154 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH 1976

[151 P. Bach-y-Rita, "Sensory plasticity," Acta. Neurol. Scandinav, [19] -, "Localization of tonal stimuli in the vertical plane," JASA,
vol. 43, 1967, pp. 417-426. vol. 43, pp. 1260-1266, 1968.
[16] P. Bach-y-Rita, C. C. Collins, L. Scadden, G. W. Holmlund, and [20] G. H. Harris, "Binaural interactions of impulsive stimuli and pure
B. K. Hart, "Display techniques in a tactile vision-substitution tones," JASA, vol. 32, pp. 685-692, 1960.
system," Medical and Biological Illustration, vol. 20, 1970, pp. [21] A. W. Mills, "On the minimum audible angle," JASA, vol. 30,
6-12. pp. 237-246, 1958.
[171 S. K. Roffler, "Sound localization in the vertical plane," unpub- [22] S. S. Stevens, "Neural events and the psychophysical law,"
lished Ph.D. dissertation, University of Chicago, 1967. Science, vol. 170, pp. 1043-1050, 1970.
[18] S. K. Roffler and R. A. Butler, "Factors that influence the local- [23] D. Rowell, "Auditory display of spatial information," unpub-
ization of sound in the vertical plane," JASA, vol. 43, 1968, lished Ph.D. dissertation, University of Canterbury, Christchurch,
pp. 1255-1259. New Zealand, 1970.

Communications.

A Digital QRS Detector Based on the Principle of

Contour Limiting A D
/--
IA
/"."
I

Threshold Th I Th I

HENK G. GOOVAERTS, HENK H. ROS,

THOMAS J. VAN DEN AKKER, AND I,g I/

HANS SCHNEIDER Detector L Det. ,, - v/ Det.

Abstract-The article describes a detector for physiological phe-
nomena, e.g., the QRS-complex, having a trigger accuracy of 0.5 ms.
The configuration to be recognized first is preprocessed then fed into a
pair of amplifiers with adjustable gain and offset, representing the
upper and lower contour-limit derived from the actual signaL These
signals are sampled and A/D converted, then stored in two memories
during the "read"-operation.
The actual signal, which is continuously sampled and A/D converted,
will be fed into a third memory. The contents of this memory will be
compared with those of the aforementioned memories. Continuous
refreshing of the third memory shifts the actual signal through the
memory, thus obtaining a situation in which the actual signal fits into
both contour-limits. If so, the comparators, operating between the
samples, will generate a trigger signal.
Averaging methods requiring a high accuracy are performed for non-
invasive investigations on the His-bundle activity. Here the accuracy is
quantitatively determined by a small counter reading, the number of
samples for which the actual signal fits into both contour-limits.
INTRODUCTION
The on-line detection of a specific configuration of electro-
physiological signals is an important aid for the processing of
these signals. One can roughly distinguish two methods of
which one method deals with the threshold detection of the
filtered input signal [1], [2] while the other method demands
some rigidly defined detection criteria which have to be ful-
filled by part of the configuration of the input signal [3].
Manuscript received January 23, 1975; revised April 28, 1975.
The authors are with the Department of Medical Physics, Free Uni-
versity, Amsterdam, The Netherlands.
.t- , Output
t b.
I'I t t
1 _-
(a) (b) (c)
Fig. 1. Trigger errors due to alterations in the triggering signal. (a)
Alterations in steepness. (b) Alterations in amplitude. (c) Alterations
due to baseline shift.
However, detection of slightly different configurations is not
possible with these methods.
Introducing additional criteria increases the discrimination
of the method of detection, but at the same time a decreasing
number of configurations is detected owing to the presence of
noise and artifacts in the signal. Besides, the accuracy of the
derived detection signal is not optimal because concessions
have been made in the set-up of conditions.
Alterations in the steepness of the signal will introduce a
detection error while the same holds good for variations in
amplitude because the latter may be regarded as changes in
steepness.
In Fig. l(a) and (b) the resulting detection error of both
components is shown. Detection errors due to baseline shift,
which are shown in Fig. 1(c), can easily be eliminated through
the use of a high-pass filter.
In short, several conditions have to be satisfied in order to
derive a detection signal from a given signal configuration.
Even so, there are artifacts that will satisfy these conditions
for a given signal configuration. This brings us to the conclu-
sion that the desired signal configuration itself has to specify
the conditions on which a detection signal will be generated in
order to obtain optimal accuracy.
Summarizing, all the aforementioned approaches deal with a
principle based upon average conditions to which the trigger-

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COMMUNICATIONS
ing signal must match. In our design, it is the configuration
itself that is taken as a norm, thus specifying its own detect-
ing condition.
DESCRIPTION OF THE PRINCIPLE
In starting the design the idea was to recognize the actual
signal by means of pattern-recognition. The basic principle
of this system involves the generating of an upper limit and a
lower limit whose forms specify a certain area as shown in
Fig. 2(a). If a given input falls within this area, an indication
is given that the required signal has been received.
In this figure the actual signal meets the specifications to be
recognized if the following equation holds:
CU > X > Cl. (1)
In other words, if and only if the configuration of the actual
signal remains between the upper and lower contour-limits, a
recognition will be possible, and this recognition will occur
during the whole time that the actual signal is present in the
area bounded by the two contour-limits. The accuracy of the
time detection will then obviously be dependent on the width
of the bounded area.
METHOD OF OPERATION
Contour-limits (C") and (Cl) are present in a memory con-
taining these limits in n samples. A third memory contains
the last n samples of the actual signal (X). Before the next
sample of (X) is taken, the contents of these three memories
are compared according to the following equation:
cu i > Xi > cli (2)
in which Xi, Cu1 and Cl1 represent the sample number i of the
actual signal and the contour limits (i = 1,.* *, n).
If equation (2) is not fulfilled, no detection signal will occur.
Then a new sample from the actual signal (X) is added to the
(X) memory while eliminating the earliest sample in this
memory.
Again comparison takes place between the contents of the
three memories. After a certain number of samples the con-
figuration of (X) will fit into both contour-limits, thus gen-
erating a detection signal. The accuracy of this detection
signal only depends on the sampling frequency of the system.
Adjustment of the contour-limits in such a way that
(Cu - Cl) increases will allow signals with a smaller signal-to-
noise ratio to be detected. The contour-limits may be gen-
erated artificially or by using samples of the input signal.
Design Considerations
In order to build such a piece of equipment, certain charac-
teristics must be kept in mind:
1. The (time-) accuracy of the detection depends upon the
sampling frequency of the system.
2. The width of the area (Cu - Cl) determines the range
of variability of the input signals which will be detected.
3. It is not necessary that equation (2) be true for all
samples (example: normal QRS with slight artifact).
4. In the case of biological signals it is advantageous to be
able to use the signal itself in setting the limits.
5. A visual display is necessary for the adjustment of limits.
DESCRIPTION OF THE SYSTEM
The total setup as given in Fig. 3 can be divided into four
sub-systems:
a. Input-preprocessor.
b. A/D-converter, memories and comparator.
c. Output-display.
d. Clock.
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155
(a) (b)
Fig. 2. The principle of contour limiting. (a) The contour-limits (Cu)
and (Cl) derived from a previous triggering signal are adjusted while a
new similar configuration (X) is moving from the right to the left into.
the contour-limits. No trigger signal is generated. (b) The triggering
signal fits into both contour-limits thus generating a trigger signal.
Fig. 3. Block diagram of the system. The upper and lower contour-
limits are stored in the upper and lower shift registers, respectively.
The actual signal shift through the middle register. The contents of all
three registers are compared for similarity and D/A converted for dis-
play purposes.
a. Input-Preprocessor
The input preprocessing consists of a wide band amplifier
and a two stage multiple-feedback filter having a pass-band
between 0.5 Hz and 500 Hz. At the output of the filter the
signal is distributed on three lines. Two of these lines are fed
into amplifiers which can be connected to the upper and lower
contour memories.
Through the use of high-resolution potentiometers and a
10-bit A/D-converter, the resolution of the contour-limits
retained in memory is ± 10 mV. In Fig. 4 the schematic
diagram of the preprocessing unit is given.
b. Memory and Comparator
The preprocessed signal now is converted into two contour-
limits. These limits are fed into a pair of 10-bit A/D con-
verters if push button "READ" is operated (Fig. 3). If the
"READ" switch is disengaged only the preprocessed signal is
available on the input of one A/D converter.
The A/D converted samples of 10-bits are then stored in a
1024 X 10 bit dynamic shift register. Sampling is done at a
rate of 1 or 2 kHz. Sample gates are open for approximately
20 ,is. The last sample is fed into the (X)-buffer, whereupon
the buffers are circulated in parallel through the comparators.
This comparison is performed at a clock frequency of 1.2 MHz
or 2.4 MHz, and during each clock pulse equation (2) is per-
formed on the three binary words presented in the three
buffers.
Each time that equation (2) is satisfied a logical 1 will be
presented to the counter. The counter therefore contains the
number of times which equation (2) is fulfilled.
In Fig. 5 a simplified diagram of the A/D converter, memory
and comparator section is given.
After completing the cycle, the counter is reset. In the
instrument a small counter is incorporated which counts the
number of successive samples for which the equation holds.
156 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH 1976

Input

Fig. 4. Simplified schematic diagram of the preprocessing unit. AU switch functions are performed by means of digitally
controlled FET switches.

Trigger

Clock 2

Fig. 5. Simplified diagram of the A/D converter, memory and comparator section. Clock 1 represents the high frequent
clock of 1.2-2.4 MHz which recirculates the shift registers. Clock 2 is the low frequent clock of 1-2 kHz used for sam-
pling of the actual signal.
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 | rJ~ rCbock2
COMMUNICATIONS
From Ll
Cu men or
X nmeowry
C~~~1
memor
Fig. 6. Simplified diagram of the display section. The Z-axis part of this section is designed to be used with a Tektronix
7904 oscilloscope. Using different oscilloscopes, the Z-output may cause insufficient blanking and unblanking. Supply-
ing both 2N3904's from +15 V and -15 V may correct this.
c. Output-Display Unit
In order to read the desired signal and for the case of adjust-
ing the contour-limits, it is necessary to visualize the contents
of all three buffers. This can easily be done by just adding
three D/A converters to the system, because for comparing
all three buffers the necessity for circulating exists. After D/A
conversion one has a continuous signal that is repeated with
each cycle. Because of the relative high sampling frequency
it is possible to alternate the analog converted contents of all
three buffers.
An appropriate time base is derived from the clock pulses
used for cycling of the buffers. This clock is fed into a 10-bit
counter which is followed by a D/A converter. The output of
this D/A converter presents a ramp voltage during cycling of
the buffers facilitating in this way the display of the buffer
contents. In Fig. 6 the simplified diagram of the display sec-
tion is given. Furthermore this section provides blanking and
unblanking of the displayed signal.
It is possible to shift both contour-limits to the right side of
the screen in such a way that the end of the configuration to
be recognized ends the display. In this way a minimum delay
is achieved. It should be noted that the display may be cali-
brated in real-time figures. So it will be possible to adjust
precisely the delay in milliseconds while looking at the time-
scaling display presented at a clock rate of 1 or 2 kHz.
d. Clock
Timing is achieved through a very simple cyclic approach
consisting of one pass for sampling and the next for cycling
the buffers. From the end of the sampling pass a read pulse
feeds this sample into the buffer. Then memory cycling starts
at a frequency 1200 times higher than the sampling frequency.
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157
__
n
00 100
At the same time a counter stores the number of words
shifted. When the word number 1024 is reached, the clock
is inhibited. In the meantime a new sample is taken during the
cycling procedure and is presented at the outputs of the A/D
converter. Then the read pulse is derived which brings us to
the beginning of the main cycle. In Fig. 7(a) the timing dia-
gram is shown.
If a read pulse is presented to the buffers at the same time,
the inputs to the buffers must be enabled. Use is made of dy-
namic shift registers requiring a two-phase clock-pulse ob-
tained by means of a flip-flop.
In order to reduce the power dissipation of the shift-registers
in the logical-0 state of the clock-pulse, the duty-cycle is re-
duced by means of a R.C. network. This configuration is
shown in Fig. 7(b).
Horizontal shifting of the contour-limits is achieved by using
the read clock pulse without enabling the input gates. This
shifting, which is only possible in the time-scaling mode, ob-
structs a proper positioning of these limits due to the fast mov-
ing display. Improvement of this shifting speed is easily ob-
tained by omitting a certain number of read pulses by means
of gating.
APPLICATIONS, RESULTS
1. Fig. 8 shows the results which are obtained with an input
signal having a large noise artifact. Line B shows the trigger
signal resulting from the contour-limit detection while line C
shows the output of a conventional QRS detector. It can
clearly be seen that no trigger signal is gathered in response to
 158 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH 1976

Clock 2

Read
enable

Convert
command

1/2 SN 7473

(b)

Fig. 7. (a) Tining diagram of the connection between clock 1 and clock 2 and the derived sampling pulses. Shifting one
contour-limit with respect to the other is obtained by omitting the read enable pulse (lower trace of the extracted area).
(b) Schematic diagram of the duty-cycle reducing circuit applied to clock 1.

Fig. 8. Strip chart recording presenting the actual signal (trace A) and the derived trigger signal (trace B). For comparison,
the output of a conventional detector is recorded (trace C). It should be noted that due to the cycle time of the detector
a certain time delay between the occurrence of the triggering signal and the derived trigger pulse is generated.

the artifacts. This can be of advantage in cases where false similarity of the triggering signal with the adjusted contour-
positive triggers must be avoided. limits, it is possible that an artifact will inhibit the appropriate
2. Fig. 9 shows detection of extrasystoles having a specific trigger though the configuration without artifact would meet
configuration. Since it is well known that the configuration of the specifications presented in these contour-limits. Therefore
the extrasystole as seen on the ECG is dependent upon the the design provides the possibility of generating a trigger signal
point of origin of the extrasystole, such an instrument could at different similarities of the compared samples. In our case,
be used to monitor patients suspected of having ectopic foci. 100%=n, 75% 3 n, 50%= 2 n and 25%= 1 n.
It can clearly be seen that an artifact (R), similar to the The trigger accuracy will depend on the time elapsed be-
extrasystole but not having the correct configuration, will be tween entrance of the configuration in the bounded area and
rejected. departure from this area. Shifting one contour-limit with
In Fig. 10 a long term recording is shown with the detector respect to the other will narrow this area. The trigger accuracy
adjusted to extrasystoles. will then be improved because the configuration will remain in
the bounded area during a shorter period of time. This will
DISCUSSION allow the configuration to vary in amplitude within both
A point of discussion is the necessity for all samples to contour-limits without considerable reduction in accuracy.
satisfy equation (2).
Authorized For,
licensed use if theto:trigger
limited is generated
PSG College of Technology. 100% on July
atDownloaded the same
In 26,2010 at 06:33:28 it isfrom
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Restrictions baseline of both
COMMUNICATIONS 159

Fig. 9. Strip chart recording showing trigger signals (trace C) derived from the instrument with contour-limits adjusted to
an extrasystole. It should be noted that an artifact similar to an extrasystole (R in trace A) is rejected. Trace B shows
the filtered signal, while trace D shows the triggers obtained from a conventional QRS detector.

Fig. 10. Long term recording showing triggers generated with the instrument adjusted to extrasystoles (trace D). Trace A
shows the actual signal, trace B the filtered signal and trace C shows triggers generated with a conventional detector.

contour-limits in such a manner that the area in which the more than one configuration with individual limit adjustment.
baseline of the configuration has to remain will be increased. Thus a trigger output can be produced with the occurrence of
In this case a certain amount of baseline shift will be allowed. any one of several stored configurations.
It will be clear that any possible combination of amplification
factor, baseline adjustment and contour shifting can be CONCLUSIONS
achieved. It should be clearly pointed out that depending on the pur-
Reducing the number of samples raises the possibility of a pose for which the instrument will be used, adjustment of
higher sampling frequency, facilitating the detection of con- contour-limits has to be made for maximum detectability or
figurations of shorter duration. Detection of such phenomena maximum accuracy of the generated trigger signals.
would require a higher trigger accuracy, which is automatically maximum detectability As mentioned before, maximum accuracy contraindicates
due to the presence of noise in the sig-
available due to the increased sampling rate. After each cycle nal. Configurations with slight variations in similarity can be
the comparator/counter contains the number of samples that detected, but due to the allowance for these variations, with a
satisfied equation (2). If the system is not operated at 100% decreased accuracy. An interesting application will be the
agreement it is possible to apply some statistical analysis to the field of signal averaging.
contents of the counter in order to detect possible repetitive a. Averaging methods applied to the ECG in order to derive
dropouts. These dropouts could be the result of periodic noise a representative configuration from the ECG taken under
mixed with the input signal. stress will be improved by a higher trigger accuracy.
A slight modification of the instrument enables one to store b. Due to the accuracy it will be possible to use averaging
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 160
methods in order to obtain high frequent components present
in the QRS complex. For instance averaging of "slurs and
notches" [41, [5].
c. Also averaging of the complete ECG will be possible.
This enables non-invasive investigations on the conduction
system of the heart to be carried out [61.
ACKNOWLEDGMENT
The authors are very grateful to Mr. J. G. Meijer of the De-
partment of Physiology for the photographic assistance in
the preparation of the illustrations. They also wish to thank
Mrs. W. M. U. van Barschot for the accurate typing of the
manuscript.
REFERENCES
[1] W. P. Holsinger, K. M. Kempner and M. H. Miller. A QRS prepro-
cessor based on digital differentiation. IEEE Trans. Biomed. Eng.,
vol. BME-18, nr. 3, pp. 212-217, May 1971.
[2] A. R. Hambley, R. L. Moruzzi and C. L. Feldman. The use of
intrinsic components in an ECG filter. IEEE Trans. Bionm Eng.,
vol. BME-21, nr. 6, pp. 469-473, November 1974.
[3] A. Sandman, D. W. Hill and A. H. Wilcock. Analogue preproces-
sor for the measurement by a digital computer of R-R intervals
and R wave widths. Med. Biol. Eng., vol. 11, nr. 2, pp. 191-
200, March 1973.
[4] N. C. Flowers and L. G. Horan. Diagnostic impact of QRS notch-
ing in high-frequency electrocardiograms of living subjects with
heart disease. Circulation, vol. XLIV, pp. 605-611, October 1971.
[5] P. H. Langner, D. B. Geselowitz and S. A. Briller. Wide band
recording of the electrocardiogram and coronary heart disease.
An. Heart Journ., vol. 86, nr. 3, pp. 308-317, September 1973.
[6] E. J. Berbari, R. Lazarra, P. Samet and B. J. Scherlag. Noninvasive
technique for detection of electrical activity during the P-R seg-
ment. Circulation, vol. XLVIII, pp. 1005-1013, November 1973.
An Interactive Computer Peripheral to Measure the
Electromyographic Silent Period
S. S. ALTUG, C. T. CHILDRESS, JR., S. M. DEMUND,
W. D. McCALL, JR., MEMBER, IEEE, AND M. M. ASH, JR.
Abstract-A device to provide automated measurement of the electro-
myographic silent period with real time capability uflizing a voltage-
time window is described. This device is being used in the clinical
dental diagnosis and treatment of functional disorders of the masti-
catory system. The design, performance, utilization, and other applica-
tions of this device are discussed.
INTRODUCTION
Controversy abounds in clinical dentistry over the no-
menclature, etiology [1]-[4], and treatment [5]-[9] of pain
associated with the muscles of mastication and the temporo-
mandibular joint (TMJ). DeBoever [10] has reviewed these
controversies while Agerberg and Carlsson [ 11 ] have reported
epidemiological evidence that up to 57 percent of the adult
population report one or more symptoms of TMJ dysfunction
Manuscript received October 22, 1974; revised April 25, 1975. This
work was supported by the USPHS under Grant DE 02731.
The authors are with the Bioengineering and Occlusion aboratory,
Department of Occlusion, Dental Research Institute, School of Den-
tistry, University of Michigan, Ann Arbor, MI 48104.
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IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH 1976
and about 12 percent of the population report pain on jaw
opening. This syndrome appears to be a problem of some
complexity, and therefore a quantitative diagnosis would be
valuable in assessing symptom severity, treatment progress,
and competing treatment plans.
Our laboratory has taken a multi-faceted approach to the
problem of quantifying the diagnosis of TMJ problems [ 12] -
[15]. The goal is to improve the curative and preventive
techniques of the dentist by providing quantitative measure-
ments for diagnosis.
One quantitative measurement technique reported to have
diagnostic significance is the duration of the electromyographic
(EMG) silent period following the jaw-jerk or myotatic reflex.
Bessette, Bishop, and Mohl [ 16] have reported that the silent
period duration is greater than 32 ms in diagnosed TMJ
patients and less than 28 ms in asymptomatic patients.
Further, they report that successful treatment results in a
decrease of the silent period duration to within the normal
range [16]. Studies from our laboratory have confirmed and
extended these results [14], [15].
Previous techniques for measuring the duration of the silent
period whether using a mechanical device [ 16], optical scanner
[17], or photographic projection [18] all involve slow, post-
experiment hand measurements with the attendant possibilities
for bias and error. The importance of the phenomena, the
number of measurements required, and the possibility of
human error all suggest that a rapid, automated technique for
measuring silent period duration would significantly enhance
research progress. The purpose here is to describe a device that
implements such a technique. A preliminary report has been
presented [19].
DESIGN CONSIDERATIONS
Input Signal Constraints: While physiologically the silent
period is comprised of a complex interaction of disfacilitation
and inhibition at the motoneuron, operationally a simple
definition must be used. Experience suggested that a defini-
tion including both an amplitude criterion and duration
criterion would be satisfactory. An amplitude window is
necessary because noise in the recording system precludes an
absolutely "silent" silent period. A time window, constraining
the duration of acceptable silent periods to within reference
minimum and maximum durations, is necessary to exclude
zero crossings and other short periods of low activity on the
minimum side and rest and other periods of low activity on the
maximum side.
Even with the two windows, some parts of EMG traces were
expected to fit the operational definition of the silent period
and cause false alarms, so a monitoring technique would be
necessary. This would retain the clinical judgement of the
clinician as to what constituted a silent period while relieving
him of the measurement chore. The intent is not to replace
the dentist but to relieve him of non-clinically oriented tasks.
Another feature of the EMG signal is variability of signal and
noise amplitude from patient to patient. Hence the ability to
control the windows was considered necessary. Variations on
the order of milliseconds were expected from the nature of the
waveform as the EMG signal entered and left the silent period.
Therefore device accuracy on the order of ± 1 percent was
considered adequate. This would amount to ± 80 Mus for the
shortest silent period expected. The EMG signal has a
spectrum that extends to a few hundred Hz but most of the
power is concentrated between 30 and 100 Hz [201, [211.
Hence commercially available devices would give adequate
frequency response.
Laboratory Environment: This design must interface to
other items of laboratory equipment. The flow of information
is shown in Fig. 1. The EMG amplifiers and polygraph were