!

BM 402 ENGINEERING IN MEDICINE LECTURE NOTES

Ata AKIN
Institute of Biomedical Engineering Bo!azii University

2013 by Ata Akn

! ! PREFACE
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These lecture notes are a collage from several books and my own experiences. I would like to thank my former student, Ms Zeynep Susam, for compiling these notes while I was lecturing. She was kind enough to include many pictures and graphics (along with some cartoons) to make these notes more attractive.

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! ! TABLE OF CONTENTS
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Definition of Biomedical Engineering Health care delivery team that seeks new (innovative) solutions for the difficult problems confronting modern society Innovation patent: 1. Novel ! no one should have taught about these before 2. Non-(not) obvious 3. Applicable ! must serve a new purpose

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Primitive medicine (BC 10,000) They did not have any medication but they were interested in: " Art of herb doctoring " Bone setting " Midwifery " Surgery They believed that diseases are visitations of evil spirits. Egyptians (BC 3,000) Imhotep (peaceful sleep), the architect of the 1st pyramid "#$!"%&'! (!)*+,! 4

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! ! Greek Medicine (BC 500) God of healing: Aesculapius " Hospitals with tempts " Island of Cos: Hippocrates o Injected scientific spirit into medicine.
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Scientific spirit: systematic approach (cause ! effect), observation o He was able to bring diagnostic observation ! clinical treatment Romans (AD 500) " To use proper sewer system (public health) " Refrigerated foods (sterile and fresh) " First aid (they were warriors) Dark Ages " Church dominates medicine " Belief in drugs meant distrust to the healing power of pray Renaissance (AD 1,500) " Anatomical investigations Leonardo daVinci ! Golden Ratio Florence Nightingale (19th century) (English Nurse) " Hospital conditions accounted more than the diseases in death amounts " She discovered the importance of nursing "#$!"%&'! (!)*+,! 6

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1896 ! Wilhelm Conrad Roentgen discovered X-ray 1901 ! He won the Nobel Prize 1906 ! Siemens & General Electric made the first X-ray machine 1914 ! X-ray machine became mobile and it could work without electric. 1903 ! Electrocardiogram (ECG)

1%2#)30,!&.!1/4!
Biomedical Engineering

Diagnostic Systems Medical Instrumentation Signal / Image Processing Nanomedicine

Therapeutic Systems Instrumentation Prosthetic devices Rehabilitation

Clinical Engineering

Medical Informatics

Biotechnology Biosensors

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5!67"89!:4;"4<!&#!=+>?"@A@B>!C!5D5E@/>!!
=3-,*&F&G*)2F!?-,$0H,! A group of interconnected or independent organs that work together to perform a specific function or a group of functions in the body

x (t)

h (t)

y (t)

System (Transfer) Function System: processes inputs to produce outputs Biochemical Physical Electrical Environmental INPUTS OUTPUTS Physiological System

Biochemical Physical Electrical

HW 1 PART I: Find 2 different definitions of Biomedical Engineering PART II: Find websites related to Biomedical Engineering and organize them under the following headings: 1. Academic Websites 2. Industry 3. Professional Organizations

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8*%)(F2$&%-!I82%'*&J2,)(F2%K!?-,$0H! Organs: heart, blood vessels Lung

Aorta Left Atrium Left Ventricle

Body

Left Ventricle: Responsible for pumping oxygen rich blood to the body The heart works with electricity.

SA node

AV node

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SA node has a direct contact from central nervous system to control / modulate the rhythm of the heart. Heart rate modulators: 1. Central nervous system 2. Hormonal stimulation 3. Blood flow (mechanical) 4. Biochemical / ionic modulations on a heart muscle

Coronary arteries supply oxygen, glucose, blood to the tissue of the heart. " No blood supply due to obstruction ! occlusion ! ischemia ! hypoxia ! cell death Ectopic focus ! ventricular fibrillation

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D0%J&(,!?-,$0H! Integration and control of all body functions

Central Nervous System (CNS) All the nerve tissue enclosed by the bone Brain & spinal cord

Peripheral Nervous System (PNS) Nerve tissue that is not enclosed by the bone Nerve fibers from the spinal cord, muscle nerve fibers

Stroke: Bleeding of blood vessels ! resulting in partial paralysis Blood Vessels

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Coagulant ! fills where theres an explosion " Fibers cross over in brain stem; left side of the brain controls the right side of the body.

Frontal ! executive function Parietal ! motor-sensory systems Temporal ! auditory Occipital ! vision

Reflex Arch

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There are multiple control systems in the brain

Corpus Callosum # Bridge to share information

" Split brain syndrome (still used to treat epilepsy) Underneath the frontal lobe ! emotional control and memory " Cerebrospinal fluid underneath and around the brain The top and under pressures are the same The fluid is inside 4 ventricular chambers

Central Nervous System

Autonomic Nervous System

Sympathetic Nervous System Fight Mode! Excitatory

Parasympathetic Nervous System Flight Mode!

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:0,L*%2$&%-!I=(FH&#2%-K!?-,$0H!! Enables cardiovascular system to exchange gases with air " Nose, pharynx, larynx, trachea, lungs

PairVair = Plung Vlung

Pair Vair is constant ! Plung decreases; Vlung increases ! rush of fresh air through the lungs Huge oxygen gradient between the deoxygenated blood and alveolar As the red blood cell flows, oxygen is diffused through mucosa (secreted by the certain cells that have hair) and the red blood cell fills with oxygen. CO2 is formed as HCO3- because it is not desired in gas phase in the plasma. It is dissolved in acid form. The undissolved part is carried by the red blood cell. CO2 is diffused freely in alveolar. "#$!"%&'! (!)*+,! 14

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Smoking: Smoke has tar in it. Tar sits on top of mucosal layer. Alveolar needs to secrete more mucosa. The thickness has increased, diffusion takes longer. If you smoke more, the distance that the oxygen should travel increases and theres no more oxygen transfer. # Emphysema Respiratory system is controlled by signals if cerebellum. B2,$%&*#$0,$*#2F!IM*G0,$*J0K!?-,$0H! Concerned with the ingestion and digestion of food, elimination of the residues of the gastrointestinal system " Liver, gallbladder, pancreas, stomach, intestines colon

Esophagus ! peristaltic activity (Squeezes the food down)

Gastroesophageal reflux 1. Neoplasia 2. Dysplasia "#$!"%&'! (!)*+,! 15

! ! 3. Cancerous formation o Immortality o Uncontrolled growth " Metastatic " Barnetts Esophagus
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7%&G0#*$2F!?-,$0H! " Production, storage, elimination of urine " Reproduction o Kidneys, bladder, ovaries, prostate Kidneys: Responsible for maintaining water equilibrium, balance of minerals, and removal of toxic components from the blood. " Filtration system, continuous blood flow

Input: Blood

Output: Blood

Bladder

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Kidneys maintain mineral level (Ca, Mg, Zn, Fe) ! Maintain homeostasis (static state of the body) Kidneys are responsible for maintaining blood pressure. Too much water ! pressure in blood vessels Kidneys send hormones to blood vessels to relax the vessels ! renin activates angiotensin ! Squeezing down the vessels Dialysis: A filtration system to remove toxins and urea from the blood. Kidney Stone:

Pancreas: Responsible for secreting hormones to maintain blood glucose level. " Hypoglycemia " Diabetes Mellitus

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! ! /(,)(F&,N0F0$2F!?-,$0H! " Muscles & skeleton Maintaining balance, movement, keeping warm
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Amount of signals determine how many muscles should be recruited to carry the weight. Signals can be sent as a whole or one by one.

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Force generated by muscles is a function of " Neuronal stimulation from the brain (frequency & intensity) " Amount of blood supply " Available nutrients " Ionic concentration around muscle (Ca2+) " Previous activity level

" Lactic acid vs. endurance " Hypertrophy

4#'&)%*#0!?-,$0H! Regulation and control of visceral functions " Secretes hormones via glands that control growth, metabolism and reproduction. o Pituitary gland, thyroid, parathyroid, adrenalin gland, thymus Glands are bags that are covered by muscles.

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Pituitary gland: growth, reproduction Thyroid gland: around the trachea at the larynx " Controls the rate of metabolism o Hyperthyroidism o Hypothyroidism Parathyroid gland: on top (around) the thyroid gland " Responsible for maintaining calcium balance in the blood stream and tissues Adrenal glands ! epinephrine Small amounts ! vasodilation Large amounts ! vasoconstriction

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+0H2$&L&*0$*)!?-,$0H!C!A-HL32$*)!?-,$0H! Production of blood & blood components Immune system components " Bone marrow, spleen, lymphatic tissues Bone marrow: production of red & white blood cells Spleen: storage of blood cells Lymphatic tissues: collection of plasma, dead red blood cells " Production of immune system components Red blood cells: storage of hemoglobin White blood cells: soldiers of the body

Integumental System Skin, hair, nails Skin ! protection Nails ! finger support Hair ! protects the brain from heating, provides sweating

HW 2 PART I: Pick a physiological system of your choice and describe its functions, organs in 2 pages PART II: Find a major disease of this system. Explain its pathophysiology, progression, diagnosis and therapeutic interventions in 1 page. "#$!"%&'! (!)*+,! 21

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Sensors that are used to measure electrical, chemical, physical activities from human body Biomedical Instruments

Diagnostic

Therapeutic

Invasiveness Non-invasive Invasive " Ionization (radiation) X-ray, UV, "-ray " Contact with blood " Intrusion into the body Minimally invasive " Contact with blood " Intrusion into the body Non-invasive " Surface or remote diagnosis / therapy Minimally invasive Invasive

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A General Block Diagram for a Diagnostic Instrument

Instrument Control Sensors Data Acquisition

Display

CPU

Printer

Memory

Rem ote site

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830H*)2F!?0#,&%,!
Blood components, glucose, ions, hormones, and pH, O2, CO2

O2 measurement

Clark Electrode Invasive (accurate) Non-invasive (not so accurate) -

Pulse Oximetry Non-invasive (not so accurate)

8F2%N!4F0)$%&'0!

Rate of electron transfer is measured by the resistance of electrodes.

V = IR Ohm' sLaw !L R= A
O2 + H 2 O + 4e $ " 4OH $ Ag # Ag + + e $ Ag + + Cl $ " AgCl !

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=(F,0!@O*H0$%-! Detector

Hb HbO2

Finger

!1

!2

" Detector: non-laser red light sources Light is used to measure the concentrations of [HbO2] and [Hb] (Near infrared)

& OD((1 ) # S O2 = A ' B $ ! % OD((2 )"

S O2: Saturation of O2 OD: Optical Density

1*&)30H*)2F!?0#,&%,! " Glucose, hormone, blood components " O2 measurement: spirometer to measure O2 gas amount and CO2 gas in the air exchanged by the lungs

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" Results of biopotentials ! biologically generated electrical signals Cells are electrically excitable. "#$!"%&'! (!)*+,! 25

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Resting membrane potential ! Due to the existence of ions across the cell membrane

Action Potential

" Is due to the rapid exchange of ions across cell membrane through channels and gates " Muscle cell ! gates " Heart muscle ! gap junctions transfer electrical potentials between cells " Dipole " Einthovens triangle Electrical Sensors

Non-invasive Surface type ! Surface electrodes "#$!"%&'! (!)*+,!

Invasive Needle ! deep tissue measurement 26

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Wire Ag / AgCl

Electrolyte Skin Double side adhesive Electrolyte: electrically conductive gel with NaCl " It allows the passage of electrical signals to the metal Adhesive secures the electrode onto the skin surface.

4F0)$%&)2%'*&G%2H!I48BK! P: atrial contraction QRS: left ventricle contraction T: refilling of the ventricle

" Heart Rate " Pacemaker

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! 4F0)$%&H-&G%2H!I4/BK! " Measurement of electrical signals of the muscle

+ _

Cable of electricity

Stimulus

Needle electrodes 200-400 m thick wires Invasive

+ _

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The electrodes make a goof approximation about the electrical activity. " 20 electrodes across the head (cap electrodes) "#$!"%&'! (!)*+,! 28

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" Visual Evoked Potential " Evoked Response " Cortical electrodes

HW 3 PART I: What are the operational principles and clinical applications of 1. ECG 2. EMG 3. EEG (1 page each)

PART II: What is functional electrical stimulation (FES)? What are its clinical applications? (1 page)

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=3-,*)2F!/02,(%0H0#$,!
" Volume, force, temperature, pressure, sound

;&F(H0!/02,(%0H0#$!
Breath

Rubber strand
A

To measure the change in current:

R= R=

V I

#"R
!R " !l

!L
A

" Calibration curve

Linear sensitivity

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I ! limit of detection I II III II ! linear range III ! saturation (cut-off) range

"V " Transducer

Breathing by rubber strand:

T period

Breath Rate =

no of breaths min

12-15 min-1 Amplitude gives basic info about the amount of air exchange

P&%)0!C!?$%2*#!/02,(%0H0#$! I F

+ V

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Rubber substrate

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F " !R " !l

1. Intraesophageal balloon

Pump

2. Strain Gage

Rubber Needle

Surface of stomach

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=*0Q&0F0)$%*)!E%2#,'()0%! o Force, pressure, flow A crystal that produces electricity when mechanically strained. Metal

Voltmeter

Q = kF
Q: electric charge produced k: coefficient of the crystal F: force applied

1F&&'!=%0,,(%0!/02,(%0H0#$!

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E0HL0%2$(%0!/02,(%0H0#$! 1. Mercury Based Measurement 2. Electrical Thermometer 3. Optical Thermometer

Electrical Thermometer

+
I Thermistor

( " 1 1 %+ R(T ) = R0 exp *! $ ! ') # T T0 &,

!I " !R "
1*&,0#,&%,!

1 T

Sensors that measure the concentration of chemical components of solution

Cholesterol

Biological compound

Glucose Membrane

Enzyme

Transducer "#$!"%&'! (!)*+,! 34

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Glucose + enzyme $ glucanic acid $ alters the pH of the sheet pH ! Glucose

HW 4 PART I: What is a biosensor? Find 1 clinical application for it. PART II: What is a molecular beacon? What is a quantum dot? Find their usage in biology.

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1"@/4M"85A!"D?E:7/4DE5E"@D!
A generalized block diagram of a biomedical device

M2$2!=%&)0,,*#G!7#*$!
Noise Removal " Elimination of unwanted signals " Electromagnetic interference = Power lines, TV-Radio broadcast, mobile phones, computers, lab equipment

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! ! 1. Noise filter
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x (t)

h (t)

y (t)

Transfer Function

Transfer function ! filter out unwanted noise

2. Data Filter " Designed to extract relevant physiological information out of others Low pass filter, high pass filter, band pass filter

x (t)

hD (t)

y (t)

Convolution: y(t) = x(t) * hD(t) 3. Gain " Performed to increase the amplitude of the signal

x (t)

y (t) = G x (t)

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4. Differential Measurement n(t) V1(t) VR(t) + _ V2(t) Vo(t)

VL(t)

V1 (t ) = VR (t ) + n(t ) ! V2 (t ) = VL (t ) + n(t ) Vo (t ) = V1 ! V2 = VR (t ) ! VL (t )

" To eliminate common noise

Typical signal conditional steps

Differential measure + _

Noise filter hN (t)

Data filter hD (t)

Gain

y (t)

[x1 (t ) ! x2 (t )]

[x1 (t ) " x2 (t )]! hN (t ) {[x1 (t ) " x2 (t )]! hN (t )}! hD (t )

y(t ) = G{[x1 (t ) " x2 (t )]! hN (t )}! hD (t )

Sensor SCU CPU

CPU

A/D converter "#$!"%&'! (!)*+,!

Microprocessor 38

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Analog to Digital Convertors Types of Signals 1. Analog ! real world, continuous signal 2. Digital ! digitized signals ! sampled and stored in the computer o A digital representation of the signal

A / D Converter # Resolutions 1. Temporary Resolution o How fast a signal is sampled [samples/sec] = sampling rate Fs Typically Fs = 1000 samples/sec 2. Dynamic Resolution o How fine are you quantizing a signal? [bits]

"=

Dynamic Range Vmax ! Vmin = no of levels 2n

n: number of bits = 10-12 bits

Ex: 12 bit A / D converter, Fs = 200 samples/sec records data for 10 min from 16 electrodes. What is the size of the data file?

Data size = no of bits " Fs " Duration of record " no of sensors = 12 " 200 " (10 " 60 ) " 16 = 23M bits ! 2.8MBytes

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1*&H0'*)2F!?*G#2F!=%&)0,,*#G!
Bioelectric Signals " Generated by nerve and muscle tissues when they are electrically active. ! Result of electrochemical changes across the cell membrane. Biomagnetic Signals " Magnetic fields are generated due to changes in electric field.

# Magnetoencephalogram (MEG)

Biochemical Signals " Concentrations of ions (Ca2+, K+, Na+, Cl-), hormones, chemical compounds, blood gases Biomechanical Signals " Motion, displacement, tension, force, pressure, flow Bioacoustics Signals " Due to vibration, flow of blood, respiratory system (lung) sounds

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! Characteristics of Signals!

Deterministic Signals

Random (stochastic) Signals

Periodic

Aperiodic

Deterministic: an explicit mathematical representation exists " Periodic signals ! x(t ) = x(t + T )

x(t)

" Aperiodic signals ! x(t ) = Ae !t / T x(t) A-

e !t / T

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Random: characterized by statistical values (mean, standard deviation) " EEG signals P&(%*0%!E%2#,.&%H! A means of representing the contribution (weight) of different frequencies within a signal 1.

x1 (t ) = A1 sin(!1t )

T1 A1

- A1

2. x2 (t ) = A2 sin(!2t )

T2 A2

-A2

xT(t)

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! x(f) A1 A2 f1 f2 frequency !

Data Compression

" Fourier Transform is random.

" EEG o Grand averaging Ensemble averaging

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/4M"85A!"/5B"DB!
Medical Imaging

Functionality

Invasiveness

Morphological Anatomical
Map of organs

Physiological
Provide information on how well an organ is functioning

Non-invasive
Remote Surface contact

Min-invasive
Intrusion into the body Contact w/ blood

Invasive
Radiation

6(2F*$-!*#!/0'*)2F!"H2G*#G!
1. Spatial Resolution " How small can we detect [pixels/area] 2. Contrast Resolution " How fine of colors do we see? [bits/pixel] 3. Temporal Resolution " How many images can you take in 1 second? [frame rate] = [frames / second] ! 24 frames/sec (real time)

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:2'*2$*&#!"H2G*#G!
- Depends on the use of X-rays to image the absorption (attenuation) distribution of the tissues

Object

I0

Photographic film covered with fluorescent material

I < I0

Source Object

Visible light
Fluorescent material

1896 Discovery of X-ray 1901 The very first Nobel Prize was given to Wilhelm Conrad Roentgen

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! ! =%*#)*LF0,!&.!RS:2-!"H2G*#G!!
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Attenuation of X-rays by tissues between body parts having minimally different density, fat, muscle, result in a shadow image ePhotographic film " Pulse generation Collimator Florescent cover " Collimator: aligns X-ray beam Holes A grid of photo detector

X-ray lamp

Pb

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=3-,*),!&.!RS:2-!"H2G*#G!

Ionizing radiation

E = hf
h: Plancks constant f: frequency of electromagnetic wave

" f =

c #!

Ionization: decomposition of matter Vaporization of tissues

" rays, X rays pass through tissues and give permanent damage to skin

X-ray source

Detector

I0

z "#$!"%&'! (!)*+,! 47

! !
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! !

I ( z ) = I 0 e " !mz
z: distance between source and detector %: density of the object : attenuation coefficient

7#*$,!&.!RS%2-!4OL&,(%0! Roentgen ! R = 2.58 * 10-14 C/kg Produces ionization of either charge (+ or -)

When light enters (I0), some of it is absorbed by the body not to eliminate X-ray immediately. A typical X-ray session: 10 100 millirads Absorption of X-ray by body (chest X-ray)

Onset of radiative effect: 50 rads Radiation death > 200 rads

B0&H0$%*)!7#,32%L#0,,! X-ray source Fan beam f s

Image plane "#$!"%&'! (!)*+,! 48

! ! s: source to image plane distance t: center of object to image plane distance f: fixed size of the object
-.!/*)!012#341!56#17!

! !

d=

f "t s!t

Goal: minimize d (f fixed) 1. Increase s ! increase source detector distance 2. Decrease t ! bring the object close to image plane

X-rays ! planar image

8&HL($0%!5*'0'!E&H&G%2L3-!?)2##0%!I85E!?)2#K!
Computerized Tomography (CT)

Source

Detector

The detector rotates and cross-section images are obtained at every 1-2o

"#$!"%&'! (!)*+,!

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! !
-.!/*)!012#341!56#17!

! !
2+ 1 2 4

%1 1

%2 2

1+

%3 3

%4 4

1+

1+

" i = !i i

We have 4 unknowns We need 4 independent projections to solve # Back Projection Algorithm Reconstruct cross-sectional image of an object by projected data s

1st Generation CT 1 source, 1 detector 60 seconds to 4-5 minutes for each rotation Rotates at every 6o angle for one cross-section 2nd Generation CT 1 source 30 detectors All detectors are close to the source at equal distances to reduce geometrical sharpness 3rd Generation CT 300 detectors ! 2 4 seconds "#$!"%&'! (!)*+,! 50

! !
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4th Generation CT Only the source (fan beam) is rotating 700 detectors around (2 4 seconds)

PF(&%&,)&L-! Patient is given a radio opaque (X-ray absorber) material and the movement of this material is observed under light by camera.

5#G*&G%2L3-! Injection of radio opaque material into the veins for observation of occlusions

HW 5 1. What is X-ray mammography?

2. What is balloon angioplasty?

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! !
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! !

:2'*&#()F*'0!"H2G*#G!
Nuclear medicine ! radioactive elements Invasive ! ionizing radiation Functional physiological imaging ! Curries

Nuclear particles en, p+

! energy

n ! p + + e " + # e" + energy p + ! n + e + + # e" + energy

Through a catheter

Powder

radioactive

mix in solution

The solution circulates in the body and targets several organs I ! radioisotope ! mixed in the solution and accumulates in thyroid C6H12O6 ! Isotopes C11, C15 ! accumulates in the parts where glucose is consumed

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! !
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! !

=&,*$%&#!4H*,,*&#!E&H&G%2L3-!I=4E!?)2#K! An imaging technique that uses " cameras (& cameras) to monitor the whereabouts and intensity of a radioactive element injected into the body

It is possible to monitor the progress of the activity in time. It can be used to measure the effect of chemotherapy. It can also be used to measure the effect of the drugs.

:2'*&2)$*J0!M0)2-!

N (t ) = N 0 e " !t
N0: initial amount of material ': decay constant t: time

T1 / 2 =

0.693

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! !
-.!/*)!012#341!56#17!

! !

1*&F&G*)2F!+2F.SF*.0! Time needed for the body to excrete half of the amount of radionuclide. Tb1/2

eff 1/ 2

T 1 / 2 !T1b /2 = b T 1 / 2 +T1 / 2

O15, T1/2 = 122 sec C11, T1/2 = 20.5 min

" Molecular Beacon

" Quantum Dot

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! !
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! !

/2G#0$*)!:0,&#2#)0!"H2G*#G!I/:"K!
Uses non-ionizing radiation to probe the soft tissue contrast Provides excellent soft tissue contrast

=3-,*),!&.!/:"! Uses electromagnetic waves at radiofrequency (50-60 MHz)

Charged electron spinning around the axis Creation of 2 poles Magnetic dipole moment

Non-magnetic
-

Because all moments facing different directions

Magnet S N All moments are at the same direction

1. All spinning nuclei have a characteristic resonance frequency which depends on the atomic composition 2. When atoms are combined to form larger molecules, their overall resonance frequency depends on their total weight

"#$!"%&'! (!)*+,!

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! !
-.!/*)!012#341!56#17!

! !

D()F02%!/2G#0$*)!:0,*,$2#)0!?L0)$%&,)&L-!ID/:?K! Different proportion of molecules # Different spinning frequency

A2%H&%!P%0T(0#)-!

" = $ #0 " = 2! f
": gyromagnetic ratio &0: applied magnetic field Each molecule starts to rotate according to gyromagnetic ratio, resulting in (A, (B, (C, and (D.

A% "

IA ! 100 IT

IT = I A + I B + IC + I D

"#$!"%&'! (!)*+,!

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! !
-.!/*)!012#341!56#17!

! !

PG

Re

PG: Pulse Generator Re: Receiver

B1

S B0

1. Place the sample inside a static magnetic field (B0) 2. Close S1 (off S2) ! Generate a B1 ) B0, 3. Off S1, on S2 ! Listen to incoming signal B1 << B0 at a specific (0

Free Induction Decay, which is a signal like this:

FID

* A

A *

the amount of compound present within the sample the density of compound present within the sample "#$!"%&'! (!)*+,! 57

! !
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! !

"H2G*#G!"#!/:! Idea: Image 3-D object according to the distribution of H+ ion

Each cube is called a voxel. Min resolution: 1 mm x 1 mm x 1 mm

H + " $ H+ BT !=#T !

Srec Rec SX PGX PGY PC SY Display

"#$!"%&'! PGZ (!)*+,! SZ

58

! !
-.!/*)!012#341!56#17!

! !

PG require high current to operate High current means heat generation ! cooling system is necessary

MRI An anatomical imaging technique Used in observing tissue contrast changes (Inflammations, lesions, tumor formation, muscle injury) Contrast agents ! enhances MR signal to investigate joints (Gd injection)

Functional MRI (fMRI) Used only for research Measurement of physiological changes in human body (Manic depressive normal brain) It uses hemoglobin molecule to trace the functional activity level of the brain.

HW 6 PART I: What is CT-PET Scanner? What is its clinical use? PART II: What are functional MRI and its clinical use?

"#$!"%&'! (!)*+,!

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! !
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7AE:5?@7DM!"/5B"DB!
Uses sound waves to probe the mechanical properties of the tissues (pressure waves)

+ = 1500 m/sec Some sound waves reflect from the boundary. Some continue their way. ultra ! not audible , 5 30 MHz

Pfat ( z ) = P0 e

"! f z f

P0: initial intensity of pressure wave !! : attenuation coefficient of the tissue !! = !! f f: frequency of operation !! : initial coefficient zf: thickness of the tissue f - Pf . (more attenuation) ! less penetration depth ! but spatial resolution increases

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! !
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Medical Ultrasound

Diagnostic

Therapeutic Kidney stones (lithotripsy) Wound healing Bone healing Muscle injury rehab Surgical

Anatomical

Functional Blood flow

Amplitude (A mode) Ultrasound

"#$!"%&'! (!)*+,!

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! ! Brightness Mode (B Mode)

-.!/*)!012#341!56#17!

! !

The echoes are turned into gray scale image

Array of US sensors

Non-invasive!

"#$!"%&'! (!)*+,!

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! !
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M&LLF0%!7F$%2,&(#'! Doppler Effect is the result of changing the wavelength of a source by its velocity.

US Beam / P0 P1 (fd) f0

fd =

2" cos! f0 C

+: velocity of object C: speed of sound Occlusion Front (coronal) view

f0 +: measure the change in blood velocity fd

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! ! Kidney Imaging
-.!/*)!012#341!56#17!

! !

Blood moving away from the probe

Blood towards the probe

B Mode + Doppler US Kidney stone

4)3&)2%'*&G%2H! ! Live anatomical image of the heart + Movement of blood through the heart

B mode: observe anatomical problems Doppler: quantify the degree of disease Doppler is less invasive than B mode because the patient is exposed to less Ultrasound. (Still the two applications are non-invasive)

"#$!"%&'! (!)*+,!

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! !
-.!/*)!012#341!56#17!

! !

E30%2L0($*)!7F$%2,&(#'! ! Lithotripsy (stone breaking) Locating the Stone Ultrasound (transmitter)

Bathtub

"#$!"%&'! (!)*+,!

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! ! 4F0)$%&!?3&)N!<2J0!A*$3&$%*L,-!
-.!/*)!012#341!56#17!

! !

1*&H0'*)2F!@L$*),!
The use of light in diagnostic and therapeutic applications

Diagnostic

Therapeutic

Microscopic (<100m)

Macroscopic (>100m)

Surgical

Rehab

Cosmetic

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! ! Light and Matter Interaction " ray Absorption Scattering

-.!/*)!012#341!56#17!

! !

X ray Invasive

UV

vis

Infrared Non-invasive (Diagnostic)

(Treat cancer) ! Depends on the 1. Wavelength 2. Intensity Less water absorption

High water absorption

;*,*UF0!A*G3$!"H2G*#G! Endoscopy

Coils to move the tubes to look around the organs 4 holes, 5 mm in dimension

PF(&%0,)0#)0!"H2G*#G! - A certain color of light is used to excite certain chromophores

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! !
-.!/*)!012#341!56#17!

! !

E30%2L-! ! Surgical inventions o Cut the tissues o Coagulate the vessels and tissues o Ablate the vessels and tissues o Weld the tissues

A2,0%! Coherent, focused light beam

Cornea Pupil

:032U*F*$2$*&#!=%&)0'(%0,!&.!A*G3$! Infrared Therapy o Tissue Damage Cosmetic applications 1. Plastic Surgery 2. Epilation

"#$!"%&'! (!)*+,!

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! !

Comparative Matrix of Imaging Systems1

Ionization X-Ray CT US MRI PET Endoscopy Very low Low None None High None

Operation Anatomic Anatomic Anatomic/ Functional Anatomic Functional Anatomic

Clinical Use Soft/hard tissue contrast Soft tissue Soft tissue Soft tissue Metabolic Surface

Resolution (mm) 3-5 mm 1-2 mm 2-3 mm 1-2 mm 3-5 mm 1 mm

Real time No No Yes No No Yes

Cost* Low High Moderate High High Low

Mobility Yes No Yes No No Yes

Invasiveness 4 5 1 3 6 2

* Low < $50K, Moderate $50K - $200-300K, High > $300K 1: Most non-invasive, 6: most invasive

! !

I would like to thank Mrs. Nilfer Adoran from the MDSI (2012) program for helping me with this table 69 "#$!"%&'! (!)*+,!

! !
-.!/*)!012#341!56#17!

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:032U*F*$2$*&#!4#G*#00%*#G!
Application of technology to help (ease) the problems faced by people with disabilities Activities in Rehabilitation Engineering 1. Prosthetics and Orthotics Artificial hand, wrist, arms, foot, legs, Hand splits, upper limb braces Bone / joint prosthetics Functional Biocompatible

2. Assistive Devices for persons with severe visual impairments Devices to aid reading, writing TV magnifiers, electronic Braille Aids for independent mobility (laser cane)

3. Assistive Devices for persons with severe auditory impairments Digital hearing aids ! cochlear implant

Mic

Cochlea Skull

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! ! Lip reading instruments

-.!/*)!012#341!56#17!

! !

4. Mobility manipulation aids Grabbers, feeders, page turners, wheel chairs, driving aids

A general block diagram of an assistive technology

Analog data

Sensors

Digitalized data

Perception

Cognition

Motor Control

Effectors

information

knowledge

"#$!"%&'! (!)*+,!

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! !
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! !

8F*#*)2F!4#G*#00%*#G!
An engineer who manages, maintains and improves the safe use of medical equipment in hospitals It started when safety problems aroused Electroshock, electrocution proper grounding issue

Job Descriptions of Clinical Engineers " Supervise performance of safety testing of medical equipment by companies " Repair medical instruments " Inspect of incoming equipment " Organize inventory control " Manage calibration and repair services " Coordinate outside use of technical services " Train medical personnel in safe and effective use of equipment " Develop and implement documentation protocols required by external accreditation and licensing agencies

Safety Issues in Hospitals Dangers: - Electrical Hazards - Mechanical Hazards - Environmental Hazards (solid, waste, noise, utilities, gas)

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! !
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! !

- Biological Hazards: infection control (isolation, contamination, sterilization, biological waste disposal) - Radiation Hazards

/0'*)2F!4$3*),!
Nature of Life and Its Significance Immanuel Kant (1724 1804) What can I know? What I ought to do? What can I hope? What is man?

Ethics Represents the codes of conduct of society, the study of right and wrong, good and evil in human conduct Questions 1. Should body deformed infants kept alive? 2. Should treatment be stopped to allow terminally ill patients to die? 3. Should humans be used in experiments? Medical Dilemmas 1. Is it more important to preserve life or prevent pain? 2. Is it right to withhold treatment when doing so may lead to a shortening of life?

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! !
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! !

3. Does an individual have the right to refuse treatment when refusing it may lead to death? (Euthanasia: good death) Kants theory: Humans are owed a special kind of respect simply because they are people Experiments Human Ethics Review Board Animal Ethics Review Board

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