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This full text paper was peer reviewed at the direction of IEEE Communications Society subject matter experts

for publication in the WCNC 2010 proceedings.

ECG Monitoring over Bluetooth: Data Compression and Transmission

Bo Yu, Liuqing Yang Department of ECE, University of Florida, Gainesville, FL 32611 and Chia-Chin Chong DOCOMO USA Labs, 3240 Hillview Avenue, Palo Alto, CA 94304

AbstractRemote health monitoring by exploiting wireless communications technologies is an emerging area receiving increasing interests from academia, research labs and industry. This issue has also been brought up in the standardization process of IEEE 802.15 Task Group 6 Wireless Body Area Networks (WBAN). The challenge is to nd the appropriate combination of medical data processing techniques and the wireless technology in order to meet the particularly stringent error, latency and power consumption requirements of healthcare applications. In this paper, we present the results of a case study on wireless electrocardiogram (ECG) monitoring over Bluetooth. Based on the special considerations of (processing and transmission) power consumption at wireless ECG sensors, we rst propose a low complexity ECG compression method. Comparisons with existing approaches conrm the superior performance of our method. We then study the data reconstruction performance at the Bluetooth receiver and nd that: i) the uncompressed ECG data transmission is not necessarily better than the compressed transmission; and ii) there exists an optimum ECG data compression ratio for the wireless link.

I. I NTRODUCTION Our era is witnessing an increasing pressure on the quality and quantity of healthcare due to the increase of aging population, chronic diseases, and health consciousness of people [1]. People put more attention in prevention and early risk detection. A system that can continuously monitor the health condition of elderly people and share information with remote care providers or hospitals will be in great demand. As an effort of catching up with this trend, wireless body area network (WBAN) as an emerging technology for providing this kind of health information, has been attracting more and more attention recently. IEEE 802 has launched the IEEE 802.15 Task Group 6 (WBAN) in November 2007 to develop a communications standard optimized for low power devices operating on, in or around the human body to serve a variety of applications including medical and consumer electronics [2]. WBAN is still at its infancy and there are a lot of open research problems. One of the emerging issues is how to exploit wireless communications technologies in WBANs. IEEE 802.15.4 ZigBee is a low-cost low-power standard. The drawback of ZigBee is the limited data rate, which is 250 kbps when operating at 2.4 GHz band, in order to support heterogeneous medical services. In addition, it may suffer from strong interference

since IEEE 802.11 radios as well as other devices such as microwave ovens also operate in this frequency band. The backward compatibility is another matter of concern. Ultrawideband (UWB) has also been considered as a potential wireless technology. However, the UWB wireless chips are not yet well commercialized at this moment. On the other hand, the IEEE 802.15.1 Bluetooth [3] is one of the most promising technologies for WBANs, particularly for wireless healthcare [4]. The main advantages are the small size, reduced cost, low power consumption, and especially the great market penetration. The system employs a frequency-hopping multi-access scheme, which helps combat interference and fading, and increase the security in radio transmission. The data rate is up to 1 Mbps, adequate for transmitting most realtime biomedical signals. In addition, diverse prototypes of sensors based on Bluetooth have been developed for different biomedical signals, including ECG, glucometers, tensiometers, pulse-oximeters and even stethoscopes. For instance, Continua Alliance has adopted Bluetooth as the wireless link for their wireless healthcare applications [4]. These commercial Bluetooth terminals permit a straightforward integration of general purpose devices (e.g., PDAs, smartphones, etc.) into WBAN. Despite the apparent suitability of Bluetooth technology for medical WBANs, its performance in combination with medical data processing techniques has not been studied in the literature. In this paper, we perform a case study on wireless ECG monitoring over Bluetooth link in order to evaluate the data transmission quality and how it is affected by the ECG compression. In Section II, we will briey introduce the network architecture under consideration. We will then propose a very low complexity ECG data compression method in Section III. Using this method, the inuence of data compression on


Intra-BAN Comm.
SpO2 Body Central Unit

Extra-BAN Comm.


Glucose Blood pressure

work is supported by DOCOMO USA Labs.

Fig. 1.

WBAN architecture under consideration.

978-1-4244-6398-5/10/$26.00 2010 IEEE

This full text paper was peer reviewed at the direction of IEEE Communications Society subject matter experts for publication in the WCNC 2010 proceedings.

ECG Data in Data Compression GFSK Modulation AWGN Data Decompression GFSK Demodulation Fading channel


ALGORITHM Wavelet and Huffman [9] Wavelet-SPIHT [8] Wavelet-Hilton [7] Wavelet-Djohn [7] AZTEC [10] TP [10] CORTES [10] Fan/SAPA [10] DCT and Golomb-Rice [5] DCT and arithmetic [6] DCT and LZW (proposed) PRD 3.2 1.18 2.6 3.9 28 5.3 7 4 1.5 1.82 1.9 CR 9.4:1 8:1 8:1 8:1 10:1 2:1 4.8:1 3:1 6.5:1 14.73:1 (m=7) 9:1

ECG Data out

Bluetooth Radio System

Fig. 2.

Wireless ECG monitoring over Bluetooth.

the ECG signal reconstruction performance at the Bluetooth receiver will be studied in Section IV. Summarizing remarks will be given in Section V. II. N ETWORK A RCHITECTURE OF M EDICAL WBAN The WBAN architecture under consideration is shown in Fig 1. This architecture consists of two main parts: multiple body sensor units and a body central unit. The body sensor units are able to perform vital medical data acquisition, data (pre-)processing, actuator control, data transmission and some basic user feedback. The body central unit links multiple sensor units, performs data collection, data processing/compression, actuator control, basic event detection/management and provides external access together with a personalized user interface. In this paper, the intra-BAN communications between the body sensor units and the body central unit is based on Bluetooth. For the extra-BAN communication, gateway functionality via e.g., a cell phone will be used to provide connectivity to devices further away or to health care providers at a remote site. The system is intended to provide the following functions: i) monitoring of the health parameters in order to detect an emergency; and ii) providing medical assistance in cases of emergency. III. ECG DATA C OMPRESSION FOR WBAN In the literature, ECG data compression has been extensively studied (see, e.g., [5], [6], [7], [8], [9], [10]). However, WBAN applications not only require small reconstruction error (distortion) and high compression ratio (CR), but also require these to come at low complexity. A compression method providing high CR with small distortion can reduce the cost of the wireless data transmission, and make it possible for prolonged local data storage at individual sensors until the detection of an emergency. However, existing ECG data compression approaches either do not achieve both high CR and small distortion, or provide these at very high complexity. On the other hand, low complexity is essential for wireless health monitoring sensors running on batteries, whose power efciency and endurance can be life-critical. In this section, we propose a simple but highly effective ECG data compression method. Existing data compression techniques for ECG signals can be classied into three main categories: 1) direct data compression methods, 2) transformation methods, and 3) parameter extraction methods. A good review and comparison of some of these methods are presented in [10]. For the

transformation methods, discrete cosine transform (DCT) and wavelet transforms have been widely investigated for lossy data compression. Our proposed method is a 2-stage data compression process that combines a lossy data compression technique and a lossless coding scheme. Both DCT and wavelet transforms have been widely investigated for lossy data compression. Here, the DCT-based transform is used in the rst stage of the compression process due to the fact that the frequency of ECG signal concentrates mainly between 0.05 Hz and 130 Hz. Therefore, through DCT transform, we can represent the original ECG signal in a few transformed DCT coefcients, which can achieve higher CR and is insensitive to noise effect. In addition, the DCT-based method is simpler than wavelet based compression and more exible to control the CR. After the DCT, the LZW coding is used in order to compress the DCT coefcients in the second stage of the compression process. LZW coding is a lossless dictionarybased compression algorithm which looks for repetitive sequences of data and builds a dictionary based on them. Since it is a lossless compression, the percentage root-mean-square difference (PRD) can be well conserved. Therefore, the whole process of the ECG data compression can be summarized as follows: 1) Split the original signal into M blocks, each containing N samples; 2) Transform each block using DCT; 3) Retain K( N ) DCT coefcients; 4) Quantize the K retained DCT coefcients; and 5) Encode the quantized DCT coefcients using LZW coding. To facilitate comparisons with existing approaches, the PRD [5]-[10] is employed to measure the data reconstruction error: P RD =
N 1 2 n=0 (xn xn ) N 1 2 n=0 xn



where xn is the original data and xn is the reconstructed data after compression. The performance comparisons using record 117 in terms of CR and PRD are shown in Table I [6], [11]. In our simulation, each block contains 1000 samples and 180 DCT coefcients are retained for each block. From the table, the only method that outperforms our proposed DCT-LZW algorithm is the DCT-arithmetic algorithm

This full text paper was peer reviewed at the direction of IEEE Communications Society subject matter experts for publication in the WCNC 2010 proceedings.

[6]. However, this method uses a user specied PRD value to nd the optimal threshold value for the DCT coefcients via an iterative method, which signicantly increases the computational complexity. In general, our proposed DCTLZW algorithm achieves low PRD and high CR at much lower complexity in comparison with existing alternatives. The low complexity is essential for wireless sensors running on batteries. This is particularly important for healthcare purpose sensors since their endurance can be life-critical. The low PRD and high CR are also important for WBAN. In particular, high CR reduces the cost/energy consumption of wireless transmissions. High CR further allows the sensors built-in memory card to store non-critical data, which can be collected upon the occurrence of an emergency. The high CR allows data storage of a long period pre- and post-emergency. IV. W IRELESS ECG M ONITORING OVER B LUETOOTH In this section, we consider the ECG monitoring over the Bluetooth physical link based on the proposed ECG compression method in the previous section. The overall system block diagram is shown in Fig. 2. First, the digitized ECG signals are passed through the data compression module. Then the compressed data is transmitted through the Bluetooth Radio System module. At the receiver, the reverse is performed to reconstruct the ECG signal. A. Bluetooth Radio Link We rst briey describe the Bluetooth radio link functions and parameters. A.1. Bluetooth Transmitter The block diagram of the Bluetooth transmitter is shown in Fig. 3(a). The transmitter uses Gaussian Frequency Shift Keying (GFSK) modulation. A passband transmitted GFSK signal can be represented as [12] 2Eb cos[2f0 t + (t, ) + 0 ], (2) T where Eb is the energy per bit, T is the bit period, f0 is the carrier frequency, 0 is an arbitrary constant phase shift. The output phase deviation (t, ) is determined by the input data sequence = ..., 2 , 1 , 0 , 1 , 2 , ... with i {1} in the form of s(t, ) =
n nL

Input bits

NRZ signal

Gaussian filter BT=0.5


Voltage Controlled Oscillator

IF filter


Sample at T



Fig. 3. (a) Block diagram of the Bluetooth transmitter; and (b) Block diagram of the Bluetooth receiver.

results in a positive slope in phase and bit 0 results in a negative slope. The phase is extracted by passing the In-phase and Quadrature path of the complex base-band signal to an arctan block. Then the resulted phase is sampled at T intervals. Denote the phase difference of the nth and (n 1)st samples as n . Then the nth transmitted symbol is determined as 1 if n is positive and vice versa. The block diagram of the demodulator is shown in Fig. 3(b). B. Simulations and Discussions Now we are ready to evaluate the ECG monitoring performance over Bluetooth. We use the MIT-BIH Arrhythmia database [11] for the evaluation. In this standard database, the ECG signals were digitized by sampling at 360 Hz with 11bit resolution. The rst 10000 samples of 10 MIT-BIH records have been tested. In our simulation, the SNR is dened as the signal power to the noise power. The relation between SNR and Eb /N0 is: Eb 1 Eb R = , (4) N0 B N0 BT where Eb is the bit energy, N0 is the one-sided noise power spectral density, R = 1/T is the bit rate, and BT is the 3 dB bandwidth-time product. The channel model is Rayleigh at fading. SNR = B.1. Under Perfect Channel Condition As we mentioned in Section III, the CR of our DCTLZW algorithm can be easily adjusted by retaining different numbers of DCT coefcients for a given data block size. Fig. 4 shows the original and reconstructed signals of MITBIH record 117 when different numbers of DCT coefcients are retained, under perfect channel conditions in the absence of noise and channel fading. The number of DCT coefcients retained and the corresponding CR and PRD values are also listed in Table II. Clearly, as the number of DCT coefcients increases, the quality of the reconstructed signal improves monotonically.

(t, ) = 2h

i q(t iT ) + h
i= t

i ,


where h is the modulation index, q(t) = g( )d with t t g(t) = Q( BT ( T 1 )) Q( BT ( T + 1 )) being the 2 2 frequency pulse with constant = 2 2 and Q() is the ln Gaussian Q-function. In the Bluetooth standard [13], the modulation index h can vary between 0.28 and 0.35 and the 3 dB bandwidth-time product is specied as BT = 0.5 with T = 106 s, which leads to a g(t) with effective duration of 2T . A.2. Bluetooth Receiver At the receiver, we use a simple phase differential demodulator [12]. From the GFSK modulator, we know that bit 1


DCT # Retained 50 100 150 200 300 CR 24.44:1 13.58:1 10.02:1 8.28:1 6.99:1 PRD 13.8154 7.8659 3.2845 1.6 1.4134

This full text paper was peer reviewed at the direction of IEEE Communications Society subject matter experts for publication in the WCNC 2010 proceedings.

2 0 Amplitude

2 2 0






1 2 2 80 0 60 0 200 400 600 800 1000 PRD 2 2 0 2 0 200 400 600 800 1000 40 20 0 0 200 400 600 800 1000


1000 samples



5 trials


Fig. 4. Compression and reconstruction results of Record 105 for different number of retained DCT coefcients (300, 200, 100, and 50 from top to bottom). Solid: original. Dashed: reconstructed.

Fig. 6.

Average of 10 random channel realizations at 26 dB.

5 SNR = 22 dB 0 5





5 SNR = 24 dB 0 5 5 SNR = 26 dB 0 5

price of a higher data rate compared the compressed data transmission. Though the raw data preserved maximum information about the original ECG signal, the reconstruction performance after propagating through a fading channel is not perfect. As shown in Fig. 5, there are some spiky errors, which can mislead the medical interpretation. These errors can not be corrected by averaging, as illustrated in Fig. 6, where the average of 10 random channel realizations still exhibits spiky errors. Thus, some error correction mechanism is necessary in this case. Compressed ECG data transmission performance: When our DCT-LZW algorithm is employed at the transmitter, the ECG data reconstruction performance behaves differently. In Fig. 7(a) and Fig. 7(b), the original and reconstructed ECG signals are shown at SNR levels of 22 dB and 26 dB, respectively. As we can see, at 22 dB, the reconstructed signal exhibits severe distortion. At 26 dB, however, the reconstructed signal preserves most of the basic shape and clinical features of the original signal. Compared to the raw data transmission at 26 dB (see Fig. 5), the compressed case actually gives better reconstruction performance at a lower data rate. We also investigated the relationship between the CR and the PRD of the reconstructed signal at different SNRs. As shown in Fig. 8, we plot the average PRD versus CR (essentially determined by the number of retained DCT coefcients) for 400 random trials at SNR levels of 22 dB and 26 dB. Note that for each SNR level, there exists a compression level at which the PRD is minimized. This is different from the perfect channel condition, under which case the quality of the reconstructed signal improves monotonically with the increase of the number of DCT coefcients. There is actually a tradeoff between the PRD and the number of DCT coefcients retained. Since the frequency of ECG signal mainly concentrates between 0.05 Hz and 130 Hz, the DCT coefcients almost tend to zero at the tail of each block. These DCT coefcients are more sensitive to the channel noise effect. So with less of these









Fig. 5.

Original and reconstructed signals for raw data transmission over Bluetooth (Solid: original; Dashed: reconstructed).

B.2. In Fading Channels with AWGN However, the situation is very different when the channel fading and noise effects are also taken into account.We will next consider raw and compressed data transmissions separately. ECG raw data transmission performance: The ECG signal from each channel is digitized at 360 Hz with 11-bit resolution, giving rise to a raw data rate of about 3.88 kbps per channel. Typically, 12 channels of ECG signal are sufcient for medical diagnosis. Accordingly, the Bluetooth system with a base rate of 1 Mbps is potentially feasible for transmitting 12 channels of raw ECG data. This will reduce the processing burden at the body sensors, at the

This full text paper was peer reviewed at the direction of IEEE Communications Society subject matter experts for publication in the WCNC 2010 proceedings.

1.5 SNR = 22 dB

90 80 SNR = 22 dB SNR = 26 dB

1 70 60 PRD 0 0.5 20 1 10 0 200 400 samples 600 800 1000 50 40 30





300 400 DCT coefficient numbers



1.2 SNR = 26 dB 1 0.8 0.6 Amplitude 0.4 0.2

Fig. 8.

PRD versus CR for SNR level of 22 dB and 26 dB.

link in fading channels with AWGN. Through this study, we found that directly transmitting the raw ECG data is not advantageous compared to the transmission of compressed data. In addition, there exists an optimum ECG compression ratio for the wireless link.

0 0.2 0.4 0.6


400 samples




(b) Fig. 7. Original and reconstructed signals for compressed data transmission for SNR level of: (a) 22 dB; and (b) 26 dB. (Solid: original; Dashed: reconstructed.)

DCT coefcients retained, the noise effect can be effectively reduced. V. C ONCLUSIONS In this paper, we carried out a case study on wireless ECG data transmission using Bluetooth technology. To facilitate such a study, we rst proposed a low complexity ECG compression algorithm by combining DCT and LZW. Although both DCT and LZW are existing techniques, the combination is new. And when compared with existing alternatives, the proposed method gives superb compression performance with very low complexity and high exibility. These make it very suitable for WBAN applications with low power and high performance requirements. We then investigated the ECG signal reconstruction performance over a wireless Bluetooth

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