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1. Introduction
age of communication era internet email broadband
became a household term

One purpose: transmit (messages)

Reuben B. De Castro, Jr., MD, MSc

Dierent modes (medium; direction) Dierent area of interest: message or

transmission or medium

Disturbance
Sender
F E E D B A C K D I S T U R B A N C E

maybe caused by
The sender Transmission channel Receiver itself.

s n m

Channel Receiver

For simplicity: disturbance is additive

Mixture m is the sum of signal s plus noise n

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Disturbance
Example of superimpose disturbance
Environmental noise clinicians room, street, garbled

Five configurations S-T-R

S R S R S = R S ? ? R

speech

The variables m,s,n are time-varying signals Maybe digital or analog May consist parallel components:
3-channel electrocardiogram 16-channel electroencephalogram

S maybe time-varying image: echocardiography

S R
One-way transmission Both sender and receiver are known Receiver interest in message not transmission

S R
Bidirectional communication Known sender/receiver Receiver is interested in message Example
Clinician-patient conversation during history

channel Example

Heart auscultation Sender is heart; Signal s is audible sound generated by valves & blood

taking

ow turbulence

N could be respiration; noise in room; stethoscope

brushing against clothes

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S R

S = R
Sender and receiver are one Typically, not interested in message but in the

Bidirectional communication Known sender/receiver Receiver is interested in message Example

Clinician-patient conversation during history

channel

Example
Ultrasound Generated by an array of piezoelectric crystals and the

taking Sender is patient (listening/answering) S is speech N is speech disturbance R is clinician ( ask/answer)

echoes received from tissue boundaries Sender (S) = crystals Signal (s) = ultrasonic wave (Mhz) Noise (n) = distorting reections Receiver (R) = crystals receiving echoes

S ?
This is an academic situation wherein the

? R
Typical situation wherein symptoms are

receiver is

Not present Not paying attention Or has no correct transducer

detected but cause of symptom is still unknown Example

Deviating laboratory values Blood chemistry

Example
Symptoms overlooked by clinicians (like

symptoms occurring randomly)

Undetected extrasystoles

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Ultrasound
Diagnostic purpose: neurology, cardiology,

Ultrasound
Ultrasonic signals can be enhanced
Digitized and computer-processed Speed of blood ow

obstetrics Signal or wave front with a frequency of 1,2,8 MHz, depending on desired resolution Ultrasonic wave is directed to organ of interest (e.g. obstetrics- fetal heart or skull) Echoes receive are the mixture of signal and noise Receiving transducer detects only reected signals (S=R) Echoes reected generate a picture (fetal position; tumor; asymmetry in brain tissue cause by internal bleeding)

Imaging
Cardiology
Using contrast materials: radiopaque uid injected Information on the size of ventricles Received signals give information on tissue

Wireless Transmission
Holter monitoring Implant a transducer or transmitter in the

density

Sensing device (R) can be a photographic

emulsion or photonmultiplier (cardiac output)

Estimate ventricular volume as a function of time

body Measure intracranial pressure Trasmitter S sends signals to some receiver R not too far remote from body Radio transmission is used to avoid wires that would hamper the natural protrusion of the micro-transmitter

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Man-made sender/receiver
Ultrasound
S and R are identical

Transmission by natural language

Patient history taking Spoken language and unspoken (body language) Disturbance not only environment noise but

Imaging
S (X-ray tube) and R (camera) are physically

hidden message

opposite and mechanically coupled

Superimposition of s and no does not apply No true physical or quantitative value True message by interpretation and coding Natural language by computers is extremely

Wireless transmission
Loose connection between sender and receiver

dicult; never fully attainable

Biosignals
Generated by every living cell, organ,

Biosignals
Biochemical
Blood gasses PO2 PCO2

organisms Electrochemical

Depolarization of cell Result of ows of ions that pass through cell

membranes, Na+, Cl-, Ca++

Hormonal
Release of oxytocin during labor

Mechanical
Respiration Motion by thoracic muscles resulting in airow

and pressures

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Aspects of information
Directly related to 3 stages of human activity (1st lecture) 3 stage of diagnostic-therapeutic cycle

Aspects of Information
Syntactic aspect
Grammar or syntax for the description, storage, or

transmission of messages

Can be best called data Data do not necessarily have to be interpreted by

receiver
Many observations in healthcare are just data Only after human interpretation, do data acquire

meaning, which is

Aspects of Information
Semantic aspect
Pertains to the meaning of message Not interest on the way information was received

Aspects of Information
Pragmatic aspect
All interpretations lead to activity A decrease in uncertainty in making a diagnosis or

or the syntax Signicance for interpretation and decision- making Can only be derived through context Free text or natural language Time ies like an arrow

testing a hypothesis is an eect of information

In healthcare, pragmatic aspect is the eect on

the therapy

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Aspects of information
8.2 Hb 8.2 BT / diet / drug

Mathematical Aspects
Shannon
Information is the negative value of the logarithm

of the probability of occurrence

-log2 P where 0 p 1 Syntactic aspect

Information science
Brillouin
Information is a function of the relation between

Information entropy
Use an optimal transducer
ECG: using noise-free electrodes (stainless steel

possible answers before and after reception Related to semantic aspect

with a silver-silverchloride pase) photosensitive devices

X-ray: use high-resolution lm material or

Wiener
Information is a name for the content of what is

exchanged with the outer world as we adjust to it and make our adjustments felt upon it Related to pragmatic aspect

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Information entropy
Keep the transmission channel short
Blood chemistry: measure the PO2 directly in

Information entropy
Reduce the transmission channel disturbance
ECG: screening o of external electric or magnetic

blood than transcutaneously Intracardiac conduction: recording of HIS-bundle electrogram instead of a body surface ECG Fetal cardiac intervals: preferably put electrode directly on fetal skull instead of on maternal abdomen

elds

ECG: reduce disturbance caused by respiration

and muscle activity

Information entropy
Use, where possible, redundant information
Record a series of parallel ECG complexes

Information entropy
Use prior knowledge for interpretation as

much as possible

(coherent averaging) Observations of the heart by independent methods

Echocardiography catheterization

Patient history: use available (clinical) knowledge

to obtain necessary information for decision making (applying feedback to sender) Signals and images: using knowledge of frequency domain and occurrence of events as a function of time

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Data in Computers
Integers: a discrete number
Number of premature ventricular contractions per

Data in Computers
Codes
Disease Drugs Personal observations: pain; swelling

time unit; Number of leukocytes

Temperature Blood pressure

Reals: a measured variable

Text: natural language

Text in patient history Documentation of event during patient

monitoring

Reliability
Completeness Accuracy
Correctness Conformity

Precision