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1 Journal of the Korea Academia-Industrial cooperation Society Vol. 15, No. 4 pp , ISSN / eissn 고성능의료용아날로그프론트엔드 (AFE) 를이용한 12 채널심전도획득및부정맥판단시스템개발 고현철 1, 이승환 1, 허정현 1, 이정직 1, 최우혁 1, 최성환 2, 신태민 1, 윤영로 1* 1 연세대학교의공학과, 2 씨유메디칼시스템 The Development of 12 channel ECG Measurement and Arrhythmia Discrimination System with High Performance Medical Analog Front-End(AFE) Hyun-ChulKo 1,SeungHwanLee 1,JungHyunHeo 1,Jeong-JickLee 1, Woo-HyukChoi 1,Sung-HwanChoi 2,TaeMinShin 1 andyoung-royoon 1* 1 Dept.ofBiomedicalEng.,YonseiUniversity, 2 CU MedicalSystems 요약본논문은의료용아날로그프론트앤드 (analogfrontend;afe) 를이용하여 12 채널심전도를측정하고신호분석을 통해부정맥을판단할수있는시스템개발에관한논문이다. 최근국내급성심정지발생이증가하고있으며이에원인이 되는부정맥을진단할수있는시스템의필요성이증가하고있다. 기존의 12 채널심전도시스템은회로구성이복잡하고 큰부피를차지하는단점이있으며이를개선하기위해본논문에서는의료용 AFE 와부정맥을판단할수있는알고리즘 및신호처리를위한 DSP 로시스템을구성하였다. 추가적으로 12 채널심전도의파형관찰과부정맥판별결과를 7 인치 LCD 를통해출력하며터치패널을통해사용자입력을받는다. 본논문에서구현된시스템을검증하기위해심전도시뮬레이터 의출력신호 ( 정상신호 / 부정맥신호 ) 에대한판별테스트와부정맥알고리즘을임베디드환경에적용하기위한최적화과정 의성능평가를진행하였다. Abstract This paper deals with system development which measures 12 channel ECG using medical analog front end(afe) and discriminates arrythmia through signal analysis. Recently, occurrences of cardiac arrest have been increased. So the need of system that diagnoses an arrythmia which results in cardiac arrest is increasing. There are some drawbacks of conventional 12 channel ECG system that it occupies bulk and consists of complicated circuit. To improve those, we made up the system composed of medical AFE, algorithm for discriminating arrythmia and DSP for signal processing. This system can be monitored 12 channel ECG waveforms and the discriminant analysis result of arrhythmia through 7" LCD and received the input through touch pannel. In this study, we conducted normal operation test about output signal of ECG simulator(normal/abnormal ECG signal) to verify the implemented system and performance evaluation of the optimization process for applying arrhythmia algorithm to an embedded environment. Key Words : 12 channel ECG, Analog Front End, Arrhythmia-Discrimination, Electrocardiographic. 1. 서론 보건복지부의연구보고서자료에의하면국내급성 심정지발생건수는 2010 년 25,909 건에서매년조금씩증 가하여 2012 년에는 27,823 건에달하고있다 [1]. 이와같 은급성심정지는심장기능의이상에의해발생하며정 본연구는교육부와한국연구재단의지역혁신인력양성사업으로수행된연구결과임 (No. 2011H1B8A ). * Corresponding Author : Young-Ro Yoon(Yonsei Univ.) Tel: yoon@yonsei.ac.kr Received March 5, 2014 Revised (1st April 2, 2014, 2nd April 9, 2014) Accepted April 10,

2 한국산학기술학회논문지제 15 권제 4 호, 2014 확한진단을위해서는흉부심전도와사지유도심전도를동시에관찰하여야한다. 이측정방법이 12 채널심전도측정이며전문의는각파형을분석하여정확한부정맥발생원인과위치를진단하게된다 [2-4]. 최근집적회로에대한기술의고도화가이루어져생체신호계측전용칩이출시되고있다. 생체신호를계측하기위한회로는신호계측의안정성과재현성을수반하여야한다. 신호계측을위한전처리회로를의미하는아날로그프런트앤드 (analogfrontend;afe) 는주파수대역필터와증폭기,ADC 까지포함하고있다 [5]. 전처리회로를최소화시키는장점을이용해휴대용생체계측기기를개발하는다양한연구가진행되었다. 먼저 CMOS 방식을이용한휴대용뇌전도 (Electroencephalogram ;EEG) 및심전도측정기술 [6], 다채널설정심전도측정시스템 [7], 무선수신이가능한심전도및근전도 (Electromyogram ;EMG) 시스템 [8] 등의연구가이루어지고있다. 이외에도신호계측후 DSP 칩을이용하여디지털필터를통한데이터후처리를적용한연구 [9] 도있었으나신호파형의추출및분석에대한기능은적용하지않았다. 이와같이기존의연구에서는단순신호계측용도의시스템에대한연구만진행되었으며, 진단을목적으로하는시스템의소형화및시스템개발에대한연구가필요한상황이다. 특히 12 채널심전도를계측하기위한회로는시스템에서차지하는부피가크기때문에환자감시장치및제세동기등연관되는의료기기의소형화를위해서 AFE 를이용한회로구성과분석시스 템은필수적이다. 이에본논문에서는의료용 AFE 를이용하여 12 채널심전도를획득하고신호처리를위한 DSP 칩을추가구성하여부정맥상태를판단할수있는시스템을개발하였다. 그리고개발된 12 채널심전도획득및부정맥판단시스템을통해심전도시뮬레이터의정상신호 / 부정맥신호를판단해보았다. 2. 본론 2.1 시스템구성본시스템에서는 Fig.1 의시스템블록선도와같이심전도획득을위한전처리부, 부정맥판단알고리즘에관한연산을수행하는신호처리부, 디스플레이와신호저장및외부통신을위한 Arm Core 부로구성된다. 내부적인통신은모두 SPI 통신으로데이터를송 수신한다. 전원공급을위한의료용 SMPS 아답터 (12V) 를사용하여입력받은전압을 5V,3.3V,2.5V,-2.5V 로변환하는하압회로단과 LCD 동작을위한 30V 승압회로를거치게된다. 전원과접지영역은아날로그단과디지털단으로구분하여다음과같이전기적으로분리하였다. 아날로그단은전극리드커넥터 -전처리부및보호회로로구성되며디지털단은 DSP,ARM core 부, 저장, 통신및디스플레이관련회로를포함한다. 전처리부에서는심전도신호를계측하고데이터를디 [Fig. 1] System block diagram about 12 channel ECG system 2218

3 고성능의료용아날로그프론트엔드 (AFE) 를이용한 12 채널심전도획득및부정맥판단시스템개발 지털신호로변환하는역할을한다. 이과정은 Texas Instrument 사의 ADS1298 을통해이루어지며저전력 24ibt 분해능의 ADC 기능을가진것이특징이다. 세부적으로는총 8개의입력채널을통해 500Hz 의샘플링주파수로데이터를입력받는다. 신호처리부는부정맥판별알고리즘을적용하며, 이알고리즘은빠른수학적연산환경을필요로하기때문에 DSP 칩 (TMS320F28069) 을추가하였다. 이를통해초당 80MHz 의연산속도와 32bit 부동소수점연산을제공하는점이외에통신인터페이스를통합으로내장하여주변회로구성이간소하다는장점이있다. 12 채널심전도신호측정과부정맥판단에대한전반적인제어는 ARM core 에서이루어진다. 본시스템에구성된 ARM Coretex-M 계열의 STM32F407 은최대 168MHz 클럭으로동작할수있으며대용량의데이터를후처리하기위해충분하다. 통신인터페이스로는 SPI, RS232c,Ethernet 및 USB 를지원하며마이크로 SD 카드에심전도데이터를텍스트파일로저장하는기능을수행한다. 최종적으로사용자의입력 ( 측정시작, 측정중지및판별결과확인 ) 을받기위해터치스크린기능을가진 7인치 TFT-LCD 를구성하였다. 2.2 부정맥판별알고리즘본논문에서적용된부정맥판별알고리즘은 Fig.2 의알고리즘의순서도와같이 dataconditioning,adaptive threshold 방법과 supportvectormachine(svm) 으로구성된다. 먼저 AFE 를통하여획득한심전도데이터는포토커플러를통해 DSP 칩으로입력된다. 입력된데이터는 dataconditioning 과정을거치고검출된각각의 QRS complex 에서특징을추출한다. 최종적으로추출된파라미터들을부정맥과정상심전도로판별하기위해 SVM 을적용하고, 이과정까지총세단계의절차를거쳐부정맥을판별하게된다 [10]. 각단계별세부적절차는다음과같다. 첫번째단계인 dataconditioning 과정에서는 AFE 로부터 500hz 주파수로샘플링된심전도데이터를 250Hz 로다운샘플링한다. 이는부정맥판단을위한필요구간이 QRScomplex 이므로 250Hz 의주파수로도신호분석이가능하며데이터처리성능을향상시키기위함이다. 또한,4 초동안의심전도데이터를저장하고 2~40Hz 의 밴드패스필터를거친후,500ms 윈도우를가진 DC 제거기를적용한다 [8]. [Fig. 2] flow chart of discriminant algorithm 두번째로는심전도파형의특징추출과정으로, 이과정은심전도의외형적특성중피크들을 adaptive threshold 방법으로검출한다. 그리고 QRS complex 를평가구간의기준으로선별하여해당 4초세그먼트내의 R-Rinterval,complex 경사도및 complex 의형태간일치도를정량화하여추출하였다. 이과정에서사용된기법은 crosscorelation 으로,[10] 에서제안한알고리즘은데이터처리를위한윈도우크기를 500 개의데이터로고정하였다.PC 상에서개발된이알고리즘을본시스템과같은임베디드환경으로적용하였으며부정맥판단알고리즘의처리성능을평가하였다. 추가적으로처리성능평가에따른알고리즘의최적화를진행하였으며 QRS Complexwidth 에따라데이터윈도우를가변할수있도록개량하고판별성능을유지하는범위내에서성능차이를측정하였다. 마지막단계는심전도특징판별을위한 SVM 의적용이다. 다양한 SVM 종류중에서본단계에서는 C.Cortes 와 V.Vapnik 이제안한방법을사용하였다 [11]. 특징추출단계에서획득한 R-Rinterval,complex 경사도그리고 complex 모양간일치도를파라미터로입력하고여기서발생하는다중파라미터문제는 oneagainstal(oaa) 방법으로해결하였다. 본논문에서사용된 SVM 은 2219

4 한국산학기술학회논문지제 15 권제 4 호, 2014 GaussianRadialBasisFunction(RBF) 커널을적용하였다 [11]. SVM 의판별모델을만들기위하여 MIT-BIH ArhythmiaDatabase 중부정맥신호 131 개로 training 하였으며 [12], 이때판별정확도를높이기위하여 Cross-validation 을시행 (5 회 ) 하여최적의 c값과 gamma 값을얻어내었다. 이 c와 gamma 는 SVM 모델에서판별을할때필요로하는가중치들이다 [10]. 300BPM 의범위의심박수를 0.05mV~5.50mV 의크기로발생시킨다. 비정상상태의심전도파형은총 30 가지종류를제공하며검출성능테스트를위해쓰인심전도신호는심실성부정맥인심실빈맥, 심실세동과정상신호총 3가지이다. 2.3 시스템구현시스템구성에따라구현된시스템은 Fig.3 과같다. 전처리부와신호처리부를하나의보드로구성하였으며 ARM core 부와저장및통신기능에대한회로를하나의보드로구성하여총 2장의 PCB 로제작하였다. 입력전원으로는 12V 의료용전원공급기를사용하여구동되며모든사용자입력은터치패널을통해이루어진다. 일반구동상태에서는 12 채널심전도모니터링기능으로운용되며분석시작버튼을통해 2~5 초간실시간으로분석후판독결과를출력하게된다. 판독결과는분석된현재심전도상태와평균심박수및분석시간을출력한다. 구현된시스템의테스트를위해 FLUKE 사의 12 채널심전도시뮬레이터인 medisim300b 를를이용하였다. 테스트를위해쓰인시뮬레이터는측정케이블의임피던스를변경할수있으며 1% 의정확성을보장한다.30~ (a) [Fig. 3] Result of 12 channel ECG Measurement system and test with patient simulator (medisim300b, FLUKE) (b) [Fig. 4] System flow charts (a) Main flow chart of ARM core (b) Flow charts of 12ch ECG acquisition, raw data transmit and transmit result of algorithm to ARM core 2220

5 고성능의료용아날로그프론트엔드 (AFE) 를이용한 12 채널심전도획득및부정맥판단시스템개발 시스템구성에서언급한바와같이 AFE 의운용과 DSP 펌웨어에이식되어있는판별알고리즘의제어는 Arm core 에서이루어진다. 이에대한펌웨어의순서도는 Fig.4 와같으며 SPI 통신을통해 DSP 와 AFE 로데이터송수신, 판별시작및정지등의메시지통신을한다.Fig.4 의 (a) 는 ARM core 의순서도이며 (b) 는 AFE-DSP 간,DSP-ARM core 간제어순서를나타낸다. 본시스템은부정맥의종류중심실빈맥 (ventricular tachycardia) 과심실세동 (ventricularfibrilation) 을판별할수있으며정상상태 (normalsinusrhythm) 의심전도파형일경우모두정상으로출력한다. 추가적으로계산된심박수와데이터분석에쓰인데이터구간을초 (sec) 로표시한다.Fig.5 는 12 채널심전도시뮬레이터를통해테스트한결과화면이며좌, 우 6개의파형을출력하도록인터페이스를구성하였다. 3. 결론급성심정지를일으킬수있는질환의정확한진단을위해서는 12 채널심전도계측은필수적인방법이다. 본연구에서구현한시스템은 12 채널심전도를계측할뿐만아니라부정맥판단이가능하다.12 채널심전도계측을위한 AFE 을이용하여소형화시스템을구현하였으며 DSP 와 ARM core 를구성하여판별알고리즘과같은고성능을요하는작업을충족하도록하였다. 시스템의정상동작을확인하기위해서심전도시뮬레이터인 medisim300b(fluke 사 ) 로정상상태와부정맥 ( 심실빈맥, 심실세동 ) 신호를입력하여테스트하였다. 부정맥판단및심박수의변화 (60~258BPM) 도오차없이정확한측정결과를출력하였다. 판별성능을유지한상태에서진행한알고리즘최적화에따른성능평가는실행시간, 단축시간, 성능효율을비교하여분석하였다 [13]. Table1 은심전도의정상상태와부정맥 ( 빈맥, 심실세동 ) 상태의입력신호별임베디드프로그램의최적화전, 후의실행시간을나타낸것이다. 상대적으로심실세동의 [Table 1] Type of comparison - ECG signals by the run-time and performance efficiency (a) ECG type Run-time (previous) (sec) Run-time (revised) (sec) Reduced time(sec) Performance eficiency (%) normal Vtac Vfib (b) (c) [Fig. 5] Discriminant analysis results of system implementation (a)nomal ECG (b)tachycardia (c)vfib [Fig. 6] Type of comparison - ECG signals by the run-time 2221

6 한국산학기술학회논문지제 15 권제 4 호, 2014 경우더많은연산시간을필요로하는것을알수있으며이는 QRScomplex 구간을식별하기어려운불규칙적인파형에기인한것으로파악된다. 각심전도별로 10 회의실험을진행했으며본연구에서적용한알고리즘최적화를통해평균약 94.5% 의시간이절감되는것을볼수있다.Fig.6 는최적화전, 후의실행시간과성능향상률을한눈에볼수있도록그래프화한것이다. 정상상태와부정맥 ( 심실빈맥, 심실세동 ) 신호에대해프로그램최적화과정이후실행시간이단축된것을볼수있다. 향후타의료기기와의접근성과본시스템의상용화에있어심전도분석에대한알고리즘의고도화가필요하며부정맥의다른종류인심방세동및심근경색과같은파형의판별정확도를높여야할것이다. 그리고생체신호를획득하고처리하는과정에있어서안정성과재현성에대한부가적인기술들이접목되어야상용화를하는데문제가없을것으로판단된다. 본연구의기술을토대로의료기관, 공공장소에비치가가능한휴대형심전도분석기개발이가능하며소형화를통해디자인적인면을개량하면응급구조사, 비의료인의현장대처능력을향상시킬수있다. 추후자동제세동기와의연동인터페이스개발및장비호환시스템구축에관한연구를통해사용자에게이점을줄수있을것이다. References [1] S. Y. Hyun, H. K. Park, C. H. Park, S. K. Kim, " Announcement of Sudden Cardiac Arrest Investigation", p.1, Korea Ministry of Health & Welfare, [2] Y. H. Kim, S. Y. O, D. S. Lim, D. S. Hyun, S. G. Chang, Y. H. You, Y. J. Kim, B. S. Sim, H. W. Lee, The Relationship Between ST-T Electrical Alternans on EKG and Ventricular Arrhythmia, Korean Circulation Journal, Vol.20, No.3, pp , [3] Surawicz, Borys, Electrophysiologic Basis of E.C.G and Cardiac Arrhythmias, pp , Williams & Wilkins, [4] Dale Dubin, Rapid Interpretation of EKG`s, p , Cover Publishing Company, [5] Refet Firat Yazicioglu, Patrick Merken, Robert Puers, Chris Van Hoof, A 60W, 60nV/Hz Readout Front-End for Portable Biopotential Acquisition Systems, Journal of solid-state circuits, Vol.42, No.5, pp , DOI: [6] K. A. Ng and P. K. Chan, A CMOS Analog Front-End IC for Portable EEG/ECG Monitoring Applications, IEEE Transactions on circuits and system-i:regular paper, Vol.52, No.11, pp , DOI: [7] Punapung, Anucha, Suradej Tretriluxana and Kitiphol Chitsakul, A Design of Configurable ECG Recorder Module, Biomedical Engineering International Conference (BMEiCON-2011), pp.67-70, [8] Dixon, A. M., Allstot, E. G., Gangopadhyay, D., & Allstot, D. J. Compressed sensing system considerations for ECG and EMG wireless biosensors. Biomedical Circuits and Systems, IEEE Transactions on, 6(2), pp , DOI: [9] Kening Wang, Shengqian Ma, Jing Feng, Weizhao Zhang, Design of ECG Signal Acquisition System Based on DSP, Procedia Engineering, Vol.29, pp , DOI: [10] Seung Hwan Lee, Hyun-Chul Ko, Young-Ro Yoon, Classification of Ventricular Arrhythmia using a Support Vector Machine based on Morphological Features, th Annual International Conference of the IEEE(EMBC), pp , DOI: [11] C. Cortes and V. Vapnik, Support-Vector Networks,, Machine Learning, vol. 20, No.3, pp , DOI: [12] Cuiwei Li, Chongxun Zheng, Changfeng Tai, Detection of ECG Characteristic Points Using Wavelet Transforms, IEEE Transactions on biomedical engineering, Vol. 42, No 1, pp , DOI: [13] Chang Kyu Jeon, Kyeung Seek Lew, Yong Deak Kim, Program Execution Speed Improvement using Executable Compression Method on Embedded Systems, The Institute of Electronics and Information Engineers, vol. 49, No.1, pp ,

7 고성능의료용아날로그프론트엔드 (AFE) 를이용한 12 채널심전도획득및부정맥판단시스템개발 고현철 (Hyun-ChulKo) [ 정회원 ] 2009 년 2 월 : 연세대학교보건과학대학의공학부 ( 의용전자공학사 ) 2009 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과 ( 공학석박사통합과정 ) 이정직 (Jeong-JiuckLee) [ 준회원 ] 2009 년 2 월 : 연세대학교보건과학대학의공학부 ( 의용전자공학사 ) 2009 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과 ( 공학석박사통합과정 ) 신호처리, 제어시스템, 회로설계 신호처리, 제어시스템, 회로설계 이승환 (SeungHwanLee) [ 정회원 ] 2009 년 2 월 : 연세대학교보건과학대학의공학부 ( 의용전자공학사 ) 2009 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과 ( 공학석박사통합과정 ) 최우혁 (Woo-hyukChoi) [ 정회원 ] 2008 년 2 월 : 연세대학교보건과학대학의공학부 ( 의용전자공학사 ) 2010 년 2 월 : 연세대학교보건과학대학의공학과 ( 공학석사 ) 2010 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과 ( 공학박사과정 ) 신호처리, 제어시스템, 회로설계 의료용컴퓨터,System Integration, 신호처리 허정현 (JungHyunHeo) [ 준회원 ] 2009 년 2 월 : 연세대학교보건과학대학의공학부 ( 의용전자공학사 ) 2009 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과 ( 공학석박사통합과정 ) 최성환 (Sung-HwanChoi) [ 정회원 ] 1998 년 2 월 : 강원대학교물리학과 ( 이학학사 ) 2000 년 2 월 : 강원대학교컴퓨터공학과 ( 공학석사 ) 2001 년 12 월 ~ 현재 :( 주 ) 씨유메디칼시스템연구소장 신호처리, 제어시스템, 회로설계 신호처리, 의료생체계측, 심장전기생리 2223

8 한국산학기술학회논문지제 15 권제 4 호, 2014 신태민 (TaeminShin) [ 정회원 ] 1981 년 2 월 : 연세대학교공과대학전자공학과 ( 공학사 ) 1983 년 2 월 : 연세대학교공과대학전자공학과 ( 공학석사 ) 1989 년 2 월 : 연세대학교공과대학전자공학과 ( 공학박사 ) 1990 년 3 월 ~ 2000 년 2 월 : 국립경상대학교공과대학전자공학과교수 2001 년 3 월 ~ 현재 : 연세대학교보건과학대학의공학과교수 의료용컴퓨터, 컴퓨터하드웨어,System Integration 윤영로 (Young-RoYoon) [ 정회원 ] 1981 년 2월 : 연세대학교공과대학전자공학과 ( 공학사 ) 1986 년 6월 : California State University,LosAngeles 전기공학 ( 공학석사 ) 1991 년 2월 : Purdue University 전기공학 ( 공학박사 ) 1994 년 3월 ~ 현재 : 연세대학교보건과학대학의공학과교수 신호처리, 패턴인식, 제어시스템, 회로설계,u-Healthcare 2224

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