MYOCARDIAL TEMPERATURE SENSOR

Progress report

Group 23
Demi Shen, Hehaoyu Zou, Bicong Li
Project Scope (Updated)

This project is designed to cater to cardiac surgeons during open heart surgeries like

Cox-maze IV so that temperature monitoring during cold-blood plegia does not interfere with

surgical maneuvering. The primary source of interference, the data transmission cable

attached to a traditional myocardial temperature probe, is thus removed in our design. The

top priority of this project is to implement the wireless data communication. Given multiple

sources of frequency noises in a surgery room, the transmitted signal is vulnerable to

tarnishment. Emulating the accuracy of transmission cable is beyond the scope of this

project, though maximum effort of improving the resolution would be made. The computer

program will receive the digital temperature data and process it into Celsius degree reading

that displays on the monitor screen. It will also have an alert feature that gives off alarming

sound when temperature goes out of desirable range. This feature offers surgeons the

convenience of not having to divert attention to the screen constantly. By the end of this

project, a simplified model will be developed as a proof of concept to show the feasibility of a

wireless monitor system for myocardial temperature that yields reliable measurement under

conditions that closely match that of an operation suite.

Design Specification (Updated)

Feature Specification

Accuracy 0.2

Range 0~40

Wireless transmission distance 6~10m

Needle stability the needle is expected to stand on its own

without falling off during surgery

Automatic alert-triggering customizable desired monitoring range

Alarming consecutive until back to safe range

Needle length 8mm/15mm/30mm

 Since the manufacturing process of electronics is not at our discretion, it would be

almost impossible to integrate the signal transmitter and the probe needle into a practical

size that is small enough to match the current myocardial temperature probes. Therefore, we

will no longer seek to maintain an equal size while we add the wireless feature. What we aim

instead is to offer a demonstration of a workable wireless monitoring system using the

affordable products within our reach. The design will still be able to achieve previously

promised features including stability of needle, wireless convenience and reliability of

temperature reading. But most likely the needle-shaped temperature sensor and the signal

transmitter will be two blatantly separated parts, instead of a delicate entirety as they should

if it were to become a marketable and useful product.

Potential Designs

Needle Head Alternatives

For the needle design at the end of the thermistor, a small needle head would be

desirable. Smaller size needle head tips impose a larger pressure on the contacting surface

of tissue hence would be easier for penetrating the tissue surrounding the myocardial

muscle. In addition, it would leave a smaller incision wound. Causing less damage to the

heart muscle is crucial for design process, as accuracy is required to not causing any side

injuries in the coronary vessels surrounding the epicardial surface of the heart.

The overall design is to have a hollow pencil point needle, with the thermistor

enclosed inside the tip. The needle cover has to be able to pull back after incision, exposing

the thermistor head for temperature sensing purpose.

Several designs can be made for the shape of the needle tip. Inspiration was drawn

from various surgical needles forms for penetrating tissues of different mechanical properties.

Comparison of different needle tip design is listed below.

Method 1: Straight and Hard Needle

Straight and hard needles would be the most straightforward design and the easiest

to make. It is easy to penetrate tissue and leaves minimal damage to the heart wall.

Because it is straight, the penetration depth can also be readily known if the needle head is

placed at a 90-degree angle to the base. However, it has the disadvantage of being not

stable, and it might fall off during the procedure.

Method 2: Spiral-shaped Needle

Through experimental confirmation, a spiral-shaped needle head would be the most

stable option as for staying in the desirable position during a surgical process. Regarding

accuracy, though depth can be known quickly, the diameter of the spiral makes it harder to

determine the exact position of the needle tip. The biggest disadvantage of having a spiral

needle is the medical safety. To reach the same depth, the needle needs to be a lot longer

than a straight model, hence leaving more damage to the heart, which would be especially

problematic if the region of incision is dense in coronary artery. Complication might also

arise when the needle stays in a contracting heart. As the muscles fibers are doing cross -

bridge cycles, the already twisted fibers might break as their endurance is significantly lower

when subjected to mechanical torque and local ischemia could follow as a result. In addition,

a spiral shape is also harder to make.

Method 3: Hook-shaped needle

A hook-shaped needles stability is in between straight and spiral design. It is the

second most common surgical needle shape other than straight. It is considerably easy to

make and causes small damage. The accuracy for the tip to reach a particular spot is only

moderate as the hook angle can alter. The biggest concern for this design would be the

penetration depth: with a hook, the depth it can reach is small if no extra damage is caused

to the heart wall.

Method 4: Flexible Needle

A flexible needle can provide the surgeons with the optimal placement angle, and

give surgeons more freedom regarding the area of interest for the thermometer. However, it

might be dangerous to make the needle flexible, but still sharp, as flexibility means that it is

going to be a lot harder to control, and this would potentially cause more damage than film

needles. Furthermore, it would be more dangerous to use, and surgeons might have to take

extra time for putting the needle in place than simply put the hard needle in. It would also be

much harder to make.

Method 5 and 6: Angled Needle with Fixed or Changeable Angle

The needle itself can be a straight line; however, the angle between the needle and

the base part of the device (hanging outside the heart) can vary too, for example, 45

degrees. This design can make the device hang more stable on the heart, decreasing the

possibility of the needle falling out from position. The needle need to be longer than the

straight, 90-degree angle design to reach the same penetration depth, hence could

potentially cause a little damage.

The angle between the base and the needle can move between different, which will

provide the surgeons more flexibility to direct the sensor head to the region of interest by

varying the angle of the thermometer to the base. It would be great if there can be a locking

device that can lock a particular angle when needed, and allow readjustment of the angle

when the point of interest is changed. However, as the length of the needle itself is fixed, the

penetration depth varies with different angle. For a desirable range of depth, the angle can

only change in a very limited fashion.

The angle can also be fixed. Although sacrificing the flexibility of usage, a fixed angle

has the advantage of predicting the position of needle tip and is much easy to use than a

change and lock design. If one unit of the temperature monitor probe is relatively cheap,

then a set of needles with different angles can be produced.

Pugh Analysis

Angled
Hard Spiral- Hook- Angled Needle
Flexible Needle
Criteria weight Straight shaped shaped (Changeable
Needle (Fixed
Needle Needle needle Angle)
Angle)

Production
4 5 1 3 2 4 1
Easiness

Damage 5 5 1 3 2 4 4

Stability 5 2 5 4 2 4 4

Accuracy 4 5 2 3 3 5 5

Flexibility 2 0 0 0 5 0 4

Overall
75 42 59 50 76 72
Score
Tab le 1. Pugh chart for needle shape design.

From our Pugh analysis, a thin and hard needle, with a fixed angle to the base, would

be the best option regarding the needle head design. The optimum angle needed still require

further validation.

Wireless transmission Alternatives

Method 1: Bluetooth

Bluetooth is a standard wireless communication protocol primarily serving short-

distance communications. Devices need to be within approximately 10 meters of each other,

and the typical data transfer rate is around 2 megabits per second (Mbps). Every device

using Bluetooth has a low-cost transceiver microchip that can both emit and receive signals.

In a typical setup, there is a master device, and one or more other devices serve as slaves.

The master device uses link manager software to identify other Bluetooth devices to connect

and exchange data with them.

In our case, the transmission range is long enough to cover the entire space of a

typical cardiac operating suite, which is about 600 square feet 1. The cost is affordable. We

can easily buy a Bluetooth microcontroller at grocery price. A typical resolution of 10-

bits(60dB) and link budget (an accounting of received power in telecommunication) of 100dB

is also good enough for small DC current or voltage data.

1
Operating Room Design Manual, Shine, Leone, Martin et al., 2012
 However, Bluetooth is vulnerable to interference. Bluetooth uses short-wavelength

UHF radio waves in the ISM frequency band from 2.4 to 2.485 GHz, an unlicensed band

reserved for the use of radio frequency(RF) energy for industrial, scientific and medical

purposes. Medical devices emitting RF can create substantial electromagnetic interference

and thus disrupt Bluetooth communication in the same band. The threat is especially real in

Cox-maze IV procedure, where RF ablation is often employed.

Method 2: Infrared Communication

Infrared(IR) communication is a common, easy-to-use and inexpensive wireless

communication technology. It is often employed in short-range communication among

computer peripherals and personal digital assistants. Remote control for television is one

most recognized paragon of this method. Usually, an infrared light-emitting diode emits

infrared radiation that is focused by a plastic lens into a narrow beam. However, any source

of heat can be IR emitters. A standard modulation scheme used to distinguish the data-

transmitting beam from the ambient IR is called 38kHz modulation. When triggered, the IR

LED blinks at a frequency of 38kHz, a frequency very rarely found in IR spectrum of natural

lights. The receiver, mostly silicon photodiode, pick the signal up and convert the signal into

electric current. The diode responds exclusively to fast pulsing lights, filtering out the slowly

changing ambient interference. The range is limited and usually does not carry further than

about 10 meters.

Convenient as IR communication might sound, it has several drawbacks. First, its

beam transmission fashion requires an approximate straight line of sight. Inadvertent

movement of surgical staff or equipment might block the path and thus shut down the

transmission. Second, the modulation scheme might involve a whole set of amplifier, band-

pass filter, demodulator, integrator, and comparator, significantly complicating the schematic

design. Third, Intensity Modulation/ Direct Detection(IM/DD), the only practical technique for

indoor IR communication, has a signal-to-noise ratio directly proportional to received optical

power. This implies a low tolerance for path loss and a requirement for high transmitter

power, the latter of which could raise eye safety concerns.

 Figure 1. Transmission and Reception in an infrared link with IM/DD technique.

Method 3: Zigbee

Zigbee is a wireless mesh network standard aimed at short-range, low-power digital

radio communications. Compared with conventional wireless technologies like Bluetooth,

Zigbee provides a low data transfer rate due to its very low power consumption. Its duty

cycles, which refers to the amount of time the radios are actually on versus off, are

thousands of times less than Bluetooth devices. As a trade-off for this disadvantage, it costs

much less and results in much longer battery life. It usually operates in 2.4 GHz ISM band

and is capable of a data rate up to 250 kbps using offset quadrature phase shift

keying(OQPSK). But in the US, Zigbee is assigned to 915MHz band instead, and the

modulation scheme is changed to binary phase shift keying(BPSK), cutting down the

maximum data rate from its defined value to 40kbps. The data is transferred in packets with

a maximum size of 128 bytes.

Besides the three-low features, Zigbee also provides considerable robustness to

interference. Bluetooth 4.0 uses a star bus topology as the network architecture. The system

crashes if the master node fails. By comparison, ZigBee deploys a mesh network which will

not suffer significantly from a single point of failure. Though ZigBee has been proved to be
suitable for data transmission inside operation rooms 2, there is a lack of complete design for

ZigBee inpatient monitoring. Furthermore, our single point-to-point design scheme may not

entail the mesh network that guarantees the signal reliability.

Method 4: Ultra-Wideband (UWB)

Ultra-wideband is a radio technology that consumes tiny energy for short-range, high-

bandwidth communications across a wide portion of the radio spectrum 3. The idea of

dividing up the band into multiple 528-MHz wide channels is conjured up to maximize

channel capacity, an indicator of the theoretical maximum number of bits per second of

information that a system can convey. According to the ShannonHartley theorem, the

channel capacity of a properly encoded signal is proportional to the bandwidth of the channel

and the logarithm of the signal-to-noise ratio (SNR). Thus, channel capacity could be

optimized by increasing the channel's bandwidth to the maximum value available, or, in a

fixed-channel bandwidth, by increasing the signal power exponentially. By the large

bandwidths inherent in UWB systems, large channel capacities could be achieved, if SNR is

right just sufficient, without entangling higher-order modulations that require a very high SNR.

However, one technical complication is that the receiver signal detector needs to match the

transmitted signal in bandwidth, signal shape and time. A mismatch can cause loss of

margin for the UWB radio link.

Pugh Analysis

Ruling out other evident wireless choices such as Wi-fi, which would be a waste of

capacity for our short-distance communication, and Near-field communication, which

requires devices to be within less than 1m, we are left with the four choices above. As the

wireless transmission feature is the top priority of this project, signal robustness to

interference and the practicality of implementing become the primary concerns. Since we are

aiming for a stand-alone device that relies on batteries, power consumption is another

2 Paksuniemi M., Sorvoja H., Alasaarela E., Myllyl R. Wireless Sensor and Data Transmission Needs
and Technologies for Patient Monitoring in the Operating Room and Intensive Care Unit. Proceeding
of 27th Annual International Conference of the Engineering in Medicine and Biology Society (IEEE -
EMBS 2005); Shanghai, China. 14 September 2005; pp. 51825185.
3 USC Viterbi School of Engineering. Archived from the original 2012-03-21.
important issue. As for data rate, most of the methods being evaluated are theoretically able

to afford data at this size. Cost is also an important factor. Good news is that most of the

wireless modules are available at a price reasonably affordable to everyone. Last, the size of

operating suite makes the transmission distance a less demanding factor given the

capabilities of these technologies.

Criteria weight Bluetooth IR Zigbee UWB

Robustness 10 9 10 10 10

Readiness of
10 8 5 5 2
implementing

Power
7 8 3 10 9
consumption

Data rate 4 10 2 7 10

Cost 5 8 5 6 6

Transmission
3 10 5 10 10
distance

Overall score 336 211 305 283

Tab le 2. Pugh analysis for wireless communication protocol.

The Pugh analysis gives the highest score to Bluetooth, closely followed by Zigbee.

Hence, our first-choice short-range wireless protocol would be Bluetooth.

Temperature Sensor Alternatives

Method 1: Thermistor

A thermistor is a type of resistor whose resistance varies with temperature. There are

two opposite kinds of thermistors, NTC (Negative Temperature Coefficient) and PTC

(Positive Temperature Coefficient). With NTC, resistance decreases as temperature rises

and is commonly connected parallel in a circuit. With NPC, resistance increases as

temperature increases and is often installed series in a circuit.

Compared with the resistance temperature detectors (RTDs), which operate over

larger temperature ranges, thermistors achieve higher precision within a limited temperature

range. Calibration is necessary for thermistor over large temperature changes. However,
over small changes in temperature the relationship between temperature and resistance can

be modeled using a linear relationship.

= ,

where =change in resistance

=change in temperature

= temperature coefficient of resistance

The self-heating effect of a thermistor must also be taken into consideration during

our design. Current flowing through a thermistor will generate heat that will raise the

temperature of the thermistor above that of its environment 4. Since our goal is to measure

the myocardium, this self-heating effect will introduce a significant error into the

measurement if not corrected. The following equations can be used to correct for electrical

heating errors effectively.

The electrical power input to the thermistor is =

The power is converted to heat which is then transferred to the environment. The rate

of transfer is defined by Newtons Law of Cooling: = (() 0 ), where is the

temperature of the thermistor as a function of resistance R, 0 is the temperature of the

surroundings, and K is the dissipation constant. At equilibrium, the two rates equal.

2
After solving the equation, 0 = ()

In addition to the high accuracy, thermistors can be purchased at a very low price.

There are thermistors with 0.2 tolerance in the market for less than 25 dollars.

4 Practical Temperature Measurements, Agilent Technologies

 Figure 2. The size of thermistors is in the magnitude of mm, which make s it suitab le for the highly non-

invasive Cox-Maze Procedure

Method 2: Resistance Temperature Detectors (RTDs)

Common RTD sensing elements consist of pure material, typically platinum, nickel, or

copper. As these elements are fragile, they are often wrapped in protective probes. RTDs

have a repeatable resistance versus temperature relationship (R vs T) and operating

temperature range. In other words, the temperature coefficient of resistance is relatively

constant over the operating range of the sensor, and is calculated using the following

equation:
100 0
=
1000

where 0 =resistance of sensor at 0

100 =resistance of sensor at 100

In contrast to thermistors, calibration must be performed at temperatures other than

0 C and 100 C for RTDs. Although RTDs are considered to be linear in operation, it must

be proven that they are accurate in the temperature region that they will be used 5. There are

two common calibration methods: fixed-point method and the comparison method.

Fixed point calibration is used for the highest-accuracy calibrations (within 0.001 C).

It uses the triple point, freezing point, or melting point of pure substances to generate a

5 Sensors Technology Series: Biomedical Sensors, Jones, 2010

known and repeatable temperature. Comparison calibration is commonly used with industrial

RTDs. The sensors being calibrated are compared to calibrated thermometers in a bath with

a uniformly stable temperature. For both of these calibration methods, additional equipment

needs to be purchased, which is highly undesirable for our projects budget.

Figure 3. Typical RTD design, consisting of coiled resistance element, core, and connector wires

Compared to thermistors, RTDs are less sensitive to small temperature changes and

have a slower response rate. Even though thermistors have a smaller temperature range,

this projects desired operating range is especially narrow and can be well accommodated

by thermistors. Another type of temperature which will be discussed later, thermocouple,

also possesses a faster response to temperature changes (fractions of a second as opposed

to seconds) than RTDs. Time response is measured by immersing the sensor in water

moving at 1 m/s with a 63.2% step change6. A thermocouple can only achieve a tolerance of

2 C and will drift within the first few hours of use, while RTDs are capable of higher

accuracy and can maintain stability for many years. With regard to size, a standard RTD

sheath is 3.175 to 6.35 mm (0.1250 to 0.2500 in) in diameter; sheath diameters for

thermocouples can be less than 1.6 mm (0.063 in), making both of these sensor types

suitable for usage in the minimally invasive Cox-Maze procedure.

6 Standard Platinum Resistance Thermometer Calibrations from the A r TP to the Ag FP, Gaithersburg,
2008
Method 3: Thermocouple

A thermocouple produces a temperature-dependent voltage as a result of the

thermoelectric effect, and the voltage can then be interpreted to measure temperature. In

contrast to thermistors and RTDs, thermocouples are self-powered and require no external

form of excitation. The main limitation of thermocouples, however, is accuracy; system errors

of less than two degrees Celsius are difficult to achieve. Because most thermocouples do

not obey a linear voltage-temperature relationship, calibration is necessary from the region

that the thermocouple will be used. Two standard calibration methods are tolerance testing

and characterization of thermocouples. Similar to RTDs, both calibration options require

purchasing of additional equipment. Thermocouples are inexpensive but drift in only a

couple of hours 7.

Pugh Analysis

Sensitivity has the highest priority in our design because our product needs to be

able to sense small temperature changes for physicians to monitor the patient heart's

condition accurately. Thermistors can achieve a sensitivity of 0.2 , RTD is slightly less

sensitive, while thermocouple can hardly achieve a 2 tolerance. Response time is the

second most important factor in our consideration because delay of temperature data

communication might lead to over- or under-infusion of cardioplegia. Thus real-time

temperature sensing is very desirable, which can be achieved by thermistors only. Even

though thermocouple has the largest operating range, our product only is operated in a very

narrow temperature range, 0 to 40 , which can be achieved by any of the three sensor

types. All three types are optimal in size and cost, suitable for the minimally invasive Cox-

Maze procedure and this student design project. Calibration difficulty is characterized by

whether the sensor needs calibration and the complexity of calibration methods. Thermistors

follow a linear resistance-temperature relationship and do not need calibration, while

additional equipment needs to be purchased for calibrating two other sensor types.

7 Thermoelectric Materials for Thermocouples, University of Cambridge

 Criteria weight Thermistor RTD Thermocouple

Sensitivity 10 10 8 3

Operating Range 3 9 9 9

Size 7 10 8 10

Cost 5 9 7 7

Stability 5 10 5 5

Response Time 9 10 7 5

Calibration Difficulty 8 10 2 3

Overall score 462 302 256

Tab le 3. Pugh analysis for temperature sensor options.

In conclusion, thermistor is the optimal temperature sensor type for use in myocardial

temperature sensor.

Overview of chosen solution

Overall, we pick an optimal solution on each part of our design. Among several other

more intricate designs that we have brainstormed, we decide on thin-hard needle inserted at

an angle to the epicardial surface. The optimal angle needs further evaluated through

experiments. For wireless communication protocol, we decide on Bluetooth after carefully

weighing all factors. Since a significant advantage does not outweigh Zigbee, we still reserve

the option of Zigbee. As for temperature sensor, researches have contradicted our previous

inclination towards thermocouples and suggested thermistor as a much better choice. The

challenge for next step would be integration of the three parts into one device.
Proposed Budget

We need a hollowed stainless needle and a thermistor to assemble into a temperature probe

needle. A glass encapsulated thermistor is available from OMEGA for $23, with excellent

long-term stability, and a tolerance of 0.2C from 0 to 70C. Electronics-wise, we need a

Bluetooth emitting module and a receiving terminal that enables computer programming.

Since we are aiming for a demonstration model, Arduino is the most convenient and cost-

effective platform for implementing simple wireless communication. Fortunately, Arduino

offers Bluetooth modules integrated with analog to digital converters that come at a price

less than $30. The USB-terminal to be plugged onto computer costs less than 20 bucks.

Taking into account some potential costs that could arise from additional trial-and-errors, we

are asking from BME department a total budget of 150 dollars.

 Appendix Works Cited

1. Operating Room Design Manual, Shine, Leone, Martin et al., 2012

2. Paksuniemi M., Sorvoja H., Alasaarela E., Myllyl R. Wireless Sensor and Data

Transmission Needs and Technologies for Patient Monitoring in the Operating Room

and Intensive Care Unit. Proceeding of 27th Annual International Conference of the

Engineering in Medicine and Biology Society (IEEE-EMBS 2005); Shanghai, China.

14 September 2005; pp. 51825185.

3. USC Viterbi School of Engineering. Archived from the original 2012-03-2

4. Practical Temperature Measurements, Agilent Technologies

5. Sensors Technology Series: Biomedical Sensors, Jones, 2010

6. Standard Platinum Resistance Thermometer Calibrations from the Ar TP to the Ag

FP, Gaithersburg, 2008

7. Thermoelectric Materials for Thermocouples, University of Cambridge