Journal of Medical Systems, Vol. 26, No.

2, April 2002 ( C 2002)

Theory and Applications of Biotelemetry

Nihal Fatma Guler1,2 and Elif Derya Ubeyli1

In this study, biotelemetry and its evolution is explained in detail. Bioelectric and physiological variables could be measured by biotelemetry systems. The development of a biotelemetry system and its principal operation are presented. The components of a biotelemetry system are explained. Biomedical data has been telemetered through every medium between two sites by using a variety of modulated energy forms. Designing of the link between transmitter and receiver is described. Important factors in designing a backpack or implanted telemeter are explained. The main features of implanted biotelemetry units are determined. Single-channel and multichannel biotelemetry systems are dened. The types of telemetry, and a comparison thereof, are given. The power sources of biotelemetry systems and features of different power sources are explained. A survey of biotelemetry applications on humans and animals is presented and advantages of using biotelemetry systems are determined.
KEY WORDS: biotelemetry; remote monitoring; data gathering; implantable device; modulation; telemetry types; single channel and multichannel biotelemetry.

INTRODUCTION Biotelemetry is dened as transmitting biological or physiological data from a remote location to a location that has the capability to interpret the data and affect decision making. Biomedical telemetry is a special eld of biomedical instrumentation that often permits transmission of biological information from an inaccessible location to a remote monitoring site. When direct observation is impossible, biotelemetry can be used to obtain a wide spectrum of environmental, physiological, and behavioral data.(1) Biotelemetry includes the capability for monitoring humans and animals with minimum restraint and for providing a reproduction of the transmitted data. If measurements and monitoring techniques are applied to restrained humans and animals, stress of immobilization causes alterations of measured variables. According to this concept, the advantage of biotelemetry is the measurement of physiological
1 Department

of Electronic and Computer Education, Faculty of Technical Education, Gazi University, 06500 Teknikokullar, Ankara, Turkey. 2 To whom correspondence should be addressed; e-mail: fnguler@tef.gazi.edu.tr. 159
0148-5598/02/0400-0159/0
C

2002 Plenum Publishing Corporation

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variables in conscious, unrestrained humans and animals. The method of biotelemetry is offering wireless, restraint-free, simultaneous, long-term data gathering.(24) It is obvious that any quantity that could be measured was adaptable to biotelemetry. Measurements that have been done in biotelemetry can be determined in two categories: 1. Bioelectrical variables, such as ECG, EMG, and EEG. 2. Physiological variables that require transducers, such as blood pressure, gastrointestinal pressure, blood ow, and temperature. By using suitable transducers, telemetry can be employed for the measurement of a wide variety of physiological variables.(5,6) Biomedical telemetry like many other things began as a laboratory curiosity but has evolved into a useful, reliable tool for data gathering. In 1903, Einthoven transmitted electrocardiograms from a hospital to his laboratory. Immersion electrodes were connected to a remote galvanometer directly by telephone lines. In this instance, telephone lines were merely used as conductors for current produced by biopotentials.(5) The use of wires in the transmission of biodata suited his purpose, but a major advantage modern telemetry has is the elimination of wires. In 1921, Winters transmitted heart sounds over a marine radio link. External transmitters of various signals evolved as electronic methods evolved to produce small transmitters. Later, several groups inserted small coils and electrodes into the skulls of animals so alternating currents could be induced for a primitive form of telestimulation.(6) The transmission of signals from a subject was a technique that evolved slowly. In 1950s transistors were invented and then signals were transmitted from the body. Endoradiosonde was one of the earliest biotelemetry units developed by Mackay and Jacobson.(5) Since the invention of integrated circuit technology in 1958, contributions of microelectronics to biomedicine and health care have been enormous. Many advanced diagnostic, therapeutic, and rehabilitative devices and systems would not have been possible without these contributions. The circuits tested by Markevitch showed that signals could be transmitted through the tissues of the body from quite small coils placed within the body.(7) Miniature and micropower are two concepts of modern biotelemetry design and construction. Improvements in these areas have closely paralleled the evolution of semiconductor and microcircuit technologies. Reliable, stable integrated sensors and biotelemeters on microcircuit designs and implementations are studied.(27) Biotelemetry is an important method for monitoring physiological variables by providing a wireless link between the subject and the data collection equipment. Biomedical data has been telemetered through every medium between two sites, including air, space, water, and biologic tissue, by using a variety of modulated energy forms like electromagnetic waves, light, and ultrasound. Physiological measurements are frequently telemetered from a subject. This can be done by a transmitter carried on a belt or in a pocket. However, there are cases in which the transmitter is swallowed or surgically implanted in subject. The transmitting unit can be carried outside the monitored subject as a backpack unit or can be implanted within the subjects body after appropriate miniaturization and sealing against body uid. An implantable biotelemetry unit is a device usually designed to sense a physiological event and

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transmit this information, at least over few centimeters of tissue, to an external receiver.(8,9) Although there had been examples of biotelemetry in the 1940s, they did not receive much attention until the advent of the NASA space programs. Biotelemetry is a specialized telemetry that NASA developed for shuttle ights in which electronic biomedical data taken from astronauts is transformed into radio waves and sent back to the ground. NASA has studied the design of advanced and reliable biomedical sensors and biotelemetry devices.(5,10,11)

THE COMPONENTS OF A BIOTELEMETRY SYSTEM Size, cost, circuit complexity, power requirements (and operational lifetime), transducers, nature of data to be transmitted, and performance dictate the design of a telemeter. First of all, a simple system is described to illustrate the basic principles involved in telemetry. The stages in a typical biotelemetry system are shown in Fig. 1.(6)

Transmitter and Receiver The stages of a typical biotelemetry system can be divided into functional blocks, as shown in Fig. 2 for the transmitter and in Fig. 3 for the receiver.(5) Physiological signals are obtained from the subject by means of appropriate transducers. Then, signal is passed through a stage of amplication and processing circuits that include generation of a subcarrier and modulation stage for transmission. The receiver consists of a tuner to select transmitting frequency, a demodulator to separate the signal from the carrier wave so as to display or record it. The transmitter generates the carrier and modulates it. The receiver is capable of receiving the transmitted signal and demodulating it to recover the information.

Fig. 1. Block diagram of a biotelemetry system.

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Fig. 2. Block diagram of a biotelemetry transmitter.

Information to be transmitted is impressed upon the carrier by a process known as modulation. Amplitude-modulated (AM) and frequency-modulated (FM) carriers have been used in biotelemetry. In an amplitude-modulated system, amplitude of the carrier is caused to vary with the transmitted information. In a frequency-modulated system, frequency of the carrier is caused to vary with the modulated signal. In biotelemetry systems, the physiological signal is sometimes used to modulate a low frequency carrier, called a subcarrier. Radio frequency (RF) carrier of the transmitter is then modulated by the subcarrier. If several physiological signals are transmitted simultaneously, each signal is placed on a subcarrier of a different frequency and all of the subcarriers are combined to simultaneously modulate the RF carrier. This process of transmitting many channels of data on a single RF carrier is called frequency multiplexing. Frequency multiplexing is more efcient and less expensive than employing a separate transmitter for each channel. At the receiver, a multiplexed RF carrier is rst demodulated to recover each of the separate

Fig. 3. Receiver storage display units.

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subcarriers and then demodulated to retrieve the original physiological signals.(6) In describing this type of system, a designation is given in which the method of modulating subcarriers is followed by the method of modulating RF carrier. For example, a system in which subcarriers are frequency-modulated and RF carrier is amplitudemodulated is designated as FM/AM. FM/FM designation means that both subcarriers and RF carrier are frequency modulated. Although FM/AM has been used in biotelemetry, FM/FM systems have been more popular because overall performance expected of FM radio link is better.(7) Also, FM radio frequency oscillators are easy to implement with a single transistor. FM/FM biotelemeters have been popular in a variety of restraint-free monitoring studies. Most of the other approaches use a technique known as pulse modulation, in which the transmission carrier is generated in a series of short pulses. If the amplitude of the pulses is used to represent the transmitted information, the method is called pulse amplitude modulation (PAM). If the width (duration) of each pulse is varied according to the information, pulse width modulation (PWM) or pulse duration modulation (PDM) system results. In pulse position modulation (PPM), timing of a very narrow pulse is varied with respect to a reference pulse. Other designations are pulse code modulation, (PCM) and pulse interval modulation (PIM). In pulse code modulation, information is represented by a sequence of coded pulses, which is accomplished by representing the signal in discrete form in both time and amplitude. Pulse interval modulation uses the spacing between constant width (length) pulses to transmit the data.(12) In all these systems, the designations can be dened as PIM/FM, PWM/FM, and so on. As in amplitudeand frequency-modulation systems, multiplexing of several channels of physiological data can be accomplished in a pulse modulation system. However, instead of frequency, time multiplexing is used. In time multiplexing, each of the physiological signals is sampled and used to control either amplitude, width, or position of one pulse, depending on the type of pulse modulation. If sampling rate is several times the highest frequency component of each data signal, no loss of information results from the sampling process. The signal transmitted at low power on the FM transmitter is collected by the receiver and tuned to the correct frequency. The subcarrier is removed from RF carrier and then demodulated to reproduce a signal the amplitude and frequency of which can be transformed back to the original data waveforms. Later, this signal can be displayed or recorded on a chart and stored on tape for other use.(5,13)

Antenna Tips The distance the transmitted signal can be received is called as the range of the system. The range of the system depends on power and frequency of the transmitter, relative locations of transmitting and receiving antennas, and sensitivity of the receiver. There are several important factors that telemetry users should be familiar with when using antennas. Some of these factors are as follows: (1) Keep clear of the antenna when taking a bearing. (2) Do not stand within 1/2 wavelength of the antenna elements. (3) Protect the antenna elements to prevent them from getting bent out of shape. (4) Keep all metal objects from interfering with the

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antenna. In this way, confusion will be reduced and success rate in tracking will be increased.(14) Transmitting devices built for patients must have light weight and be compact to ensure adequate user comfort. This physical constraint on package volume means that any built-in antenna must be electrically small, with correspondingly low efciency. Further problems appear as the telemeter is usually worn next to the skin at chest or abdominal level, so the transmitting antenna is at extremely close proximity to body tissue. In practice, the most important operational parameters for a body-surfaceworn antenna used for biotelemetry are its radiation efciency and the radiation pattern in the azimuthal plane. The analysis of electrically small antennas under near-body proximity conditions has received little consideration. The use of numerical electromagnetic modelling methods such as nite difference time domain (FDTD) technique can provide a exible, more efcient alternative. Application of FDTD to the analysis of body-surfacemounted radiators for use in 418 MHz radio biotelemetry systems have been explained. Numerical simulation of whole body problems using suitable models enables a rapid determination of all critical parameters affecting close coupled antenna performance.(8,15) Implantable Device In some occasions, it is desirable to implant the telemetry transmitter or receiver subcutaneously. The transmitter is swallowed or surgically implanted in the subject. These systems allow monitoring and collecting data from conscious, freely moving subjects. Conscious subjects provide data free from the effects of anesthesia. It has been clearly shown in the literature that anesthetic agents can change blood pressure, heart rate, peripheral vascular resistance, thermoregulation, gastrointestinal function, and other body functions. Comparing with the tethered animal model animals instrumented with implanted telemetry are free of exit-site infections. Also, animals instrumented with implanted telemetry are free of infections that result from exteriorized catheters and lead wires that are often required when using jacketed telemetry. In this situation, animals are free of stress and discomfort of carrying instrumentation in tight-tting clothes. Once the telemetry device is implanted, data can be monitored 24 h per day without human intervention or contact while the animal remains in its home cage. Highest quality data can be collected by implanted units.(16) The function of the instrumented implant and the external system components are described.(17) However, there are some requirements for the usage of an implantable telemetry. Implantable units must have relatively small size and be lightweight. Internal power source has to be used for a long time. Miniaturization and long-term use of implant electronic systems for medical applications have resulted in growing necessity for an external powering system. Another requirement is encapsulation of the unit. Implantable parts of the system must be encapsulated in a biocompatible material. The outer case and any wiring must be impervious to body uids and moisture. For many implantable electronic instruments, packaging is important. Requirements of packaging materials, used in current techniques are as follows: (1) epoxy, silicone rubber, and other polymeric material; (2) metal at-packs with resistive, electron beam, or laser beam welding, or solder sealing; (3) pyrex and ceramic outer cases with epoxy

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or metal solder sealing. The unmet needs in packaging, as well as potentially useful materials and techniques for packaging implantable electronic devices or systems for use in chronic situations, are given. Problems of packaging solid state transducers include the determination of the volume and weight of the packaging material.(18) The use of implantable units also restricts the distance of transmission of the signal. Body uids and skin greatly attenuate the signal, and because of this the implanted unit must be small. Therefore, the unit has little power and the range of signal is quite restricted. This disadvantage has been overcome by picking up the signal with a nearby antenna and retransmitting it. If applications involve monitoring over relatively short distances then retransmission is not necessary.(19) Single Channel and Multichannel Biotelemetry Units There are two types of biotelemetry units: single-channel and multichannel. In general, more than one channel of physiological information is studied. The simplest encoding can be used for telemetering a single channel of slow data. Pulse interval modulation or pulse width modulation can be used for a single slow variable. Telemetering a single channel of fast data requires quite different encoding because the carrier must be continuously varied. Either its amplitude or its frequency may be modulated.(8) A multiple subject biotelemetry system is composed of an implantable system, which consists of a command receiver, a subject selection receiver, a conditioner and a transmitter, and external systems, such as a power command signal transmitter and a subject selection signal transmitter, as shown in Fig. 4.(19) As indicated in Fig. 4, such a system is capable of accepting signals from a variety of sensors. The function of the command receiver is to connect or disconnect the battery to each implantable telemetry system on demand. Subject selection receiver is designed for receiving the subject selection signal from an external subject selection transmitter and then selecting a specic subject from the eight subjects and then switching the power source to the selected subject. The conditioner circuit consists of an 8-to-1 multiplexer, a comparator, a signal generator, and an 8-state ring counter. In order to transmit the measured biological signals at low power, the transmitter is designed for pulse width modulation, having high noise immunity and frequency modulation (FM). The receiver system is for receiving, demodulating, and demultiplexing telemetry signals. This system enables one subject to be selected from eight subjects, and the biological signals from seven implantable sensors to be obtained sequentially using a synchronization gap.(3) The custom asynchronous digital multiplexer IC can combine the output signals from many digital sensors onto a single pair of wires. A novel system architecture assures system startup as well as detection and recovery from inactive sensing elements. Computer simulation of the system architecture provides a verication of the digital logic design and an evaluation of the system performance.(20) A CMOS integrated circuit for a noninvasive biological signal telemetry system specied for use in medical and physiological studies of the inuence of weightlessness in space is presented. The system can monitor multichannel (4 channels maximum) biological signals from multiple subjects (4 subjects maximum) in real time by using time multiplexing.(2123)

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Fig. 4. Block diagram of a multiple-subjects telemetry system.

TYPES OF TELEMETRY Biomedical data has been telemetered through every medium between two sites, including air, space, water, and biologic tissue by using a variety of modulated energy forms like electromagnetic waves, light, and ultrasound. Radio Telemetry In general, biotelemetry systems involve the use of radio transmission. A radio frequency carrier is a high efciency sinusoidal signal propagated in the form of

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electromagnetic waves when applied to an appropriate transmitting antenna. Radio telemetry is an excellent tool for gathering data on the biology of animals and their interactions with the environment they inhabit.(24) The choice of operating frequency has always been the subject of considerable controversy amongst researchers. Many select the radio frequency at which they conduct their studies basing solely upon the availability of equipment at hand or simply on tradition. Researchers are often not fully aware of the proximal impact of frequency choice on overall system performance and its ultimate impact upon the quality of the data that the study generates.(25) Infrared Telemetry Infrared (IR) telemetry also has a very wide eld of application. The IR radiation enables transmission of different physiological parameters from moving subjects like patients in intensive care units, wards, newborn babies in incubators and animals in biological and hospital laboratories. In a typical IR biotelemetry system, the patient carries a battery-powered transmitter and one or more small arrays of infrared light emitting diodes (IRLEDs) that send encoded data to remotely located photodetectorbased receivers.(26) IR radiation in information transmission is used in two ways: Narrow beam or direct radiation and diffuse IR radiation. Diffuse IR radiation ll up almost homogeneously the room where the IR transmitter and receiver are located. The mobility of the transmitter worn by the patient is complete within the room, without any restraint. The coverage of the room with IR radiation is based on reections from the walls, ceiling, and oor. This is the reason for greater application of diffuse IR radiation in biotelemetry than narrow beam or direct IR radiation in biological parameter measurements. For analyzing an IR telemetry system and its feasibility in a room, it is important to know the voltage amplitude and photoamplier output related to the noise level voltage in any location at the room. At least one reection must occur on the pathway between transmitter and receiver to realize a diffuse IR radiation. There are two opposite types of reection. One is called specular (mirror-like) reection and the other is reection from matt surface. In some large rooms there are some locations where IR irradiance is not sufcient. This can happen in some corners with dark background, close to the windows, or in very long rooms. A repeater can solve such problems. The repeater consists of a sensitive enough IR receiver and transmitter; the receiver is situated in a place where there is enough irradiation so that pulses can be received. The efciency coefcient is the most important parameter that enables the estimation of how large the room can be. Pulse frequency or pulse time interval modulation is used for biopotential or some other biological signal transmission.(26,27) Ultrasonic Telemetry Acoustic energy is the best available technique for marine shes to send a signal over a distance. Ultrasonic ranges 30100 kHz are above most animal auditory ranges and are transmitted with low energy loss through seawater.(28) There is a

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denite need to reveal the daily activities of animals that range out of sight of an underwater observer and to obtain information on behavior beyond release and recapture sites. Ultrasonic telemetry appears to be well suited for such studies as animals can be followed from boats or by other arrangements for up to several kilometers distance.(29) Sound travels at a predictable speed through water. If a pulsed signal is detected at a series of hydrophones at known positions, the position of the sound source can be calculated from the differences in time taken for the sound to reach each of the hydrophones successively more distant from the source. A number of tracking systems based on this principle have been used to track sound-producing animals as well as acoustically tagged individuals. Several transmitters may also be tracked simultaneously using such techniques. Consideration of position-xing errors associated with xed-array acoustic tracking techniques has generally centered upon the consequences of inaccuracies in the timing of the arrival of the ultrasonic pulse at each hydrophone.(3035) The simplest type of ultrasonic transmitter the pinger, which emits pulses of a given ultrasonic frequency and repetition rate to transmitters with sensors for monitoring swimming speed, tail-beat frequency, water depth, and water temperature. Most pingers are augmented with a coded output that allows for recognition of individual animals.(36) Most acoustically telemetered eld data are interval-encoded. Data can also be encoded in the duration of the ping, but power constraints usually mean that off-time is a better way to carry signal than on-time, which is minimized for signaling. Most standard, available acoustic receiving equipment is designed to decode data in this off-interval format. Receivers are usually set to ignore later pulses in a blanking interval, typically 200300 ms.(37)

COMPARISON OF TELEMETRY TYPES Telemetry is an active process requiring energy output to send a signal over a distance. Electromagnetic energy, particularly at radio frequencies, is rapidly absorbed as it passes through even a few centimeters of seawater. Thus, acoustic energy is the best available technique for marine shes. Acoustic energy is transmitted with low energy loss through seawater.(28) The use of modulated infrared (IR) light as an alternative to RF carriers in biotelemetry systems has many advantages: man-made electrical impulse noise causes interference in radio telemetry links.(38) In IR telemetry there is much less man-made and natural interference noise. The space occupied by the transmitting and receiving antennas is not required in IR telemetry. The transmitter worn by the patient is more compact and does not require an inductive coil so that it can be realized in surface-mount technology in a very small size.(27) When IR biotelemetry systems are used for monitoring and locating hospital patients, there are no bandwidth restrictions. Some reports suggest that RF transmission causes electromagnetic interference in medical devices such as cardiac pacemakers or infusion pumps.(3944) The possible effects of electromagnetic interference during wireless connectivity are searched and no evidence was found of electromagnetic interference of IR modems with any of the medical devices. Furthermore, IR modems showed similar

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performance to a wired system even in an electrically noisy environment. As a result, IR wireless connectivity can be safely and effectively used in operating rooms.(4548) The disadvantages of IR biotelemetry are as the following: range of IR biotelemetry is short and restricted to a single room. The short range is not particularly troublesome in medical telemetry, since patients are usually conned to small rooms or wards. Diffuse IR biotelemetry system has difculties with multisystem operation in the same room. Realization of a multisystem operation is not as simple as in radio frequency telemetry. There are two possibilities: frequency multiplex and time division multiplex. Transmitters are difcult to separate by wavelength division multiplex (frequency multiplex). It cannot be realized easily because of the broad frequency response characteristics of photodiodes. In IR biotelemetry system power consumption of transmitter is relatively high. Transmitter power consumption may be kept to a minimum by operating the infrared light emitting diodes in a pulsed mode with a favorable duty cycle. The pulse duration is usually set to just a few microseconds, and pulse position modulation (PPM) is used to convey the data. It is only necessary to transmit one IR pulse for each physiological signal or data channel.(26)

POWER SOURCES OF BIOTELEMETRY SYSTEMS In many applications of short range biotelemetry, long operational life of the remote unit is a prime requirement. Many different types of biotelemetry systems featuring low battery drain have been developed over the years, but adequate battery life can still be a problem.(49) Various environmental power sources have been investigated, such as light, atomic radiation, radio waves, and biomechanical and biochemical energy converters. Biotelemetry systems that do not actively use their own internal power to transmit information have been described in the past and take two basic forms. RF-powered devices could be considered one class since these derive their power from a base unit transmitter and use the power to excite an internal low power transmitter broadcasting telemetry data on another frequency. Another approach is to use the same RF frequency for powering and transmission, but on a time-sharing basis. When properly designed, this technique eliminates the crosstalk between the powering circuit and the signal circuit and only requires a single coil set for the implant. Two factors in RF-powered telemetry need to be considered: (1) the RF interference of the signaleither on the transducer or on the biological systemand (2) the biological, particularly the long term, effect of RF radiation on the subject.(50) Another class might be considered passive biotelemetry systems. A passive telemetry system has been developed, operating according to the principle of the impedance transformation of two inductively coupled coils. Signal-dependent modulation of the implanted coils load, which can be achieved with practically zero power consumption, reduces the data transmission to the impedance measurement of the external receiver coil.(51,52) Long operating life of implantable electronic circuits can be obtained by using low power transmission techniques. For example, pulse code modulation combined

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with remote switching systems to turn the circuit on only when monitoring is necessary.(53) A single-transistor low power underdamped RF pulse position modulator, with remote switching, for implantable biotelemetry units has been presented.(54) Inductive powering of implantable monitoring devices is a widely accepted solution for replacing implanted batteries. Inductive powering is based on the magnetic coupling between an internal coil and an external coil that is driven by an alternating current.(49,55) Both coils form a loosely coupled, coreless transformer. Parallel resonance of the internal coil with a capacitor is most often used for higher link efciency. This method demands technically skilled operators to tune constantly the power link parameters. This becomes particularly important when the external system must also be portable. Acceptable lifetimes for the external batteries can be obtained by a precise optimization of the power efciency of the inductive link. Inductive powering system can be successfully developed for hospital use.(56,57)

APPLICATIONS OF BIOTELEMETRY In the early days of human space ight, NASA used biotelemetry to provide biomedical data from orbiting astronauts to medical personnel. Biomedical data transmitted to earth from space included astronauts heart rate, body temperature, ECG, and oxygen and carbon dioxide concentration. Telemetry was employed to establish an understanding and to monitor health and well-being of the astronauts while they were in orbit. So NASA has been involved in the development and application of biotelemetry since the Agencys beginnings.(5,11,58) Because of the great distance from the earth, systems and procedures were developed to support medical operations in ight. All astronauts wore a biosensor harness, which provided for transmitting critical physiological data back to the earth from the space craft and lunar surface. This real-time telemetry was also available to monitor astronauts in the event of illness in ight.(58) NASA had role in the development of space ight animal habitats and monitoring hardware in 1970s. In response to this development advanced biosensor and bioinstrumentation technologies were required. Miniaturized, specic-application biosensors, biotelemetry, and noninvasive monitoring has become vital to the telemedicine industry. Sensors 2000! (S2K!) program at NASA has implemented a variety of advanced biosensor and bioinstrumentation technologies for space research and ground medical and surgical applications. For these applications, miniaturized implantable biosensor to measure blood pH, ionic sensors for Ca+ , K+ , and Na+ , biophysical sensors for ow, pressure, and dimension, and miniature high resolution CO2 sensors, as well as advanced biotelemetry and instrumentation and data systems, are developed.(10,59) Advanced biosensors and biotelemetry systems are used in sensing a wide variety of phenomena in the body and transmitting this information to receivers near the body. These sensors can provide remote, continuous biomedical monitoring of patient data. Continuous ambulatory monitoring of the condition of the mother and fetus following in utero surgical repair of life-threatening congenital birth defects is required by the University of California, Fetal Treatment Center (FTC).(11) In 1993, Sensors 2000! established a relationship with FTC to adapt NASAs implantable

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biotelemetry devices to their monitoring needs of human fetus and its uterine environment.(60) Sensors 2000! used NASAs technology to design a system that could accurately measure intrauterine pressure changes, and the body temperature and heart rate of the fetus.(10) A transmitting unit in a uterus monitors physiological parameters and tranmits its reading to external equipment. The fully developed transmitting unit, resembling a large pill, would be small enough to be implantable by minimally invasive surgery.(60) A pressure/temperature pill transmitter is the rst of a family of implantable and/or ingestible pill transmitters that will measure a variety of physiological parameters. Other measurements will include pH, ions of interest (Ca+ , Na+ , K+ ), heart rate, ECG, EEG, EMG, blood gases (O2 , CO2 ), and glucose. Testing had been done on a prototype pH pill transmitter similar in design to the pressure/temperature device. The pill shape and small size of the transmitter, its ultra-low power consumption, long life, and the powerful capabilities of its data analysis software make this system unique. The portability of the system makes it easily adaptable to any hospital setting and ideal for use in a home-based monitoring environment. Applications of these pill transmitters are very common and go beyond fetal surgery.(61) A complete biotelemetry system is designed for telemetry of various physiological signals such as ECG, EEG, etc. The main advantage of this biotelemetry system is that it provides an easy and practical way for long-term monitoring of various physiological signals from a patients body while maintaining a low implementation cost.(4) An intraoral plaque pH measuring system has been developed incorporating a hydrogen-ionselective eld effect transistor. The telemeter is a temperaturecompensated FMFM system utilizing voltage feedback to the input sensing circuit.(62) A telemetry pill is proposed to investigate bladder pressure under normal life circumstances. Extremely high compactness could be achieved using integrated and hybrid technology. A 3-mm wide thick-lm substrate carries all electronics from sensor to transmitter, including a dedicated control chip for minimal power consumption and is sealed by a micromachined package.(63) The use of telemetry to monitor a swimmers rectal core temperature has been presented and measurements taken from swimmers have been shown.(64) Progress in the development of an implantable telemetry system for assessing blood oxygen saturation and hematocrit is described. The key element of the system is an optical sensor, which employs optoelectronics and on-chip signal processing electronics to measure light backscattered by blood.(65) Long-term monitoring of central haemodynamics with implanted monitoring systems might be valuable in managing heart failure patients.(66) Emergency medical care has become an important part of the overall health delivery system. In many areas ambulances and emergency rescue teams are equipped with telemetry equipment to allow electrocardiograms and other physiological data to be transmitted to a nearby hospital for interpretation.(5,67) A compact, low power, implantable system for in vivo monitoring of oxygen and glucose concentrations is developed. The telemetry instrumentation system consists of two amperometric sensors: one oxygen and one glucose biosensor and two potentiostats for biasing the sensors, an instrumentation amplier to subtract and amplify sensor output signals, and a signal transmitter subunit to convert and transmit glucose-dependent signal from the sensors to a remote data acquisition

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system.(59,68) A system is designed to simultaneously acquire ECG and respiration data and send them to a receiver over a telephone line. Respiration data is acquired by measuring the transthoracic impedance between two electrodes.(69) The data each FM-modulate subcarriers which then FM-modulate a carrier. The transmitter is battery powered to assure patient safety. An electrohydraulic pulsatile blood pump has been developed for implantation in the thoracic cavity. The system can be used as a circulatory assist device or as an articial heart with modications. Remote biotelemetry systems provide power, remote monitoring, and control.(70) A single-channel implantable microstimulator for functional neuromuscular stimulation is developed. This device can be inserted into paralyzed muscle groups by expulsion from a hypodermic needle, thus reducing the risk and discomfort associated with surgical placement. The device receives power and data from outside by RF telemetry.(9) The walking (gait) analysis telemetry system (walking analyzer) consists of miniature sensors/transmitters that are afxed directly over the leg muscle group being studied. The muscle activity sensed by the electrodes is transmitted to a computer by biotelemetry process. This system is used to determine the degree and location of abnormal muscle activity and in prescribing treatment.(71) A system for measuring force in both legs and crutches or cane, for the patient, during walking is developed. A special sensor based on infrared radiation changes is realized for force measurement in the crutches or cane. To extend patients free mobility, an infrared telemetry system is applied.(72,73) The most reliable operation of IR biotelemetry has been found in hospitals and in biological laboratories.(45) An IR diffuse telemetry system is realized for ECG and temperature transmission. The basic patient unit has an IR receiver and transmitter, because biological data and signals have to be transmitted and commands and identication to the basic patient unit have to be received.(27) A wireless biotelemetry system for the transfer of digital data through intact skin tissue has been developed to provide a safe and noninvasive communication between implanted medical devices and outside of the body. The system utilizes two miniature infrared transmitter/receiver modules. Data are transmitted through intact skin and subcutaneous tissue on an infrared carrier signal. The system has been evaluated in human cadavers and during in vivo implantation of articial hearts.(2) The infrared telemetry system provides a reliable and effective way of performing continuous real-time ambulatory urodynamic monitoring in infants and young children. With the development of more powerful telemetric data transmission technologies, such a method could be extended in the near future to a truly ambulatory urodynamic recording with real-time on-line facilities, either at home or in the clinic, both for adults and for children.(74) A through-water ultrasonic data telemetry system burst-mode frequency shift keying (FSK) is described. The system can be adapted for the transmission of data from various sensors, but it has been designed principally for monitoring the respiratory rate, heart rate, temperature, and depth of a free-swimming diver over a range of up to 300 m. This application requires the transmission of low rate digital signals through water from a moving source to a receiver that is either stationary or moving.(75)

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Different biotelemetric applications are done on a wide variety of animal species since 1950s. Information about wildlife biotelemetry activity with some historical perspective are presented.(76) For many species, determination of habitat selection is based on habitat-use data obtained through radio telemetry. The effects of habitatpatch size, level of telemetry signal inhibition, and selection pattern are observed. Monte Carlo simulations are used to assess the effect of habitat-dependent bias in radio telemetry studies on the assessment of habitat selection. The characteristics of habitat mosaics selected by animals can be studied in this way.(77,78) Animals of various species are used in biomedical researches, and some of the radio telemetry systems employed consist of implantable transmitter and receiver. Implantable devices used to monitor various physiological parameters in mice, hamsters, rats, rabbits, ferrets, dogs, cows, sheep, bears, and other species. Implant sites for pressure telemetry can vary with the objectives of the study. Implants that measure ECG have exible leads extending from the housing, similar to those used in heart pacemakers. When measuring telemetered ECG, sensing leads are placed under the skin at locations similar to the surface electrodes. For EEG measurements, the transmitter leads can be connected to screw electrodes or deep electrodes to monitor various sites within the brain. For EMG measurements, the transmitter leads can be connected to ne-braided stainless steel wire to be threaded through or buried in the muscle.(7982) Implants that measure temperature generally have a sensor imbedded in the electronics module. When measuring core temperature, the device is often placed in the peritoneal cavity. Core body temperature is a critical measure in studies of behavioral and physiological control of metabolism and body temperature regulation.(8386) Activity measurements are derived by the receiver and obtained by sensing changes in signal strength that occur as the animal moves about its cage. Various biotelemetry systems have been developed for small animals to record alterations in their autonomic and behavioral activity. The major asset of telemetry method is the possibility of recording various parameters at a time in the unrestrained, conscious animals. A wireless telemetry system to assess heart rate, core temperature, and gross locomotor activity in freely moving rats while performing a behavioral task. The telemetry system consists of a small implantable transmitter, a receiver connected to a computer with data acquisition controlled by a computer board and software package.(8791) Biotelemetry can be used for monitoring aquatic species in their natural environment. Sustained direct observation of aquatic species is often impossible. Thus, biotelemetry has become an increasingly important tool for studying the behavior of shes. A combined acoustic and radio transmitting tag employing a dynamic conductivity switch suitable for investigating the migratory behavior of diadromous sh is described. The unique feature of the transmitter is its ability to sense the electrical conductivity of the ambient water and therefore operate in the appropriate signal mode. Under freshwater conditions the transmitter operates in radio mode, in seawater it operates in acoustic mode.(92) Modern telemetry systems can gather many kinds of data, indicating which animals are near telemetry receivers and what they are doing. Sharks were among the rst marine animals to carry telemetry systems because of their size and the

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need to understand their interactions with humans. The examples show the parallel progression of shark biology and acoustic biotelemetry illustrating that telemetry systems are tools for gathering data.(28) Movement rates of sharks are often estimated from the distance traveled by an animal over a certain time period, where the sharks position is obtained from a telemetry device. This resultant speed is referred to as rate of movement or point-to-point swimming speed. Instantaneous swimming speed requires more complicated and expensive transmitters to be externally attached.(29,93) Electromyographic (EMG) telemetry involves implantation of transmitters in sh that relay muscular activity to aerial or submerged antennas and receiver systems. Muscular activity rates in free-swimming sh are used to describe upstream migrations, spawning behavior, swimming performance and oxygen consumption, activity associated with stressors such as temperature changes and metabolic rates and to test bioenergetic models.(9496) Telemetered EMG signals indicate that muscle activity varied signicantly for electrodes implanted at different longitudinal positions along the sh. As a result, electrode placement is an important inuence affecting the signals obtained from radio transmitters.(97) The monitoring of neural signals of aquatic animals in the freely behaving condition is essential to understand the neural mechanism of their behavior. Underwater radio telemetry system is developed to receive electroencephalographic (EEG) signals from the sh freely swimming in freshwater areas. The system uses simple and generally available instrumentation and is composed of a transmitter and a receiver. By using the system, EEG signals are successfully received from the sh freely swimming in an outdoor pond.(98) Heart rate telemetry has been utilized as a tool for the assessment of metabolic rate in wild sh by a number of investigators. It is obvious that remote monitoring of heart rate is a good indicator of physiological activity.(99) Animal movement and behavior is remotely assessed within a wide range of environments characterized by water conductivity and depth. The optimal mode of transmission is dependent upon ambient conductivity and water depth and determined by the transmitters microprocessor and sensing devices.

CONCLUSION Biotelemetry systems have been used for about forty years and have become a useful tool for obtaining bioelectrical and physiological data from humans and animal species, and for monitoring these variables as well. Biomedical telemetry is a special area of biomedical instrumentation that permits transmission of physiologic information from an inaccessible location to a remote monitoring site. The goal of biotelemetry include the capability for monitoring humans and animals with minimum restraint and to provide faithful reproduction of the transmitted data. Biotelemetry is a reliable tool for data gathering and with the invention of integrated circuit technology in 1958 contributions of microelectronics to biomedicine and health care have been enormous. Many advanced diagnostic, therapeutic, and rehabilitative devices and systems would not have been possible without these contributions. Miniature and micropower are two concepts of modern biotelemetry design and construction. Improvements in these areas have closely paralleled the evolution

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of semiconductor and microcircuit technologies. Size, cost, circuit complexity, power requirements (and operational lifetime), packaging, transducers, nature of data to be transmitted, and performance are important in the design of a backpack or implanted biotelemetry unit. It seems likely that future development will be in the further miniaturization and integration of biotelemeters and transducers, improved power sources, and improved packaging. Techniques and applications of biotelemetric methods continue to expand and seem to be limited only by the imagination of the investigators using new technologies as they evolve. Since the rapid growth in technology different applications of biotelemetry could be used for data gathering from a remote location.

REFERENCES
1. Wolcott, T. G., New options in physiological and behavioral ecology through multichannel telemetry. J. Exp. Marine Biol. Ecol. 193:257275, 1995. 2. Mussivand, T., Hum, A., Holmes, K. S., and Keon, W. J., Wireless monitoring and control for implantable rotary blood pumps. Artif. Organs 21(7):661664, 1997. 3. Meindl, J. D., and Ford, A. J., Implantable telemetry in biomedical research. IEEE Trans. Biomed. Eng. BME-31(12):817823, 1984. 4. Guler, I., and Kara, S., A low-cost biotelemetry system for long time monitoring of physiological data. J. Med. Syst. 20(3):151156, 1996. 5. Cromwell, L., Weibell, F. J., and Pfeiffer, E. A., Biotelemetry. In Huebner, V. (ed.), Biomedical Instrumentation and Measurements, Prentice-Hall, Englewood Cliffs, chap. 12, pp. 316343, 1980. 6. Jeutter, D. C., Telecommunications for Health Care, Biomedical Engineering Department Marquette University. Available at http://www.eng.mu.edu/biotelem/objectives.html 7. Kasten, C. K., Telemetry is Coming of Age. Available at http://www.raven1.net/telem1.htm 8. Welkowitz, W., Deutsch, S., and Akay, M., Biotelemetry. Biomedical Instruments Theory and Design, Academic Press, San Diego, CA, chap. 11, pp. 313330, 1976. 9. Ziaie, B., Nardin, M. D., Coghlan, A. R., and Naja, K., A singlechannel implantable microstimulator for functional neuromuscular stimulation. IEEE Trans. Biomed. Eng. 44(10):909920, 1997. 10. Hines, J. W., Medical and surgical applications of space biosensor technology. Acta Astronautica 38:261267, 1996. 11. Biomedical Sensors and Telemetry for Remote Monitoring of Patients. Available at http://www. nttc.edu/telmed/bmfact.html 12. Haykin, S., Pulse modulation. In Elliot, S. (ed.), Communication Systems, Wiley, New York, chap. 6, pp. 351406, 1978. 13. Oppenheim, A. V., Willsky A. S., and Nawab, S. H., Communication systems. In Oppenheim A. V., Signals & Systems, Prentice-Hall, New Jersey, chap. 8, pp. 582625, 1983. 14. Biotelemetry: Antenna Tips. Available at http://www.biotelem.org/antenna.htm 15. Scanlon, W. G., Evans, N. E., and Burns, J. B., FDTD Analysis of closecoupled 418 MHz radiating devices for human biotelemetry. Phys. Med. Biol. 44:335345, 1999. 16. The Technology. Available at http://www.datasci.com/technology.html 17. Graichen, F., Bergmann, G., and Rohlmann, A., Patient monitoring system for load measurement with spinal xation devices. Med. Eng. Phys. 18(2):167174, 1996. 18. Ko, W. H., and Smith, S. R., Packaging of implantable elecronic instruments. IEEE Trans. Biomed. Eng. BME-27(9):533, 1980. 19. Park, J., Choi, S., Seo, H., and Nakamura, T., Fabrication of CMOS IC for telemetering biological signals from multiple subjects. Sens. Actuat. A 43:289295, 1994. 20. Shapiro, F. B., Shott, J. D., and Meindl, J. D., A custom IC for multichannel telemetry with digital sensors. IEEE Trans. Biomed. Eng. BME31(8):577, 1984. 21. Kawahito, S., Ueda, S., Ishida, M., Nakamura, T., Usui, S., and Nagaoka, S., A CMOS integrated circuit for multichannel multiple-subject biotelemetry using bidirectional optical transmissions. IEEE Trans. Biomed. Eng. 41(4):400406, 1994. 22. Karita, N., Kawahito, S., Nagaoka, S., Usui, S., and Nakamura, T., Multichannel multiple-subject biotelemetry system. Proc. 11th Int. Symp. Biotelem. pp. 5053, 1990.

176

Guler and Ubeyli

23. Jones, K. E., and Normann, R. A., An advanced demultiplexing system for physiological stimulation. IEEE Trans. Biomed. Eng. 44(12):12101220, 1997. 24. Salvatori, V., Skidmore, A. K., Corsi, F., and Van der Meer, F., Estimating temporal independence of radio-telemetry data on animal activity. J. Theor. Biol. 198(4):567574, 1999. 25. Sisak, M. M., Lotimer, J. S., Frequency choice for radio telemetry the HF vs. VHF conundrum. Hydrobiologia 372:5359, 1998. 26. Weller, C., Modulation scheme suitable for infrared biotelemetry. Electron. Lett. 21(14):601602, 1985. 27. Santic, A., Theory and application of diffuse infrared biotelemetry. Crit.l Rev. Biomed. Eng. 18(4):289 309, 1991. 28. Voegeli, F. A., Smale, M. J., Webber, D. M., Andrade, Y., and ODor, R. K., Ultrasonic telemetry tracking and automated monitoring technology for sharks. Environ. Biol. Fishes 60:267281, 2001. 29. Sundstrom, L. F., Gruber, S. M., Clermont, S. M., Correia, J. P. S., Marignac, J. R. C., Morrissey, J. F., Lowrance, C. R., Thomassen, L., and Oliveira, M. T., Review of elasmobranch behavioral studies using ultrasonic telemetry with special reference to the lemon shark, Negaprion brevirostris, around Bimini Islands, Bahamas. Environ. Biol. Fishes 60:225250, 2001. 30. Smith, G. W., Urquhart, G. G., MacLennan, D. N., and Sarno, B., A comparison of theoretical estimates of the errors associated with ultrasonic tracking using a xed hydrophone array and eld measurements. Hydrobiologia 371/372:917, 1998. 31. Freitag, L. E., and Tyack, P. L., Passive acoustic localization of the Atlantic bottlenose dolphin using whistles and echolocation clicks. J. Acoust. Soc. Am. 93:21972205, 1993. 32. Lagardere, J. P., Ducamp, J. J., Favre, L., Dupin, J. M., and Sperandio, M., A method for the quantitative evaluation of sh movements in salt ponds by acoustic telemetry. J. Exp. Mar. Biol. Ecol. 141:221236, 1990. 33. Juell, J. E., and Westerberg, H., An ultrasonic telemetric system for automatic positioning of individual sh used to track Atlantic Salmon (Salmo Salar L.) in a sea cage. Aquacult. Eng. 12:118, 1993. 34. Smith, G. W., Glass, C. W., Johnstone, A. D. F., and Mojsiewicz, W. R., Diurnal patterns in the spatial relationships between saithe, Pollachius virens, schooling in the wild. J. Fish Biol. 43:315325, 1993. 35. Sarno, B., Glass, C. W., Smith, G. W., Mojsiewicz, W. R. A., and Johnstone, A . D. F., A comparison of the movements of two gadoid species in the vicinity of an underwater reef. J. Fish Biol. 45:811817, 1994. 36. Voegeli, F. A., Lacroix, G. L., and Anderson, J. M., Development of miniature pingers for tracking Atlantic salmon smolts at sea. Hydrobiologia 371/372:3546, 1998. 37. Voegeli, F. A., and Pincock, D. G., Determination of sh swimming speed by ultrasonic telemetry. Biotelem. Patient Monit. 7:215220, 1981. 38. Riemann, A. I., and Evans, N. E., The incidence of radio-frequency impulsive noise within hospital buildings: Initial measurements in the 450 MHz band. Med. Eng. Phys. 21:569574, 1999. 39. Barbaro, V., Bartolini, P., Donato, A., Militello, C., Altamura, G., Ammirati, F., and Santini, M., Do European GSM mobile cellular phones pose a potential risk to pacemaker patients?. Pacing Clin. Electrophysiol. 18(6):12181224, 1995. 40. Clifford, K. J., Joyner, K. H., Stroud, D. B., Wood, M., Ward, B., and Fernandez, C. H., Mobile telephones interfere with medical electrical equipment. Aus. Phys. Eng. Sci. Med. 17(1):2327, 1994. 41. Yesil, M., Bayata, S., Postaci, N., and Aydin, C., Pacemaker inhibition and asystole in a pacemaker dependent patient. Pacing Clin. Electrophysiol. 18(10):1963, 1995. 42. Trudeau, S., and Ladue, M., Radiofrequency interference with medical devices. A technical information statement. IEEE Eng. Med. Biol. Mag. 17(3):111114, 1998. 43. Baba, I., Ito, T., Furuhata, H., Nojima, T., Kano, T., Tsubota, S., and Watanabe, S., Experimental study of electromagnetic interference from cellular phones with electronic medical equipment. J. Clin. Eng. 23(2):122134, 1998. 44. Hayes, D. L., Wang, P. J., Reynolds, D. W., Estes, M. I., Grifth, J. L., Steffens, R. A., Carlo, G. L., Findlay, G. K., and Johnson, C. M., Interference with cardiac pacemakers by cellular telephones. N. Engl. J. Med. 336(21):14731479, 1997. 45. Hagihira, S., Takashina, M., Mori, T., Taeneka, N., Mashimo, T., and Yoshiya, I., Infrared transmission of electronic information via LAN in the operating room. J. Clin. Monit. Comput. 16:171175, 2000. 46. Hirayama, M., and Tanaka, N., Infrared rays application to optical LAN systems. DOC:IEEE 802(11):121, 1997. 47. Gfeller, F. R., and Bapst, U., Wireless in-house data communication via diffuse infrared radiation. Proc. IEEE 67:1474, 1979. 48. Hof, A. L., Bonga, G. J., Swarte, F. G., and de Pater, L., Modular PPM telemetry system with radio, infrared and inductive loop transmission. Med. Biol. Eng. Comput. 32(1):107112,1994.

Biotelemetry

177

49. Ko, W. H., Liang, S. P., Fung, C. D. F., Design of radio frequency powered coils for implant instruments. Med. Biol. Eng. Comput. 15:634640, 1977. 50. Ko, W. H., and Liang, S. P., RF-powered cage systems for implant biotelemetry. IEEE Trans. Biomed. Eng. BME-27(8):460467, 1980. 51. Nagel, J. H., Passive biotelemetry systems. IEEE Trans. Biomed. Eng. BME-31(8):577, 1984. 52. Towe, B. C., Passive biotelemetry by frequency keying. IEEE Trans. Biomed. Eng. BME-33(10):905 909, 1986. 53. Leung, A. M., Ko, W. H., Spear, T. M., and Bettice, J. A., Intracranial pressure telemetry system using semicustom integrated circuits. IEEE Trans. BE-33:386395, 1986. 54. Abatti, P. J., and Pichorim, S. F., Single transistor underdamped RF pulse position modulator with remote switching for implantable biotelemetry units. Electron. Lett. 30(19):15641565, 1994. 55. de N. Donaldson, N., and Perkins, T. A., Analysis of resonant coupled coils in the radio frequency transcutaneous links. Med. Biol. Eng. Comput. 21:612627, 1983. 56. Vanschuylenbergh, K., and Puers, R., Selftuning inductive powering for implantable telemetric monitoring systems. Sens. Actuat. A 52(13):17, 1996. 57. Jeutter, D. C., Overview of biomedical telemetry techniques. IEEE Eng. Med. Biol. 2:1724, 1983. 58. NASA TelemedicineHistory Biotelemetry. Available at http://www.quasar.org/21698/nasa/history .html 59. Beach, R. D., Von Kuster, F., and Moussy, F., Subminiature implantable potentiostat and modied commercial telemetry device for remote glucose monitoring. IEEE Trans. Instrum. Measur. 48:1239 1245, 1999. 60. Biotelemetry Using Implanted Unit to Monitor Preterm Labor, Ames Research Center, Moffett Field, CA. Available at http://nasatech.com/Briets/May99/ARC14280.html 61. Technology Opportunity, Implantable Biotelemetry System for Preterm Labor and Fetal Monitoring. Available at http://ctoserver.arc.nasa.gov/techopps/biotelemetry.html 62. Fleischacker, A. E., Smith, R., and Fromm, E., Telemetered measurement of intraoral plaque pH. IEEE Trans. Biomed. Eng. BME-31(8):577, 1984. 63. Sansen, W., Puers, B., and Vereecken, R., Realization of a pressure telemetry capsule for cystometry. IEEE Trans. Biomed. Eng. BME-31(8):577, 1984. 64. Finlay, J. B., Lysynski, B., Liggins, A. B., and Weir, R.C., Monitoring rectal core temperature in marathon swimmers. Med. Biol. Eng. Comput. 34(1):97100, 1996. 65. Schmitt, J. M., Mihm, F. G., Shott, J., and Meindl, J. D., Implantable telemetry for measurement of O2 saturation. IEEE Trans. Biomed. Eng. BME-31(8):577, 1984. 66. Ohlsson, A., Bennett, T., Ottenhoff, F., Bitkover, C., Kjellstrom, B., Nordlander, R., Astrom, H., and Ryden, L., Long-term recording of cardiac output via an implantable haemodynamic monitoring device. Eur. Heart J. 17(12):19021910, 1996. 67. Anantharaman, V., and Han, L. S., Hospital and emergency ambulance link: Using IT to enhance emergency pre-hospital care. Int. J. Med. Inf. 61:147161, 2001. 68. Salehi, C., Atanasov, P., Yang, S. P., and Wilkins, E., A telemetry instrumentation system for long-term implantable glucose and oxygen sensors. Anal. Lett. 29(13):22892308, 1996. 69. Reisman, S. S., Instrument for remote ECG and respiratory monitoring. IEEE Trans. Biomed. Eng. BME-31(8):577, 1984. 70. Mussivand, T., Hendry, P. J., Masters, R. G., Holmes, K. S., Hum, A., and Keon, W. J., A remotely controlled and powered articial heart pump. Artif. Organs 20(12):13141319, 1996. 71. Walking (Gait) Analyzer. Available at http://spaceight.nasa.gov/history/shuttle-mir/science/spinoff/ walk.htm 72. Santic, A., Bilas, V., and Lackovic, I., System for measuring forces in the legs and crutches from ambulatory patients. Annu. Int. Conf. IEEE Eng. Med. Biol. Proc. 5:18951898, 1997. 73. Lackovic, I., Bilas, V., Santic, A., and Nikolic, V., Measurement of gait parameters from free moving subjects. Measur. J. Int. Measur. Confed. 27(2):121131, 2000. 74. Yeung, C. K., Continuous real-time ambulatory urodynamic monitoring in infants and young children using infrared telemetry. Br. J. Urol. 81(3 Suppl.):7680, 1998. 75. Woodward, B., and Bateman, S. C., Diver monitoring by ultrasonic digital data telemetry. Med. Eng. Phys. 16(4):278286, 1994. 76. Long, F. M., and Weeks, R. W., Animal biotelemetry. IEEE Trans. Biomed. Eng. BME-27(9):533, 1980. 77. Rettie, W. J., and McLoughlin, P. D., Overcoming radiotelemetry bias in habitat-selection studies. Can. J. Zool. 77(8):11751184, 1999. 78. Rettie, W. J., and Messier, F., Hierarchical habitat selection by woodland caribou: Its relationship to limiting factors. Ecography 23(4):466478, 2000.

178

Guler and Ubeyli

79. Harrison, J. E., Avitable, M. J., and Gutstein, W. H., An implantable electronic brain stimulator for small animals. IEEE Trans. Biomed. Eng. BME-27(9):533, 1980. 80. Mast, R. T., Reite, M. L., and Pauley, J. D., Long term physiological monitoring of biotelemetry data using an on-line real-time system. IEEE Trans. Biomed. Eng. BME-27(9):533534, 1980. 81. Kramer, K., Van Acker, S., Voss, H., Grimbergen, J., Van der Vijgh, W., and Bast, A., Use of telemetry to record electrocardiogram and heart rate in freely moving mice. J. Pharmacol. Toxicol. Meth. 30:209 215, 1993. 82. Gelzer, A. R. M., and Ball, H. A., Validation of a telemetry system for measurement of blood pressure, electrocardiogram and locomotor activity in beagle dogs. Clin. Exp. Hypertens. 19:11351160, 1997. 83. Schneider, J. R., Veltri, A. M., Degraw, W. A., and French, J. A., Telemetered temperature monitoring in preweanling mongolian gerbils. Physiol. Behav. 57(1):199203, 1995. 84. Kluger, M. J., Rudolph, K., Soszynski, D., Conn, C. A., Leon, L. R., Kozak, W., Wallen, E. S., and Moseley, P. L., Effect of heat stress on LPS-induced fever and tumor-necrosis-factor. Am. J. Physiol. Regul. Integr. Compar. Physiol. 42(3):858863, 1997. 85. Wright, B. E., and Katovich, M. J., Effect of restraint on drug-induced changes in skin and core temperature in biotelemetered rats. Pharmacol. Biochem. Behav. 55(2):219225, 1996. 86. Kettlewell, P. J., Mitchell, M. A., and Meeks, I. R., An implantable radio-telemetry system for remote monitoring of heart rate and deep body temperature in poultry. Comput. Electron. Agric. 17(2):161 175, 1997. 87. Diamont, M., Wolfswinkel, L. V., Altorffer, B., and Wied, D., Biotelemetry: Adjustment of a telemetry system for simultaneous measurements of acute heart rate changes and behavioral events in unrestrained rats. Physiol. Behav. 53:11211126, 1993. 88. Pitsillides, K. F., Symons, J. D., and Longhurst, J. C., Biotelemetry of cardiovascular hemodynamic measurements in miniswine. IEEE Trans. Biomed. Eng. 39(9):982986, 1992. 89. Hicks, K. K., Seifen, E., Stimers, J. R., and Kennedy, R. H., Effects of streptozotocin-induced diabetes on heart rate blood pressure and cardiac autonomic nervous control. J. Auton. Nerv. Syst. 69(1):2130, 1998. 90. Rollins, D. L., Killingsworth, C. R., Walcott, G. P., Justice, R. K., Ideker, R. E., and Smith, W. M., A telemetry system for the study of spontaneous cardiac arrhythmias. IEEE Trans. Biomed. Eng. 47(7):887892, 2000. 91. Brockway, B. P., Mills, P. A., and Azar, S. H., A new method for continuous chronic measurement and recording of blood pressure, heart rate and activity in the rat via radio-telemetry. Clin. Exp. Hypertens. A13:885895, 1991. 92. Niezgoda, G. H., Mckinley, R. S., White, D., Aderson, G., and Cote, D., A dynamic combined acoustic and radio transmitting tag for diadromous sh. Hydrobiologia 371/372:4752, 1998. 93. Dagorn, L., Josse, E., and Bach, P., Association of yellown tuna (Thunnus albacares) with tracking vessels during ultrasonic telemetry experiments. Fishery Bull. 99(1):4048, 2001. 94. Bunt, C. M., A tool to facilitate implantation of electrodes for electromyographic telemetry experiments. J. Fish Biol. 55:11231128, 1999. 95. Okland, F., Finstad, B., Mckinley, R. S., Thorstad, E. B., and Booth, R. K., Radio-transmitted electromyogram signals as indicators of physical activity in Atlantic salmon. J. Fish Biol. 51(3):476488, 1997. 96. Briggs, C. T., and Post, J. R., Field metabolic rates of rainbow-trout estimated using electromyogram telemetry. J. Fish Biol. 51(4):807823, 1997. 97. Beddow, T. A., and Mckinley, R. S., Importance of electrode positioning in biotelemetry studies estimating muscle activity in sh. J. Fish Biol. 54(4):819831, 1999. 98. Kudo, Y., Satou, M., Kitamura, S., Iwata, M., and Takeuchi, Y., Underwater radio-telemetry of electroencephalographic activity from the Hime salmon, landlocked sockeye-salmon OncorhynchusNerka. Fisher. Sci. 63(5):687691, 1997. 99. Anderson, W. G., Booth, R., Beddow, T. A., Mckinley, R. S., Finstad, B., Okland, F., and Scruton, D., Remote monitoring of heart rate as a measure of recovery in angled Atlantic salmon, Salmo salar. Hydrobiologia 371/372:233240, 1998.