)
are available than ordinary low-cost types.
 Temperature drift is usually not a big issue for biomedical
instrumentation which is usually used in office conditions
(constant temp)
 Base current must flow all the time to keep the input transistors
turned on
 The error is minimized by connecting, at the non-inverting input, a
resistor equal to the parallel resistance to ground connected to the
inverting input (i.e. the input and feedback resistors).
 There will still be a small error remaining because of the slight
difference between the bias currents of the two input transistors
(called the input offset current in the specifications).
Basic amplifier circuits
 Inverting amplifier Vo    R2 / R1  Va
 Input impedance = R1
va -

 Non-inverting R2  R1
Vo  Vb
amplifier R2 R1
 Input impedance of R1
open loop opamp is -
increased vo
Basic amplifier circuits

 Unity gain buffer (voltage

follower) -
 Purpose is for impedance vo
transformation vb +
 All open loop gain is used to
increase input impedance
Differential amplifier R  R2  R4 R2 
 Vo  1 Vb   Va  
R2 R4 R1  R3  R4 R1  R2 

 If R1  R 2 R 3  R 4
R1 R2
 Then
Vo  Vb  Va  va
 Differential gain Ad is R2/R1 while R3 vo
common mode gain Ac is zero, so
CMRR (Ad/Ac) is infinite vb +
theoretically R4
 In reality: Resistor tolerances
limit CMRR to about -
 eg. 0.1% resistors CMRR~60dB
Differential Amplifier with Buffered Inputs

v1 + R1 R2

v4 R3 vo
- R4

v2 +
 With buffered inputs:
 eliminates the influences of electrode impedances on input impedance
and their imbalance on CMRR
 R1 and R3 have no influence on input impedance

 Still requires matched resistors for good CMRR

Instrumentation amplifier

2 R1 R3
AD  (1  )
Rgain R2

 Advantages
 varying Rgain does not change the common mode signal hence CMRR
increases in direct proportion to differential gain (a useful property);
 If V+ = V-, 0 V across Rgain, and ACM = 1 (in first stage, see later).
 Large CM voltages can be handled
 if the two input amps are similar, their common-mode errors tend to
be cancelled by the 3rd amp due to symmetry.
 Disadvantages
 High parts count but can be bought as a single IC
Typical instrumentation amp
V1  VCM 
2 + V1 '


R2 -
v Vo
R2 R1 +

- V2 ' R4 Tune to optimise

V2  VCM 
2 +
Instrumentation amplifier
V1  V2 V V
If V 
, VD  V1  V2 then V1  Vcm  D ,V2  Vcm  D and V  Vcm
2 2
Equivalent circuit of front end stage
R1 R2 R2 R1
Note: midpoint V must be
V1 ' V2 ' VCM from symmetry

2 2
Current flowing VD  R1 
V1 '  Vcm  1  
VD VD 2  R 2 
Vcm   Vcm 
2 2 VD VD  R1 
I  V2 '  Vcm  1  
2 R2 2 R2 2  R 2 
Instrumentation amplifier CMRR
 Since VCM is not amplified, best strategy is to maximise CMRR by
maximising gain of first stage
 R 
1  1 
 R2 
 HOWEVER, AAMI says we need to cope with offsets of ± 300mV on any
 So this limits the gain, depending on our power supplies and capacities
of amp, e.g. ± 5V rails we should not use a gain much higher than 10
(may cause saturation)
 Note the following stage is just a common differential amplifier (with
gain of R4/R3)
 Output
 R1  R4 VO / VD
VO  VD 1   CMRR  
 R2  R3 VO / VCM
 We can either use the potentiometer to get high CMRR or use precision
 A gain of 10 would add 20dB to CMRR attainable just from a differential
AC instrumentation amplifier
 DC offsets can be a problem – lose high
CMRR Gain(magnitude)
 Place a capacitor in series with R2.
 DC gain of front stage is 1 (for
differential and common mode).
 This means we can make front end
gain as high as we like without 1
worrying about offset voltages. In turn
leads to very high CMRR
 But since R2 is small for high gain
means we need to use very high f
capacitances for low fc (0.05Hz). fc=1/(2πR2C)
 Capacitances this high are only
available as polarised, electrolytic
Patient Protection

 Dangerous currents are not allowed to flow into the

patient, by putting current limiting resistors in the patient
 The high impedance input (>10MΩ) guarantees that in normal
operation this doesn’t lead to a reduced input
 In the case of the amplifier breaking down (single fault condition)
and shorting the input to the power supply, the current is limited by
the resistors
 10KΩ is usually sufficient
 As well as protecting the patient, it is often desirable to
protect the equipment from defibrillator or other high
voltage inputs. This is normally done using diodes or
breakdown devices (e.g. neon tubes)
 See next slide
 The patient current limiting resistors above also protect the device
Defibrillation protection

10K, 3000V


 The first resistor must be able to withstand very high voltages for short
periods of time (~10msec)
 Example: carbon composition type resistor (NOT film type)
 The second resistor limits current into the amplifier (which has its own
internal protection diodes)
 The gas discharge tube in middle can be replaced by zener diodes
 It clamps the midpoint voltage to a few hundred volts
 The resistors also protect the patient against fault conditions and the
amp against RF interference
Isolation amplifiers

 An Power
isolation amplifier is an Power
Supply amp that has its Supply
signal input circuit isolated from
the power input and signal output
ut circuits (2-port isolator).

 A 3-port isolator also has isolation

between power input and signal
output. 2-port
 They provide extra CMRR and
patient protection. Power
 Transfer of signal and power Supply
across the isolation barriers is via
optical coupling or magnetic
coupling. Input

 As they tend to be expensive,

isolation in commercial devices is
often put in digitally later in the
circuit, especially for multi-channel 3-port
Movement artefact
 This can induce quite large voltages on the patient, as common mode
voltages, and transiently as differential voltages.
 It is therefore desirable not to have DC amps unless the biopotential
requires it (e.g. EOG). However, putting coupling capacitors in the
differential pathway is likely to degrade the CMRR because
 (i) of the difficulty in matching C’s (leads to potential divider effect)
 (ii) the need to provide input bias current for the op-amps – i.e. dc
path to common on both + and – inputs (not a problem for high
input impedances >10MΩ)
 Usually, differential input stages are DC coupled, while coupling
capacitors only used when single-ended.
 If the gain is high before this, the capacitor might “block” (i.e. only
discharge slowly) if an amplifier saturates, thus ceasing output for
some time.
 The early differential stages are thus invariably designed with low gain
until the signal is single-ended (after the instrumentation amp)
Sample design
Driven right leg details

Is vs
Insulated To balanced
Stray Cs ECG amp
capacity shoes
VCM + R3
VCM 1 -
R2 5
VCM + 2 +
- R1 Ra4

4 +
Insulated RL + Vout
shoes -

Right leg driven (RLD) circuit
Ra/2 Rf
KCL at opamp -ve input
id 2
Rf 2Vcm / Ra  V0 / R f  0
+ - Ro  V0  2 R f Vcm / R a , but
vc +  Vcm  R RL id  V0 , thus
m RRL id
 Vcm 
(1  2 R f / Ra )
id RRL id
 Vcm 
 Example: with reference to the figure (1  G )
determine the common mode voltage where G  2 R f / Ra  gain of RLD cct
Vcm on the patient when a displacement
current of id = 0.2 A flows to the The effective resistance between the right leg
patient from the power lines. Choose and ground is thus
resistance values so that the common
mode voltage is minimal and there is
only a high resistance path to ground R e f f  RRL /(1  G)
when the drive op-amps saturates.
Designing RLD
 When the differential amplifier saturates the saturation voltage appears
at the input to the drive circuit and could result in a high voltage at the
right leg electrode.
 Note due to high gain of RLD cct that it will saturate before the
differential amplifier does
 When the RLD amp is saturated the normal laws of feedback no longer
apply. Under such conditions VCM increases and there is increased current
flow to the subject. Ro is thus usually included to limit any current to safe
levels (from 10KΩ to 5MΩ depending on other isolation).
 However, when the amplifier is not saturated, it is desirable to make the
common mode voltage as low as possible. Hence Ro is usually included in
the feedback loop
 To minimise common mode voltage Vcm requires the ratio Rf/Ra to be
large. Rf may be as large as 5MΩ and typically Ra is around 25 KΩ giving
a loop gain of 400. The effective resistance between right leg and ground
Reff is then (if RRL = 20KΩ):

R e ff  RRL /(1  G ) VCM  50  0.2  A

 20000 / 401  10 V
 50
RLD (continued)

 If the loop gain G is high and sufficient phase shift occurs, instability
and oscillations can result.
 Note other phase shifts in circuit affect this, such as input lead
shield capacitance.
 This can be partly compensated for by replacing Rf by a capacitor
(next slide), and ensuring that the amp is well isolated and has a
low leakage capacitance to ground.
 So far we have only considered 50 Hz of mains CM voltage.
 But fluorescent lights can cause a CM voltage as a short burst of
1kHz of radiation at 10ms intervals which depending on the
patients position and other factors, could be as large as 10-50%
of the 50Hz CM voltage.
 This high frequency interference can be transformed into 100 Hz
interference by non-linearities in the electronics or recorder.
The driven right leg circuit, provided it has sufficient gain at 1
kHz will also reduce this noise signal to an acceptable level.
Overall front end for ECG amp
 To avoid instability, loop -
Input a
gain of driven shield +
circuit is made < 1 10k 100 -
 Loop gain of the driven +

RL circuit is 300 at 50 Hz,

giving a 50 dB Input b -

improvement in CMRR +

 The gain is lower at 1nF 10k

higher frequencies to 1M -

avoid oscillations Driven Right +

Anatomical Planes
 An anatomical plane is a structure used to
transect the human body, in order to describe
the location of structures or the direction of
movements. In human and animal anatomy,
three basic planes are used:
 The sagittal plane, being a plane parallel to
the sagittal suture, divides the body into
sinister and dexter (left and right) portions.
 The midsagittal or median plane is in
the midline; i.e. it would pass through
midline structures such as
the navel or spine
 The coronal or frontal plane divides the
body into dorsal and ventral (back and
front, or posterior and anterior) portions.
 The transverse plane, also known as an axial
plane or cross-section, divides the body into
cranial and caudal (head and tail) portions.
Electrocardiogram (ECG)

 A beating heart generates an electrical signal

 This appears throughout the body and on the surface
 Can be used as a diagnostic tool to assess cardiac function
 or simply to monitor that the heart is beating adequately.
 For diagnostic purposes, twelve ECG traces are usually
recorded. These are:
 Three limb leads – leads I, II and III.
 Three augmented limb leads – aVR, aVL, and aVF.
 Six chest leads – V1 to V6.
 Why so many?
 When a cardiac ischaemia (lack of oxygen) occurs it can
scar the tissue and perhaps lead to an infarction (dead
 These conditions can change the way the ECG appears but it
may only show up in one or two leads, depending where it
Einthoven’s triangle

 The voltages of leads I, II and III can be considered to be projections of the equivalent cardiac dipole
on an approximately equilateral triangle in the frontal plane – Einthoven’s triangle
 The bipolar limb leads add vectorially: II = I + III
 I = VLA – VRA, II = VLL – VRA, III = VLL – VLA
ECG Limb leads

Note additive effects


 Fixed origin dipoles in 3 dimensions require 3 variables to

describe (e.g. magnitudes in x, y and z directions)
 We can consider the ECG to arise from the cardiac vector,
which is a 3 dimensional vector changing in amplitude and
direction during the cardiac cycle.
 The bipolar limb leads are measuring the projections of
this dipole (during time) in the 3 lead directions 0o, 60o and
120o (see previous slide) in the frontal plane
Generation of the ECG signal in the
Einthoven limb leads
 At the start of the cardiac
cycle the dipole begins at
the sinoatrial (SA) node
and is small in magnitude
 Voltages measured
between two body surface
electrodes (lead voltage)
depend on:
 lead location
 heart location
 heart vector (position,
direction and magnitude)
 torso volume
Generation of the ECG signal in the
Einthoven limb leads
Generation of the ECG signal in the
Einthoven limb leads
Lead vector

• Can be shown that: VI

VI = H cos  
VII = H cos (-60) ~
VIII = H cos (-120) VII VIII
• Where H is magnitude of
Heart Vector,  is angle LL
of Heart vector
• Note that VI + VIII = VII
Wilson central terminal (WCT)

 Frank Norman Wilson (1890-

1952) investigated how ECG
unipolar potentials could be
 Wilson central terminal
(WCT) was formed by
connecting equal-valued
resistors from each limb lead
to a common node
 Voltage at WCT is the average
of the voltages at the 3 limb
 provides reference
potential for unipolar
 Modern equipment does not
determine this by an electrical
circuit but mathematically.
Augmented limb leads
 The limb electrode voltages can form so-called unipolar rather than
bipolar leads.
 For example, WCT could be used as a reference for each.
 In 1942 Goldberger noted that if the average of the other two limb
leads were used instead of WCT as the reference, the signal became
50% larger
 Hence the term “augmented”
 aVR, aVL and aVF
 But they contain the same information as the bipolar leads and can be
considered redundant
Precordial (chest) Leads

 Pre-cordial (in front of, the heart)

 In addition to the six limb leads (I, II, III, aVR, aVL, aVF), a 12-lead ECG
includes six “chest” leads.
 The chest leads look at the heart’s electrical activity in a slightly off-
horizontal plane around the front of the chest (traverse plane).
 This detects problems that might not be obvious from the standard limb
leads, which measure electricity in a vertical (frontal) plane.
 The chest leads are often called V-leads.
European vs. American 12 lead ECG
AHA North America IEC Europe

Inscription Colour Location Inscription Colour

RA White Right arm R Red

LA Black Left arm L Yellow

RL Green Right leg N Black

LL Red Left leg F Green

V1-6 Brown Chest C1-6 White

Information content of 12 lead ECG
 Much redundant
 12 leads (traces) ECG
requires only 8 A/D
channels (why?)
 We really only need 3
leads (x, y and z) to
measure in 3 planes
Vectorcardiography (VCG)
 The basic principle of
vectorcardiography is
illustrated based on
ideal uniform lead fields
which are mutually
orthogonal being set up
by parallel electrodes
on opposite sides of the
torso (bipolar
 Projection of Heart
Vector into 3 planes –
frontal, traverse and
 Track change in 3D
vector co-ordinates
over time course of
cardiac cycle
Frank lead system
 The lead matrix of the Frank
VCG-system. The electrodes
are marked I, E, C, A, M, F,
and H, and their anatomical
positions are shown. The
resistor matrix results in the
establishment of
normalized x-, y-, and z-
component lead vectors
 Cardiovascular Physiology Concepts