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Copyright © 2007, New Age International (P) Ltd., Publishers
Published by New Age International (P) Ltd., Publishers
‘Bio’ denotes all things which are connected with life. Firstly man has learnt the use of herbs
for treatment and the knowledge of botany becomes essential for the practitioner of medicine.
Gradually man has learnt to apply laws of physics and chemistry to living things which has led to the
evolution of sciences of biophysics and biochemistry. In recent years, there has been rapid progress
in the field of the health care. The need to effectively utilize high technology equipment and systems
in the health care necessitates the expertise of clinical engineers, hospital physicians and computer
scientists. Hardly any patient today would pass through a hospital or even a family physician’s
chamber without the use of this technology.
The knowledge of basic engineering and the need of biomedical engineers in health care is
increasingly accepted. The biomedical engineering is the inter marriage of engineering and medicine.
The biomedical engineering as a subject has been introduced in the engineering courses to equip the
engineering graduates to work in the health care industry. It is, therefore, essential for engineering
students of almost all disciplines to have a sound knowledge of biomedical engineering. This book is
designed to explain the fundamentals of biomedical engineering in the areas of biomechanics, biofluid
flow, biomaterials, bioinstrumentations and in use of computing in biomedical engineering. Though
this book is chiefly based on the syllabus of Uttar Pradesh Technical University, but an effort has
been made to cover the syllabus of several other universities as well as based on my experience of
teaching.
I have endeavoured to present a systematic explanation of the basic concepts of the biomedical
engineering by firstly introducing the topics of anatomical terms and planes, terms related to movements
medical terminology, histology and physiological systems of the body. A large number of objective
type questions are included to enhance the understanding of the principles of theory.
I express my gratitude to Dr. Jasdev Singh Sawhney, FRCR and Dr. Pooja Sachdev Sawhney
MRCP for their valuable suggestions which have helped me immensly in conceptualizing and writing
this book. I am also thankful to my doctoral guide, Dr. S. Prasad, NIET Greater Noida for moral
support. I am also thankful to Dr. Sujay K.Guha, SMS, IIT kharagpur who has been my inspiration
in the field of biomedical engineering.
I am also thankful to Dr. V.K. Goswami and the faculty of GNIT, Greater Noida specially Mr.
Devraj Tiwari of Mechanical, Prof O.P. Sharma and Mr. Manish of Information Technology, Mrs.
Minakshi Awasthi of Physics and Mr. S.D. Nautyal of library for their contributions.
Above all, I wish to record my sincere thanks to my wife, Jasbeer Kaur for her patience
shown throughout the preparation of this book. I am also thankful to the staff of New Age Publishers
who have associated with the completion of this book. Last but not least, I want to thank Mr. K.K.
Aggarwal, chairman and Dr. A.M. Chandra, Director of Lord Krishna College of Engineering,
Ghaziabad where I joined recently for their constant encouragement.
I would appreciate receiving constructive suggestions and objective criticism from students
and teachers alike with a view to further enhancing the usefulness of the book by e-mailing at
channi_sawhney@hotmail.com
G.S. SAWHNEY
CONTENTS
Preface v
1. Introduction 1
2. Concepts of Physics, Mechanics and Fluid Mechanics 23
3. Biomedical Engineering 33
4. Biomechanics of Bone 38
5. Biomechanics of Soft Tissues 48
6. Skeletal Joints 52
7. Mechanics of the Spinal Column 57
8. Mechanics of Upper Limbs 62
9. Mechanics of Lower Limbs 74
10. The Cardiovascular System and Blood Flow 89
11. The Respiratory System 111
12. Kidney and Blood Flow 122
13. Prosthesis and Therapeutic Devices 127
14. Orthosis 141
15. Metallic Biomaterials 146
16. Polymeric Biomaterials 151
17. Bioceramics 158
18. Composite Biomaterials 162
19. Biogradable Polymeric Biomaterials 165
20. Orthopedic Prostheses Fixation 167
21. Physiological Signals and Transducers 169
22. Signal Processing 181
23. Digital Image Acquisition and Processing 186
24. Radiography 194
25. Computed Tomography 204
26. Magnetic Resonance Imaging 213
27. Ultrasound Imaging 219
28. Radioisotopes and Radiotherapy 226
viii
ANATOMICAL TERMS AND PLANES also used for the bones of the pelvis. The
lowest part of the pelvis or in other words
1. The body is made up of the head, trunk and the lowest part of the trunk is the perineum.
limbs. The trunk consists of the neck, thorax The central axis of the trunk is the vertebral
(chest) and abdomen (belly). The lower part column, and the upper part of it (cervical
of the abdomen is the pelvis. This word is part) supports the head.
Head
Neck
Thorax
Arm
Fore Arm
Radial side
Abdomen
Ulnar side Pelvis
Hand Perineum
Dorsal surface
Palmar surface
Thigh
Leg
Foot
Dorsal surface
Planter surface
Anatomical Terms
2 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
2. The main parts of the upper limb are the 5. The ‘Median plane’ is an imaginary vertical
arm, forearm and hand. Arm in strict longitudinal line through the middle of the
anatomical term means the upper arm (the body from front to back, dividing the body
part between the shoulder and elbow) into right and left halves. The ‘sagittal plane’
however, this word is commonly used for is any plane that is parallel to the median
the whole of the upper limb. plane. The adjective ‘medial’ means nearer
to the median plane, and ‘lateral’ means
3. The main parts of the lower limb are the
farther from it. Thus we can say in
thigh, leg and foot. Here also leg in strict
anatomical position, the little finger is on
anatomical form means the lower leg (the the medial side of the hand and the thumb
part between the knee and foot) but the is on the lateral side, similarly the great toe
word is commonly used for whole of the is on the medial side of the foot and the little
lower limb. toe on the lateral side. If we consider forearm
4. In order to describe the positions of which has two bones with radius bone on
structure in human anatomy, the body is the lateral side and ulna bone on the medial
assumed to be standing upright with the feet side, then the adjective ‘radial’ and ‘ulnar’
together and the head and eyes looking to can be used instead of lateral & medial.
the front with the arms straight by the side Similarly in the lower leg where there are
two bones, the fibula on the lateral side and
and the palms of the hands facing forwards.
the tibia on the medial side, the alternative
This is the anatomical position and
adjectives ‘fibular’ and ‘tibial’ can be used.
structures are always described relative to
6. ‘Coronal planes’ are imaginary planes at right
one another using this as the standard
angles to the median plane. Horizontal or
position. This is also applicable even when transverse planes are at right angles to both
the body is lying on the back to bed or when the median and coronal planes.
lying on a dissecting table.
M ed ia n plan e
C o ron al
p la ne
H o rizon ta l
or
T ran sve rse
p la ne
Planes
INTRODUCTION 3
7. The terms ‘anterior’ and ‘posterior’ are used ipsilateral while the left biceps branchii
to indicate the front or back of the body muscle and the right rectusfemoris muscle,
respectively. Therefore we have anterior and are contralateral. The ‘supine’ position of
posterior view of the body or any part of the body is lying on the back and the ‘prone’
body or organ. It is also used to describe position is lying face downward.
the relationship of two parts. One is said to
be anterior or posterior to the other if it is TERMS RELATED TO MOVEMENTS
closer to anterior or posterior to the body
surface. Hence on the face, the nose is 1. Wherever two or more bones meet, it is
anterior to the ears and the ears are posterior known as a joint. The degree of mobility
to the nose. Sometimes ‘ventral’ is used varies from joint to joint. Some joints have
instead of posterior.
no movement (as in bones of skull), some
8. In describing the hand, the term ‘palmar’ have only slight movement (as in vertebrae)
and ‘dorsal’ surfaces are used instead of
and some are freely morable. These
anterior and posterior. Similarly in describing
movements are made in any of three planes
the foot, the ‘plantar’ and ‘dorsal’ surfaces,
are used instead of lower and upper surfaces. as explained above. Different terms are used
to describe the movements as explained
9. The terms ‘proximal’ and ‘distal’ describe
the relative distances from the roots of the below.
limbs. The arm is proximal to the forearm 2. ‘Flexion’ is a movement that takes place in
and the hand is distal to the forearm. a sagittal plane. It is infact folding of the
10. The terms ‘superior’ and ‘inferior’ means bones so as they may come nearer. For
nearer the upper or lower end of the body example, flexion of the elbow joint bring the
respectively. Hence the nose is superior to anterior surface of the forearm to the anterior
the mouth and, inferior to the forehead. of the arm. It is usually an anterior
‘Superficial’ means near the skin surface movement but it can be posterior movement
and ‘deep’ means farther away from the
also as in the case of the knee joint.
surface. The terms ‘internal’ and ‘external’
are used to describe the relative distance of ‘Extension’ means unfolding or straightening
a structure from the centre of an organ or the joint. The movement usually takes place
cavity. ‘Ipsilateral’ and ‘contra-lateral’ are in a posterior direction. However, flexion
used for parts on the same side or not of and extension of trunk takes place in the
the body. Hence, left hand and left foot are coronal plane (lateral).
Flexio n
Flexio n
E xte nsio n
E xte nsio n
S h ou ld er jo in t E lbo w join t K n ee joint
Flexation and Extension
4 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
3. ‘Abduction’ of a limb is the movement away the fingers and toes abduction signifies the
from the midline of the body in the coronal spreading of these parts and adduction
plane. ‘Adduction’ of a limb is the movement indicates the drawing together of these parts.
towards the body in the coronal plane. In
A d du ctio n
A b du ctio n
A b du ctio n
A bduction
A d du ctio n
A d du ctio n
(c) ‘Pronation of the forearm’ is medial (d) ‘Supination of the forearm’, is a lateral
rotation of the forearm in such a manner rotation of forearm from the pronated
that the palm faces posteriorly. position so that palm of the hand comes
to face anteriorly.
ROOTS
(o) Arteries = Aeir (air) + tercm (to keep). look like humans and it is functions,
It is a greek word. After death the not form which matters. Robots have
arteries (blood vessels to take blood to capability to interact with humans via
organs) are usually empty of blood synthesised speech. They have vision
whereas the veins (blood vessels to sensors to identify obstructions, road
take blood to heart) are full of clotted blocks and detect motion in the
blood. The ancient concluded from this, environment. They can navigate and
that the arteries carried air. Hence the make documentation. They can be
name given to these vessels as arteries. programmed to make decisions.
(p) Robotic = Robota (Slave) + ic (Like). Robotic intensive care cart is being
In 1921, Czech dramatist, KAREL used in intensive care unit. Robots can
CAPEK published ROSSUM’s be used as device to provide technical
UNIVERSAL ROBOTS. Based on this, aids to the handicapped.
the word “robot” has been coined for
something working as slave. A Robot MEDICAL GLOSSARY
is any mechanical device operated
1. In this book many medical words have been
automatically to perform in seemingly
used which are unfamiliar to the readers.
human way. Current research efforts
The glossary of medical words which will
focus on creating a smart robot that
be used in this book is presented in
can hear, touch, taste & consequently
alphabetical order.
make decision. Robots do not have to
INTRODUCTION 9
A B
Anatomy – A study of the structure of Bifurcation – Branching as in blood vessel.
the body and the relationship Bioelectricity – Electrical phenomenon that
of its constituent parts to appear in living tissue.
each other.
Brachial – Relating to the arm or a
Alveoli – Air sacs in the lungs formed comparable process.
at the terminals of a
Bradycardia – A slow heart rate.
bronchiole. It is the thin
membrance of the alveoli that Bronchus – Bronchial tubes, (air passage)
allows oxygen to enter the i.e., two branches of trachea
blood stream. going into the right and the
left lungs.
Aorta – The great trunk artery that
carries blood from heart to be Bundle of His – A small band of cardiac
distributed by branch arteries muscle fibers transmitting the
throughout the body. wave of depolarization from
the atria to the ventricles
Aortic valve – Outlet valve from left
during cardiac contraction.
ventricle to the aorta.
Arrhythmia – An alteration in rhythm of the C
heart beat either in time or
force. Capillaries – Smallest vessels of the blood
Arteriole – One of the small terminal vascular system connecting
branch of an artery that ends arterioles with venules
in capillaries. and forming or network
throughout.
Artery – A vessel through which the
blood is pumped away from Cardiac – Pertaining to the heart
the heart. Cardiology – The study of the heart about
Atrio ventricular – Located between an atrium its action and diseases
and ventricle of the heart. Cardiovascular – Relating to the heart and blood
Atrium – A main chamber of the heart vessels.
into which blood returns from Catheter – A tubular device inserted in
circulation any passage of body to keep
Auscultation – The act of listening for it open or to inject or
sounds in the body. withdraw fluid.
Axon – A never cell process which Cell – A smallest living matter
conducts impulse away from capable of functioning as an
the cell body of a neuron. independent unit.
Cerebellum – A part of brain to coordinate
muscle and to maintain
equilibrium.
10 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Isometric – Having same length. A muscle Motor – A muscle, nerve or centre that
acts isometrically when it effects or produces
applies force without movement.
changing its length. Myelin – A fat like substance forming
Isotonic – having same tone. A muscle a sheath around certain nerve
acts isotonically when it fibers
changes length without Myocardium – The walls of the chamber of
changing much the force it the heart which contain the
exerts. musculature which acts
during the pumping of blood.
K Myograph – An apparatus for recording
Korotkoff sounds – Sounds produced by sudden the effects of the muscular
pulsation of blood being contraction
forced through a partially
occupied artery and heard N
during ausculatory blood Necrosis – Death of tissue
pressure determination.
Nerve – A cord like structure that
L conveys impulse from one
part of the body to another.
Latency – Time delay between stimulus
and responses Neuron – A nerve cell.
Liver – the largest gland of the body
lying beneath the diaphragm. O
It is irregular in shape and Orthosis – Making straight, the
weight from 3 to 3 ½ pounds correction of maladjustment.
or about 1/40 the weight of Oxyhaemoglobin – A compound of oxygen and
the body. It secretes the bile haemoglobin which is formed
and it is also of great in lungs whereby oxygen is
importance in both carried through the arteries to
carbohydrate & protein the body tissue.
metabolism.
Lung – The organ of respiration in
which aeration of the blood P
takes place.
Pathology – The science and study of
M disease, its causes and cure.
Membrane – A thin layer of tissue that Perfuse – To pour over or through.
covers a surface or divides a Permeate – To pass through the pores
space or organ Pneumograph – The recording of the thoractic
Metabolism – The sum of all the physical movement or volume change
and chemical processes by during respiration.
which the living organised
Prosthesis – Artificial substitution of a
substance is produced and
missing or diseased part the
maintained.
Mitral valve – Valve between the left atrium like lower limb.
and ventricle of the heart.
12 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Protein – Part of cell and each cell is three- Stenusis – Narrowing of a duct or canal.
fourth protein. Stroke volume – Amount of blood pumped
Pulmonary – Associated with lungs during each heartbeat.
Pulse pressure– The difference between systolic Superior vena
and diastolic blood pressure. cava – Main vein feeding back to the
heart from systemic
R circulation above the heart.
Radioisotope – An isotope that is radioactive Systemic – Pertaining to or affecting the
produced artificially from the body as a whole.
basic element by the action of Systole – The contraction specially of
neutrons, protons, deutrons or ventricles during which blood
alpha particles in cyclotron by is forced into the aorta and
chain reaction. These are used the pulmonary trunk.
as tracer with stable element
(labeled) by injecting in body to T
study the functioning of organs.
Tachycardia – Rapid heart action.
Radiology – The chief X-rays methods used
Tendon – A fibrous cord or band that
in the examination of the chest
connects a muscle to a bone.
which are fluoroscopy,
It consists of tissue fascicles
radiography, tomography and
of very densely arranged
bronchography.
almost parallel collagenous
fibres.
S Thorax – The part of the body between
Semi lunar neck and abdomen.
pulmonary valve – Outlet valve from the right Thrombus – Clotting of blood within a
ventricle into the pulmonary blood vessel
artery. Tissue – Similar cells united in the
Sinoatrial – The pacemaker of the heart, performance of a partcular
cardiac muscle which is function.
responsible for initiating each Trachea – The main trunk of the system
cycle. of tubes by which air goes in
Sphygmomanometer or comes out of the lungs.
– Instrument for measuring blood Tricuspid valve – The valve connecting right
pressure (arterial). atrium to right ventricle.
Spirometer – Instrument for measure air
which is entering and leaving the V
lungs.
Ventricle – A chamber in heart which
Spleen – It is a blood forming organ in receives blood from atrium
early life. It is storage organ for and forces it into arteries.
corpuscles and because of large
Venule – A small vein.
number of macrophages acts as
a blood filter.
INTRODUCTION 13
(leucocytes) and platelets (thrombocytes). which is called pus. Leucocytes are also
Plasma is the liquid portion of the blood of useful in transporting waste particles and fat
which it forms about two-third and contains globules. These are produced in the bone
about 80% of water. It is almost colourless marrow and lymphatic glands and are
clear fluid and contains an everchanging destroyed in the lymph organs.
variety of substances in solution and Thrombocytes or platelets contain a
suspension. Among the various substances chemical which plays an important role in
present in the plasma are gases, absorbed the clotting of blood. The various functions
food material, inorganic salts, vitamins, of blood are :
metabolic waste products, hormones, anti (a) Transport of gases : RBC combines with
toxin and a soluble blood protein called oxygen to form oxyhaemoglobin which
fibrinogen. The cytoplasm of red corpuscles breaks up and release oxygen in tissues.
contains a pigment, the haemoglobin which In tissues, RBC combines with carbon-
makes these cells appear red. In bulk these di-oxide to form carboxy haemoglobin
cells give blood its red colour. The which breaks up in the lungs to release
haemoglobin combines readily with carbondioxide for expiration.
oxygen to form an unstable compound,
(b) Transport of food material: All the
oxyhaemoglobin. In the tissues it breaks up
absorbed food circulated by the blood
releasing the oxygen. Here it combines with
till it is taken up and used by tissue cells.
carbondioxide to form an unstable
compound, carboxy haemoglobin, which (c) Transport of substances: Many other
breaks up in the lung, releasing substances such as enzymes, hormones
carbondioxide for expiration. Haemoglobin, and anti toxins are transported by the
therefore, transports the gases and as such blood to the places where they are
plays a vital part in respiration. The red required.
corpuscles are formed in liver and spleen (d) Defence against disease: This is
which also destroy the worn out corpuscles. effected in two ways. Firstly the white
As these are nucleated, they live for a pretty blood corpuscles feed on disease
long time. The white blood corpuscles germs. Secondly blood possesses
(leucocytes) are small, semitransparent, certain antioxins which unite chemically
nucleated and amoeboid cells. These can with toxins and then neutralize them.
crawl out between neighbouring endothelial (e) Equalization of the body temperature:
cells and hence are found in every nook and As the blood circulate throughout the
corner of the body. At part of body having body, it brings about an equalization of
infections, they accumulate in very large the body temperature by transferring
numbers and serve to defend the body heat from one part to another.
against the disease germs. They are able to (f) Transport of metabolic wastes: The
eat bacteria and other germs in an amoeba nitrogenous waste material is carried by
like manner. This process is known as the blood to the liver where it is
phagocytosis and hence they are known as converted into urea. The later is now
phagocytes. Some of the WBC are killed by carried by the blood to the kidney where
bacterial acids. Thus they may accumulate it is removed out along with the urine.
at the seat of infection as living or dead
bacteria, leucocytes and disintegrating cells. (g) Clotting of blood: Blood has a soluble
All these form a whitish or yellow mass solution called fibrinogen which is
converted into a mesh work of fine
INTRODUCTION 15
N u cleu s
N u cleu s N u cleu s
(1) neurons with many processes are with surroundings. We have a multi level
called multipolar. control system with its communication
(2) neurons with two procesess arising at network which organises these internal
opposite poles are known as bipolar. systems to perform many complex
functions. We are able to sustain our lives
(3) neurons having two processes arising
due to organised operations of all these
from the same pole are known as
internal systems and their various
unipolar. The cytoplasm of each neuron
subsystems. In medical terms, a study of
contain a large and spherical nucleus,
the structure of the body and the relationship
large number of dark staining minute
of its constituents parts to each other is
particles (Nissl Granules) and numerous
known as ‘Anatomy’ while the study of
cytoplasmic strands known as
function of these parts as a system is known
neurofibrillae. Neurofibrillae help in the
as physiology. The major functional
passage of the nerve impulse.
physiological systems of the body are:
PHYSIOLOGICAL SYSTEMS OF THE BODY (a) The cardiovascular system
(b) The biochemical system
1. In our body, we have mechanical, electrical,
(c) The respiratory system
chemical, thermal, pneumatic, hydraulic and
(d) The nervous system
many other types of system. Each system
(e) The excretory system
communicates internally with other systems
(f) The locomotor system
of the body and externally it communicates
(g) The digestive system
Energy (E 1)
Light vision
Vibration (hearing) Mass (M1)
Flow (smell) Food Intake
Liquid Intake
Inspired Air
Mass (M2)
Solid Waste
Liquid Waste
Expired air
Perspiration
Energy (E2)
Body
movement
Tactile
sensation
2. The cardiovascular system: The hydraulic system through veins and pumps
cardiovascular system is a closed hydraulic it to the lungs for oxygenation. The left side
system. It has heart and blood vessels. The of the heart receives blood from the lungs
heart works as a four chamber pump. The (oxygenation system), and pumps it into
blood vessels are flexible and sometimes the main hydraulic system which is formed
elastic tubing of varying sizes. The tubings by the various organs of the body. The heart
rate and stroke volume are constantly
changed to control the flow of the blood in
the system to meet the requirements of body
parts. The blood performs all functions as
elaborated in para 25 of this chapter. The
blood flows in laminar manner. Superior
vena cava is a large venous channel which
collects blood from the upper half of the
body and delivers into the right atrium. It
has no valve. The inferior vena cava (larger
than superior vena cava) also opens into
right atrium. It returns the blood to the heart
Blood Circuit from the lower half of the body. Since the
Cardiovascular system
R ig h t a triu m R ig ht ve ntricle P ulm on ary a rte ry
blood in the inferior vena cava has to flow
against gravity at times, special one way
L eft L e ft P u lm o na ry L un gs valves are located in it to prevent gravity
ven tricle a triu m ve in from pulling blood against the direction of
flow. The cardiac output flow rate and
A o rta
volume of the fluid at various places in the
body are important indicators for proper
change their sizes to control blood pressure, functioning of the system.
for example arteries and arterioles. Certain
tubings act as reservoirs as they can control
their volume as per the requirements by a
system of valves and variable resistance to From veins From lun gs
flow by constriction and dilation of the
control blood tubings. These tubings are R igh t A trium L eft Atrium
veins and they take blood back to heart. The
heart acts as two functionally isolated two
stages pumps working in parallel. In first
stage of each pump, the blood is taken into R igh t V entricle L eft Ve ntric le
the reservoirs (atriums) from the system
and it is pumped into second stage reservoirs
(ventricles). The action of the second stage
is so well coordinated that the blood is To L ungs To A orta
pumped into the system immediately when
it is received from the first stage. The circuit
of the blood is shown in the diagram. Right
side of the heart collects blood from the Heart Works a Pump
18 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
3. The biochemical system: There are many into the blood from the incoming air in about
chemical systems in our body that produce 300 million alveoli present in the lungs. The
energy for the functioning of our body. The oxygen and haemoglobins in blood form
energy is required for growth, body oxyhaemoglobins and carbondioxide
functions and body repairs. These chemical removed from the blood is pushed out from
systems are interconnected and these can lungs to the surroundings. An automatic
be considered as the subsystems of a very control system maintains pneumatic pump
efficient chemical factory. There is a single operation (rate of contraction of diaphragm)
point intake of fuel (food, water and air) for at a speed that is adequate to supply oxygen
this factory which is also source for all and to remove carbondioxide as required by
chemical reactions which are taking place body. It is also possible to accelerate or
inside the body. This chemical factory also deacelerate the operation of the pneumatic
contains all monitory devices which are pump by manual control whenever it is
essential to carry out necessary control for required. Automatic control returns
each chemical operation. The waste disposal whenever manual control is not applied.
system is also a part of this biochemical
5. The nervous system: The nervous system
system.
consists of control and communication
4. The respiratory system: The respiratory network which coordinates the functions of
system is a pneumatic system which ensures all parts of the body. The brain is the central
exchange of gases by a biological process information processor and it works as a
which is termed respiration. The body computer. It has memory, power to
requires oxygen to combine with carbon, compute, capability to make decisions and
hydrogen and other nutrients to produce heat innumerous input, and output channels for
and energy for sustenance of life. The entire communication. These channels form
process of taking inside oxygen from complicated networks with many
surroundings, transporting it to body cells,
interconnections (nodes) which take singnals
removing the carbondioxide from the cells
from a large number of sensory devices
and pushing out the carbondioxide into
(each sensory device detects light, sound,
surrounding is called respiration. Air enters
pressure, heat and chemicals) to the brain
the lungs through air passages which include
(computer) for analysis. Some network is
the nasal cavities, pharynx, larynx, trachea,
again used to take the output control signals
bronchi and bronchioles. The lungs are
from the brain to the motor units of the
elastic bags located in a closed cavity, called
muscles to carryout the desired motion or
the thorax. The diaphragm is a special bell
to exert force. The nerves form signal lines
shaped muscle located at the bottom of the
to carry signals (informations) generated by
closed cavity. When this diaphragm
the nerve action potentials (sensory devices)
contracts, thorare is pulled downward,
enlarging the closed cavity. The resultant to the brain and same signal lines are used
increase in the volume of the closed cavity, to carry control signals generated by the
a negative pressure (vacuum) is created brain for the motor units. In addition to the
which is relieved by air entering the lungs control of the brain, a large number of simple
from the surroundings. When the diaphragm decision making devices in the form of spinal
moves up and reduces the volume of the reflexes are present in the body to control
thorax, the used air with carbon dioxide is independently some motor devices from
pushed out of the lungs. Oxygen is taken certain sensory inputs. Example of this is
INTRODUCTION 19
the Portal system which consist of vein and from worn out red blood corpuscles. Bile
capillary network. pigments colour undigested food. The other
6. The excretory system : It consists of all important gland is pancreas which secrete
organs that are responsible for the removal digestive pancreatic juice and discharge it
of waste products formed by metabolism in into intestine. This is done by exocrine part
the organisms. The kidneys are the major of the pancreas. The endocrine part secretes
excretory organs in man. The left kidney is hormones like insulin. Insulin promotes
located at slightly higher level than right glucose utilization, protein synthesis and the
kidney, one on each side of the vertebral formation and storage of neutral lipids.
column. The kidneys have ‘bean’ shape and Insulin is given to the persons suffering from
they are also called renes from which it is diabetes.
known as rent. The renal tubules act as filters 9. Cell, DNA and atoms: Our body possess
to remove from the blood (1) Excess water numerous cells (almost 10,000 trillion) of
(2) Urea and uric acid (3) Excess mineral almost some few hundred varities. Each cell
salts (4) Yellow pigments from the bile. The performs an important role to keep us fit.
mixture of these substances forms urine. All activities like standing, walking, talking
When the human kidneys fail to function, and playing are possible through these cells.
the urine accumulates in the blood resulting The cells extract nutrients from food,
death of the person from toxic poisoning. distribute the energy and remove the waste
7. The locomotor system: The system from the body. They also fight against
provides locomotion or movement to the becteria and billion of cells die daily in this
body. Bones and joints play an important role process.
for this system. Statics and dynamics of the 10. Inside every cells is a nucleus which has 46
musculoskeletal system; forces and motions chromosomes (23 come from father and 23
acting in the skeletal system; forces and come from mother). Chromosomes carry
movements within the body; behaviour of all instructions necessary for our growth and
bones, tendons, ligaments and cartilages for to maintain us. They contain long strands
stress and strains; and prosthesis design etc. of chemical called DNA.
will be covered in details in later chapters. 11. In microscopic level, each cell of our body
8. The digestive system: It includes all organs is made of atoms. We have in our body
that help in ingestion, digestion, absorption about 63% by hydrogen atoms, 25.5%
and egestion of undigested food. It includes oxygen atoms, 9.5% carbon atoms, 1.5%
the alimentary canal and asociated glands like
nitrogen atoms and only 0.5% atoms of other
liver and pancreas etc. The liver is the largest
gland in the body. It is located on the right atoms (Iron, Cobalt, Sodium and Potasium
side, just under the diaphragm. It has etc). When we die our atoms will dissemble
irregular shape and it weighs 3 to 3 ½ pounds and move off to form new uses elsewhere
(1/40th the weight of the body). It secretes as atoms can not be destroyed. Some atoms
bile juice which plays an important role in
may form a part of a flower or other human
metabolism of both carbohydrate and protein.
The nitrogenous waste material is carried being or a drop of rain. It is also possible
by the blood to the liver where it is that we may be having atoms in our body
converted into urea. Bile pigments are which once belonged to Budha, Gandhi or
derived from the breakdown of hemoglobin Nehru.
20 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
12. Cloning: Cloning occurs in nature for simple identical gene in short time. In animal cloning,
organisms (bacteria and viruses) which the donor's DNA is introduced into egg of
reproduce by splitting when their DNA has another animal of same species after egg's
replicated itself. Cloning can also be done in DNA has been removed. The egg is then
humans and other animals when a single inserted into surrogate animal's womb and
fertiliged egg divides and separates to form pregnancy procceds as normal. Another
two or more identical individuals. Gene genetic advancement is the creation of
cloning is generally done in the laboratory by transgenic animals which can be used for the
means of the polymerisation chain reaction production of human compatible organs such
which enables to reproduce millions of as hearts. Pigs are being used for this purpose.
E g g D on or
E m b ryo
C e ll an d eg g are im p la nted in to
fu se d to ge th er surro g ate a nim a l
E g g w ith ou t D N A
E g g D on or
Cloning of Animal
30. The corpuscles which are able to eat bacteria 40. The respiratory system is a ____ system.
and other germs so as to defend the body ((a) air (b) pneumatic)
against disease are ______.((a) RBC (b) 41. The ______ is the central information
WBC processor of the nervous system. ((a) motor
units (b) brain)
31. The clotting of blood is done by ____. ((a)
thrombocyctes (b) leucocytes) 42. The _____ is the major organ of the
excretory system. ((a) liver (b) kidney)
32. Striped muscle tissues are _____ the control 43. The filtering of the blood for removal of
of ‘will’. ((a) under (b) not under) wastage is done in ____. ((a) liver (b)
33. The muscles of joints are ______ muscles. kidney)
((a) striped (b) unstriped) 44. The digestive system includes ____ and
34. The alimentary canal, the lungs and the blood associated glands. ((a) stomach (b)
alimentary canal)
vessels have _____ muscles. ((a) unstriped
(b) striped) 45. The digestive pancreatic juice and insulin is
secreted by _____. ((a) liver (b) pancreas)
35. The ______ muscle is found only in the wall 46. Red blood cells are formed in the ______.
of heart. ((a) unstriped (b) cardiac) ((a) liver (b) bone marrow)
36. The study of the parts of the body is ____ 47. The valves are found in only _____ ((a) artery
and the function of the parts is _____. (b) vein)
((a) physiology, anatomy (b) anatomy, 48. Artery takes the blood _____ and vein takes
physiology) the blood _____ the heart. ((a) away,
37. The vascular system is a closed _____ towards (b) towards, away)
system. ((a) hydraulic (b) pressure) 49. A portal system is ______. ((a) vein (b) vein
38. The heart works as ____ chambers pump. and capillary network)
((a) two (b) four) 50. An artery has ______ wall than a vein. ((a)
39. The heart can be considered as _____ stages thicker (b) thinner)
pumps. ((a) two (b) four)
ANSWERS
INTRODUCTION MECHANICS
1. Physics is the study of nature and law. 1. Mechanics is a science which deals with the
Nature governs with laws and to explain the state of rest or the state of motion of body
laws, the science of physics is developed. under the action of forces. The application
Physics is concerned with the basic rules of this science to actual problems is called
which are applicable to all objects whether applied mechanics. Statics is the branch of
innert or living. Therefore understanding of mechanics which relates to bodies at rest.
physics helps us to apply these laws in the Dynamics is the other branch of mechanics
study of bio and medical sciences. No one which deals with bodies in motion. The
has been given authority to frame the laws analysis of force system on bodies is based
of physics. These laws were discovered on some of basic laws which are
while observing the events happening in fundamental laws of mechanics. First law
nature. A falling apple from a tree gave of motion states that a body tends to stay in
Newton an idea of law of gravitation. state of rest or of uniform motion unless an
Mathematics has given us a concept of external force is applied. Second law of
induction and deduction reasoning. When a motion states that the rate of change of
person makes observations or experiments momentum of a body is directly proportional
and on their basis, reaches a conclusion, to the applied force and in same direction
then it is said to be inductive reasoning. i.e., force = mass × acceleration.Third law
Deductive reasoning on other hand, proceeds of motion states that for every action, there
from assumptions rather than observations. is an equal and opposite reaction.
It is usually by inductive reasoning that 2. If all the forces in a system lie in single plane,
mathematical results are discovered while then it is called a coplanar force system. If
they are proved by deductive reasoning. the line of action of all forces lie along a
24 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
m1
–y y1
on a knife edge in three planes i.e., median plane, while weight of the man acts at xcg from point A.
coronal plane and horizontal plane. The point of The free body diagram of the body is shown in the
balance will give the line in that plane on which the figure. Now ΣPy = 0, therefore RA + RB = wm+ wb
centre of gravity of the body is lying. and wm can be found out. Similarly ΣM A = 0,
The intersection of these three lines will give the therefore,
actual centre of gravity of the body from a point in
l
space. Statistical method can also be used for finding × wb + xcg × wm – l × RB = 0, and xcg
2
can be found out. Similarly ycg and zcg can
y
be found out.
W e ig h t o f
B o ard m an = w m
w e ig ht w b
Horizontal Plane W e ig h in g
w e ig hing
sca le
A sca le B
x
x CG wm
A B
l/2
RA wb
RB
l
11. The centre of gravity of a man depends on
the relative position of his limbs (lower and
upper) as compared to the anatomical
position. Locations of the centre of gravity
of upper and lower limbs will change
depending upon their positions which will
change the overall centre of gravity of the
man. If knee is flexed backwards, the centre
M edian Plane
z
of gravity of leg as well as that of the man
will shift backwards. Smilarly, the centre of
gravity of arm as well as the man shifts
forward if the elbow is flexed. An athletic
can take full advantage by positioning his
limbs so as to shift his centre of gravity as
high as possible while jumping over the high
bar.
Coronal plane
the centre of gravity. A man (weight = wm) is lying
supine on a board (weight = wb) and reaction force
RA and RB are read from the measuring scale. The Positioning of Limbs to
length of board is 'l' and its weight will act at l/2 Help While Jumping
CONCEPTS OF PHYSICS, MECHANICS AND FLUID MECHANICS 27
B o un da ry La yer I
II III
Flow A
S o lid B ou nd ary I
Boundary Layer
their relative positions at successive cross wall depending upon the pressure of the
sections of the flow passage in the laminar
Pr
flow. There is no transverse displacement fluid. Thickness (t) = where P =
of fluid particles. Soldiers marching in σp
orderly manner is an analogy to laminar flow.
pressure, r = radius and σ p = permissible
In turbulent flow, the motion of fluid
particles is irregular. The fluid particles move stress
along erratic and unpredictable paths. The
velocity of fluid particle fluctuates both
R a dius = r
along the direction of flow and also
perpendicular to the flow. A crowd of
commuters on a railway station rushing for P re ssu re (p)
boarding a train is an analogy. Th ickne ss = t
The Reynolds numbers is a dimensionless
number which is used to predict whether Thin Tube
the flow is laminar or turbulent in a tube.
The Reynold's number = Inertial force/ 6. Equation of continuity and Bernaulli's
viscous force = ρu2 D2 / µuD = ρuD/µ = equation. The total mass of fluid going
uDv, where µ = viscosity, v = kinematic inside the tube through any cross section
viscosity = µ/ρ, ρ = density, u = velocity remains same. Therefore the equation of
and D = diameter of tube. If inertia force is continuity is A1u1 = A2 u2, where A stands
much higher than viscous force, Reynolds for cross sectional area and u stands for
number will be more and less chance for velocity. As per Bernaulli's equation, the total
the flow to be laminar. In a tube, turbulent head of the fluid remains constant at every
flow occurs when Reynolds number > 6000. cross section of the tube. The Bernoulli's
For laminar flow in a tube, following are equation is
applicable:
1
∂P r P + ρu 2 + ρgh = constant where
(a) Strear stress τ = – . where r = 2
∂x 2 P = pressure, ρ = density, g = coefficient of
∂P gravity, h = height of cross section from a
radius of layer and = Pressure gra- datum line and u = velocity of the fluid.
∂x
dient along direction of flow. 7. Applications of Bernaulli's equation. The
speed of liquid coming out through a hole in
1 ∂P 2 2 a tank at a depth 'h' below the free surface
(b) Velocity u = – (R – r ) where
4µ ∂x is the same as that of a particle falling freely
R = radius of tube, r = radius of layer through the height 'h' under gravity i.e., u =
(c) Ratio of maximum velocity to average 2gh . This is known as Torricelli's
velocity = 2 theorem. When a person is bleeding, we try
32 µu L to reduce 'h' so that blood flow can be
(c) Loss of pressure head = reduced. Other application is Aspirator pump
ρ g D2
which works on the principle that the
Flow
where u = and L = Length of pressure of fluid decreases where ever its
Area
speed increases. As shown in the figure, the
flow.
air is pushed through a narrow opening at
5. The tube must have same thickness of the
30 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
D e viation W
S h in in g R o ug h
A1
P1 A1 = F
v1 v2
P1 A2 = W A2
P1 = P RESSURE CONSTANT
Fill up the gaps 8. Ideal fluid has _______ viscosity. ((a) unit
(b) zero)
1. Static is the branch of mechanics which
relates to bodies in _____. ((a) rest (b) 9. The ratio of Inertia force and viscous force
motion) is ______ number. ((a) Rayleigh (b)
Reynold)
2. If all the forces in a system lie in single plane,
then it is called a ____ force system. ((a) 10. Turbulent flow has _____ value of Reynold
coplanar (b) concurrent) number. ((a) lower (b) higher)
3. If all the forces in a system pass through a 11. The _____ is used for measuring gauge or
point it is called a _____ force system. ((a) vacuum pressure. ((a) manometer (b)
coplanar (b) concurrent) pressure meter)
4. Lami's theorem can be applied for three 12. The blood pressure is always given in _____.
_____ force system. ((a) coplanar (b) ((a) gauge height (b) vacuum height)
concurrent) 13. P + ½ ρu2 + ρgh = constant is known as
5. The condition of equilibrium in a coplanar ______ equation. ((a) hydraulic (b) Bernoulli)
force system gives ____ equations. ((a) 14. A1u1 = A1 u2 wher A = area and u = velocity
Three (b) two) is known as ______equation. ((a) continuity
6. The fluids which follows T = µ du/dy are (b) constant)
called _____ fluids. ((a) Ideal (b) σ
M E
Nowtonian) 15. = = y is called _____equation. ((a)
I R
7. Blood is a _____ fluid. ((a) Newtonian (b) Bending moment (b) Torsion)
non Newtonian)
ANSWERS
(b) Patient-monitoring equipment which use The efficient and cost effective utilization
sophisticated transducers together with of a new technology also requires careful
microelectronics, microprocessor and planning in organisation and ways of
software for processing the measured operation. Any new equipment introduced
signals. would require engineers to operate and to
(c) Information system for patient data maintain it. Regular service and regular
management and for decision support preventive maintenance combined with
integrating various sources of patient performance assurance procedure is more
data and incorporating knowledge cost effective. The installation of new
based techniques (artificial intelligence, equipment can be expensive in terms of both
expert system) for the interpretation of actual purchasing and installation costs; and
the compiled data. additional technical staff requirements to
operate and maintain.
(d) Imaging of the anatomy and functions
of the human body. The technology for BIOMEDICAL ENGINEERING
obtaining and storing the images is
changing from film to digital integra- 1. As name suggests, biomedical engineering
tion of the various image sources with is interaction of medicine and engineering
“picture archiving and communicating Hence biomedical engineering can be defined
system” (PACs) and image processing as application of the knowledge gained by a
stations is the present practice. cross fertilization of engineering and the
(e) Automated laboratory equipment for the biological sciences so that both will be more
processing of patient samples (blood, fully utilized for the benefit of man.
urine etc). It has cut down the cost by
SPECIALITY AREA OF BIOMEDICAL
making tests simpler, accurate and
faster. Information systems are ENGINEERING
extensively used to manage the process,
1. The field of biomedical engineering is ever
for quality control and for producing
expanding as new engineering applications
laboratory reports, for archiving or for
in medical field are emerging. A tendency
display to treating physicians.
has been seen to describe the personnel
(f) Technical aids for the handicapped (and working in different speciality areas of bio
for the elderly) comprising both simple engineering with the name of the area. A
and complex devices. Development in tendency has arisen to call the biomedical
information technology and in robotics, engineer as person working in the interface
have opened up new possibilities to area of medicine and engineering whereas
provide technical aids to the the practitioner working with physician and
handicapped both at home and at work. patient is called a clinical engineer. Similarly
(More on robotic refer chapter1) titles of hospital engineer, medical engineer,
bioinstrumentation engineer, biomaterial
REQUIREMENT FOR ADVANCED
engineer and rehabilitation engineer are being
MEDICAL EQUIPMENT used depending upon personnel working in
different speciality areas of biomedical
1. The effective utilization of high technology
engineering. Speciality areas are :
equipment and systems necessitates the
technical expertise of clinical engineers, (a) B i o i n s t r u m e n t a t i o n : I t i m p l i e s
hospital physicists and computer scientists. measurements of biological variables
which help the physicians in diagnosing
BIOMEDICAL ENGINEERING 35
and treatment. For the measurement of that data can be handled by the computer.
biological variables, applications of (f) Rehabilitation engineering: Rehabilita-
electronics and measurement techniques tion relates to both handicapped and
necessitate understanding and elderly persons. Rehabilitation engineer-
knowledge to operate the devices. In ing aims to enhance the capabilities and
order to handle data, computers are to improve the quality of life of per-
essential part of bioinstrumentation. sonnel having physical and cognitive
Large amount of information in medical impairment. The development of pros-
imaging system can be processed by a
thesis for amputees, provision of proper
computer.
wheel chair to paraplegic which per-
(b) Clinical engineering: It is application of mits regular exercise for fitness so that
engineering knowledge to health care in
regular assessment of the functional
hospitals.Clinical engineer with
capacity can be made and assistive de-
physician, nurses and other staff form a
vices for elderly persons are some of
health care team so that health care
facilities (patient monitoring equipment, the contributions of rehabilitation
diagnosing equipment, technical aids engineering.
for the handicapped) can be effectively (g) Orthopadic biochemistry: It is the field
utilised and computer data base can be in which malfunctioning of bones,
maintained. muscles and joints is studied so that
(c) Biomaterial engineering: Bomaterials artificial joints for replacement can be
include both living tissues and artificial designed.
developed materials which are suitable (b) System physiology: It is the field in which
for implantation. Materials can be metal engineering techniques and tools are used
alloys, ceramics and polymers which to gather a comprehensive understanding
must be chemically inert, stable and of the function of living organisms
mechanically strong to withstand the ranging from bacteria to human body.
repeated forces for a lifetime. Computer is used to model physiological
(d) Cellular, tissue and genetics engineering: systems for analysis and understanding.
With advancement in biomedical field, it
2. Biomedical engineer is a professional who
is possible to tackle the biomedical
has expertise both in biological sciences and
problems at microscopic and nenoscopic
level. The anatomy biochemistry and engineering field so as to effectively and
mechanics of cellular and subcellular safely manage medical devices and
structure are studied to understand instruments, for an overall enhancement of
disease process and to find out suitable health care. He can use engineering
therapy to overcome malfunctioning. expertise to analyse and solve problems in
(e) Medical imaging engineering: There are biology and medicine providing an overall
many techniques to generate the image improvement of health care. Other
of organs inside the body. Various rays definitions by various committes are :
and radiations like ultrasound, X-rays and (a) A clinical engineer is a professional who
nuclear radiation with physical brings to health care facilities a level of
phenomenons like magnetism, sound, education, experience and accomplish-
fluorescence and reactions on ment which will enable him to
photographic film, can be used to responsibly, effectively and safely
generate or display internal image of the manage and interface with medical
body. These images can be digitized so devices, instruments and systems and
36 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
the use of these for patient care, 3. With the need of sophisticated health care
because of high level of competence system and advent of advanced medical
and responsibly. He can directly serve equipment, there is a growing demand of
the patient, physician, nurse, and other biomedical engineers. There is a growing
health care professionals to use of the demand for them in these places:
medical instrumentations. (a) In hospital as clinical engineer
(b) Biomedical engineer is a person working (b) In industry involving manufacturing
in research or development in the biomedical equipment
interface area of medicine and
(c) In research facilities of educational
engineering whereas the practitioner
medical institutions.
working with physician and patient is
called a clinical engineer. (d) In government regulatory system for
product testing and safety
(c) Biomedical engineer is a professional
who applies knowledge gained by a (e) In performance testing of a new
cross fertilization of engineering and the product or existing product in hospital
biological sciences so that both will be (f) In establishing safe standards for
more fully utilized for the benefit of man. devices
(d) A biomedical equipment technician is an (g) In managerial position as technical
individual who is knowledgeable about advisor in marketing department
the theory of operation, the underlying (h) In creating design to understand living
physiologic principles, and the practical, system and technology
safe clinical applicaton of biomedical (j) In coordinating and interfacing function
equipment. His capabilities may include using background in engineering as well
installation, calibration, inspection, as medical field
preventive maintenance and repair of
(k) In university and in teaching institutions.
general biomedical and related technical
Biomedical engineers can effectively
equipment as well as operation or
supervise laboratories and equipment in
supervision of equipment control, safety
research institutions
and maintenance programmes and
systems.
7. Preventive medicine, diagnosis, therapy and interpretation of the compiled data (a)
rehabilitation are the components of knowledge (b) technical
________ (a) medicine (b) health care 11. Storage of images is changing from film to
8. High technology equipments normally _______ (a) digital (b) written
require more _________ (a) skill (b) men 12. Development in _______ has opened up new
9. Physicians and biomedical engineers possibilities to provide technical aids to
_________ work in isolation (a) can (b) handicapped both at home and at work (a)
cannot robotics (b) treatment
10. Information system integrate patient data and 13. Total cost of new equipment include both
________ based techniques for the equipment cost and cost of ________(a)
technical staff (b) additional technical staff
ANSWERS
BIOMECHANICS
OF BONE "
To see and understand the big picture, You've got to meet the master painter
metatarsal bones of hand and foot and free surface is covered with
respectively are small bones (refer to articular cartilage. It has two functions
figure of skeleton) (1) to reduce friction when it rubs over
(b) Flat and irregular bones are in the skull, bony surface, (2) to alter the pull of
back bone and the limb girdles. tendon to which it is attached. The
largest sesamoid bone is ‘patella’ of the
(c) Sesamoid bone is buried in the tendon
knee joint.
Cranium Cranium
Head
Cervical
Clavicle Vertebrae Neck
Thoracic cage
Scapula
Sternum
Ribs
Ribs
Thoracic
Vertebral Trunk
Vertebrae
column
Humerus
Ulna Lumbar
vertebra
Radius Innominate
bone
Sacrum
Carpal bones
Coccyx
Metacarpal
bones
Phalanges
Femur
Femur
Pelvis
Patella
Tibia Patella
Limb
Fibula Tibia
Fibula
Tarsal bones
Metatarsal bones
Phalanges Tarsal bones
Calcaneus
Metatarsal bones
Phalanges
Skeletal System
40 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
three distinct regions. The part ‘OA’ is elastic resilience energy is the area under the stress
region and the slope of this line is equal to and strain diagram. Hence absorbed energy
the elastic modulus (E) of the bone which increases with rapidly loading. It has been
is 17 GPa (109 pascal). In the intermediate
seen that bone tissues are subjected to a
region (AB), the bone exhibits non linear
elasto-plastic material behaviour. Now the strain rate of about 0.01 per sec during
bone does not retains its original length on normal activities.
removal of load (possible in region OA) and
a permanent yielding takes place. On removal din
g
oa
stL
Fa Resilience Energy
= Area Under
Curve
g
1 50 Loadin
Slo w
Stress
C I
Area I > Area II
1 28
B
S tress : σ(M pa )
A II
1 00
50 Strain
S tress
an
ad
the longitudinal loading. Stress and strain 6. Factors affecting strength: Factors
diagram for these loadings is given in the affecting the strength or structural integrity
figure. The values of ultimate strength and of bone are:
elastic modulus are given in the table. (a) Area: Larger is the bone, the larger is
ULTIMATE STRENGTH, E AND G OF BONE area upon which the internal forces are
distributed and the smaller is the
LOADING ULTIMATE ELASTIC intensity of stresses.
MODE STRENGTH MODULUS
Force
LONGITUDINAL → 17 GPa stress (σ) =
Area of bone
× TORSION 133 MPa
× COMPRESSION 193 MPa or Force = σ × Area of bone
× SHEAR 68 MPa Hence, bone with larger area can
TRANSVERSE → 11.5 GPA withstand more force for a given value
× TENSION 51 MPa of maximum permissible stress.
× COMPRESSION 133 MPa → SHEAR (b) Geometry of bone: The bone can be
MODULUS solid or hollow tube. The moment of
(G)= 3.3 GPa inertia & polar moment of inertia of
solid and hollow tube are:
5. Cancellous bone: The distinguishing
characteristics of the cancellous bone is its πD4
(I) Solid = ,
porosity. Hence cancellous bone has lower 64
density depending upon porosity. The πD4
stress-strain of cancellous bone depends (IP) Solid =
32
upon porosity and the mode of loading. In
compressive loading, stress and strain in (D4 – d 4 )
(I) hollow = π
elastic region varies linearly upto a strain 64
about 0.05 and after this yielding occurs (D – d 4 )
4
when the trabeculaes begin to fracture. and (IP)Hollow = π
32
Yielding occurs at constant stress until
Hence for equal cross sectional area
fracture, showing a ductile material
behaviour. However on tensile loading, ISolid < IHollow and (Ip)Solid < (Ip)Hollow.
cancellous bone fractures abruptly, showing According to bending moment equa-
a brittle material behaviour. The capacity to tion, applied bending moment
absorb energy is higher in compressive I × ó permissible
loading than in tensile loading. (M) =
D/2
+ Stre s s (σ) or M ∝ I
which shows that hollow bone can take
Te ns ile Lo ad in g
more bending load for given σ permis-
0 .2 0 .15 0 .1 0 .05 sible. Similarly, applied torsion
– S tra in (ε) + Stra in ( ε)
IP × τ perm
L o w D e n sity
6=
H ig h D en sity D/2
25
– S tre s s (σ) which shows that hollow bone can take
C o m p re ss iv e L o a d in g more torsion load for given τ permis-
Compressive and Tensile Loading sible as compared to solid bone.
PREFIXES
BIOMECHANICS OF BONE 43
(c) Reduction in Density: The strength of bone fractures are usually caused by bending
bone decreases with reduction of or torsional loading. Bones have spiral
density which may result due to skeletal oblique fracture pattern when they are
conditions such as osteoporosis, with fractured under excessive torsional loading.
ageing or after period of disease. Bending fractures are usually identified by
Certain surgical treatments may alter the formation of butterfly fragments.
the geometry of the normal bone which Professionals like athletes and distant runners
may reduce the strength of the bone. generally suffer bone fractures caused by
Screw holes or other defects in the bone fatigue. Fatigue fracture of bone occurs when
also reduce the load bearing capacity the wear and tear caused by repeated
mechanical stress is more than the natural
of the bone as stress concentration at
ability of the bone to repair itself. Bone failure
these locations of defects increases
can be (1) Fracture–loss of continuity of a
loading to failure.
bone (2) Dislocation– loss of continuity
between the articulating surface of a joint
σ1 A 1 σ2 A 2 (3) Subluxation–early stage which may lead
to dislocation (4) Sprain– a partial tear of a
ligament.
B o ne
2. Fracture can be classified as under:
(a) Depending on plane of the fracture
N o rm a l stress S tress (i) transverse fracture
con ce ntratio n S cre w ho le
(ii) spiral fracture
σ1 A 1 = σ2 A 2
As A 1 > A2
(iii) oblique fracture: angle with long axis
∴ σ1 < σ2 (iv) commuted fracture: more fragments
Stress Concentration (v) compression fracture: eg fracture of
thoracis spine results in decreased
length
BONE FRACTURES AND TRACTION
(b) Communication with exterior
1. When a bone is subjected to an external load, (i ) Simple or closed: No communication
it develops internal force to counteract by with exterior through the skin
some elastic deformation which disappears (ii) Open or compound: There is a
on the removal of the load and the bone communication between fracture and
regains its original shape. If the applied load the skin or mucous membrane
is high and it generates stresses in the bone
which are larger than the ultimate strength (c) According to the cause of fracture
of the bone, the bone fractures. Fractures (i) Traumatic fracture
caused by pure tensile loads are observed in (ii) Pathological fracture due to weakness
bones having a large proportion of cancellous resulting from tumour or infection
bone tissues. On other hand, fractures caused
(iii) Stress or fatigue fracture–due to
by compressive loads are seen in the
repeated stress
verterbrae of an aged person whose bones
have weakened due to ageing. Such fracture (d) According to number of fracture
are generally seen in the diaphyscal regions (i) single
of long bones. Bones have oblique fracture (ii) multiple
pattern under compressive fracture. Long
44 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
The three pulleys arrangement as shown T1 cos β = 2T1 cos α or cos β = 2 cos α
in figure, exerts a horizontal force whose As angle α is fixed and known, angle β can
magnitude is twice that of weight put in be found out. Also W2 is known, we can find
the pan. out T1 and T2 from equation (iii) amd (iv).
T 1 sin α
T1
2T 1cos α
T2
α
W B β
T2
A
2T T α T 1 sin α
T T1
w1
2T T
W
T= 2 W
w2
W2
W1 W1 l
β T1 T2
C B l
A
α β
A C B
W
W
ANSWERS
BIOMECHANICS
OF SOFT TISSUES #
Keep your face toward the light and the darkness will never be able to close
in on you.
60 Mpa
strain. They also have higher tensile
strength. Hence at joints where space is
limited, tendons enable the attachments of
muscles with the bones. Since tendons can
S tre ss ( σ)
support large loads with small strains, hence
tendons enable the muscles to transmit forces
to the bones without wasting energy in its
stretching. 0 0 .07 5 0 .05 0 .07 5 0 .1
S train ( )
B o ne 1 (Fe m ur) Stress-strain D iagram : Tendon in Tension
M uscle s
5. Ligaments are also composite materials apparent change in length of the muscle
containing crimped collagen fibers (static or isometric interaction).
surrounded by ground substance. Ligaments 2. The contractile element (motor unit) consists
contain a greater properties of elastics (elastic of many sarcomere elements connected in
fibers) which contribute to their higher a series arrangement as shown in the figure.
extensibility but lead to lower strength and
stiffness. Ligaments are viscoelastic like
M yo s in
tendons and exhibit hysteresis on loading & fila m e n t
unloading. Ligaments rupture at a stress of
about 20 MPa, yield at about 5 MPa and A c tin
deform at strain of about 0.25. Some energy fila m e n t
in ligament is dissipated in causing the flow
of fluid within the ground substance. S
Skeletal Muscle C b id
: Contractile Element
The muscle force is generated within these
20 M Pa sarcomeres by lengthening or shortening of
the muscle. The force and torque developed
by a muscle depend upon number of
sarcomeres (motor units) within muscle,
S tress (σ) number of sarcomeres utilized, the manner
L oa ding
of change of length of muscle, the velocity
U n lo ad in g
of muscle contraction and length of the lever
arm of the muscle force. Two different
0 .1 .2 .3 forces are generated in a muscle. The
S train ( )
contractable elements of the muscle produce
Hysteresis Loop : Ligaments active tension due to the voluntary muscle
contraction. The passive tension is
SKELETAL MUSCLES
developed within the connective muscle
1. Muscles are connective tissues and they are tissues when the muscle length surpasses
three types. Skeletal, smooth and cardiac its resting length. The net force is the
(refer chapter1). Smooth muscles (unstriped resultant of these two forces. A typical
& involuntary) line the internal organs and tension versus muscle length diagram is
cardiac muscles form the heart.Skeletal given in the figure.
muscle (striped & voluntary) is attached to R e stin g L en g th
at least two bones via tendons in order to
cause and control the movement of one bone S h orten in g L en gth e nin g
with respect to other bone. When muscle T 1 = N et Te nsio n
nerve, the muscle exerts a pull on the bones T p = P assive Ten sio n
to which it is attached. The development of
tension in the muscle has been possibly only
T a = A ctive Te nsio n
due to contraction of muscle fibers. The
muscle contraction can take place as a result lo
of muscle shortening (concentric L en gth
contraction), or muscle lengthening
(eccentric contraction) or without any Active, Passive and Tension Versus Muscle Length
BIOMECHANICS OF SOFT TISSUES 51
At resting, length to the number of cross- pull and it can not exert a push. A muscle is
bridges between filament is maximum. also named according to the function it
Hence active tension (Ta) is maximum & performs. A muscle is called ‘agonist’ if it
passive tension (Tp) is Zero. On lengthening causes movement through concentric
of muscle, the filaments are pulled apart contraction. An ‘antagonist’ muscle controls
resulting in reduction of number of bridges. the movement by eccentric contraction.
Hence active tension (Ta) reduces. At full Hence the biceps during flexion of the fore
extended position, active tension (Ta) arm is ‘agonist’ as the length of muscle
becomes zero. decreases and the bicep during extension of
3. The outcome of muscle contraction is always the forearm is ‘antagonist’ as the length of
tension. Hence a muscle can only exert a the muscle increases.
ANSWERS
SKELETAL JOINTS
$
Though, God's ways of operating may perplex us at times, if we trust, in due
time, we will understand.
1. The site where two or more bones come 1. Joints can be classified according to tissues
together whether or not there is movement that lie between the bones.
between them, is called a joint. The primary (a) Fibrous joints: The articulating surfaces
function of joints is to provide mobility to of the bones are joined by fibrous
the musculoskeletal system. In addition to tissues. The joint has very little
providing mobility, a joint must also possess movement which depends on the length
a degree of stability. Different joints have of the collagen fibers connecting the
different functions to perform. Therefore, bones. The connecting bones of the
the joints have varying degree of mobility skull form such joints.
and stability depending upon functions to be
performed. Joints are formed to give S u tu re
required mobility. Mobility can be triaxial P e rio steu m (fibro u s tissue )
(motion in all three planes) or uniaxial (m e m b ra ne )
(motion in only one plane). Shoulder joint
(ball and socket) is a triaxial joint, Here high
mobility is achieved at the cost of low B o ne
stability. Elbow joint (pivot joint) is a uniaxial
joint. It has less mobility (one plane only)
but more stability (less vulnerable to
dislocation). A joint may have no mobility, Fibrous Joint
The connecting bones of the skull form such
joints and they have extreme stability.
SKELETAL JOINTS 53
Synovial fluid
inside joint
cavity Sternoclavicular Joint
Bone II
Acrumiolavicular Joint
Synovial Joint
Joints.
E lbo w Joint
E lbo w Joint
m o ve m en t
P h alan ge H AND
H u m e ru s
R a dius
M e ta ca rpa l
U ln a
Hinge Joint
P h alan ge H AND
(c) Pivot joint : These joints are like a
wheel on an axel. Rotation is the only
movement possible in these joints. The Condyloid Joint
atlanto–axial and superior radioulnar
joints are pivot joints. (e) Ellipsoid joints: There is an elliptical
convex articular surface that fits into
an elliptical concave articular surface in
this type of joints. Flexion, extension
abduction and adduction can take place
in these joints. The wrist joint is a
A tlas ellipsoid joint.
(first cervica l ve rteb ra e )
Radius Ulna
B o ne y P ivo t
Concave
elliptical
surface
Convex
elliptical
A xis surface
Scaphoid Lunate Triquetral
(se co nd cervica l ve rte bra e)
Movements
Ellipsoid Joint
(f) Saddle joints: The joint resembles a
Pivot Joint
saddle on a horse’s back. The articular
surfaces are concavo-convex. Flexion,
(d) Condyloid joints : The bones have two extension, abduction, adduction and
distinct convex surfaces which rotation are possible in this joint.
articulate with two concave surfaces Carpometacarpal joint of the thumb is a
in these joints. These joints permit saddle joint.
flexion, extension, abduction, adduction
with small rotational movement. The
SKELETAL JOINTS 55
ANSWERS
C e rv ic a l
V e rte b ra e (7 )
N eck
T h o ra c ic
V e rte b ra e (1 2 )
C h est
L um b ar
V e rte b ra e (5 )
B ack
S a c ra l
V e rte b ra e (5 )
P e lv ic g ird le C o ccyg ea l
V e rte b ra e (4 )
P e lv is
S pina l C olum n
58 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
ANATOMY OF SPINAL COLUMN 4. At the superior end, spinal column has two
important joints with head. The atlanto-
1. The vertical column is made up of 33 occipital joint is the joint between the first
vertebraes which include 7 cervical, 12 cervical vertebrae (called atlas) and the
thoracic, 5 lumbar, 5 sacral and 4 coccygeal. occipital bone of the head. This is a double
In the thoracic, lumbar and sacral regions, condyloid joint (refer chapter 6) The joint
the number of vertebrae corresponds to the permits movement of the head in the sagittal
number of spinal nerves and each nerve lying plane and lateral plane. The atlanto axial joint
below the corresponding vertebrae. In is the joint between the atlas and the axis
cervical region, then are eight nerves, the (first and second verbetrae). This is a pivot
upper seven lying above the corresponding joint which permits head to rotate in the
vertebrae and the eight below the 7 th transverse plane.
vertebrae. In the coccygeal region there is
5. The movement of head and neck is provided,
only one coccygeal nerve.
controlled and coordinated by a muscle
2. The vertebrae are also grouped according group viz. prevertebrals (anterior), hyoids
to their mobility. The moveable or true (anterior) sternocleidomastoid (anterior
vertebrae include 7 of cervical, 12 of lateral) scalene (lateral), levator scapulae
thoracic and 5 of lumbar vertebrae which (lateral) suboccipital (posterior) and spleni
have intervertebrae disks in between for (posterior). The spine gets its stability from
facilating rotating movement. Hence these the inter vertebral discs and from the
are 24 movable (true) verterbrae and nine
surrounding ligaments and muscles. The
unmovable (false) verterbrae which are in
discs and ligaments provide passive stability
sacrum and coccyx region. Twelve thoracic
while muscles give active support. The
verterbrae have ribs attached to them.
muscles of the spinal column exist in pairs.
3. There are 24 movable verterbrae and they The anterior portion of spine is connected
form amphiarthrodial joints with the to abdominal muscles viz. the rectus
fibrocartilaginous interposed between each abdominis, external obligue and internal
pair of vertebrae. The fibrocartilaginous discs
obligue. These muscles can do flexion &
perform following functions.
maintain the spine in proper position. There
(1) Sustains loads transmitted from are three layers of posterior trunk muscles
segments above viz. the erector spine, the semispinalis and
(2) Act as shock absorbers the deep posterior spinal muscle groups.
(3) Eliminate bone to bone contact These muscles provide trunk extension as
(4) Reduce the effects of impact forces by they are located at posterior position of the
preventing direct contact between the spine. The effect of gravity is also overcome
verterbraes. The intervertebrae disc by these muscles. The quadratus lumborum
permits articulation of each verterbrae muscle helps in lateral trunk flexion. The
with the adjacent verterbrae in these pelvis and lumbar spine is stabilized by this
planes. Hence the entire spinal column muscle. The lateral flexion of the trunk is
functions like a single ball and socket carried out by the abdominal and posterior
joint. Flexion and extension, lateral muscles. The rotational movement of the
flexion and rotation of body is possible turnk is controlled by the simultaneous
due to the structure of spinal column. action of anterior & posterior muscles.
MECHANICS OF THE SPINAL COLUMN 59
W
=
sin β – tan α cos β
W sin β F le xion & E x tens io n
Similarly F =
sin(β – α )
W cos β R ight Left
=
sin β cos α – cos β sin α
W
=
cos α tan β – sinα
Latera l B ending
If we have W = 50 N, α = 30° & β = 60°
Movements of The Neck
60 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
2. Spine: Spine can do flexion and extension bending. It can also have rotational
in meridian plane. It can also do lateral movement in horizontal plane.
Flexion Extension
Lateral Bending
R o tatio n
Movements of Spine
ANSWERS
MECHANICS OF
UPPER LIMBS &
To see and understand the big picture, you've got to meet the Master Painter.
3. The forces involved on various joints can (g) All forces acting on a joint are coplanar
be classified as (1) internal forces (2) (h) Deformation is small and negligible in
external forces. Internal forces are muscles, bones and tendons etc
developed in muscles and joint reactions.
(k) Dynamic effect is ignored
External forces are gravitational force and
mechanical applied forces. To apply the
MECHANICS OF THE SHOULDER
principles of statics to analyze the mechanics
of human joints, following assumptions are
1. Shoulder joint: It is also called
made :
glenohumeral joint between hemispherical
(a) Only one muscle groups controls the humeral head (ball) and the shallowly
movement of joint concave glenoid fossa (socket) of the
(b) Muscle attachment is at a joint which scapula bone. Hence it is a ball and socket
is known joint which permits variety of movements
(c) The line of action of muscle tension is to the arm. The movements allowed are
known flexion and extension, abduction and
(d) Proper point of joint at which joint can adduction, outward rotation and inward
rotate is known rotation. The configuration of the articular
surfaces of this joint makes the joint more
(e) Segmental weight of the parts of body susceptible to instability. The stability of the
with their centre of gravity are known joint is due to the presence of ligaments and
(f) Frictional forces at joints are small & muscles. Ligaments are glenohumeral and
negligible coracohumeral while the major muscles of
the joint are :
64 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Shoulder joint
Abduction Rotation
(Laterally) (In Abduction)
Elevation Circumduction
2. The shoulder girdle consists of the clavicle reduced joint stability. The humeral head is
(collarbone) and scapula (shoulder blade). likely to be displaced if external loading is
The acromioclavicular joint gives small more than the strength of the muscles and
synovial articulation between acromion of ligaments.
the scapula and the distal clavicle.
Coracoclavicular ligaments join these two ANALYSIS OF FORCE ON THE
bones. The sternoclavicular joint is a saddle SHOULDER JOINTS
synovial joint and it gives articulation
1. Case study 1: Let us take a typical case of
between sternum and clavicle. Costoclavicle arm stretched fully & holding a weight (Wb)
ligaments join these bones and provide as shown in the figure. Free body diagram
stability. Both these joints of clavicle with of the arm is also shown. The shoulder joint
sternum and scapula have layers of cartilage is at point A, deltoid muscle is attached at
(called menisci) interposed in between the point B; center of gravity of the arm is at
joints. There are six types of movement point C and weight in hand is acting at point
possible as shown in the figure. There are 6 D. The force F is developed by deltoid
muscle at point B which makes an angle α
muscles that control and coordinate these
with horizontal. The reaction R acts at the
movements viz. trape = 145, levator
joint which makes an angle β with
scapulae, rhomboid pectoralis minor,
horizontal. The weight of the arm (W) acts
serratus anterior and subclavius.
vertically downwards at point C. The weight
held in hand also acts vertically downwards
C la vicle
S te rn ocla vicula r
at point D. The mechanical model of the arm
S cap ula
Joint is also shown. The distances of point B, C,
& D from point A are a, b, and c respectively.
Now we have a coplanar force system in
S te rn um equilibrium which gives us three equations
H u m e ru s of equilibrium i.e. Σ Px = O, Σ PY = 0 & Σ
M = O.
Coraco clavicular
Acromion
ligaments of scapula
M uscle
Acromio-
Clavicular
joint
S h ou ld er Jo in t
Articular surface Articular surface wb
(saddle) Costoclavicular (plane)
ligaments Arm Abducted Horizontally
A B
from the shoulder joint. Now we can analyse
C W Wb
the force system, when the arm is making
a an angle θ with horizontal.
b
c M0 = Wa × a cos θ + Wb × b cos θ.
If we take, a = 30 cm, b = 60 cm, Wa = 60
N and Wb = 300 N
Mechanical Model of Arm
M0 = 60× 0.30 cos θ + 300×0.60 cos θ
Σ Py = 0, – R sin β + F sin α – W– Wb = 0 = (18 +18) cos θ
...(i) = 36 cos θ
Σ Px = O,R cos β = F cos α ...(ii) The moment at the shoulder joint varies as
Σ MA = 0, – F sin a × a + W × b + Wb × c = 0 per the angle θ. It is maximum when θ = 0
... (iii) (arm is horizontal) and zero when θ = 90
If we have been given the value of a = 20, (arm is vertical).
b = 40, c = 60, α = 12°, m = 4 Kg
(W = 4× g = 4 × 10 = 40 N), mb= 5 Kg
b
(Wb = 5 ×10 = 50 N) then substituting these Wb
a
– R sin β + F sin 12 – 40 – 50 = 0 ... (iv)
Wa
o o
R cos β = F cos 12 ... (v) θ
by the capitulum of the distal humerus and (a) Bicep brachii: It is the most powerful
head of the radius. It is a also a hinge joint. flexor of the elbow joint, specially when
The third joint in this region is the proximal the joint is in supinated position. On the
radioulnar joint which is a pivot joint formed distal side, the biceps is attached to the
by the head of the radius and the radial notch tuberosity of the radius and on the
of the proximal ulna. The joint permits the proximal side, it has attachments at the
radius and ulna to make relative rotation top of the coracoid process and upper
about the longitudinal axis of either of the lip of the glenoid fossa.
bones. The movement by the joint from the (b) Brachialis muscle: This flexor has
palm-up to the palm down is called pronation attachments at the lower half of the
while the movement by the joint from the anterior portion of the humerus & the
palm down to palm up is called supination. coronoid process of the ulna.
H u m e ru s
(c) Triceps brachii: The muscle controls
the extension movements of the elbow.
C a pitulum It has attachments of the lower head
(ro u nd ed h ea d) of the glenoid cavity of the scapula, the
Tro chlea upper half of the posterior surface of
(spo ol sha pe d) humerus, the lower two thirds of the
posterior surfaces of the humerus and
H e ad C a vity the olecranon process of the ulna.
R a dial no tch
R a dius U ln a
Triceps
Brachialis
Brachio
Flexio n Radialis
Pronator Teres
ANTERIOR
E xte nsio n
Tricep
Brachii
POSTERIOR
2. The muscles coordinating & controlling the
movement of the elbow joint are: Muscles of the Elbow
68 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
(d) Pronator teres and supinator muscles: neighboring part of the ulna and the
The pronator teres is attached to the outer third of the radius. The muscle
lower part of the inner condyloid ridge controls supination. The coordinated
of the humerus, the medial side of the relaxation and contraction of the
ulna and the middle third of the opposing muscles enables to control
humerus, the medial side of the ulna and movement of the limbs. To raise the
middle third of the outer surface of the forearm, the biceps (two rooted muscle)
radius. As the name suggests, it contracts and shortens while triceps
performs pronation. The supination (three rooted muscles) relaxes. To lower
muscle has attachments at the outer the forearm, the reverse occurs.
condyloid ridge of the humerus, the
B ice ps in
Tricep s re stin g p ha se B ice ps
in re stin g re places
p ha se Tricep s
con tra cts
Fo re arm
Fo re arm
h alf lo w e r
a t re st
B ice ps
Tricep s con tra cts
re la xe s
Tricep s
b ack in
re stin g B ice ps b ack
p ha se in re stin g ph ase
Fo re arm
h alf ra ised
Tricep s Fo re arm
B ice ps fully
fu lly b ack rest
con tra cted
re la xe d
Fo re arm
fu lly raise d
3. The elbow joint : The elbow joint is a synovial horizontal get cancelled and the vertical
joint of the hinge variety. A ligamentous components get added up, resulting into a
capsule encloses an articular cavity filled with vertical force on the joint. The elbow joint is
synovial fluid. The synovial fluid is a thick continuous with the superior radioulnar joint.
and viscous substance. The primary function The humeroradial, the humeroulnar and the
of synovial fluid is to provide lubrication to superior radioulnar joints together are known
the articulating surfaces which reduces as cubital articulations. The long axis of the
coefficient of friction, thereby frictional arm makes an angle of about 170° with the
forces acting against movements are reduced long axis of the forearm when the forearm is
considerably. The synovial fluid also extended and supinated. The elbow joint is
nourishes the articulating cartilages . Besides susceptible to fractures and dislocations.
above two functions, the synovial fluid helps Fractures occurs at the epicondyles of the
in distributing the forces acting on the joint humerus and coronoid process of ulna.
to a large area. All forces acting on the fluid Another elbow injury that happens frequently
are transferred to the fluid as liquid pressure is tennis elbow, which occurs due to repeated
which is uniform in all directions. The and forceful pronation and supination
components of the fluid pressure along the movement of the elbow.
Capitulum of humerus
articulates with
Humerus Humerus head of radius
Trochlea of
Radius humerus articulates
with trochlear notch of ulna
Radius
Head of radius
articulates with
Synovial Ulna Ulna radial notch of ulna
Cavity
Humerus
Lateral Epicondyle of
epicondyle Capitulum Humerus
Elbow Joint
70 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
4. The radioulnar Joints : The radius and the force system and we get three equations of
ulna are joined to each other at the superior equilibrium
and inferior radioulnar joints. Supination and i.e. Σ Px = 0, Σ PY = 0 and Σ MA = 0
pronation (rotary movements of the forearm Σ PY = 0, – R + F = W + Wb ...(i)
along the long axis) are possible due to these
Σ MA = 0, F × a = W× b + Wb × c
joints,. It is a pivot type synovial joint.
Pronation and supination movements are W × b + Wb × c
similar to turning a door handle, moving a or F =
a
screw or opening a lock. The head of radius
If we take mass of forearm 2 kg (W = 2× g ≈
articulates with the radial notch of ulna in
20 Ν), mass of object 5 kg (Wb = 5 × g ≈ 50 N),
the joint.
a = 5 cm, b = 15 & c = 40 cm
H e ad of ra dius
20 ×15 + 50 × 40
N o tch ∴ F =
o f u ln a a nn ular liga m e nt 5
o bliq ue cord
300 + 2000
= = 460 N
5
R a dius
U ln a ∴ R = – 20 – 50 + 460
In te rosseu s
m e m b ran e
= 390 N
2. The above example indicates that the muscle
force and reaction at joint are considerably
A rticular d isc larger than the weight of the object. Both F
The Radioulnar Joint & R can be brought down if distance ‘a’ is
large i.e. distance between joint & point of
FORCES ON THE ELBOW JOINT attachment of the muscles. However nearer
attachment of muscle to the joint helps in
1. Let us take a typical example of the arm in
quick motion of the forearm w.r.t joint.
which elbow is flexed to a right angle and
an object is held in the hand. The freebody 3. If the muscle force is not acting vertical then
diagram of the forearm is shown indicating muscle force (F) will have a rotational
forces and reaction acting on it in component acting vertically up (as in the
equilibrium. The mechanical model of the previous example) and a translational
forearm is also shown to convert it to a component (stabilizing or sliding depending
simple mechanics problem. As shown in the on flexed position). If muscle force (F) is
figure, W = weight of the forearm acting at acting towards upper arm (making angle θ
C (Centre of gravity of the forearm), Wb = with vertical) then F cos θ is rotational
weight of the body held in the hand at point component and F sin θ is stabilising
D, F = Force exerted by the biceps muscle component acting towards joint. Now if
on the radius at point B and R = reaction muscle force (F) is acting away from the
force at the elbow joint at point A. Let the upper arm (making angle θ with vertical),
distance AB = a, AC = b and AD = c. The then F cos θ is rotational component and
force system on the forearm is a coplanar F sin θ is sliding or destabilising component.
MECHANICS OF UPPER LIMBS 71
C D
B
A
A F C D
W Wb
(a ) A rm F le xe d at rig h t a ng le R B W Wb
R F a
C D
B
b
A
W Wb c
F = Rotational effect of A
A B
R
F q F cos q F cos G = Rotational effect at A
F sin G = Stabilising effect at A
A B
F sin q
R F cos q
q F F cos G = Rotational effect at A
A
B F sin q F sin G = Destabilising effect at A
4. In practice, biceps muscle is not the only ΣPx =0, R cos α = F2 cos θ2 + F3 cos θ3..(ii)
muscle exerting force on the forearm in the
ΣMA =0, F1× a1 + F2 sin θ2 × a2 + F3 sin θ3 × a3
flexed position. The brachialis and the
brachioradialis muscles are also exerting = W × b + Wb × c ...(iii)
forces. The mechanical model of the force The muscle forces F 1 , F 2 , and F 3 are
system is still a coplanar force system as proportion to their areas i.e., A1, A2 and A3
shown in the figure. As we have three F1 A1 = F2 A2 = F3 A3
equations of equilibrium, hence the system
A1
is determinate for only three unknown. The F2 = F1 = K2 F1
three equations are ΣPx = 0, ΣPy = 0, and A2
ΣMa = 0
A1
ΣPy= 0, F1 + F2 sin θ2 + F3 sin θ3 F3 = F = K3 F1
A3 1
=R sin α + W + Wb ...(i)
F1
F3
From eqn. (iii)
R F2
α θ2
θ3 F1 × a1 + F1 K2 × a2 sin θ2 + F1 K3 xa3sin θ3
A B B2 C B3 β D = W × b + Wb × c
3
W Wb
W × b + Wb × c
a1
a2 ∴ F1 = a + K a sin θ + K a sin θ
1 2 2 2 3 3 2
b
a3
c
72 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
JOINTS OF HAND
collar bone (b) collar bone, shoulder blade 17. The movement of the elbow joint is
9. Clavicle bone & sternum form -----joint coordinated & controlled by -------
(a) Clavicular sternal (b) sternoclavicular (a) ligaments (b) muscles
10. The primary function of synovial fluid is to 18. Radius is joined with ------- to ulna
provide -------- to the articulating surfaces (a) ligaments (b) muscles
(a) support (b) lubrication 19. The radioulnar joint permits----------
11. The synovial fluid also ----------- the movement of the forearm along the long axis
articulating cartilages. (a) rotational (b) abduction
(a) nourishes (b) support 20. The wrist joint is a synovial joint of -------
12. The joint between humerus with both radius variety (a) ellipsoid (b) condyloid
and ulna is called ------- joint 21. The knuckle joint is a synovial joint of
(a) elbow (b) radioulnar
--------- variety (a) ellipsoid (b) condyloid
13. The joint between radial and ulna is called
22. The thumb joint is a synovial joint of
-------- (a) ulnaradial (b) radioulnar
---------- variety (a) saddle (b) plane
14. The shoulder girdle consists of the collar
23. Radiocarpal joint is a ----------- joint
bone and -------- (a) scapula (b) clavicle
(a) wrist (b) knuckle
15. Ligaments are ------- tissues (a) passive (b) 24. Metacarpophalangeal joint is a ---------- joint
active (a) wrist (b) knuckle
16. Muscles are ----------- tissues (a) passive 25. Carpometacarpal joint is a --------- joint
(b) active
(a) knuckle (b) thumb
ANSWERS
MECHANICS OF
LOWER LIMBS '
Knowledge is a collection of facts. Wisdom is knowing how to apply knowledge.
3. The hip bone is made of three elements the hip. The articulating surfaces of the
(ilium, pubis and ischium) which are fused femoral head and the acetabulum are lined
at the acetabulum. Two hip bones form the with hyaline cartilage. These two form a
hip girdle which articulates posteriorly with diarthrodial joint which is a ball and socket
the sacrum at the sacroiliac joints. The bony joint. Derangement of the hip can produce
pelvis includes the two hip bones, a sacrum altered force distributions in the joint
and a coccyx. Hip joint has articulation cartilage, leading to degenerative arthritis.
between the hip bone and femur. C u p s h ap ed
A c etab ulu m
4. The fibula of the leg does not take part in
the formation of knee joint. Patella (knee cap) Iliu m
Hip Join t
1. The pelvis consists of the bones viz. ilium, 3. The muscles of the hip joint can be divided
ischium, pubis and sacrum. At birth, three into (1) hip flexer (psoas, iliacus, rectus
bones are distinct. In adults these bones are femoris, pectineus and tensor fascia) to
fused and synarthrodial joint is formed which carry out activities such as running or
permits no movement. The pelvis is located kicking (2) hip extensors are gluteus
with spine at centre and one femur bone at maximus and hamstring muscles
each end. Any movement of spine or femur (biceps femoris-semitendinosus, semi
bone will result into the movement of the membranosus). The hamstring muscles also
pelvis. Hence there is no muscle whose work as knee flexers (3) Hip abductor
primary function is to move the pelvis. muscles providing for the inward rotation
Movements of pelvis are resulted by the of the femur. They are gluteus medius and
muscles of the trunk and the hip. gluteus minimus. The gluteus medius also
2. The hip joint is formed by the femoral head stabilises the pelvis in the frontal plane (4)
fitting well in to the deep socket of the Hip adductor muscles are adductor longus,
acetabulum. The transverse and teres adductor magnus and gracilis muscles (5)
femoris ligaments of the hips support and Outward rotation of the femur is provided
hold the femoral head in the acetabulum as by small deeply placed muscles.
the femoral head moves. The stability of the
hip joint is resulted from its construction FORCES ON THE HIP JOINT
which also permits wide range of motions
facilitating walking, sitting and squatting. 1. Case study 1: To understand the stability
The joint permits flexion and extension, of the hip joint, consider a man who is
abduction and adduction, and inward and bent forward and lifting a weight (Wb). As
outward rotation. The movement is shown in the figure, the man’s trunk is
controlled and coordinated by ligaments, flexed by an angle α as measured from
muscles and bony structure, and shape of the vertical.
76 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
= 12 Wm = 1.6 Wm
V e rtica l V e rtica l = 10.4 Wm
1
F α F R
R sin θ = F sin 30 = 10.4 × Wm ×
α A θ 2
R
= 5.2 Wm
A a B
B R cos θ = 10.4 Wm cos 30 – 0.4 Wm – 2Wm
b C
C = (9.152 – 24) Wm
wl wl
= 6.752 Wm
wb R = [(5.2) 2 + (6.752) 2 ] Wm2
W
l D
(w m + w b ) Wm + Wb = Wm 2.7.04 + 45.59
= 8.52 Wm
θ = tan–1 57
The forces acting on the lower limb of the
It can be seen that muscle force (F) is 10.4
man is shown in the figure. Weight (Wm + times and reaction at joint is 8.52 times the
Wb) is total ground reaction acting at point
weight of the man when trunk is flexed for
D of the feet where Wm = weight of man 30° from the vertical.
and Wb weight being lifted. Wl is the weight
of both legs including the pelvis which is 2. Case study 2: While walking and running,
acting at point C. F is the force exerted by the body weight is momentarily taken by one
the erector spinae muscle supporting the leg. For the single leg stance, the forces
trunk and acting at the point A. R is the acting on the leg are shown in the figure. F
reaction at the union of the sacrum and the is the muscle force exerted by the abductor
fifth lumbar vertebrae (point B). A muscle. R is the reaction force developed
mechanical model of man’s lower body with by the pelvis on the femur. Wm is the weight
forces is illustrated. Assume the force F is of the man which acts on the leg as a normal
acting at angle α to the vertical. Also assume force by the ground. Wl is the weight of the
shortest distance of A, C and D from B is leg. Let α and β are angles made by F and
a, b, and c as shown on the model. R with the horizontal. A mechanical model
of the leg with forces acting on it is also
Σ ΜΒ = 0, F × a + Wl× b = (Wm + Wb) × c
shown. A is point of rotation of the hip joint;
(Wm + Wb ) c – Wl × b B is point where the hip abductor muscles
∴ F = are attached to the femur; C is the centre of
a
gravity of the leg where Wl is acting, and D
Also R sin θ = F sin α
is point where ground reaction force (= Wm)
and R cos θ = F cos α – W l is acting upwards, The distance from point
– Wm– Wb B to A, C and D are a, b and c as shown in
If α = 30°, a : b : c = 1 : 4 : 6 ; the figure. α and β are the angles of F and
w1 = 40% of Wm ; and Wm = Wb R from horizontal while θ 1 and θ2 are the
angles of femur neck and femur shaft with
6 4 the horizontal. The forces acting on the leg
(Wm + Wm ) – × (0.4Wm )
11 11 form a coplanar force system which will
F =
1 give us three equations of equilibrium (Σ
11 Px = 0, ΣPy = 0, ΣM = 0)
MECHANICS OF LOWER LIMBS 77
α
F R
β
α
Wl
D
Wm
R
F a
A A
F
Fe m ora l ne ck θ1 θ1 = Fe m ur
B
B n eck a ng le
Fe m ora l sh aft
C b
C θ2 = fe m ur
Wl sha ft an gle
c wl (a cos θ1 – b co s θ2 )
θ2
D
Wm D
(a cos θ1 – c co s θ2 )
Mechanical Model of Leg
9.28 × 0.174 –.82 × 0.259 diagram of the leg and mechanical model of
= × Wm one leg in solving the magnitude of muscle
0.5
1.6 – 0.21 force (F) and reaction at the joint (R). A
= × Wm simpler approach for finding F and R is to
0.5
consider the free body diagram of the body
= 2.78 Wm
minus the right leg (as shown in the figure)
Hence force exerted by the abductor muscle with the left leg on the ground.
is 2.78 times the weight of the man.
The weight of the man minus left leg (= Wm
Σ Px = 0, F cos α – R cos β = 0 – Wl) does not act at middle line but now it
or R cos β = F cos α shifts from centre towards a point at left
R cos β = 2.78 Wm cos 75 = 0.72 side of CG point (left side is heavier than
Σ Py = 0, F sin α – R sin β – Wl + Wm = 0 right side as shown in the figure). F is
2.78 Wm – R sin β – 0.18 Wm + Wm = 0 muscle force at A and R is reaction at hip
or R sin β = 3.6 Wm joint at point B. Now we get a concurrent
force system which meet at point O. We
R= 3.62 + 0.722 × Wm can apply lami's theorem for finding solution.
= 12.96 + 0.52 × Wm = 3.67 Wm F R
3.6 =
Also tan β = =5 sin (90 + β) sin (90 – α)
0.72
or β = 78.7° Wm – Wl
=
Hence the reaction force at the hip joint is sin (180 + α – β)
3.67 times the weight of the man and it
makes angle of 78.70 with the horizontal. F R Wm – Wl
= =
cos β cos α sin (β – α )
3. Case study 3: In the last case study of one
leg stance, we have considered the free body (Wm – Wl ) cos β
∴ F= sin (β – α) cos β
α O (Wm – Wl ) cos α
β F=
sin (β – α)
C e ntre lin e
O L G S h ifte d If we take W l = 18% W m, α = 75° and
to le ft as β = 78.7°
A w e ig ht of
G le ft side (Wm – 0.18Wm )
w e ig ht of F= cos 78.7
F
β righ t sid e sin (78.7 – 75)
R 0.82Wm × .196
Wm – Wl =
x
0.0645
= 2.49 Wm
R
β 0.82 × 0.26
R= Wm= 3.3 Wm
α O y 0.0645
4. Case study 4: In one leg stance, if a man
carries dumb bell in each hand, we can find
F
Wm – Wl muscle force (F) and hip joint reaction (R).
In the free body diagram of the upper body
Single Leg Stance
MECHANICS OF LOWER LIMBS 79
2 /3 w m
1 /3 w m
F R
dm dw
5 W
m
6
F
dm dw
R 5/6w m
Abduction Gait
Effect of Cane
MECHANICS OF THE KNEE the femur and the tibia. These articulations
are separated by layers of cartilage, called
1. The knee is the largest joint in the body. It is menisci (fibrocartilaginous discs). The
also a most complex joint. The complexity lateral and medial menisci prevent bone to
is the result of fusion of three joints in one. bone contact between the articulating
It is formed by fusion of the lateral surfaces of the femur and the tibia and they
femorotibial, medial femorotibial and also work as shock absorbers. The
femoropatellar joints. It is a compound femoropatellar joint is the articulation
synovial joint, incorporating two condylar between the anterior end of the femoral
joints between the condyles of femur (thigh condyles and the patella which is a floating
bone) and tibia (leg bone) and one saddle bone kept in position by the quadriceps
joint between the femur and the patella. The tendon and the patellar ligaments. The patella
femorotibial has two distinct articulations also protects the knee from impact related
between the medial and lateral condyles of injuries and enhances the pulling effect of
MECHANICS OF LOWER LIMBS 83
Femur Quadriceps
Patella
patella
ligamentum
head patellae bicepsfemoris
biceps femoris
of fibula
anterior
border of tibia Tibia
fibula
Front view
Q ukad riceps femo rls ext ending knee
Quadriceps
collateral
Tibial collatera tendon Quadriceps
ligam ent
Femur
Lateral Patella
condyle Fibular
collateral biceps
Medial ligam ent patella
condyle femoris
Lateral Patellar ligam ent
Medial meniscus
meniscus
meniscus Tibia ligaments
Tibia
Cruciate ligam ents
Capsular ligaments
y x
R Ry RX
F θ
0 Fy
β
A a Fy
B
b
w ly
wl w lx
C α C α
w bx w by
wb
Exercising Knee Joint
86 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
F Wm R
= =
cos β sin (α – β) cos α
Wm cos β
∴ F = sin α – β
Wm cos α
and R =
sin (α – β)
Ankle Joint
88 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Accept God's advice gracefully as long as it doesn't interfere with what you
intend to do.
INTRODUCTION flow and volume are measured by using
engineering techniques.
1. The blood has carriers of fuel supply. The
WORKING PRINCIPLE OF
blood has ability to transport waste materials
to predestined destinations. The blood also CARDIOVASCULAR SYSTEM
contains a mechanism for repairing small
system punctures and a method for rejecting 1. The cardiovascular system or the blood
foreign elements from the system. Man is vascular system is a closed hydraulic
able to sustain life because the blood is system. The blood consists of plasma and
supplied to all systems of the body. The corpuscles. The red corpuscles, white
circulating blood supplies oxygen and corpuscles and thrombocytes are suspended
nutrients to the cells of the body. The heart in the plasma. There are about 4.5 to 5.5
is a very important organ in the body which million red blood cells per cubic millimeter
acts as a pump to circulate the blood in the of blood. There is about 3.5 to 5 litres/min
body. The failure of heart is the cause of blood circulating in normal adult at rest. The
many deaths. There are many techniques blood circulating system consists of:
and instruments to measure functioning of (a) Heart: The circulation of blood is
heart and to diagnose any of its maintained within the blood vessels by
malfunctioning for treatment so as to avoid the rhythmic pressure in the trunk
its failure. The cardiovascular system vessels exerted by the contraction and
consists of heart, distribution system (arteries expansion of the heart. The heart acts
and arterioles), diffusing system (capillaries as a pump whose elastic muscular walls
in contact with cells) and collecting systems contract rhythmically to develop
(veins), The cardiovascular system is a pressure to push the blood through the
closed hydraulic system. Blood pressure, vascular system. The heart contracts
90 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Right Atrium
Right
Ventricle CO 2
O2 Tissue
Superior Left A trium
Vena Cava
Left
ve ntricle Left Lung
Right Lung O2
O2 Pulmonary
Vein
Coronary sinus
CO 2
CO 2
Pulmonary
Artery
Aorta
Inferior
VenaCava
Vena Cava
Tissue
CO 2 O2
V e nu le
V e in
C a pilla rie s B igg er A rte ry
Blood Circulation
2. The organs which are supplementing the and in maintaining the chemical quality
functioning of cardiovascular system are: of the blood.
(a) Lungs: The blood with carbon dioxide
THE HEART: WORKING AND
and air intake reach lungs which
provide a region of interface for the STRUCTURE
transfer of oxygen to the blood from 1. The heart can be considered as a pair of
air and removal of carbon dioxide from two stage pumps working in series with each
the blood to the air. stage of the pumps arranged physically in
(b) Kidney/liver and spleen: These organs parallel. However the circulating blood
help in the removal of waste products passes through from first stage to second
92 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
stage. The heart has two halves viz. the (also called bicuspid) valve by the
right heart and the left heart. The right heart contraction of the left atrium muscles. When
is a low pressure pump while the left heart the left ventricular muscles contract, the
is a high pressure pump. The right heart pressure increases and it closes the mitral
receives blood from inferior venacava and valve. The pressure further increases and it
superior venacava veins and pumps it to the forces the aortic valve to open, permitting
lungs. The blood flow through the lungs is the blood to rush into the aorta. The outward
called the pulmonary circulation. The left flowing of the blood from the right and left
heart receives blood from the pulmonary heart takes place synchronously. The
vein. The left heart acts as a pressure pump pumping cycle can be divided into two parts
and it pumps the blood for the systemic viz. systole and diastole. Diastole is the period
circulation which has a high circuit of dilation when the left and right atrium are
resistance with a large pressure gradient filled with blood. Systole is the period of
between the arteries and veins. The muscle contraction, of the left and right ventricle
contraction of the left heart is larger and muscles when the blood is pumped into the
stronger as it is a pressure pump while the aorta and the pulmonary artery. Once the
right heart is a volume pump with lesser blood has been pumped into the arterial
contraction. However, the volume of blood system the muscles relax resulting in a
handled by each pump is same as they are decrease in pressure in both ventricles. The
working in series. The cardiac muscles form in a outlet valves close and inlet valves open
the wall of the heart. The structure is to restart a new cycle of the heart. The
somewhat in between striped and unstriped. volume of blood is about 5 to 6 litres in a
The muscles are not in the control of “will”. man and the heart pumps about 5 litres per
The muscles contract rhythmically and they min during resting. Hence heart can circulate
are immune to fatigue. The muscles receive complete blood in about one min. However,
their own blood supply from the coronary during running or heavy exercise the
arteries. circulation rate is increased considerably. 120
2. The deoxygenated blood enters the storage mm Hg (Mercury) is the average blood
chamber of the right heart which is called pressure during systole which is called “high
the right atrium. The coronary sinus also blood pressure”. 80 mm Hg is the average
brings the deoxygenated blood after blood pressure during diastole which is called
circulating through the heart by the coronary “low blood pressure”. A healthy person has
loop and empties it into the right atrium. 120/80 blood pressure which means systolic
When the right atrium is full, the right heart pressure = 120 mm Hg (it is gauge pressure,
contracts and it forces blood through the which gives absolute pressure = 120 + 760
tricuspid valve into the right ventricle. Now 880
the right ventricle contracts, the tricuspid mm = 880 mm Hg ≈ × 13.6 × 9.81 =
1000
valve closes and the pressure in the ventricle
117.4 kpa) and diastolic pressure = 80 mm
forces the semilunar pulmonary valve to open
Hg (It is gauge pressure. The absolute
so that the blood can flow through
pressure = 80 + 760 = 840 mm of Hg =
pulmonary artery into the lungs. The blood
is oxygenated in the lungs. 840
× 13.6 × 9.81 = 112.07 kpa). The rise
3. The oxygenated blood enters the left atrium 1000
from the pulmonary vein. The blood is of the blood pressure or the fall of the blood
pumped into the left ventricle through mitral pressure from the normal blood pressure
THE CARDIOVASCULAR SYSTEM AND BLOOD FLOW 93
indicates malfunctioning of heart or any each lungs, open into the left atrium. The
blockade in the arterial system. opening has no valve. The left atrium is
4. Structure of the heart: The walls of the connected to the left ventricle through the
heart are composed of a thick layer of cardiac atrioventricular orifice which is guarded by
muscle which is called myocardium. the mitral valve. The left ventricle is
Myocardium is covered externally by the connected to the aorta through the aortic
epicardium and lined internally by the orifice which is guarded by the aortic valve.
endocardium. The heart is divided into four It consists of three cusps. The walls of the
chambers by septum. Septum is a thin wall left ventricle are three times thicker than the
where it divides atrial portion into right and walls of the right ventricle as to withstand
left atrium. Septum is a thick wall where it the six times higher pressure in the left
devides ventricular portion into right and left ventricle as compared to the right ventricle.
ventricle. The superior venacava opens into As the ventricle has to perform stronger
the upper part of the right atrium. The pumping work, its walls are thicker than the
opening does not have any valve. It returns walls of the atrium and its surfaces are
the deoxygenated blood from the upper ridged. The shape of right ventricle is
portion of the body. The larger inferior vena circular while it is crescentic for the left
cava opens into the lower part of the right ventricle.
atrium. It has non functioning valve at the D e ox yg e na te d B lo od
opening. The deoxygenated blood from the
lower portion of the body enters through it. Su pe rio r
Ve na C a va Pu lm o n a ry
The coronary sinus brings blood after Va lv e
Endocardium Epicardium
Parietal Serous
Pericardial Cavity Pericarduim Heart Structure and Blood Flow
semilunar cusps as shown in figure. Semilunar valves are the aortic and
B ic usp id V a lv e pulmonary valves. They are called semilunar
(M itral va lv e )
P u lm on ary V alve valves because their cusps are semilunar in
shape. Both valves are similar to each other.
Each valve has three cusps which are
attached to the vessel wall. The cusps form
A o rtic V alve
small pockets with their mouth facing away
from the ventricles. The valves are closed
during ventricular diastole when the cusps
expand in the ventricular cavity.
T ric us pid
V a lv e 6. The conducting system of the heart: The
heart contracts rhythmically at about 70
beats per minute in the resting adult. The
rhythmic contractile process originates
Four Valves of the Heart
(Cut portion and Atria Removed)
spontaneously in the conducting system and
the impulse travel to different regions of the
Atrioventricular valves are made of a fibrous heart so that both atriums contract first and
ring to which the cusps are attached. These together which is to be followed later by the
are flat and project into the ventricular cavity. both ventricles contracting together. The
The valves are closed during ventricular slight delay in the passage of the impulse
systole. The tricuspid valve has three cusps. from the atria to the ventricles permits time
Fibrous ring for the atria to empty their blood into the
ventricles before the contraction of the
ventricles. The sinoatrial node (SA) is
Cusp
located superior to the right atrium (full
thickness of myocardium) where the
Papillary
Muscle
excitation of the heart contraction is initiated.
Sinoatrial (SA) node is also called pacemaker
and it is a special group of excitable cells.
Atrioventricular Valve Once initiated, the cardiac impulse spreads
It can admit the tips of three fingers. The through the atrial myocardium to reach
bicuspid (Mitral) valve has two cusps. It can the at rioventricular (AV) node. The
admit the tips of two fingers. The bicuspid atrioventricular node is situated in the lower
cusps are smaller and thicker than those of part of the atrial septum just above the
the tricuspid valve. The atrioventricular valve tricuspid valve. From AV node, the cardiac
having 3 cusps is shown in figure. impulse is conducted to the ventricles
b y t h e a t r i o ventricular bundle. The
THE CARDIOVASCULAR SYSTEM AND BLOOD FLOW 95
atrioventricular is the only muscular action of these nerves is called their tone.
connection between the myocardium of the The nerves affecting the rate of the heart
atria and the myocardium of the ventricles. are controlled by the brain. The heart rate
The atrioventricular bundle descends to the increases when a person is anxious,
lowest part of the ventricle septum. At the frightened or when a person indulges into
upper part of the septum, the atrioventricular overeating or has respiration problems or
bundle divides into two branches, one for high blood pressure.
each ventricle. The right branch moves
down on the right-side of the ventricular
S A N od e
septum and emerges at the anterior wall of (P a cem ake r)
the right ventricle where it joins with the
fibers of the purkinje. The left branch of the
A V N od e
bundle pierces the septum and passes down
on the left side of the septum beneath the B u nd le
endocardium. The left branch further divides o f H IS
into two branches which ultimately join with
the fibers of the purkinje of the left ventricles.
R ig h t b un dle
The conducting system not only generates b ran ch
rhythmical cardiac impulses but also
conducts these impulses quickly throughout
P u rkin je
the myocardium of the heart. It is essential fibe rs
so that the different chambers of the heart L eft bu n dle
b ran ch
can contract in a coordinated and efficient
The Heart : Conduction System
manner. The SA node creates an impulse of
electrical excitation that spreads across the
RESTING AND ACTION POTENTIAL
right and left atrium. The right atrium
receives the early excitation as it is nearer 1. Surrounding the cells of the body are body
to the SA node. This excitation causes the fluids which are ionic and they provide
atria to contract. A short time later, the conducting medium for electric potential.
excitation simulates the AV node. After a brief The cells of nerve and muscle which are
delay the activated AV node initiates an required to generate biopotential, have a semi
impulse into the ventricles through the permeable membrane. The membrane has
bundle of HIS. The bundle branches take unique characteristic to permit ions of some
the impulse to the fibers of purkinje in the substances to pass through it while others
myocardium. The contraction occurs in the are blocked on its surface. The body fluids
myocardium and the blood is pumped into have prinicpal ions of sodium (Na + ),
pulmonary artery and aorta from the right potassium (K+ ) and chloride (Cl–). The
and left ventricles. The heart rate is controlled membrane permits potassium and chloride
by the frequency at which the SA node ions to enter inside the cell while it blocks
generates impulses. But the nerves of the sodium ions. In order to maintain the balance
sympathetic nervous system and the vagus of ions inside and outside the cells, there is
nerve of the parasympathetic nervous system higher concentration of sodium ions at
cause the heart rate to quicken or slow down outside which is equal to higher
respectively. The effects of the sympathetic concentration of chloride ionsat potassium
and vagus nerves are in opposition to each ions of inside the cell. Though ionic balance
other but the result is additive if they both from the concentration point of view is
occur together in opposite directions. The achieved but the charge imbalance exists with
96 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
positive charge at outside and negative sodium ions. The net result is more positive
charge at inside. The biopotential is ranging ions inside the cell. This potential is known
from –60 to –100 mV. It is called the resting as action potential. Its value is about +20
potential of the cell and cell in the resting mV. The process of a cell gaining an action
state is called to be polarized. When potential on excitation is known as
membrane is excited by any external
depolarization. When the rush of sodium ions
energy, the characteristics of the
membrane change. The membrane now inside the cell stops, the ionic current does
permits more sodium ions to enter into the not flow and the membrane again becomes
cell.The movement of positive charged impermeable to chloride and potassium ions.
sodium ions constitutes an ionic current flow The sodium ions inside the cell are quickly
transported to the outside by a process called
sodium pumping and cell is again polarized
to the resting potential. This process is
known as repolarization.
Polarisation of a Cell
40
30
20
10
0
Tim e
– 10 (m illi se con ds)
– 20
B iop oten tia l
– 30
– 40
– 50
– 60
– 70
– 80 A b so lu te a nd R e la tive
D e po la risatio n R e po la risatio n R e fra ctory
P eriod
In nerve and muscle cells, repolarization is propagation rate or conduction rate. The
fast after depolarization and cycle is conduction rate depends upon the type of
completed in short time (about 1 milli cell and diameter of muscle or nerve. The
second). On other hand, the cell of the heart conduction rate is faster in nerves (about 2
repolarizes very slowly and cycle takes more to 140 meter/sec) while it is slow in heart
time (about 150 to 300 millsec). The muscle (0.03 to 0.4 meter/sec.)The
waveform of action potential does not depend biopotentials generated by the muscles of
upon the intensity of the stimulus. However the heart give electrocardiogram (ECG) The
the stimulus must be strong enough to biopotential generated by the neuronal
activate the cell. After the completion of the activity of the brain is called the electro
cycle, there is a short time during which the encephalogram (EEG). The biopotential
cell can not be excited. This period is called associated with muscle activity constitute
the absolute refractory period and it lasts electromyogram. (EMG)
about one millisec. After the absolute
refractory period, the cell can be excited by THE ELECTROCARDIOGRAM (ECG)
a very strong stimulus during a period of
time which is called a relative refractory 1. The biopotentials generated by the muscles
of the heart with time is called the electro
period. The relative refractory period lasts
cardigram. The action potential starts from
for much longer time as compared to the
a point called the pacemaker or sinoatrial
absolute refractory period.
(SA) node which is located near the top of
3. Each excited cell generates an action the right atrium. The action wave form
potential and current begins to flow. The propagates in all directions along the surface
other cells in the neighbourhood of the of both atria. The waveform reaches the
excited cell also get excited and the action junction of the atria and the ventricles. The
potential begins to travel which is called waveform terminates at a point on this
the propagation of the action potential. The junction which is called the atrioventricular
rate at which it propagates is called (AV) node. The propagation of excitation is
98 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
R
P
B iop oten tia l T
J U
Q
S
Tim e
ECG Waveform
delayed at AV node so that the ventricles wave T represents the repolarization of the
can be filled up with the blood from the atria. ventricles. The after potential in the ventricles
Once the period of delay is over, the is given by the U wave. The P–Q part of
excitation is spread to the all parts of the the curve shows the period of the delay
ventricles by the bundle of His. The fibers caused to excitation wave at the AV node.
in the bundle (called Purkinje fibers), branch The ECG helps in the diagnosis of
out into two parts to initiate action potential malfunctioning of the heart. Longer cycle
simultaneously in the myocardium of the time or slow heart is called bradycardia while
ventricles. The action potential moves from shorter cycle time or fast heart is called
the inside to the outside of the ventricular tachycardia. The cycles must be evenly
walls. The waveform terminates at the tip spaced otherwise a patient has arrhythmia.
of the heart. The depolarization is If the duration between P and R is greater
completed. After 0.2 to 0.4 sec, a wave of than 0.2 second, it suggests the blockage of
repolarization starts in which neighbouring the AV node. If any feature of the curve is
cells play no part but each cell returns to its missing, it indicates a heart block.
resting potential independently. Electrocardiography is the instrument used
2. If the biopotential is recorded from the to record ECG. The cardiac disorder,
surface of the body, the curve is obtained specially those involving the heart valves can
which is called ECG. A typical ECG is as not be diagnosed by the ECG and other
shown in the figures. If prominent features techniques like angiography (X-ray photos
of the curve are given alphabetic after injecting contrasting medium into the
designations, we can explain the events blood stream) and echocardiography
related to the action potential propagation (Ultrasound measurement of the heart) are
with the help of these features. The used.
horizontal portion right of the point P is
HEART SOUNDS
considered as the baseline or equal potential
line. The wave P represents depolarization
1. The beating of the heart and the pumping
of the atrial myocardium. The depolarization
of the blood is associated with the
of ventricles and the repolarization of the
generation of sounds. The technique of
atria take place simultaneously which is
listening to sounds produced by the heart
indicated by QRS part of the curve. The
THE CARDIOVASCULAR SYSTEM AND BLOOD FLOW 99
R
T
P
First S e co n d Th ird
H e art S o un d
Tim e
and blood vessels is called auscultation. The distribution, diffusion and collection system
physicians are trained to diagnose the heart of the blood. The blood pressure has to be
disorders by listening to the sounds. The sufficient high to overcome the resistance
stethoscope is the device used to listen to of the arterial vascular pathways. The flow
the sounds. The “lub-dub” are two distinct must not stop at any cost and even remotest
sounds that are audible by the help of a capillaries must receive sufficient blood
stethoscope with each heart beat. The lub which further pass it into the venous system.
is produced when the atrioventricular The other requirement of the blood vascular
valves close and prevent any reverse flow system is that the system must be capable
of the blood from the ventricles to atria. to dampen out any large pressure variation.
The lub is also called the first heart sound Our body is equipped with a monitoring
and it occur at the time of the QRS part of system which can sense and take corrective
the ECG. The “dub” sound is produced by steps by regulating the cardiovascular
the closing of the pulmonary and aortic operations to maintain proper flow.
valves. The “dub” is also called the second Therefore in our body, pressure is maintained
heart sound and it occurs about the time of within a relatively narrow range and the flow
the end of the ‘T’ wave of the ECG. The is kept within the normal range of the heart.
third sound is sometimes produced after 2. Determining an individual’s blood pressure
second sound by the rushing of the blood is a standard clinical measurement. Blood
from the atria to the ventricles. pressure values in the various chambers of
BLOOD PRESSURE the heart and in the peripheral vascular system
help in diagnosis of functional integrity of
1. The heart has to develops sufficient pressure the cardiovascular system. First we have to
to circulate blood from heart (1) to lungs understand the two basic stages of diastole
and back for oxygenation of the blood (2) and systole with each heart beat. The pumped
blood from heart has the blood pressure
to all body systems with the help of the
which is a function of time (1) in the aorta
100 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
(dotted lines) (2) in the left atrium (dot circle pressure falls as the blood moves further
lines) (3) in the left ventricle (full lines ) (4) away in the blood vascular system. The
pulmonary artery (–00– 00) (4) right
systolic period is completed with the closing
ventricle (–m–m–) which are shown in the
of the aortic valve to prevent any back flow
figure. The events of the heart are also
of the blood from the aorta to the left
correlated with the features of the ECG in
ventricle. The dichrotic notch (sudden stop
the same figure.
in the drop of pressure) indicates the closure
3. During systole, the output of the blood from of the aortic valve in the figure. Atvial systole
the left ventricle is high in the beginning and lasts for 0.1 sec and ventricle systole lasts
the blood pressure in the aorta increases to for 0.3 sec. The arterial pressure gradually
the maximum (120 mm Hg). The blood decreases with further flow of the blood into
THE CARDIOVASCULAR SYSTEM AND BLOOD FLOW 101
the distributing and diffusing system. The 30 mm Hg and the blood also loses its
duration of cardiac cycle is 0.8 sec at the oscillatory character when the blood flows
heart rate of 72 beats per min. through the capillaries into the venous
4. The pressure of the pulsating blood changes system, the pressure drops down to 15 mm
as it moves through the arteries. The blood Hg. The chief seat of peripheral resistance
gets dampened and reflected by the walls of is arterioles. In venous system, the pressure
the arteries. The pressure and volume also further decreases to 8 mm Hg in the venules
get changed when any artery is branched and to 5 mm Hg in the veins . The pressure
into smaller arteries. In smaller arteries and is as low as 2 mm Hg in the vena cava
arterioles, the pressure decreases to 60 to Normal mean pulmonary artery pressure is
15 mm Hg.
1 30 S ystolic
1 20 P re ssu re
1 10 C u ff P ressure
1 00 L in e
90
80
70
60 D ia sto lic P ressure
50
40
30
20
H a nd B u lb
4. Example: Let us find the stress in the blood blood flow can occur in reverse direction.
vessels if 1 mm Hg = 130 N/m2 for (1) an The elasticity of the walls of the blood
aorta having mean internal pressure 110 mm vessels helps in smoothing out the pulsation
Hg, t = 1.2 mm and diameter of 2.4 cm (2) and pressure of the blood. The capillaries
a capillary having mean pressure of 20 mm can enlarge or constrict under the influence
Hg, t = 0.5 µm and diameter of 10 µm (3) of certain drugs or when exposed to low
the superior vena cava having mean internal temperatures. The blood flow reduces during
pressure of 10 mm Hg, t = 0.15 cm and vascoconstriction of the capillaries. The
diameter of 0.03 m. blood flow increases during vasodilation of
the capillaries. Hence the status of the
D
As found out σ = pi × circulatory system can not be determined
2t by measuring only blood pressure as it varies
110 × 130 × .024 with the flow resistance of the capillaries.
Case 1 : σaorta = The basic theory of circulatory function is:
2 × 0.8012
= 143 KN/m2 (a) The blood flow to each tissue of the
body is always precisely controlled in
20 × 130 × 10 –5 relation to the tissue needs.
Case 2 : σcapillary =
2 × 0.5 × 10 (b) The cardiac output is controlled
primarily by the local tissue flow.
10 × 130 × 0.03−5 (c) The arterial pressure is independent of
Case 3 : σvenacava =
2 0.15 × 10 local blood flow or cardiac output.
= 26 KN/m2 (d) Veins besides transporting blood back
to heart from the tissues, act as
BLOOD FLOW reservoir of blood. The veins can
contract and expand as venous walls
1. Blood flow is highest in the pulmonary artery are thin which permit the veins to hold
and the aorta as the blood leaves the heart more blood or less blood depending
from these two points. The flow at these upon the requirement of various
points is called cardiac output. The cardiac systems.
output in a normal adult at rest varies from
(e) Circulatory shock is caused by
3.5 to 5 litres/min. The stroke volume is the
decreased cardiac output. It can be due
amount of the blood that comes out during
to cardiac abnormalities that decrease
each heart beat. If heart beat = 80 per min
the ability of heart to pump blood. It
and cardiac output = 4 litres /min, then stroke
can be also due to the factors that
4 decrease the vanous return flow. The
volume = = 0.05 litres/beat. Similarly
80 most common cause is trauma to the
cardiac index (n) is defined as the cardiac body as hemorrhage is caused by the
output per min per sq meter body surface trauma.
area. The typical value of n is 3.3 litres/m2/ 2. As we have seen in chapter 2, Newtonian
mm. The mean circulation time (≈ 60 sec) fluids obey Newton’s viscosity equation and
can be obtained by dividing cardiac output viscosity does not change with the rate of
to the total amount of blood circulation. In deformation. Non Newtonian fluids do not
the arteries, blood flow is pulsatile. During follow the linear relationship between shear
certain parts of the heart beat cycle, the stress and the rate of deformation i.e.
104 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
P lastic Flu id
s t ic
l P la <1
τ Id e a id dn du
n
F lu du an µ dy
(S h ea r stre ss) ia n d y τ =
on µ
e wt τ = u id
N Fl
No
n ia n
w to n D ilatan t F lu id
Ne n
τ = µ du a nd n > 1
dy
Fluid Classifications
S ten osis
is also possibility of increasing concentration which arises from rhythmic action of the
of suspended particles (hyaluronic acid heart. The pressure and volume increase
molecules) in synovial fluid due to filtration during systole which gradually decrease
in porous cartilage and its surface during diastole.
topography which provide boosted joint (g) The blood has unusual fluid properties. The
lubrication. The articular surfaces are blood consists of millions of different
protected due to the boosted lubrication. corpuscles suspended in the plasma. These
corpuscles can deform when these are
Fe m ur required to pass through the blood vessels
having diameter smaller than their own.
A rticular
C a rtila ge A rticulating (h) The blood vessels can contract or enlarge
C a vity w ith
syn ovial flu id as explained earlier. The veins can enlarge
to act as reservoir to store more blood.
5. Hagen-poiseuille flow: The flow of blood
in arteries was investigated by the physician
Poiseuille. He considered laminar flow
Tibia through a horizontal round blood vessel as
Fibu la shown in the figure. The flow moves in
cylindrical laminae.
Knee Joint : Synovial Fluid
4. Special characteristics of blood flow are:
(a) the Reynolds number of the blood is high
(range 10,000) which results into a larger
entry length (the length in which 99% of
Cylindrical Laminae
the final velocity profile is achieved). In
most cases in the blood vessels the fully Laminar Flow Through Round Artery
developed flow is never reached as the
The equilibrium of a cylinder of radius r and
blood vessels start branching before this
length dx is considered with pressure P at
stage is attained.
right and P – δP at left when the blood flow
(b) The blood is flowing through the blood
is from right to left. The net pressure force
vessels which have different properties. The
at the ends must be equal to the shear force.
reason for the different properties is that
the blood vessels are formed of different P πr2 – ( P + δp) πr2 – = τ 2πr.dx
substances such as elastin, collagen and
smooth muscles. dp r
(c) Unusual large bifurcation or branching of or τ = ...(i)
dx 2
the blood vessels. There are million of blood
vessels in the blood circulating system. dp R
maximum shear stress τ = – when r = R.
(d) The blood vessels have to bend into unusual dx 2
curvature in the blood circulating system
which leads to secondary flow in some cases.
(e) The turbulent flow may arise due to a stenosis
or obstruction in the circulating system. It
may also be due to the defective valves.
(f) The blood has unusual pulsating nature Velocity Profile : Laminar Flow of Blood
106 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
by the earlier described methods. The dye venous occlusion cuff is inflated to stop
is injected at a constant infusion rate I (gms/ blood return from the veins of the forearm.
min). A detector measures the dye Arterial flow causes the increase in volume
concentration down stream. Concentration of the forearm segment which the chamber
increases and finally reaches a constant value measures. The flow of the blood is
Co (gms/litre). The blood flow F (litres/min) proportional to the change in the volume of
= I /Co. In chamber plethysmography the the chamber.
M ag ne t
N
B loo d V essel
B loo d
F lo w
S ign al w ith
fre qu e ncy (F)
Flow D o pp le r shift
o f fre q ue ncy (Fb )
is p ro po rtio n al
to velocity of the b lo od
V olume Calibrator
V enous O
O cclus ionncuff
cclu sio
P r es s ure
T rans ducer
Fill in the gaps 17. The sympathetic nervous system ----- the
heart rate (a) quickens (b) slows down
1. The blood has carrier of ---------- supply 18. The Vagus nerve of the parasympathetic
(a) fuel (b) water nervous system ---- the heart rate
2. The rhythmic pressure is maintained by the (a) quicken (b) slows down
contraction and expansion of the -----------
(a) artery (b) heart 19. The ---- state of a cell is called polarised
3. The heart beats without rest about 1,00,000 (a) resting (b) action
times per ------------ (a) day (b) week 20. The process of gaining an action potential
4. The average heart rate is ------------ beats on excitation is called -------(a) polarisation
per min (a) 75 (b) 150 (b) depolarization
5. Arteries, arterioles and capillaries form ---- 21. After sodium pumping the cell is -------- to
------ systems (a) diffusing (b) distribution the resting potential (a) depolarized
6. The veins form ------------- system (b) repolarized
(a) dispatching (b) collecting 22. The dub sound is introduced by the heart
by the closing of the valves (a) atrio
7. The left heart receives blood from the ventricular (b) semilunar and aortic
pulmonary ----- (a) vein (b) artery
23. The 'lub' sound is produced by the heart by
8. The ----- heart is larger and stronger as it is the closing of the ------ valves (a) atrio
a pressure pump (a) left (b) right ventricular (b) Semilunar and aortic
9. The -------- heart is a volume pump 24. The lub is the -----heart sound (a) first
(a) left (b) right (b) second
10. The heart is divided into four chambers by - 25. The dub is the -- heart sound (a) first
----- (a) epicardium (b) septum
(b) second
11. The inferior and superior vena cava open
into ------ atrium (a ) left (b) right 26. The first heart sound occurs at the time of
the -------- part of the ECG (a) PQR
12. The right atrioventicular orifice is guarded
by ---------- valve. (a) tricuspid (b) dicuspid (b) QRS
13. The pulmonary orifice is guarded by 27. The second heart sound occurs at the -----
pulmonary valve which consists of --------- ----- of the ‘T’ wave of the ECG (a) start
semilunar cusps (a) two (b) three (b) end
14. The left atrioventricular orifice is guarded 28. The blood pressure is measured by an indirect
by the ------------- valve (a) mitral method using a -----manometer (a) cuff
(b) tricuspid (b) sphygmo
15. SA node is also called --------- (a) pulse 29. ------- pressure is the difference between
maker (b) pacemaker systolic and diastolic pressure (a) pulse
16. The propogation of excitation is delayed at (b) heart
AV node so that--------can be filled up with 30. The systolic period is completed with the
the blood from the -------- (a) atria, vena closing of the -------- valve (a) mitral
cava (b) ventricles, atria (b) aortic
110 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
31. The systolic period starts with the closing 35. The pressure in the left ventricle can be ---
of the valve (a) mitral (b) aortic -------times higher than the right ventricle
32. The action potential is about --------- millivolt (a) four (b) six
(a) –70 (b) +20 36. The walls of --------- are thicker and ridged
33. The resting potential is about ---------millivolt as composed to the wall of --------
(a) –70 (b) +20 (a) ventricle, atrium (b) atrium, ventricle
34. The walls of the left ventricle is -------times 37. The delay line is at ------- node (a) SA
thicker than the walls of the right ventricle (b) AV
(a) two (b) three
38. From the AV node the cardiac impulse is
conducted to------- (a) the bundle of His
(b) The purkinje fibre
ANSWERS
1. Respiration consists of two phases viz. 1. The right and left lungs are elastic bags which
inspiration and expiration. Inspiration and are soft and spongy. They are located in a
expiration are accomplished by the alternate closed cavity which is called thoracic cavity.
increase and decrease of the capacity of The right lung has three lobes while the left
thoracic cavity. The respiration rate is 16 to lung has two lobes. The lungs can shrink to
20 per minutes in adults. It is faster in one-third or less in volume. Air enters into
children and slower in the aged. During the lungs through the air passage formed
inspiration, air is taken in the lungs and the by the nasal cavities, pharynx, larynx,
blood is oxygenated. During expiration, the trachea, bronchi and bronchioles. The
lungs eliminate carbon dioxide in a controlled trachea (wind pipe) connects the larynx
manner. Oxygen is required to sustain life (voice box) to the left and right bronchus.
as oxygen combines with hydrogen, carbon The epiglottis is a valve above the larynx
and other nutrients in order to generate heat which prevents any liquid or food from
and energy. This is called the process of entering into the larynx. Each principal
metabolism which is taking place in the cells. bronchus enters into the corresponding lung.
Carbon dioxide and waste are produced from Each principal bronchus on entering the lung
the metabolism. The respiration is the entire divides into secondary bronchus which
process of taking in oxygen as a part of air passes to a lobe of the lung. A secondary
from the atmosphere, transporation of bronchus gives off tertiary bronchi. Each
oxygen to the cells and transportion of tertiary (segmental) bronchus goes to a
carbon dioxide from the cells to the structurally and functionally independent
atmosphere.
112 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Left bronchus
Right
bronchus
Diaphragm
T ra ch ea
Le ft P rinc ipa l
R ight P rin cipa l B ro nc hu s
B ro nc hu s
S ec on da ry
B ro nc hu s
Ter tia ry
B ro nc hu s
Ter m inal B ro nc hu s
D eox yge nate d bloo d
fro m p ulm o nar y O x y ge nated bloo d to
A rtery ha rt th ro ugh
R es pir atory B ro nc hu s pu lm on ar yv vein
ein
P ulm o na ry v e nule
A lv eola r s ac
A lv eola r du cts
A ir
sasc s
A lv eola r s ac
C apilla ry
C apilla ry
and sternum. The geometry of the rib cage the pulmonary capillaries which are located
is such that on its lifting, it increases the in the walls of the alveolar sacs. Here oxygen
thoracic cavity. As thoracic cavity increases is taken up by the red corpuscles which form
in volume, a negative pressure is created in oxyhemoglobin. Simultaneously carbon
the lungs. The negative pressure is relieved dioxide is liberated from the blood cells
by air rushing into the lungs from the which is pushed out to the atmosphere by
atmosphere. The lungs themselves are expiration. The blood pressure in the
passive organs in the inspiration process. pulmonary artery is about 20 mm Hg when
Thoracic diameter blood is pumped by the right ventricle and
increases blood pressure is about 4 mm Hg when
vertically
superior and inferior vena cava brings blood
Diaphragm to the right atrium. The interchange of
contracts
& moves down oxygen and carbon dioxide takes place in
the capillary surface of the alveoli. The
New position capillary surface is more than 75% surface
of diaphargm
Diaphragm
of the alveoli (80 m2).
3. The oxygenated blood from the pulmonary
Descent of Diaphragm capillaries is carried through the pulmonary
veins to the left atrium. The blood from the
Rib cage moves up
left atrium moves to the left ventricle which
pumps the blood into the aorta at high
Thoracic diameter pressure (about 80 to 120 mm Hg) so that
increase laterally
Rib lifted the blood can be circulated through all the
parts of the body. The blood gives out oxygen
at the cells of the tissues. The deoxygenated
Rib blood is collected by the venous systems
Sternum Vertebrae
into the superior and inferior vena cava.
4. The flow of the air in the respiratory system
is usually laminar. However, during heavy
Antero Posterior Expansion
breathing or when there is any obstruction
The expiration process is also passive and it during breathing, the flow of the air can
starts with the release of the diaphragm and become turbulent. The Reynolds number at
rib cage muscles. The volume of thorocic which the flow of the air becomes turbulent
cavity reduces and a positive pressure is is as high as 50,000. When Reynolds number
developed in the lungs which forces air out is small, viscous forces dominate over
of the lungs into atmosphere. During inertial forces. If Reynolds number is less
inspiration, the pressure inside the lungs is than one, inertial forces can be neglected.
negative (about–3 mm Hg). During Low Reynolds number flow is the
expiration, the pressure inside the lungs is characteristic of air flows in alveolar
positive (about +3 mm Hg) passages of diameter less than a few hundred
2. Deoxygenated blood is brought by the microns.
superior and inferior vena cava into the right 5. Some of the terminology used for the
atrium, from here it moves into the right respiratory measurements are:
ventricle. The blood is pumped to the lungs (a) Hypoventilation: Insufficient
from the right ventricle through pulmonary ventilation to maintain normal partial
artery. The blood in the lungs passes through
pressure of carbon dioxide ( PCo2 )
THE RESPIRATORY SYSTEM 115
E n d in sp ira to ry le ve l
E n d expiratory levels IR V IC
V o lu m e TL C TV
VC
(cap acity)
ERV
FR C
RV
Tim e
Spirometer
under the bell, the bell moves down with can be found out by a gas analyser by
inspiration and moves up with expiration. finding the volume and concentration
The height of the bell above the water line of the helium.
can be calibrated to the volume of the air
(b) The nitrogen wash out technique: It
breathed in and out.
involves the inspiration of pure oxygen
2. A gas analyzer is used along with a
and expiration into an oxygen purged
spirometer to measure the residual volume,
FRC and total lung capacity. Following spirometer. After breathing, the gas
techniques are used: remaining in the lungs is 78% nitrogen.
On breathing of pure oxygen, oxygen
(a) The closed circuit technique: It involves
rebreathing from a spirometer charged will mix with nitrogen in the lungs. On
with a known volume and expiration, a certain amount of nitrogen
concentration of helium (marker gas). will wash out which can be measured
After considerable breathing so that the with expired breath. A washout curve
complete mixing of gas in spirometer can be obtained with each breath from
and pulmonary gases can be assumed, which the residual volume (RV)
the residual volume (RV) of the patient capacity can be found out.
118 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
C o un te r w e igh t
P u re oxyge n (O 2 )
N itrog en
a na lyse r
O ne w a y
valve
M ou th piece
S p iro m ete r
O xyg en (O 2 )
N itrog en (N 2 )
C a rbo n dioxid e (C o 2 )
3. The functional residual capacity (FRC) can decreases (dVP is negative)resulting increase
be measured by using a body
in box volume i.e., ∆vb is positive. Increase
plethysmograph. It is an airtight box in
which the patient is seated. The patient in box volume results in the decrease of the
breaths air from within the airtight box pressure in the box (as PV = constant).
through a tube provided inside the box. The Similarly during inspiration the volume of
tube has a shutter to close off the tube and lungs increases and the box volume
an airflow transducer. Pressure transducers decreases which results into increase in the
measure the pressure inside the box and in pressure in the box. Now the shutter in the
the breathing tube on the patient's side of breathing tube is closed and airflow in the
the shutter. Now total air is sum of the air mouth is stopped. The pressure transducer
inside the box (Vb) and the air in the patient's in the tube measures the mouth pressure
lungs (VP) i.e. Vt =Vb + VP . Since the box which is almost equal to alveolar pressure.
is airtight and The changes in mouth pressure correspond
to the changes in box volume which
dVt = o, hence
correspond to the volume of lungs during
dVb = – dVp. expiration and inspiration. If the test is
We also know that if temperature is performed at the time of end of expiratory
constant, then PV = constant is applicable level, the intrathoracic volume must be equal
for air in box as per the Boyle’s law. Now to the FRC.
during expiration, the Vp (Volume of lungs)
THE RESPIRATORY SYSTEM 119
S h utter
A ir
P re ssu re Tra nsd ucer P a tie n t
to m ea sure
a ir p re ssure in bre athing
tu be
B re athing tu be A ir Tigh t b o x
A ir
p um p P re ssu re tra nsdu cer
to m ea sure p ressure
in b ox
Body Plenthysmogram
21. Functional residual capacity can be measured 22. Artificial ----------- is used whenever patient
by ---------(a) spirometer (b) body has reduced breathing (a) lungs (b)
plethysmograph ventilation
ANSWERS
1. The kidneys are a pair of excretory organs 1. Each kidney consists of one to three million
situated on the posterior wall of the abdomen of tiny functional units which are called
just below the diaphragm, one on each side nephrons. Each nephron consists of a cluster
of the vertebral column. They remove waste of capillary loop which is called the
products of metabolism, the excess of water glomerulus which opens into a collecting
and the excess of salts from the bloods. They tubule. The renal arteries carry blood from
also maintain pH value. Each kidney is bean the aorta into the glomerular capillary tuft
shaped. Each kidney is about 11 cm long, 6 through arterioles. The blood pressure in the
cm broad and 3 cm thick. The left kidney is glomerulus capillary tuft is about 70 to 90
a little lengthier and narrower than the right mm of Hg. The flow of blood is controlled
kidney. The kidney is about 150 gm in by the arterioles by the amount of
normal adult. The kidneys are also called contraction. Due to the pressure the waste
renes from which the deriative renal and water and salt in the plasma of the blood
nephron have been derived. The red pass through the thin walls of the capillaries
corpuscles of the blood supple oxygen to into the glomerulus, from where they move
the tissues of the kidney. In return the into the tubule. The glomerulus filtrate a
kidneys remove waste products from the larger quantity of fluid, about 180 litres per
blood plasma and regulate the composition day which consists mainly of water and other
of blood plasma. substance besides the body waste. A large
KIDNEY AND BLOOD FLOW 123
A rteriole
P e ritub ular
cap illa ry U re te r
B loo d from
re na l a rte ry
G lo m eru la r
cap illa ry
tu ff
Tu bu le
To V e in
Working of Nephron
amount of water and other substance are of blood equivalent to extra-cellular fluid can
reabsorbed by kidney tubules and waste pass through the kidneys once every 15
which is called urine (about 1 to 1.5 litres mins. Hence the composition of blood
per day) is passed to bladder through ureter. plasma and extra cellular fluid is closely
The total blood flow through the kidneys is regulated by the kidneys. Special aspects of
about 1200 millilitre per min while blood flow through the nephrons–.
extracellular fluid (fluid outside cells) is about (a) The glomerular capillary tuff has high
15 litres out of total body fluid of 40 litre blood pressure which helps in filtering.
which means that intra cellular fluid volume
(b) Low pressure in the peritubular capil-
is 25 litres (fluid inside the cells). The blood
lary which permits fluid being absorbed
plasma and extra-cellular fluid are in
continually into the capillaries.
equilibrium which ensures that the amount
124 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
2. Uremia is urine in blood which is a renal blood. The renal failure results in changes
malfunction. In acute renal failure, urine in the body fluid due to the progressive
formation stops as kidneys fail to perform decrease in the number of functioning
excretory or regulatory function on the nephrons. Due to decrease in number of
KIDNEY AND BLOOD FLOW 125
functional nephrons, the clearance of urea, preforation (diameter of about 5×10–9 m) and
creatinine and other metabolic waste waste products of the blood are able to pass
products in the plasma of the blood through the membrane into the dialysate fluid
decreases which is called reduction in the because of the existence of a concentration
glomerular filteration rate (GFR). The gradient across the membrane. The
kidneys become less effective as regulatory movement of waste products from the blood
organs. Uremia is the clinical state resulting to the dialysate results in clearing of the
from renal failure. Uremia affects other blood and dialysate with waste products is
organs of the body as certain substances discarded. To speed up the dialysis either a
that accumulate in the blood are toxic. The positive pressure is applied to the blood
artificial kidney (Dialyzer) is used which is compartment or a negative pressure is
a mechanical device to remove the created in the dialysate compartment.
accumulated waste products in the blood.
W a ste P ro du cts
THE ARTIFICIAL KIDNEY (DIALYZER)
membrane to --------(a) dialysate (b) urine 17. The glomerulus filtrate about ----------- fluid
14. To speed up the dialysis either a -------- per day (a) 1.5 litres (b) 150 litres
pressure is applied to the blood compartment 18. A large amount of water and other substance
or a -------- pressure is created in the of the filtrate are reabsorbed by kidney ----
dialysate compartment (a) positive, negative ------ (a) tubules (b) ureter
(b) negative, positive 19. The kidneys function on the blood----------
15. The composition of the blood plasma and to remove waste products and to regulate
extra celluar fluid is closely --------by the composition (a) corpuscles (b) plasma
kidney (a) monitored (b) regulated 20. The -------supply oxygen to the tissues of
16. The blood pressure in the glomerulus the kidney (a) plasma (b) red corpuscles
capillary tuff is about ------------ (a) 10 mm 21. The kidneys are located ---------the
Hg (b) 70 mm Hg diaphragm on the posterior wall of the
abdomen (a) above (b) below
ANSWERS
the right lower extremity is in stance and left feet are in contact with the
phase. A single gait cycle contains right ground at the same line. There are two
and left stance. Stance phase consti- double support phases in a gait cycle.
tutes 60% of the gait cycle. (e) Stride: Two steps consisting of a right
(c) Swing phase: It is the interval inwhich step and a left step comprises a stride.
the foot of the reference extremity does Step length is the distance from the
not contact the ground. Therefore a point of heel strike of one extermity to
single gait cycle contains right and left the point of heel strike of the second
swing phase. The swing phase consti- extremity. Stride length is the distance
tutes 40% of the gait cycle. from the point of heel strike of one ex-
(d) Double support phase: It is the inter- tremity to the point of heel strike of the
val in which body weight is transferred same extremity.
from one foot to the other and both right
Double support phase Stance phase right Swing phase left Double support phase
Gait Cycle
PROSTHESES AND THERAPEUTIC DEVICES 129
(f) Units: Each phase of gait has been di- dorsal flexion moment (DM) have been
vided into units. The stance phase has shown in the figure for various units
units of (1) heel strike (2) footflat (3) of stance phase. The ground reaction
mid stance (4) heel off (5) toe off. vector (R) changes from a position
Swing phase has units of (1) accelera- anterior (in heel strike) to posterior (in
tion (2) midswing (3) deceleration. flat foot) which changes the direction
(g) Ground reaction and moments: The of moment at knee from counter
ground reaction vector (R), flexion clockwise to clockwise. The direction
moment (FM), extension moment of moment changes in each unit of
(EM), plantar flexion moment (PM) and stance phase.
heel striks the ground. The shin there- and the interposing joint mechanism in
fore tends to rotate forward causing both the swing and stance phase. The
unwanted knee flexion. This rotation of alignment device must permit (1) tilt-
the shin has to be counteracted by the ing of the socket in any direction from
mechanism of the prostheses. the vertical (2) movement of the socket
relative to the foot in any horizontal of
the joint axis in a horizontal plan direc-
tion (3) rotation (4) proper calibration
for the adjustment purpose.
4. Prostheses for Ankle-Foot: The clinical
requirements for the prostheses during the
gait cycle are :
(a) Stance phase: The prostheses should
allow plantar flexion without foot stop
R = Th e gro un d
rea ctio n of at heel contact so that the ground reac-
he el-strike tion is located anteriorly towards the
ankle axis. This alleviates the forward
R
rotation of the shin and stabilises the
H eel Strike knee. The stabilisation of knee allows
and assists the shin to become vertical
when the body passes over the foot.
(c) Toe off: A similar reverse action oc-
Some doriflexion of the foot is required
curs at toe off as the ground reaction
before the heel rises to prevent exces-
is at the anterior end of the horizontal.
sive knee stability.
The shin therefore tends to rotate back-
ward impeding flexion of the knee. (b) Swing phase: The prostheses must be
light as the ankle foot complex is at the
extremity of the limb. It must rise of at
toe off with knee flexion to clear the
ground. During swing phase, it should
dorsiflex.
R = Th e gro un d
rea ctio n a t
toe o ff
Toe-off
Single Axle Ankle Joint
(c) Swing phase: During this phase, the
socket exerts force through the skel-
eton to the joints which activate their
mechanism to propel the prostheses for-
ward.
(d) Alignment Device: A good prosthesis
depends upon a well fitting socket Solid-Ankle Cushionded Heel Foot (Sach)
which is properly aligned with the foot
132 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
5. Knee Joints: Knee joints fall into two gorups: (3) protheses tibiale supra condylienne.
(1) A below knee prosthesis (2) An above Earlier, only conventional type of prostheses
knee prosthesis. In a below knee prosthesis, was available which has a shank which holds
the stump is too long and patient can retain a foot ankle assembly and a socket. The socket
his useful natural knee. In an above knee cannot provide any supporting force on the
anterior aspect. The weight is born by the
prosthesis, the amputation is high enough,
stump on its medial and lateral aspects and the
permitting the artificial knee joint to be
thigh. A simple hinge joint connects the thigh
incoporated in prosthesis. The clinical corset to the socket. With the present trend of
requirements of this type of prostheses are: an extension of the patellar tendon bearing
(a) Stance phase: The prosthesis must per- below knee prostheses commonly known at
mit little flexion during full extension while PTB has been developed, a below knee stump
in midstance. It must support the body can not be subjected to much pressure at the
weight while in flexion. It must extend if distal end due to shearing stress developing
required even while supporting the body between soft tissues and the cut end of the
bone. After careful consideration of the
weight. It should be durable.
complete biomechanical problem, the full
(b) Swing phase: The prosthesis can flex at advantage of weight-bearing capabilities of the
toe off so as to allow the heel to rise patellar tendon is taken in fabrication of this
freely and clear the ground. However prostheses. A cuff is provided for the
excessive rise due to inertial force is to suspension. To do away even with the
be prevented. It must develope force to suspension straps and also to increase the
decelerate the shin and foot when it is weight bearing on the patellar tendon, a
changing from flexion to full extension. prostheses properly known as PTC
(Prostheses Tibiale supra condylienne) has
A BELOW KNEE PROSTHESES been developed. Here the socket is aligned with
1. Three types of prostheses are available to a the knee in flexed position and the suspension
below knee amputees viz. (1) conventional is achieved by an extension of the socket so
(2) patellar tendon bearing. (PTB) and as to completely enclose the patella and the
major portion of the femoral condyles.
Patellar Tendon
PROSTHESES AND THERAPEUTIC DEVICES 133
2. Earlier nearly all prostheses for below knee action. In below knee amputation, the nautral
amputation had jointed side steels on either knee can largely provide the control for both
side. This is nothing but a simple, uniaxial, the stance and swing phase.
elevis mortice-and-tenon or box joint to AN ABOVE KNEE PROSTHESES
which a lock is fixed. Since natural knee is
not a simple uniaxial joint and there is
difference between working of natural and 1. For the above knee amputee, the natural
artificial joint, there is a tendency to control of knee joint is lost. The prostheses
exaggerate the movement between the stump must have stance and swing phase controls.
and the socket which is known as piston It is common to provide simple locks to
134 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
prevent flexion or elastic straps over the front turntable as shown in the figure. The
of the knee to help accelerate the shin as prostheses does not permit all natural
controls. More complex mechanisms may movements like foot inversion and eversion,
be more effective but they lead to weight and turning of the foot or toes upwards. To
problem and poor reliability. In simple form, avoid the stump socket tending to slip over
the artificial leg for an above knee prostheses the stump, a torque opposing knee flexion
incorporates a manual locking type of thigh is provided in the artificial leg to increase
the stump to stump socket friction.
L ock
Tu rn ta ble
functioning of the pacemaker (SA node) and timing circuit runs at fixed rate which is
conduction of the impulses. Any change in lower than the natural pacing rate of the
the NSR is called an arrhythmia. SA node heart. Hence pacemaker remains at stand by
may temporarily or permanently fail due to mode. The pacemaker takes over when the
some diseases and no impulse originates from natural pacing rate of the heart falls below
SA node. The pacing function is taken over the fixed rate set on the pacemaker. The atrial
by some other cells near AV node. However synchronous is used where the conduction
in that situation the heart is paced at a much system of the heart fails specially the AV
lower rate and such condition is called node. The SA node generates impulse which
bradycardia or slow heart. In this situation, stimulates the atria. The impulse
the heart can not provide sufficient blood corresponding to atrial contraction (the P
to meet the body's demands. wave of the ECG) is detected by the
2. A pacemaker system is a device capable of electrode of the artificial pacemaker which
generating pacing impulses like a natural triggers with appropriate delay an impulse
pacemaker and delivering the pacing impulses similar to natural AV node which has failed.
to the heart. All pacemakers have a pulse Often atrial synchronous pacemaker is
generator and electrode. Pacemakers can be combined with the demand pacemaker
(1) asynchronous (fixed rate) (2) demand type system so that the combined pacemaker can
synchronous (3) atrial-synchronous (4) rate do the jobs of defective natural pacemaker
responsive pacemaker. The asynchronous and defective AV node. The rate responsive
pacemaker generates impulse at a uniform pacemaker has a sensor which converts the
rate regardless of what is going on in the heart. physiological variables of the patient to
The oscillator controls the pulse output circuit electric signals which are fed into the
and impulse is given to the heart through controller circuits. The pacemaker is
electrode. programmed to control the heart rate as per
1 P o w er p ack the electric signal generated by the
2 O scilla to r 1 2 3 4 physiological variables. The controller
3 O utp u t circuit
4 E le ctrod e decides whether artificial pacing is required
or the artificial pacing in place of natural
ASYNCHRONOUS PACEMAKER pacing. If it is not required, the artificial
pacing remains in the non functional state.
1. Asynchronous pacing is also called The pacemakers can also be grouped as
competitive pacing as the fixed rate impulse internal pacemakers and external
may take place along with the natural pacing pacemakers. Internal pacemakers are
impulses of the heart. Hence both impulses permanently implanted in patients who have
compete to control the heart beat. The above either failed SA node or have suffered from
problem is overcome in the synchronous permanent heart block. The external pace
pacemaker. The artificial pacemaker does not makers have external wearable pulse
compete with the natural pacing impulses generator connected to electrode located on
of the heart. A demand type synchronous the heart. These pacemakers are used if
pacemaker has a timing circuit, an output patients have temporary heart irregularities
circuit electrode and a feedback loop. The or if patients are undergoing cardiac surgery.
PROSTHESES AND THERAPEUTIC DEVICES 137
O2 CO2
S uper ior vena cav a
O x ygenator
O x ygenated
T ubing
blood
H ear t
B lood
deox ygenated
R otat ing dis k s
A or t a
B lood
R oller pump
Infer ior v ena
cava F emor al
T u b in g ar ter y
Pump Oxygenerator
138 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
2. Artificial heart. It is small blood pump of of the ventricles. Atrial fibrillation leads to
biocompatible material which can replace a inadequate pumping of the blood but
deceased heart. The pump is implanted on ventricular fibrillation more dangerous as
thoracic cavity and it is operated inside from this leads to failure of blood pumping and
any electrical or pneumatic device. The death of the patient. The most successful
artificial heart can be used as a permanent method of defibrillation is the application of
replacement or as a temporary measure until
an electric shock to the heart. The electric
a suitable natural donor heart is planted.
shock is able to stimulate all muscles of the
3. Aortic balloon system. It is a cardiac heart simultaneously. All the cells of the heart
assistance device. It is a sausage shaped
muscle enter their refractory period together
balloon that can be inserted into aorta
through a femoral artery. The balloon is at the end of the electric shock, after which
connected to an external apparatus which normal heart action may resume. Generally
can inflate or deflate the balloon by supplying electric shock of intensity 6 ampere,
carbon dioxide or sucking out carbon dioxide frequency 60 HZ for duration of 0.25 to 1
from the balloon. Consider the balloon in the sec is applied. Nowadays DC (direct current)
inflated state in the aorta which is permitting defibrillation is used, in which a capacitor is
some blood to flow past it. As the ventricle charged to a high DC voltage which is
contraction starts, suction action is applied rapidly discharged through electrode across
to the balloon which causes it to collapse.
the chest of the patient. There is possibility
The ventricle will require now less effort to
of accidentally application of the defibrillator
pump the blood to replace the volume
occupied earlier by the balloon. As the aortic output during ventricular repolarization (T
valve of the ventricle closes, the balloon is wave) which may cause ventricular
expanded by supplying of carbon dioxide to fibrillation. To avoid this problem, special
the balloon. As the balloon expands, it pushes defibrillator is used which has synchronising
the blood from the aorta to the rest of the circuitry to ensure the output occurs
body. The balloon performs much of the immediately after R wave but before T wave
work which is normally done by the left can occur. Such defibrillator is called
ventrical. cardioverter which is a combination of the
4. Defibrillator. The heart is able to pump cardio monitor and the defibrillator.
blood through precisely synchronized action
of the heart muscles. The rapid spread of HEMODIALYSIS
impulse on the surface of the atria causes
atria to contract together and pump blood 1. Hemodialysis is nothing but an artificial
into the ventricles. After a delay of impulse kidney and it is a widely used as a prosthetic
at AV node, the ventricles are synchronously device for the patient having acute renal
stimulated to pump blood to the pulmonary failure. It is a mechanical device to remove
and systemic cirulatory systems. If the accumulated waste products in the blood
synchronism is lost, then this condition is (Refer chapter 12).
known as fibrillation. Fibrillation leads to the
normal rhythmic contraction of either the VENTILATORS
atria or the ventricles being replaced by rapid
1. Is a therapeutic device which assist a patient
irregular contraction of atria or ventrieles.
in ventilating his lungs. The ventilator is used
Atrial fibrillation is the fibrillation of atria whenever any patient has reduced breathing
while ventricular fibrillation is the fibrillation
PROSTHESES AND THERAPEUTIC DEVICES 139
6. Bradycardia is a condition in which heart is 15. The oxygenerator can be film type or -----
paced at -----rate (a) slower (b) faster type (a) membrane (b) screen
7. All pacemakers have a electrode and ------ 16. Artificial heart is a small blood pump of ----
(a) pulse generator (b) electric circuit --------- material which can replace a
decreased heart (a) strong (b) biocompatible
8. The fixed rate pacemaker is called---- (a)
17. Aortic baloon system is a cardiac --------
synchronous (b) asynchronous device (a) assistance (b) boosting
9. Asynchronous pacing is also called------- 18. Atria and ventricles are required to --------
pacing (a) harmonious (b) competitive simulated one after another (a)
10. The problem of the competitive pacing has asynchronously (b) synchronously
been overcome in ---------pacemaker (a) 19. ------------ leads to the normal rhythmic
synchronous (b) asynchronous contraction of either atria or the ventricles
are replaced by the rapid irregular twitching
11. The timing circuit of the demand type
(a) fibrillation (b) defibrillation
synchronous pacemaker runs at fixed rate
20. The most common method of defibrillation
which is --------- than the natural pacing rate
is the application of ---------- (a) an electric
of the natural heart (a) lower (b) higher shock (b) blood infusion
12. The controller of ------- pacemaker decides 21. A device combining the defibrillator and
whether artificial pacing is required in place cardiomonitor is called -------------- (a)
of the natural pacing (a) synchoronous (b) cardioverter (b) cardio defibrillator
rate responsive 22. Hemodialysis is nothing but a --------- (a)
13. The heart’s pumping action and the lung’s artificial kidney (b) artificial bladder
oxygenation function during cardiac surgery 23. Artificial ventilating the lungs of a patient is
is performed by the---------- (a) pump done by --------- (a) Ventilator (b)
oxygenerator (b) artificial heart Respirator
14. The pump oxygenerator has ----- and ------ 24. The principal display device for patient
---- (a) roller pump, oxygenerator (b) monitoring is the ---------- (a) CRT (b)
dialyzer, oxygenerator Display tube
ANSWERS
FA
D1
FB
D2
FC
S h ea r fo rce B e nd in g m o m en t
d iag ra m d iag ra m
ORTHOSIS FOR GAIT DISABILITY stand all moments developed during forward
movements of the limb and the body. The
1. A very throughtful orthosis device can be function of single limb support involves that
prescribed to a person with neurologic the body can carryout forward movement
involvenment so that he may access more on the weight bearing limb. The limb has to
efficient movement patterns and may reduce perform this task over a reduced area of
residual gait disability. Three basic functional support on the ground. The swing
tasks are essential for lower limbs for advancement involves removal of weight
efficient and successful ambulation. They from the limb and its forward progression
are (1) weight acceptance (2) one leg stance until next step is initiated. The ground
support (3) swing phase (limb clearance is an essential element of the
advancement). The above process must functional task of the limb during swing limb
happen in smooth manner and the limb must advancement. The funtional task, gait
remain stable. It must be able to absorb the subphase and critical events for a normal
impact of superincumbent body weight and gait cycle are as tabled below :
with paraplegia may feel himself a normal in the figure. These orthotic systems are
person having standing and walking ability. similar as the patient is braced from the mid
The most commonly used orthotic systems trunk to the feet and the knee and ankles
for the paraplegic patients are (1) bilateral immobilized in a neutral position. These
KAFO (knee-ankle-foot orthosis) (2) orthosis permit hip flexion and extention but
HKAFO (Hip-knee-ankle-foot orthosis). prevent hip adduction. The RGO is designed
KAFO requires a large energy expenditure to be worn inside the patients clothes. The
for the patients to walk. HKAFO for patient requries assistance of roller or
paraplegic gait allows ambulation at a lower reciprocating roller while walking wearing
energy cost. Two major designs of HKAFO RGO. However HGO is worn outside the
are hip guidance orthosis (HGO) and patient’s clothes and the patient walks with
reeiprocating gait orthosis (RGO) as shown the assistance of crutches.
Tru n k B an d
P e lvic B a n d D u al
cab le
syste m
H ip Jo int
P e lvic B a n d
Th ig h cu ff
K n ee cuff
K n ee
cuff
A n kle
cuff
M etal fo ot
p la te
HGO RGO
ORTHOSIS 145
ANSWERS
METALLIC
BIOMATERIALS #
You spend the first two years of your kids' lives teaching them to walk and talk
and the next 16 years telling them to sit down and be quiet.
N icke l
(e) Cosmetic correction. Example: chin 15
A u sten ite p ha se
augmentation, augmentation mamo ↑ 10
plasty.
5 Fe rite p ha se
(f) Assistance in diagnosis: Probes and
catheters are made of biomaterials. 0
5 10 15 20 25
(g) Assistance in treatment eg. catheters C h ron iu m
and drains of biomaterial.
4. As explained above, the success of implant Effects of Ni and Cr on Phase of Steel
depends upon various factors. Also if 'f' 6. Co Cr alloys : These are mainly two types
is failure and 'r' is reliability, then r = l – f. of cobalt - chronium alloys viz (1) Castable
The total reliability of implant having Co Cr Mo alloy (2) Wroughtable by forging
multiple modes of failure (f 1 f 2 ... to fn) Co Cr Mo alloy. The castable is used for
can be given as: dentistry and artificial joints. The wrought
r = (l – f1) (l – f2) ... x (l – fn) Co Cr Mo alloy is used for making
= r1 × r2 ... x rn prostheses suitable for heavy loaded joints
Most pure metals generate a severe tissue like hip and knee. The wrought Co Cr Mo
reaction. The reason is that metals have high alloy has good fatigue and ultimate strength
free energy and they tend to lower their free and it is used where we require long service
energy by oxidation/corrosion. This is the life. The cast Co Cr Mo alloy (F – 75) has
reason that vanadium steel can not be used mainly 22 to 33% Cr, 5 to 7% Mo, 2.5% Ni
for implants. and balance Co while wrought Co Cr Mo
alloy (F 562) has mainly 19 to 21% Cr, 9 to
5. Stainless steel : The austenite stainless steel 10.5% Mo, 33 to 37% Ni and balance Co.
such as 316 stainless steel (molybdenum in
small percentage) and 316 L stainless steel 7. Titanium and Alloys : Titanium is used for
(carbon up to 0.08% only) are most implant as it has low density and good
commonly used for implants. These steels mechanical properties. Titanium (also
are non magnetic and corrosion resistant. aluminium) evokes minimum amount of
The austenite stainless steel is prone to work tissue reaction as it forms a tancious oxide
hardening and it has to be heat treated after layer which resists further diffusion of metal
cold working. 316 L stainless steel has 17 ions to oxygen gas at the interface. While
to 20% chromium, 12 to 14% nickel & 2 to making implant, titanium has to be processed
4% molybdenum. The inclusion of in an inert atmosphere. Titanium is an
molybdenum enhances resistance to pitting allotropic material. It can exist as a hexagonal
corrosion. Nickel stabilizes the austenite close-packed structure (α phase) upto 82ºC
(α) phase at room temperature. It also and as a body - centered cubic structure (β
enhances corrosion resistance. The austenite phase) above 82ºC. The transformation
phase stability of steel is influenced by both temperature changes on addition of alloying
Nickel & Chromium contents as shown in elements which enables the titanium alloys
the figure. The implants of these steels are to have a wide range of properties. The main
suitable as temporary implants such as alloying elements of the alloy are aluminium
fracture plates, screws and hip nails. (5.5 to 6.5%) and vanadium (3.5 to 4.5%).
148 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
The titanuim nickel alloys have properties and hydroxide ions etc. Hence metallic
of "shape memory effect (SME)". It means implants have to face a very corrosive
that the material can gain its original shape environment. Corrosion is unwanted
on heating. Therefore these alloys having chemical reaction of metallic implant with
SME are used for orthopedic implants, environment. The metals tend to lower their
contractile muscles for artificial heart, filter energy state by electrochemical reaction
for vena cava, orthodontic dental archwires with environment. Oxidation and reduction
and intracranial aneurysm clips. are two electrochemical reactions. Oxidation
8. Dental metals : Dental amalgam is an alloy is a reaction in which electrons are
obtained by mixing silver-tin alloy with consumed. Oxidation reaction is :–
mercury. Since mercury is in liquid form, M → M+n + ne ...(I)
the silver - tin alloy can be mixed in it. The Similarly reduction reactions are –
resultant paste is packed into a prepared M+n + ne → M ...(II)
cavity of tooth. The final composition of
2H2O + O2 + 4e → 4.0H ...(III)
dental amalgam contains 45 to 55% mercury,
35 to 45% silver and 15% tin. The amalgam 4H + O2 + 4e → H2O
+
...(IV)
sets in solid form in one day. 2H + 2e → H2
+
...(V)
9. Gold : Gold being base metal has high Equation (III) gives corrosion reaction
corrosion resistance but poor mechanical occurring at neutral PH solution and metallic
properties. Gold and its alloys are used as implants are generally corroded according
dental materials as they have durability, to this. It is also seen that variation of oxygen
stability and corrosion resistance. Dental on metal surface leads to corrosion with
fillings of gold can be carried out by two sites with lower oxygen concentration
methods viz. casting and maletting. (cracks, dirt or along screw of implants)
Mechanical properties of gold can be become anodes and exposed sites with
improved by adding not more than 25% higher oxygen concentration become
copper or 4% of platinum. cathodes. These anodes and cathodes with
10. Corrosion of metallic implants : The main body solution connecting them to form
reason of metallic corrosion is its oxidation. electro chemical cells leading to deterioration
A metal in pure form stays in metastable of metallic implants.The tendency of metals
equilibrium. Tissue fluid in the human body to corrode is given by the standard
contains water, dissolved oxygen, chloride electrochemical series of Nernst potentials
as given below :
D irt
e e e e e
e e
M etal M etal
S cre w in M etal C ra cks in M etal D irt o n M e ta l
These protentials are found out in solution, then the metal having higher
electrochemical measurement in which one protential will become anode and galvanic
electode is metal and other is a hydrogen corrosion starts which is much rapid than
electrode consisting of porous platinum tube corrosion of a single metal. Hence metallic
through which hydrogen is passed. The implant should be made of a single metal
protential of hydrogen electrode is taken as without any impurity. Any region of stress
reference i.e. Zero potential. Metal having will become anode with respect to
higher protential than hydrogen electrode are unstressed region of the same material as
known as noble metals while those having stressed region has higher energy level. The
lower protential are known as base metals. corrosion of stressed region starts at the
If two dissimilar metals are present in a earliest opportunity. Also base metals are less
prone to corrosion.
150 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
P o rou s
+0 .4 4v p la tin um
tu be
V
H 2 g as
++
Fe ++
M etal Fe + +
H H
++ + S o lu tio n
Fe H
ANSWERS
2 B ra n ch ed p olym e r
Now for mixture (1) having 2A + B, we have 3. During the past few years considerable
N1 = 2, M1 = 10,000, N2 = 1 and advances have been made in the development
M2 = 20,000 of polymeric materials for use in medicine
and surgery particularly for replacements in
Σ Ni M i N1 M1 + N 2 M 2 the cardiovascular system. A number of
Mn = Σ Ni
= N1 + N 2 polymers with proper surface modification
2 ×10,000 +1× 20,000 40, 000 which can remain biocompatible for several
= = months are now available. Heart valves,
2 +1 3
heart-lung devices, catheters, artificial
= 13,333.4 membranes, pacemaker and blood pump are
Σ Ni Mi2 N1 M12 + N 2 M 22 devices which are made from polymeric
Mw = Σ N M = N M + N M biomaterials. The successful use of
i 1 1 1 2 2
polymeric implants are improved the quality
2 × (10, 000 ) + 1× (10, 000 )
2 2
of life of many patients. But the state of art
= of the production of these polymeric
20,000 + 20,000
materials for a specific perpose has not been
2 ×102 + 4 ×10 2 perfected. New polymeric biomaterials are
= = 15,000 being developed to make good prostheses
40, 000
devices which will enable the patients
Now for mixture (2) having A + 2B, we have
without limbs to lead a normal life. The
N1 = 1, M1 = 10,000, N2 = 2 and
commercial polymers can not be used for
M2 = 20,000 biomedical applications. They do not have
Σ Ni M i N1 M1 + N 2 M 2 sufficient purity and reproductibility. The
Mn = = polymeric material must meet the need of
Σ Ni N1 + N 2
the surgeons as well as the design problems
1 ×10, 000 + 2 × 20,000 of the implant. The polymeric material must
= meet the criteria outside and inside of a
3
physical system. For example chemical
50, 000 inertness and mechanical strength are
= = 16,333.4
3 outside criteria for selection of polymer but
ΣΝ i M i2 the functional characteristics of the polymer
Mw = ΣN M with physiological system are inside criteria
i i for the selection or designing the
Ν 1 M12 + N 22 M 22 composition of a polymer.
= 4. Selection of polymeric biomaterial:
N1 M 1 + N 2 M 2
Certain sets of information that case help in
1 × (10,000 ) + 2 × ( 20,000 )
2 2 selection of polymeric biomaterial for
= making of an implant can be grouped into
1× 10, 000 + 2 × 20,000
two categories viz (1) General characteristics
108 + 8 ×108 and (2) Special considerations. The general
= characteristics which a biomedical polymer
50,000
must have (1) chemical purity (2) good
9 × 108 fabrication methodology (3) adequate
= = 1.8 × 104 mechanical strength (4) no leachable
5 ×104
154 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
impurity (5) easy stretchability. The However solubility and brittleness shows
presence of traces of catalyst, residual reverse trend. Therefore, molecular
additive or other impurities in the polymeric weight of the polymers should be above
implant may trigger thrombosis formation, the limiting value. The properties of the
protein deposition or giant cell growth or polymers are also affected by the
any other unfavourable tissue response. molecular weight distribution of the
Similarly the fabrication history has great polymers which should not be broad.
significance and biomedical polymer must Incase of broad distribution, polymer
retain its characteristics even after may have two molecular weight chains
fabrication. The polymeric material of the which may dissociate and leak into the
implant is reacted upon by physiological blood stream causing malfunction.
environment. The implant must function (c) Crystallization and intermolecular
without being itself demaged and without forces : Flexible polymer can be obtained
causing adverse effect on the tissues by keeping the chain separated from
surrounding it. Hence polymeric biomaterial one another otherwise the polymer will
should not cause – (1) thrombosis (2) any be crystalline and rigid. If crystallisation
distruction of cellular element of blood (3) of the polymer occurs when implanted,
cancer (4) toxic and allergic response from
stress cracking and stiffening of
tissues (5) adverse effect on immune system
polymer take place. The highly
(6) depletion of electrolytes (7) fatal effect
crystalline polymers like nylon,
on enzymes and proteins.
polyethylene and polypropylene are
5. Specific considerations mean that a
made flexible with addition of
polymeric biocompatible material is designed plasticisers. However they can undergo
specifically to meet the functional extensive molecular rearrangement
requirement in the prevalent environment under tensile and other stresses and they
inside the body. To accomplish this, an may again become crystalline. Due to
understanding of the relationship of the this, they can readily crack or develop
structure and properties of the polymer with pits. These sites also become areas for
respect to its interaction with physiological absorption of protein molecules. The
presence of strong intramolecular forces
system at molecular level is required. The
fevours crystallisation of linear
specific considerations for designing are :
polymers which leads to cracks and
(a) Type of polymers: certain rigid and
protien absorption on the surface of the
elastometric polymers evoke less tissue
reaction and thrombosis formation than polymer.
other. (d) Mechanical properties: An implant or
(b) Molecular weight and Molecular weight prostheses device has a mechanical
distribution: Most of mechanical function to perform and hence its
materical must have enough mechanical
properties of a polymer improve with
properties which depend upon its
molecular weight upto a limiting value
processing, fabrication, shape, stress
and then remain constant with further and strain relationship and its time
increase in molecular weight. Similarly dependent changes (creep and
melting point, elasticity and other deformation). The properties of a
properties are found to have same trend. polymer like molecular weight and
POLYMERIC BIOMATERIALS 155
molecular distribution and crystallinity and surgical packaging. PVC tubing is used
(crystallinity can be prevented by in catheters, cannulae dialysis devices and
plasticizers) can be controlled which IV administration.
will ensure a good performance of the 2. Polyethylene (PE) : It is available in many
polymer. grades depending upon density as (1) high
(e) Surface characteristic: The surface of density polyethylene (HDPE) (2) low density
a polymer which comes directly into polyethylene (LDPE) (3) very low density
contact with tissues and blood, plays polyethyelene (VLDPE) (4) Linear low
an important role in deciding the density polyethylene (LLDPE) (5) Ultra high
biocompatiblity of the polymer. When molecular weight polyethylene (UHMWPE).
blood comes in contact with the HDPE is used for bottles, caps and non
polymer, there is a rapid absorption of woven fabric. LDPE is used for packaging,
plasma protein on its surface. flexible containers and nonwoven
Subsequent interaction results into the disposeables. LLDPE has excellent puncture
absorption of platelets of the blood resistance and therefore it is used for
which leads to the thrombosis pouches and bags. Extruded tubes are made
depending upon the nature of the of VLDPE. UHMWPE has high density and
primary layer of proteins. The high mechanical properties. It is used for
absorption of proteins from the plasma orthopedic implant such as acetabular cup
depends upon the type of surface, of tibia in hip joint and patellar surface in
hemorheological parameters and types knee joint.
of ionic species present in plasma. The 3. Polypropylene (PP): Thermal and physical
nature of protein absorbed depends properties of polypropylene are similar to
upon the physical and chemical nature polyethylene. Polypropylene has a very high
of the surface of the polymer. Smooth flex life and high resistance to environment
surface of the polymer which is free stress cracking. It is used for prostheses
of pits, cracks and roughness does not for finger joint, disposable hypothermic
absorb proteins. The smoothness of syringes, membrane of blood oxygenator,
the surface depends upon the packaging for devices, containers (solution
micromolecular structure of the and drugs), suture, artificial vascular grafts
polymer and also on its surface and non woven fabrics etc.
treatment.
4. Polystyrene (PS): High impact polystyrene
(HIPS), PS foam and general purpose
CERTAIN POLYMERIC BIOMATERIALS
polystyrene (GPPS) are three grades
1. Polyvinyl chloride (PVC): It is an available. GPPS has good transpancy, ease
amorphous and rigid polymer as it has large of fabrication, thermal stability, low density
side group. It has a high melt viscosity which and high modulus. Its ductility, impact
makes its processing difficult. Thermal strength and resistance to stress cracking
stabilisers are added to prevent thermal can be improved with addition of modifier.
degradation. Plasticizers are added to make It is used for vacuum canisters and
it flexible. Lubricants are added to increase filterware. One of the copolymer of
melt flow during processing. PVC is used polystyrene is acrylonitrile butadicne -
in film form for blood bags, solution bags styrene (ABS) which has good surface
156 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
properties and dimensional stability. It is used lucer filters, check valves and catheter
for IV sets, blood dialyzers, diagnostic test housing.
kits and clamps etc.
7. Polyamids (Nylons): Nylons are designated
5. Polymethylmeth acrylate (PMMA): It is by number of carbon atoms in the repeating
amorphous and it has good resistance (in
units. For example Nylon 6 and Nylon 11.
dilute alkalies and inorganic solution), light
The presence of CONH groups provides
transparency and excellent optical properties,
attraction between chains and improves
good weathering properties and good
physical properties such as strength. Certain
machineability. It is used for blood pumps
nylons have specific strength which is five
and reservoirs, IV systems, membranes for
times that of steel and they are most suitable
blood dialyzer, contact lenses, implantable
for composites. However nylon is
ocular lenses, dentures and bone cements for
hygroscopic and they lose strength in vivo
prostheses fixation etc.
when implanted.
6. Polyesters : Polyethylene terephthalate
(PET) is most common polyster which is APPLICATION OF POLYMERS
used for biomedical applications such as
vascular graft, sutures and meshes. PET can 1. The applications of polymers as biomaterials
also be converted by conventional have been elaborated with each type of
polymer. However some other applications
techniques into moulded articles such as
are :
Fill in the gaps 10. ------- is used for implantable cellular lens.
1. Polymer is many ------- joining together as (a) PMMA (b) polystyrene
a chain. (a) mers (b) erms 11. LLDPE has excellent ------- resistance. (a)
2. Heavy molecule has a ------- chain of flow (b) puncture
repeating unit in a polymer. (a) heavy (b) 12. UHMWPE is used for orthopedic implant
long such as ------- surface of knee joint. (a)
3. Polymerisation can be done by addition and patellar (b) hip
-------. (a) substraction (b) condensation 13. Nylons are designated by number of -------
4. ------- are made from two or more types of atoms in the repeating unit. (a) hydrogen
mers. (a) Copolymer (b) twin polymer (b) carbon
5. ------- is average number of mers per 14. ------- are added to increase the melt flow
molecule. (a) degree of polymerisation (b) during processing of PVC. (a) lubricant (b)
degree of saturation flow activator
6. The molecular weight of a polymer is 90 15. ------- are added to prevent thermal
and of a mer is 15. The degree of polarisation degradation of PVC. (a) thermal resistant
is -------. (a) 12 (b) 6 (b) thermal stabiliser
7. Mechanical properties of a polymer improve 16. Nylon has specific strength which is -------
with molecular weight upto a ------- . (a) times that of steel. (a) two (b) five
maxwell value (b) limiting value. 17. Hydrogels are used as ------- surface for
8. ------- is added to a polymer to make it polymers having good mechanical properties.
flexible. (a) Elasticiser (b) Plasticizer (a) grafted (b) cleaner of
9. ------- surface does not absorb protein. (a) 18. ------- rubber is used for cosmetic implant.
Rough (b) Smooth (a) silicon (b) butyl
ANSWERS
BIOCERAMICS
%
Whether you're a man or not comes from your heart, not how much hair you
have on your head
INTRODUCTION difficult to find accurate tensile strength of
ceramic which varies with the presence of
1. Ceramics are solids that have inorganic microcacks. Due to this, ceramics have low
nonmetallic materials as essential tensile strength in comparison with
components. They are mainly refractory compressive strength. A flawless ceramic
poly crystalline compounds usually inorganic is very strong even in tension. For example,
like silicates, metallic oxides, carbides, flawless glass fibres are twice stronger than
hydrides, sulfides and selenides. Ceramics steel in tension. Ceramics are very hard.
have been used in pottery for a very long Alumina (Al 2O 2) and quartz (SiO 2) are
time. Ceramics are brittle and have low ceramics having hardness which is little less
tensile and impact strength. Due to these than diamond. Ceramics are insulators
weak properties, ceramics could not find having low conductivity of electricity and
many applications. However ceramics have heat. Ceramics are refractoric materials
high compressive strength, aesthetically having very high melting points. Bioceramics
pleasing appearance and relative inertness to can be classified as:
body fluids which have made ceramics
(a) Relatively inert (nonabsorbable)
extremely suitable as biocompatible materials
to replace various parts of the body (b) Semi inert (bio active)
particularly bone, heart valve and dental (c) Non inert (biodegradable)
crowns. Ceramics have high specific
RELATIVELY INERT (NONABSORBABLE)
strength as fibers and they are increasingly
BIOCERAMICS
used as reinforcing components for
composite biomaterial for tensile loading 1. As the name suggests, these bioceramics
applications such as artificial ligament and maintain their physical and mechanical
tendons. Ceramics have high resistance to properties by resisting corrosion and wear
plastic deformation and they are nonductile in the hostile environment in the body tissues.
with zero creep. Hence ceramics are very They are (1) biofunctional for lifetime (2)
prone to fracture at microcracks where biocompatible (3) nontoxic (4) non
stress concentration takes place. It is very carcinogenic (5) nonallergic (6) non-
BIOCERAMICS 159
inflammatory. They are generally used for compatibility with tissues and blood. Pyrolite
structural support implants such as femoral carbon coated devices are extensively used
heads, bone plates and screws etc. They are for repairing disceased heart valves and blood
also used for non structural applications as vessels due to high compatibility. Carbon
ventilation tubes, sterlization devices and fibers and textiles are used as reinforcement
drug delivery devices. Certain such for composite biomaterials.
bioceramics are described in succeeding SEMI INERT (BIOACTIVE) BIOCERAMICS
paras.
1. Bioactive ceramics form strong bonds with
2. Alumina (Al 2O 3): It is obtained from
surrounding tissues of the body on
bauxite and corrundum. Natural alumina is
implantation. Surface reactive bioceramics
known as sapphire and ruby depending upon
are (1) bioglasses and ceravital (2) dense
colour due to impurities present. The
and non porous glasses and (3) hydroxy-
strength of alumina depends upon grain size
apatite. The surface reactive bioceramics are
and porosity. The strength is high for low
used for (1) coating of metal prostheses to
grain size and low porosity. Alumina is used
increase the bonding of implant with adjacent
as biomaterial for orthopedics and dental
tissues (2) reconstruction of dental defects
surgery. As it is hard it is used for watch
(3) as filler to fill the space created by donor
movements and making emery paper / belt.
bone, bone screw, excised tumors and
The properties like low friction and wear,
deceased bone (4) as bone plate and screw
and innertness to the in vivo hostile
(5) prostheses of middle ear ossicles (6)
environment have made alumina an ideal
replacing or correcting teeth
biomaterial for joint replacement. The most
popular application of alumina is in total hip 2. Glass ceramics : They are polycrystalline
prostheses. It has been found that alumina ceramics. In fine grained structure, they
hip prostheses with an UHMWPE (ultra high have excellent mechanical and thermal
molecular weight polyethylene) socket is properties. Glass ceramics can be bioglass
more perfect device than metal prostheses and cervital glass ceramics depending upon
with UHMWPE socket. composition. The formation of these
ceramics depends upon the nucleation and
3. Zirconia (ZrO2): It is obtained from Zircon
growth of small crystals and their
(Zr SiO4). It has high melting point and
distribution. 1010 to 10 15 nucles per cm3 are
chemical stability. It can be used as implant
required to develope a crystal. Certain
for bone but its properties in these respet
metallic agents and ceramics are used for
are inferior to alumina.It has good
nucleation and crystallisation. The nucleation
compatibility with body tissues and it is also
of glass is carried out at temperatures much
non active to body environment.
lower than the melting temperature. The
4. Carbons : Carbon has many allotropic growth takes place at higher temperatures.
forms like crystalline diamond and graphite, The composition of cervital is similar to that
noncrystalline glassy carbon and of bioglass in SiO2 (40 to 50%) and CaO
quasicrystalline pyrolitic carbon. Pyrolitic (20 to 30%) but differs in contents of other
carbon is generally used for surface coating components (Na2O, P2O5, MgO & K2O).
of implants. The strength of pyrolitic carbon Glass ceramics have a very low coefficient
is quite high as compared to graphite and of expansion (it can be negative also) and
glassy carbon as it has fewer number of high resistance to surface demage due to
flaws and unassociated carbons in the controlled grain. Their resistance to
aggregate. Carbon shows excellent
160 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Fill in the gaps 3. ------- have been used in the pottery for a
1. Ceramics are -------. (a) ductile (b) brittle very long time. (a) Ceramics (b) composites
2. Ceramics are mainly refractory poly 4. A ------- ceramic is very strong even in
crystallic compounds usually -------. tension. (a) sintered (b) flaw less
(a) organic (b) inorganic 5. Flaw less glass fibers are ------- stronger
than steel in tension (a) four tinos (b) twice
BIOCERAMICS 161
6. ------- has hardness which is little less than 12. ------- carbon coated devices are extensively
diamond. (a) Alumina (b) Zirconia used for repairing disceased heart blood
7. Ceramics are prone to fracture at -------. vessels.(a) fine (b) pyrolite
(a) edge (b) microcrack 13. The glass ceramics can not be used for
8. Saphire and ruby are natural -------. implant subjected to -------. (a) movement
(a) alumina (b) Zirconic (b) heavy loads
9. Carbon has many ------- forms. 14. Bioactive ceramics form strong ------- with
(a) allotropic (b) material
surrounding tissues of the body on
10. ------- is an ideal biomaterial for joint implantation. (a) adhesion (b) bonds
replacement. (a) alumina (b) quartz
15. Biogradable ceramics------- on implantation
11. Carbon shows excellent ------- with tissue in the body. (a) adjust (b) degrade
and blood. (a) adjustment (b) compatibility
16. Our natural bone and teeth are made of a
crystalline form of -------. (a) calcium
phosphate (b) TCP
ANSWERS
COMPOSITE
BIOMATERIALS &
Whether it's the pot that hits the rock or the rock that hits the pot, it's the pot
that will break every time.
INTRODUCTION by the hostile environment inside the body.
The composites are used for dental filling,
1. A composite is a non homogeneous material orthopedic implant with porous surfaces
which has two or more distinct constituent (UHMWPE) and bone cement (reinforced
materials or phases on a scale larger than methyl methacrylate).
the atomic. It is possible to achieve desired
properties like flexibility and strength by STRUCTURE OF COMPOSITE
suitably combining two or more material as 1. The desired properties can be obtained by
distinct phases without forming alloy. The suitably modifying the structure of a
composite materials offer a variety of composite. It is possible to alter the
advantages in comparison with homogeneous structure of a material by
homogeneous materials. Considerable using other material soas to get an
control over material properties can be nonhomogeneous in a larger scale structure.
achieved. There is possibility of making stiff, It is also interesting that the properties of a
strong and light weight material or highly composite depends upon (1) the shape of
resilent and compliant materials. A reinforced the inhomogeneities (2) the volume fraction
plastic is a composite having two distinct of constituents and (3) the interface among
constituents/phases of plastic and fibre glass the costituents. One of the constituent can
but brass is an alloy (not a composite) as it be in shape of fiber, platetlet or lamina. The
has no distinct phases of copper and tin. A inclusions can also vary in size and shape
foam is a composite inwhich one phase is (spherical, polyhedral, ellipsoidal or
empty space. There are existing many irregular). The inclusions can have random
natural composites. Natural composites are or orderly orientation. The properties of a
bone, cartilage, skin, dentin and wood. composite depends upon the structure. For
Lungs, cancellous bone and wood are also simple structures, it is possible to predict
natural foam type composites. A composite the properties of the composite. Some of
material can be biocompatible if the interface simple structures of composites having two
between constituents must not be degraded constituents are as shown in the figure.
COMPOSITE BIOMATERIALS 163
F
F
F
F F F
C o m p osite L am in ar Fibro us
Simple Structures
The force on the composite materials have where Ei = modulus of elasticity of inclusion
been indicated. The modulus of elasticity
Em = modulus of elasticity of matrix
(E) of the composite can be given as : –
Vi = Volume fraction of inclusion
E = Ei Vi + Em (1 – Vi)
where Ei = modulus of elasticity of inclusion 2. The strength of composite depends upon the
brittleness and duetility of inclusions and the
Vi = Volume fraction of inclusion
matrix. The fiberous composites fail when
Em = modulus of electricity of the matrix
fiber inclusions break or buckle or pullout
(main material)
take place from the matrix. Carbon fibers
It can be appreciated that by using inclusions
are generally used in HDPE as reinforcement
of material having high modulus of elasticity
it is possible to get a composite material of to get a composite for knee replacement.
higher stiffness. The shape of inclusion is Carbon fibers can be also used with
important. In isotropic system, inclusion in UHMWPE to get more stronger composite.
shape of platelet or flakes are the most Carbon fibers are also used to reduce the
effective in creating a stiff composite. The temperature of implant and in improving
inclusions in shape of fibers are also effective mechanical properties like resistance to
but little less. But spherical inclusions are creep. Metal wires are used with PMMA.
least effective. They are also used in bone cement to achieve
PARTICULATE INCLUSIONS near about equal strength of the bone.
1. It is very convenient to stiffen or harden a Graphite fibers have been used in bone
soft material (generally polymers) by the cement. The metal implants are generally
incorporation of particular inclusion. The found to be much stiffer than bone in total
shape of inclusions plays an important part hip replacement which results into the
in deciding the properties as explained shielding and resorbing of nearby bone. The
already. The stiffness E of a composite is – composite materials are better alternative to
5 ( Ei – Em ) Vi
metals for implants. They also help in
E= + Em promoting healing.
3 + 2 Ei / Em
164 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
ANSWERS
Endure today's pain today. Do not add it to yesterday's. Nor attempt to shoulder
tomorrow's.
ANSWERS
P ro sthe se s
P ro sthe ses
S yrin g e
B o ne
B o ne cem e nt
cem e nt
M esh reinfo rcem e nt
Fe m ur
B o ne cem e n t
D o ug h injection P ro sthe ses fixa tion
The use of a mesh reinforcement (a wire fixation helps in decreasing the stress on the
coil) around a prostheses in bone cement bone cement.
Fill in the gaps 5. The wire coil with the bone cement fixation
1. Bolts and nuts are the mechanical methods of prostheses helps in the ------- of the stress
of fixation of -------. (a) prostheses (b)
on the bone cement. (a) increase (b)
bones
decrease
2. The press fit used for the fixing of femoral
stem of a hip joint is a ------- mechanical 6. The large size of stem in passive mechanical
fixation. (a) passive (b) tight fit fixation helps in -------the stresses on the
3. The bone cement consists of PMMA ------ larger area. (a) localising (b) distributing
and MMA -------. (a) powder, liquid (b)
7. The passive mechanical fixation also induces
liquid, powder
the formation of a ------- at the interface of
4. The bone cement takes ------- minutes
to polymerise and set. (a) 30 – 40 the bone and implant. (a) membranes (b)
(b) 5 – 15 void
ANSWERS
One can enjoy life a lot more by saying yes than by saying no.
1. The body produces various physiological 1. Physiological signals are generated by the
signals. The accessibility to these signals is body during the functioning of various
important because (1) they can be internal physiological systems. Hence physiological
(blood pressure) (2) they may emanate from signals hold information which can be
the body (infrared radiation) (3) they may extracted from these signals to find out the
be derived from a tissue sample (blood or state of the functioning of these
tissue biopsy). All physiological signals can physiological systems. The process of
be grouped into the flowing categories – (1) extracting information can be very simple
biopotential (2) pressure (3) flow (4) as feeling the pulse to find the state of heart
dimensions ( for example : imaging), (5) beats and it can be complex which may
displacement (such as velocity, force, and require analysis of the structure of tissue
acceleration) (6) impedence (7) temperature by a sophisticated machine. Depending on
and (8) chemical concentration and type of energy, the physiological signals can
composition. be:
2. The transducer is a device that converts one (a) Bioelectrical signals: These signals are
form of energy to another. A transducer generated by nerve cells and muscle
converts a physiological signal to an electric cells. The source of these signals are
output. The transducer should respond only cells which undergo change of state
to the targeted form of energy present in from resting potential to action potential
the physiological signal and it must exclude under certain conditions. The change
all other energies. The transducer should of potential in many cells generate an
interface with the living system in such a electric field which fluctuates and in this
way that it should extract minimum of energy process it is to emit bioelectric signal.
and also it should not be invasive. ECG and EEG are obtained from the
biosignals from heart and brain
respectively.
170 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
(b) Biomechanical Signals: These signals (e) Biochemical signals: The information
are generated by some mechanical is obtained by chemical measurements
function of a physiological system. from the living tissues or analysis of
These signals are related to motion, the samples obtained from the body.
The concentrations of various
displacement, pressure and flow of the
constituents in the blood and the
physiological system. The respiratory
measurement of partial pressure of
physiological system functions with the oxygen and carbon dioxide in
movement of chest which can be respiration are found out by this method.
analysed. (f) Bioimpedence Signals: The impedence
(c) Bioacoustic Signals: These are created of the skin depends upon the
by the physiological systems which are composition of skin, blood distribution
and blood volume through the skin. The
dealing with the flow of blood and air.
measurement of impedance helps in
The flow of the blood in the heart, the finding the state of skin and functioning
opening and closing of chest in of various physiological systems. The
respiratory system generate unique voltage drop by the tissue impedence
accoustic signals. is nothing but a bioimpedence signal.
(d) Biomedical Signals: Weak magnetic (g) Bio optical Signals: These signals are
fields are generated by various organs produced by the optical variations by
the functioning of the physiological
like heart, brain and lungs while
system. The blood oxygenation can be
functioning. Magneto encephalograph measured by measuring transmitted and
is obtained from the biomagnetic reflected light from the blood vessel.
signals from the brain.
Phonocardiogram ECG
(heart sounds) (cardiovascular system)
– +
Ni – Si
Silicon solar cell
3 Thermocouple When the junction of two Measuring of:
dissimilar metals is heated and (a) temperature
other is cooled, then an emf is (b) heat flow
generated across the juctions. (c) radiation
Th erm o voltag e
Jau ctio n Jau ctio n
M etal A
1 2
M etal B
compressive force is applied, its resistance moving part moves to right, resistive
will decreases. We define gauge factor as elements R2 and R3 are relaxed tension. As
explained in the principle of wheatstone, the
∆R ∆L
the ratio of to i.e., gauge factor change of resistance is indicated by the
R L voltmeter which depends upon the linear
∆R / R movement of the transducer. In the bonded
G= . The strain gauge can be (1) strain gauge as shown is the figure, a thin
∆ L /L
resistance wire is shaped in a zigzag manner
unbonded and (2) bonded in order to obtain and it is cemented between two paper / foil
sufficient resistance for each arm (four arms covers.
of wheatstone bridge). Several turns of thin The compact strain gauge can be easily
wire are used between two posts (refer to cemented to the surface of a structure / body
figure). Four posts are mounted on stationary and any change in surface dimension is
part and other four posts are connected to indicated by the change of the resistance of
the transducer which can move to right or the strain gauge.
left with respect to the stationary part. If
R e sistan ce a rm R1 R2
(m an y tu rns o f w ire)
R1
V
R2
R3 M ovin g pa rt R3 R4
R4 S ta tion ary
m em b er
To p C over
S train g au ge w ire
B o tto m C ove r
5. Solved Example (strain gauge). A strain 2. Variable reductance : In this, core remains
gauge (l = 0.1 meter) is bonded to a surface stationary inside the coil but the air gap in
(Area = 4 cm2) having modulus of elasticity the magnetic path of the core is varied to
E = 200 G N/m2. The strain gauge unstrained change the net permeability, thereby varying
resistance is 200 ohm and gauge factor (G) the output signal as per the input variable
(displacement).
= 10. When load is applied, the resistance
changes by 0.01 ohm. Find the stress and
load applied. D isp la ce m en t
∆R / R
Gauge factor G = P late
∆L / L iro n
∆R L 0.01 0.1
∆L= × = × A ir ga p C o il
R G 200 10
C o re
–6
= 0.5 × 10 m
∆L 0.5 ×10 –6
ε = strain = = = 0.5 × 10–5 O utpu t
L 0.1
Stress σ = ε × E Variable Reductance Transducer
= 0.5 × 10–5 × 200 × 109
3. Linear Variable differential transformer
= 1 × 106 N/m2
(LVDT). The transducer consists of a
Force = σ × A
transformer with one primary and two
= 1 × 106 × 4 × 10–4 = 400 N
secondary windings. The secondary
INDUCTIVE PASSIVE TRANSDUCERS windings are connected as shown in the
1. Variable induction : The property of figure so as that their induced voltages
inductance is varied in the cercuit to change oppose each other. If the core is positioned
the output voltage in accordance with the in central position as shown in the figure,
input variable. The inductance L = n2 Gµ the voltage induced in both secondary
(n = number of turns in coil, G = form windings is equal and opposite, thereby the
factor of coil and µ = permeability of core output voltage is zero. If the core is moved
material inside the coil). Though induction upwards, the voltage in secondary 1 is
can be varied by any of these three greater than voltage in secondary 2. Similarly
parameters, but generally arrangement is the voltage in secondary 2 will be greater
made to change the permeability to achieve than voltage in secondary 1 if the core
variation in induction of the cercuit as per moves down. The output voltage will vary
the variable input. In the passive induction as per the movement of the core which is
transducer, the core is made of a soft changing as per input variable.
magnetic material which changes the
induction of the coil when it is moved inside
or outside, thereby the output of ac signal is S e co n da ry1
Fixe d P rim ary O u tpu t
changed as per the displacement of the core A C vo ltag e S e co n da ry 2
in the coil. C o il
D isp la ce m en t
LVDT
LVD T
C o re
A C S ig na ls
Induction Displacement Transducer
PHYSIOLOGICAL SIGNALS AND TRANSDUCERS 175
d M ovin g
p late
TEMPERATURE MEASUREMENT
1. The physiological state of an individual is
Fixe d indicated by his body temperature. It has
p late been seen that a person in shock has reduced
M ove m e nt blood pressure in circulating system which
C a pa cita nce C a pa cita nce
results into low body temperature. Infection
in crea se s d ecrea ses and illness are usually reflected by a high
body temperature. Special heated incubators
are used for maintaining the body temperature
of infants. The temperature of the joint of
an arthritic patient is closely linked with the
amount of local inflammation. The
temperature can be measured by (1)
C a pa cita tio n
thermocouples (2) thermistor and (3)
radiation and fiber optic detectors. The
D isp la ce m en t ‘d’ principle of thermocouple has already been
explained in para 5 of this chapter.
Variation of Capacitance with Displacement
2. Thermistors: It is a shortened word for
thermo and resistor which means that they
are semi conductors having a high negative
temperature coefficient. The resistance of
176 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Figure (a)
la m p P h oto
re sistor
Figure (d)
Transduction in variable resistivity
Force Transducer with Transduction
178 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
Fluid pre ssu re
D ia p hra gm Fluid
D e fle ctio n du e
to fluid flo w
Bourdon Tube
9. Analog to Digital transduction: Digital or rulers with digital pattern which are
data can be easily processed by computers
photographically transformed on them.
which require that the output of transducers
These patterns can be decoded with the help
or instruments should be in digital form. If
the output of a transducer is not in digital of a light source and photodiode or photo
form, a device to convert the output from transistor. The encoded disk rotates and a
analog to digital form has to be used. digital signal indicating its position is obtained
Generally transducers contain encoded disks in digital form.
Encoded Disk
PHYSIOLOGICAL SIGNALS AND TRANSDUCERS 179
R
+ –
R
B o dy
E lectro de e le ctrod e
M etal
L ea d w ire
S kin
E lectro lyte pa ste
ANSWERS
If you can find humour in anything, even in poverty, you can survive it.
S ign al
Tra n sd uce r D isp la y
P ro cessing
In pu t O utpu t
In pu t O utpu t
sig na l N o ise
5 35 40 60 5 35
Fre q ue ncy
L ow p a ss filter
(fre q ue ncy < 40 )
Filters can also be classified as passive or 100 Hz. However if noise signals have
active filters. Passive filters use passive frequency range of 50 Hz to 100 Hz, then
components such as resistor, capacitor and use of a low pass filter cercuit with a cut
inductors. Active filter use amplification in off frequency values of 50 Hz will attenuate
addition to passive components. The filters some components of ECG signals which can
can also be classified as analog and digital not be permitted. Signal averaging is the
flitters. An analog filter processes analog appropriate technique for such case. It is a
inputs and its output is analog. A digital filter digital technique of separating a repetitive
processes digital data and generates digital signals from noise without introducing signal
data output. Analog filters are based on
distortion. The requirements from the signals
mathematics operators and digital filters
and noise before employing signal averaging
require no more than addition, multiplication
are – (1) The signal waveform has to be
and delay operations. Certain instruments use
repetitive and signal must occur more than
analog to digital conversion to convert a
once at regular intervals (2) The noise has
signal to digital form which can be further
filtered by employing high speed digital to be random and non periodic (3) The
computing. All measuring and recording temporal position of signal wave form can
instruments pick up some degree of noise be accurately ascertained. Each new signal
signal of 50 Hz from power lines and nearby waveform or curve is made to align (curve
operating machineries. The noise signals of fitting) with previous signal waveform so
50 Hz can be attenuated by the application that repetitive signal are added up. The signal
of low pass filter which permits frequencies strength is increased a number of times the
below 50 Hz to pass through. Such filters signal waveforms are added. However noise
are called ‘Notch’ filters is random in occurrence and it has mean of
3. Signal averaging : Filtering is effective zero. ECG signals are corrupted by random
method to remove noise signals incase noise signals which are broadband. Noise
transducer signals and noise signals do not signals can not be removed by filter cercuits
overlap. Noise signals having frequencies without the loss of some part of ECG
higher than 100 Hz in ECG signals can be signals. The technique of signal averaging
easily blocked by employing a low pass filter is employed by first identifying the QRS
cercuit with a cut off frequency value of complex of ECG signals.
R e sp on se 1
R e sp on se 2
R e sp on se 3
R
T
P
A verag in g o r
to ta l re spo nse
Q
S
Signal Averaging
Signal averaging of this noisy signal requires amplifications as they are suitable for
a way to time align each of the QRS increasing the voltage level of signal. The
complexes of the signal responses as shown computers offer tremendous advantages in
in the figure. The time at which each flexibility and speed. Hence signal processing
stimulus occurs is considered as the employing digital computers are being
reference time and the values for each increasingly used now adays. In analog
response are summed upto get the total signal amplitude and time are varying
response at the reference time. By repetitive
continuously over its respective intervals. In
summing, it is possible to enhance the signal
a digital signal, amplitude and time take on
to noise ratio. Signal averaging is commonly
discrete values. An analog signal can be
used with ECG, EEG and EMG and it is
performed on a computer. The technique converted into digital form by following
involves digitizing signal, storing in memory processes – (1) sampling (2) quantising and
and locating the stimulus. (3) encoding. In sampling operation, only
sample value of analog signal at uniformly
4. Digital transformation: Until recently,
spaced discrete instant of time are retained.
signal processing has been commonly
carried out using analog equipment. For In quantizing operation, each sample value
example, a biopotential amplifier is to receive is approximated to the nearest level in a finite
a weak electrical signal of physiological set of discrete level. In the encoding
system and increase its amplitude so that it operation, the selected level is represented
can be conveniently further processed by a codeword that consists of prescribed
recorded or displayed. Generally such number of code elements.
amplifications are is the form of voltage
A n alog D ig ital
S a m pling Q ua n tizin g E n co d ing
S ign al sig na l
Analog to Digital
SIGNAL PROCESSING 185
ANSWERS
DIGITAL IMAGE
ACQUISITION AND !
PROCESSING
Learn from the mistakes of others. You can't make them all yourself.
1 1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1 1
1 1 0 0 0 0 1 0 0 0 0 1 1
1 1 1 1 1 0 1 0 1 1 1 1 1
1 1 1 1 1 0 1 0 1 1 1 1
1 1 1 1 1 0 1 0 1 1 1 1 1
1 1 1 1 1 0 0 0 1 1 1 1 1
1 1 1 1 1 0 1 0 1 1 1 1 1
1 1 1 1 1 0 1 0 1 1 1 1 1
1 1 1 1 1 0 1 0 1 1 1 1 1
1 1 0 0 0 0 1 0 0 0 0 1 1
1 1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1 1
O ne b it plan e bu ffe r S cre en
(zero o r o ne ) (b la ck a nd w h ite )
D ig ital to
a na lo g co nvertor
40 42 60 50 98 36
values. The quality of a digital image input brightness value to output brightness
improves in direct proportion to the spatial, value. It is time consuming and wasteful of
spectral, radiometric and time resolution. computer resources incase the above type
The spatial resolution depends upon the of operation is to be performed on a large
proximity of neighbouring image sampling image at every pixel. A look up table (LUT)
points in the image plane. The spectral is an alternative technique to map large
resolution is dependent upon the band width
images. A LUT stores an intensity
of light friquencies captured by the sensor.
transformation function which is designed
On other hand, the radiometric resolution
in such a way that its output grey level values
depends on the number of grey levels
between black and white values. The time are a selected transformation of the
resolution is dependent on the interval corresponding input values. Let us
between two successive sampling. The understand how it is done. We take a 8 bit
image is processed by a computer by computer which can have input values of
carrying out image digitization, sampling and 256 grey levels (28 = 256). Suppose it has a
quantization. In image digitization, the image designed LUT which gives an output value
function f (x, y) is sampled into a matrix of zero for input value between zero and
with ‘M’ rows and ‘N’ columns. A continues 127 and an output value of one for input
image function f (x,y) can be sampled using values between 128 to 255. Then the entire
a discrete sampling points in the image plane. point process will result in binary output
The sampled image function Fs (x, y) is the images that have two sets of pixel i.e., zero
product of the f (x, y) and S (x, y) (sampled and one. Similarly LUT can be designed to
function). The Fourier transform of the give other selected outputs for the
sampled image is the sum of periodically
corresponding input values.
repeated fourier transform F (u, v) of the
image. The transition between the value of
image function (brightness) and its
0 1 2 1 26 1 27 1 28 2 54 2 55 In pu t
equivalent is known as quantization. If ‘K’
is the number of levels of quentization and
‘b’ is the number of bits used to express the 0 1 O utput
the brightness of pixels, then k = 2b. Look up Table
object from the background. It can be (a) First level of representation. The
appreciated that the change of position of representation is iconic and it consists
the object does not affect histogram. of images containing original data about
pixel brightness in the form of integer
Manipulation of histogram can correct poor
matrices. Certain prepatory operations
contrast and brightness which can
are performed such as highlighting some
dramatically improve the quality of the aspects of the image and manipulation,
image. like filteration or edge sharpening.
(b) Second level of representation. In this,
the segmentation of images is
performed i.e., the parts of the images
are joined into groups that seems to
F req ue n cy
LOOK UP TABLE
192 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
ANSWERS
RADIOGRAPHY
"
If the wise does not approve your book, it is bad. If a fool applauds it, it is
worse.
+ –
X -ra y tu be
X -ra y g en era to r
C o llim ato r
O pe ra to r
con so le
G rid
P h otocell
Im a ge re ccp tor
2. An image receptor is a device which can a phosphor layer that absorbs x-rays and in
detect and record an x-ray image. It is placed response emits visible light. A radiographic
below the patient so that x-ray after passing cassette consists of a pair of intensifying
through patient falls on the image receptor. screens with a sheet of double emulsion film
The patient’s anatomy modulates the intensity sandwiched between the screens. The film
of the x-ray field as it passes through his
records the visible light image emitted by
body. The differential x-ray absorption and
transmission by tissues of the body results the intensifying screens in response to
in an exit radiation beam that varies in irradiation by x-ray. Two phosphor screens
intensity in two dimensions. The exit are more efficient in detecting x-ray than a
radiation beam reaches a detector which single screen. However sharpness
detects and records the two-dimensional decreases.
intensity distribution. The image receptors
used in diagnostic radiology can be :
STORAGE PHOSPHOR SYSTEM
(a) Photographic film, coupled with an (PSP)OR COMPUTED RADIOGRAPHY
intensifying phophor screen.
(b) Storage phosphor screen.
1. Storage phosphor or photostimutable
(c) Direct digital readout device. phosphor system is used to obtain radiograph
in digital form which are suitable for computer
PHOTOGRAPHY OR X–RAY FILM
based storage and processing. This method
1. X-rays normally can not be detected directly is also commonly known as computed
by the human sense. Hence indirect methods radiography. The method also uses a cassette
of visualisation have to be used to see the containing a screen coated with phosphor
image of the intensity distribution through similar to that used in conventional screen
the body of a patient. Although x-rays have film. However, the phosphor used in the
a much shorter wave length than visible light intensitying screens emits visible light
but x-rays can react with photographic
immediately upon absorption of x-rays which
emulsions in same way as it happens incase
is called fluorescence. The phophor in PSP
of visible light. The film exposed of x-ray
and carrying an image of the x-rays intensity systems responds to irradiation with x-rays
is processed in the developing solution. The by storing electrical charges in a pattern
sensitivity of the photographic emulsion can matching to the pattern of absorbed x-rays
be increased by the use of intensifying intensities. The pattern is read later by a
screens which are similar to the fluoroscopic scanning laser device. Laser causes localized
screens. The screen is kept into close heating of the phosphor which leads to
contact with the film surface so that the film stimulation of the metastable trapped charge.
is exposed to x-rays and also to the light The stimulation of the metastable trapped
emitting from the fluorescent screen. X-ray charge leads to conversion of the trapped
film is packed in light-tight cassettes with charge into visible light, which is called
or without intensifying screens. The one side
delayed luminescence. The visible light is then
of the cassette is made of thin plastic which
converted to electric current by a photo
can be easily penetrated by the x-rays.
multiplier tube which is digitized and stored
2. An intensifying screen (fluorescent screen)
as a digital image in a computer.This is called
consists of polyster with plastic coating and
computed radiography.
RADIOGRAPHY 197
U n used P S P
x-rays field
R e co rding th e
x-rays im a ge
L aser sca nn in g
E ra sing b y ligh t
fo r re use of P S P
P S P re ad y for
re use
O bject O bject
w ith slot
h id de n
Im a ge (d ark) D a rk L ig ht D a rk
im a ge d ark im a ge
d ue to
h id de n slo t
Image Formation
Im a ge
L en s
FO D
FF D
O bjec t
O bject
Im a ge Im a ge
O bjec t
Magnification
View Projection
RADIOGRAPHY 199
O b jec t O bject
Im a ge
a bsorp tion Im a ge
O b jec t
u nsha rpn ess a bsorp tion
u nsha rpn ess
Im age
X -ra ys X -ra ys
S cre en
S cre en
Film
G oo d ph otog rap h ic sha rpn ess
Film
P o or ph otog rap hic sh a rpn ess
Photographic Unsharpness
inferior to those of a good radiogram. The chief (25 kv) and output image is smaller than the
advantage is that the fluoroscopy is a real time primary fluorescent image, but there is a
radiography. Fluoroscopic system allows high brightness gain in the output image
continuous viewing of a time varying x-ray which makes it possible to observe the image
image and permits live visual evaluation of in the normal illuminated room.
dynamic events. M irro r
TV
cam e ra (–)
x-ray
im a ge F luo resc en t sc reen
in te nsifie r V ide o m o nito r w ith ph oto c a tho de
x -ray s ourc e
G rid
Image Intensifier
P a tie n t
O pe ra tor’s
IMAGE QUALITY
con so le
1. The image quality depends upon following :
C o llim ato r (a) Contrast. It is the difference in
brightness of two neighbouring regions.
In grey - scale image where signal
x-ray tub e x-ray
g en era to r differences are represented by varying
shades of grey or brightness, high
Layout of an Intensified Fluoroscopy System contrast means that two objects of
different composition in the image
IMAGE INTENSIFIER appear very light or very dark. In a
lower contrast image, there is less
1. The faint image of a fluoroscopic screen can difference in relative brightness.
be made brighter with the use of an (b) Noise. It is any signal component in an
electronic image intensifier. The intensifier image that does not convey any useful
tube contains a fluorescent screen which is information. The aim is to have a higher
coated with a special material to act as signal to noise ratio to reduce the
photocathode. The electronic image random noise.
generated on the photo cathode is focussed (c) Spatial Resolution. It is ability of an
onto a phosphor screen at the end of the image to faithfully reproduce small
tube by the help of an electrostatic lens details. It is also called sharpness.
system. Due to the acceleration of the Unsharpness (blur) indicates lack of
electrons by the electrostatic lens system spatial resolution.
202 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
10. The ratio of image size to object size is 12. Fluoroscopy allows continuous viewing of
---------. (a) magnification (b) clarity factor --------- x-ray image. (a) time varying
11. --------- is used to control the scatter (b) stable
x-rays. (a) filter (b) grid 13. The intensifier converts x-ray energy to
---------. (a) current (b) visible light
ANSWERS
COMPUTED
TOMOGRAPHY #
Too many people spend money they haven’t earned, to buy things they don’t want,
to impress people they don’t like.
2. When the x-ray tube moves over the patient, the same part of the film and images
the projected images of structures on are therefore blurred.
different levels of the body move with (c) Images of layer C move slower than
different velocities. The structure which is the film. Images are therefore blurred.
nearer to x-ray tube will have its image 3. It is possible to record sharp images of
moving faster. Similarly farther the structure structures on one layer of the body which
is to the x-ray tube, the slower its image are free from obscuring images from other
will move as the movement of x-ray tube layers. Throughout the movement, there is
and film is linked through a pivot. Hence the no change in the magnification of images on
film moves at the same velocity as images the object plane as this would produce image
of the structures only at the level of the unsharpness. For constant magnification,
pivot. Only these images are recorded on focus to pivot distance must remain constant.
the same part of the film throughout the The layer recorded sharply is called the object
movement. Images of structures on all other plane. It is parallel to the film. Generally the
layers move at a different velocity to that of film is parallel to the table to at the level of
the film and these images are not recorded the plane. If the film lies at angle of the table
on the same part of the film throughout the top during the movement, the layer will be
movement. These images are therefore visualised same angle. This technique is called
recorded as blurred. As shown in the figure, inclined plane tomography.
the film is pivoted at B layer. When x-ray
4. The height of the pivot above the table top
tube moves from T1 to T2 position during
can be changed which enables to select any
exposure, the quality of images at different
level in the patient for the tomography. The
level of layers are :
X -ra y tu be a t M ove m e nt x-ray tub e a t
T 2 po sition T 1 po sition
Fro m T 1 to T 2
P a tie n t
A A
B B
C C
Film
A1 B1 C1 C2 B2 A2
Priniciple of Tomography
(a) Images layer B move at the same level can be varied by two ways. Either the
velocity as the film and images are pivot can be lowered or raised above the
recorded on the same part of the film table top to the required level in the patient
throughout the exposure. The images (variable pivot system as shown in the
recorded at point B1 and B2 are sharp. figure) or the pivot is kept in a fixed position
(b) Images of layer A move faster than the and table top is raised or lowered to bring
film. The images of A move from the the desired level of tomography to the level
left of B1 to the right of B2 as shown in of the pivot (fixed pivot system as shown in
the figure. Images are not recorded on the figure).
206 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
X -ra y tu be X -ra y tu be
P ivo t a layer P ivo t m o ve d do w n
to B le ve l
A A A A
B B B B
Film Film
X -ra y tu be
X -ra y tu be P iovt
P iovt
A A
A A B B
A B
Ta ble
ra ised
Film
Film
5. The simplest type of movement of x-ray tube confined to one direction only which is along
and film is linear and parallel to table top the long axis of the table. In certain
tomography systems, linear movement in
which is also called line to line. The focus
other directions parallel to the table is
to film distance (FFD) changes during the allowed. Linear movements have
movement. FFD is least at the midpoint of disadvantage that they produce unsharped
the movement. Linear movement is generally images.
Fo cus
Film m o ve m e n t
Line to Line
COMPUTED TOMOGRAPHY 207
T2 T1
ELEMENTS OF DIGITAL IMAGING
SYSTEM
DATA ACQUISITION SYSTEM can detect x-ray photons. The output from
the detector is variation of electrons (current)
1. Two elements are required to acquire digital as per the intensity of x-rays with the help
images. The first element is detector of current to voltage converter. The
(sensing device) an electrical signal output multiplexing is a device to take readings
which is proportional to the level of x-rays from two or more analog integers with a
sensed. The second element is called a single analog to digital converter. An analog
digitizer which is a device for converting to digital converter is device that accepts a
the electrical output of the sensing device continuous analog voltage signals as input
into digital form. The detectors for CT and converts them in to digital output signals.
systems must have high overall efficiency The converters can be (1) voltage to
(so as to minimise the patient radiation dose), frequency converter with a counter ( voltage
large dynamic range (the ratio of the smallest is converted into pulses and number of
and just detectable signal to the largest signal pulses is portional to voltage) (2) pulse width
without causing saturation), stable with time convertor (discharged capacitor is charged
and insensitive to temperature variation. at fixed rate until it is charged to analog
Three types of detectors are commonly used voltage and resulting pulse width is
in CT scanners. They are (1) xenon gas proportional to the analog voltage) (3) up
ionization (2) scintillation detector like and down integrator converter (the input of
sodium iodide, bismuth germanate and analog integrator is alternately switched
cesium iodide crystals which convert kinetic between the analog voltage to be digiticized
energy into flashes of light which can be and a constant reference voltage and output
detected by a photo multiplier. (3) solid state of analog integrator is used to charge a
detector (single crystal (Cd WO 4 and capacitor at fixed rate as done in pulse width
ceramic Cd2O2S with photo diodes) which converter.
A n alog
C o m p u ter
to d ig ita l
C o nverter
Data Acquisition
10 4 6 10 4 6 0 4 6 P ro je ctio n
OM IM (scan II)
2 8
Im a ge
4 6 z re co nstru cted
IM (scan III)
Third Iteration
x
10 and 10. The object and image matrix
P ro je ctio n
now match as difference in values of Image Reconstruction
elements in both matrices is zero. Now
we use the final image matrix to FILTERED BACK PROJECTION
generate image with the help of the
1. It is possible that the image can be
computer.
reconstructed with the back projection after
BACK PROJECTION data has been filtered first. The back
projected image is fourier transformed into
1. In this method, the image is reconstructed
the frequency domain and filtered with a filter
directly from the projection data without any
need to compare the measured data and the proportional to spatial frequency upto some
reconstructed model. If projections of an frequency cutoff. These filtered projectios
object in the two directions normal to x and are used to construct the final back -
y axes are measured and then this projection projected image. The filtering operations can
data are projected back into the image plane, also be carried out in cartesian coordinates
the area of interaction receives their summed by using analytic algorithms which are
intensities. It can be seen that the back known as convolution techniques. This is
projection distribution is a representation of achieved by convolving (filtering) the
the imaged object. In actual process, the
shadow function with a filter. In principle,
COMPUTED TOMOGRAPHY 211
1 2 3 4 5 6 7 8 9 M ultis lice
S lice
C T sc an
C on ventional C T S can
Evolution of Multi-slice CT Scan
Spiral CT S can
212 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
ANSWERS
and neutrons possesses a nuclear spin (The that resonance signals on which the imaging
1 is based. Any nucleus having magnetic
value varies from to 1) and magnetic moment tends to align with applied magnetic
2
field and in this process it starts processing
moment which has both magnitude and
about the direction of magnetic field as
direction. The magnetic moments pertaining
shown in the figure.
to different atoms of a body tissues are
randomly aligned and their net magnetic Z
moment is zero as shown in the figure. When
B0
Z
Net
M ag ne tic X
m om e nt = 0
X Y
Precessing of Nucleus
2. The body tissue has hydrogen protons parameters (TR and TE ) inorder to generate
(nuclei) which absorb energy from the images either based on T1 or T2 properties
applied RF pulses of suitable frequency. of the tissues. Due to this reason, images of
Therefore protons are excited to higher the tissues are known as either T 1 or T 2
energy level from the lower energy level. weighted. TR stands for the time to repeat
When RF pulses are stopped, the absorbed RF pulses while TE is time to receive echo
energy of RF frequency is emitted by the i.e., time internal between application of
nuclei as the electro-magnetic energy of the pulse and listening of the signal.
same frequency similar to the source 3. Signal intensity pertains to the brightness of
(transmitter). Hence supplying signal generated by specific tissue. The
electomagnetic energy of the appropriate tissues that are bright (white) are
rotational frequency, the protons or nuclei hyperintense while darker signal tissues are
of hydrogen can be excited from a lower hypointense. The tissues which are in
energy level (E1) to higher energy level (E2). between bright and dark are isointense. The
If the energy supply is stopped, the excited signal intensity of tissue depends upon
whether image is T1 or T2 weighted. For
protons drop back to lower energy level E1
example, fat is bright on T1 weighted images
(relaxed). In this process, the nuclei emit
and less bright on T 2 weighted images.
the energy absorbed during movement from Similarly water is dark on T1 weighted
E1 level to E2 level. If the RF pulses are images and bright on T2 weighted images.
repeatedly applied and removed, the nuclei Similarly gas is dark on T2 weighted images.
start resonating between E1 and E2 energy 4. Spatial encoding of the MRI signal is
level. The signals produced during relaxation accomplished by applying magnetic field
(move from higher energy to lower energy) gradient across the region of interest. We
is dependent on density of hydrogen, the have seen that magnetic field changes the
velocity of flowing fluid through the tissue rotation frequency of nuclei. When RF pulses
and the rate at which the excited nucles are are applied, the nuclei having same frequency
relaxed. The relaxation parameters are start resonating. By sequentially varying the
marked T1 and T2. T1 and T2 depend on the frequency of RF pulses, nuclei can be
physical properties of the tissues when selectively excited. There are many
exposed to a series of pulses at techniques by which MRI information can
predetermined time intervals. Different be spatially encoded, acquired and
tissues have different T1 and T2 properties transformed into an image. One of the
based on the response of their hydrogen techniques used is electron technique in
nuclei to radio frequency pulses in the strong which magnetic gradient is rotated to obtain
magnetic field. These differential properties multiple projections which are fed into a
computer to generate an image.
are made use of by setting equipment
216 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
5. The components of a MRI system are and (6) shin coils. The layout of the system
(1) a magnet (2) gradient coils (3) is as shown in the figure.
a transmitter (4) a receiver (5) a computer
S tatic
m ag ne tic M ag ne t
Im a ge field
d isplay
syste m
C o ntrol S h in
in te rfa ce coils
G ra dien t
coils
C o m p uter
RF
tra nsm itter
A n alog to
d igita l
R e ce iver M ag ne t
con ve rte r
ANSWERS
1. The application of ultrasound in medical field 1. The human can hear sound in the frequency
is based on the sonar principle as used by range of 20 hertz to 20,000 hertz. As the
bats, ships at sea and anglers with fish name suggests, ultrasound has frequency
detectors. It is totally non invasive greater than 20,000 hertz. Diagnostic
procedure. Acoustic waves are easily ultrasound has the range of 1 to 10
transmitted in water but they are reflected megahertz. Ultrasound travels in the form
from an interface according to the change of longitudinal wave i.e., the particles of the
in the acoustics impedance. Leaving bones medium move in same direction inwhich the
and lungs, all tissues of our body are wave propagates. The wave transfers energy
composed of water which can transmit through the motion of regions of
acoustic waves easily. Ultrasound can be compression and rarefraction within the
used for obtaining images of internal organs wave. The propagation of wave depends
by sending high frequency sound waves into upon the elastic properties of the medium.
the body. The reflected sound waves If pressure change is ∆P and ∆V/V is
(returning echoes) are recorded and corresponding change in the volume of
processed to reconstruct real time visual ∆V
images by the computer. The returning the medium, than ∆P = – β
V
sound waves (echoes) reflect the size and where β = modulus of elasticity. The average
shape of the organ and also indicate whether speed of wave in biological tissues is given
the organ is solid, fluid or something in
between. Unlike x-rays, ultrasound requires β
no exposure to ionization radiation. It is also
by relation C = ρ0 where ρ0 = density of
a real time technique that can produce a the medium without disturbance. The
picture of blood flow as it is at the very average speed in tissue is taken as 1540
moment of imaging. m/sec.
220 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
2. The intensity of a wave is defined as the restricted by the properties of that medium.
energy which flows per unit time across a These properties include the density and
unit area perpendicular to the wave elastic properties which make up the
propagation. Intensity (I) = 2π2 ρ0 cf 2 ζ max acoustic impedance specific to that meduim.
for an infinite one dimensional plane wave The transmission is also limited by the
where f = frequency, ζ max = maximum transducer frequency being used. Higher
particle displacement, ρ0 = density and C = frequencies have shorter wavelengths
average speed. Therefore intensity depends (V = fλ where v = velocity, f = frequency
upon the parameters of impressed ultrasound and λ = wave length) and they can penetrate
wave (f and ζ max) and parameters of medium less than lower frequencies.
known as specific acoustic impedence z (z
= ρ0C). Biological tissue is not homogeneous M ed iu m 1
M ed iu m 2
acoustically i.e., ρ0 and C are not constant Z 1 ( ρ0 × C 1 )
Z 2 ( ρ0 × C 2 )
within the meduim. If we consider a plane In cide nt
longitudinal wave propagations from
meduim 1 to medium 2, then the percent of
R e fle cted Tra n sm itted
the incident wave energy which is reflected
( Z1 − Z 2 ) 2 Incident, Transmitted and Reflected Wave
= × 100% where Z and Z are
( Z1 + Z 2 ) 2 1 2
3. The velocity of ultrasound in a medium
acoustic impedence of the medium 1 and 2. depends upon modulus of elasticity and
2 density of the medium. The knowledge of
2Z1Z 2
The transmitted energy = × velocity in a medium is essential in calculating
Z1 + Z 2 the depth to which a wave has potential to
100%. The interface separated by the traverse before it is reflected. The depth of
greatest difference in the speed of sound will penetration is the product of velocity and time
provide the greatest reflection as then the lapsed for the wave to travel from source to
value of z1 – z2 is large. This is the reason interface and back. As the ultrasound beam
why it is difficult to visualise bone. Similarly encounters tissues of different acousitc
the acoustic impedance of air and tissue are impedance, velocities are altered such that
42.8 gm/cm2 and 16 × 102 gm / cm2 which returning echoes are received by the receiver
results into a large value of z1 – z2 thereby at different times and echocs have different
the interface makes the ultrasound energy intensities. The differences in time and
reflected completely without any penetration. intensity have useful information. This
A special jelly is used therefore to minimise information as well as the knowledge about
reflected energy from the interface of skin velocity in the tissue are used by the computer
and transducer (in air) so that ultrasound to generate the image on the monitor.
can penetrate the body for the imaging of Transmit power or intensity is manually
organs. Hence the ability of ultrasound adjustable in the machine. Ultrasound power
waves to travel through any meduim is is expressed by decible (db).
ULTRASOUND IMAGING 221
T r an sm itte r
and
re ce iver
D is p la y
m o n ito r
T r an s d u c e r C o m p ute r
and
a n alo g
p ro c e s s o r
D o pp le r
u ltra sou nd
A m p litud e
S o na r A m p litud e to Tw o d im en sio na l cro ss
m od e
(m arine ) tim e m o de section al rea l-tim e
im a ging
15. When incident sound wave is reflected from 18. Gel is applied between skin and transducer
moving target, its frequency is changed to --------- impedance. (a) lower
which is known as --------- shift. (a) hobbler (b) increase
(b) doppler 19. The change of impedance at bone interface
16. Ultrasound is a --------- imaging system. is --------- and ultrasound wave is
(a) invasive (b) non invasive completely ---------. (a) small, transmitted
17. The quality of image --------- the case of (b) large, reflected
obese patients. (a) increases (b) decreases
ANSWERS
RADIOISOTOPES
AND RADIOTHERAPY &
There is no greatness where there is no simplicity, goodness and truth
1 1P D e ca y 1 0P
1 1N 1 2N
–1 –1
– – e e
e e
β +)
Positron Decay (β
–
β
6P D e ca y 7P
8N 7N
β –)
Imgatron Decay (β
G am m a x-rays
– – – –
e e e e
N u cleu s N u cleu s
– – – –
e e e e
2P
2N
INTERACTION OF NUCLEAR
e
–
e
–
e
–
e
– RADIATION WITH MATTER
neutrons. Alpha particles interact with matter alpha, beta and gamma rays from the
in two ways. In one case, alpha particles radioisotope. These radiations are also
impart energy to orbital electrons of the atom known as ionizing radiations as they are
of the matter but without any ejection. Excited
capable of causing ionization directly or
electrons emit excess energy as photons. In
indirectly. The methods commonly used for
second case, alpha particles cause ionization
detection and measuring radioacitivity are
of matter by ejection of orbital electrons and
based on the ionization of the gases like in
leaving behind positive charged atoms. Alpha
Geiger-Mullier counter and proportional
emitting isotopes are not commonly used as
counter, or on the excitation of solids or
tracer in imaging as these isotopes have higher
solution as in scintiallation counter or on
atomic number. Beta particles (positrons and
induction of specific chemical reaction in
negatrons) are very small. They have high
certain emulsion as in auto-radiography. In
velocity resulting higher penetrating power.
Beta particles dissipate their energy largely the Geiger-Mullier counter, alpha and beta
by ionisation or excitation of the atoms with particles enter in the counter tube through
which they interact. mica window having gases under pressure
with anode and cathode as shown in figure
RADIOACTIVE DECAY
with potential difference of 800 - 2500 volts.
The alpha and beta particles ionize molecules
1. The number of atoms in a radioisotope that
disintegrate during a given time interval of the gases which move towards
decreases exponentially with time as shown appropriate electrode under the voltage
in the figure. If λ = decay constant, gradient. The process produced a continuous
No = number of atoms present originally, flow of ions which produces discharge
N = number of atoms present after time t pulses of 10 volt amplitude with duration of
then N = Noe–λt. The time for the half the 50 to 100 microseconds. These pulses are
number of atoms to disintegrate is given by counted which is a measurement of
t1/2 =0.693/λ radioactivity. In proportional counters, the
gradient voltage is kept lower than Geiger-
Mullier counter and it requires a preamplifier
to avoid reducing the pulse size. Scintillator
counter uses a chemical to convert radiation
N u m b er of
a tom s (N )
energy into light. When an ionizing particle
is absorbed in the scintillator, some of the
energy acquired by the scintillator is emitted
Tim e
as a pulse of visible light or near ultraviolet
radiation. The light falls on a photomultiplier
MEASUREMENT OF RADIOACTIVITY tube resulting in pulse of electrons which is
counted to measure radioactivity.
1. The measurement of radioactivity is
determination of the rate of emission of
230 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
+
–
Tu ng sto n a no d e
G la ss
ja cke t
H ig h pressu re argo n
a nd m etha ne g as
C o pp er cylind er
G la ss (catho de )
b ea d
M ica w in do w
Geiger-Mullier Counter
7. Radioisotopes are used as ---------. (a) tracer should be --------- focused on cancerous
(b) medicine tissues. (a) optimally (b) maximumally
8. Radiotherapy is used for the treatment of 10. --------- uses chemical to convert radiation
---------. (a) cancers (b) malfunctioning energy into light when an ionizing particle
9. The radiation dose delivered to a patient is absorbed. (a) Geiger-mullier (b)
scintillator
ANSWERS
NUCLEAR
MEDICINE '
All violence consists of some people forcing others under the threat of
violence or death to do what they do not want to do.
2. The type of tracer to be administered depends during the annihilation of the positron-
on which type of scan is to be performed. electron pair. Tracers with short life can be
Imaging can be done either immediately or produced by cyclotron and computer
after several days. The tracer that is used is
technology has widely improved. Both have
determined by what part of the body is under
study. It is because some tracers collect in helped in the development of PET.
specific organs better than others. PET measures the difference in travel times
Depending on the type of scan, it may take of the two quantas. This can be used to give
several minutes to several days for the tracer the location of tracer where annihilations
to travel through the body and accumulate taking place. PET is an analytical technique
in the organ under study. that provides a way of making in vivo
measurements of anatomical distribution and
SINGLE PHOTON EMISSION rates of specific biochemical reactions
TOMOGRAPHY specially in the brain. The use of PET to
1. The computed tomography principles are obtain images requires the integration of
also being used in nuclear medicine which three components viz (1) radioisotope /tracer
is then called single photon emission (2) PET device and (3) tracer kinetic
tomography (SPECT). Single photon mathematical models. The positron emitters
emission computed tomography is based on mostly used are carbon-11, oxygen-15 and
a rotating gamma camera. Whereas in CT nitrogen-13 which have half life in range of
scan, the image is formed processing x-rays 2 min to 20 min. These tracers are tagged
coming out from the body after absorption to various metabolically active compounds
in the tissues, in SPECT the image is such as glucose or naturally occurring
reconstructed using the counted number of compounds such as carbon monoxide to
emitted photons from the concentration of image the brain, heart and tumors. The
tracer in the tissues. Like CT scanning, tracers are administered to the patients
SPECT also uses rotating gamma camera. usually by injection but sometimes by
inhalation. Since cyclotron is required to
POSITRON-EMISSION produce positron emitters or tracers, PET
TOMOGRAPHY has a very high cost.
1. Positron-emission tomography is a from of
nuclear medicine that uses cyclotron
P h o to n
R in g o f
d e te c to r
P h o to n
C o m p u te r
D is p la y
Positron-emission Tomography
234 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
S ing le p ho ton
S cin tilla tion G am m a e m ission com pu ted
cou nter cam e ra tom og ra ph y
P o sitro n
Tra cer e m ission
te ch n olog y to m og rap hy (P E T)
ANSWERS
diseases are notifiable. List of notifiable communication are : (1) sender (2) receiver
diseases vary from country to country. (3) message (4) channel and (5) feed back.
The primary purpose of notification is The sender is the originator of the message.
to effect prevention and to control the All communications must have a single
person or group of persons as receiver. A
outbreak of contagious diseases.
message is the information which the sender
However notification provides variable
wants to transmit to the receiver. It may be
information about fluctuation in disease in the form of words, pictures or signs. The
frequency and warning about likely channel is the media of communication
spread of a disease from other between the sender and receiver. It can be
countries. face-to-face communication, mass
(d) Hospital Records : Data such as bed communication (TV, radio and newspapers)
occupany rates, duration of stay, cost- and folk media (nautanki, Harikatha and
Burrakatha). Feedback is the flow of
effectiveness of treatment policies is
information from the receiver to the sender.
useful in monitoring the use of hospital
Infact it is reaction of the receiver to the
facilities. A lot of useful information message.
about health care activities and
utilization is available from hospital S e nd er M essag e
records. The computerization of
medical records have enabled health Fe ed b ack
internet are mass communication media health. Education is to educate the public
while telephone and telegraph are point to about prevention oriented approach to health
point telecommunication.
and problems. Most of major health problems
BARRIERS OF COMMUNICATION and premature deaths can be prevented
1. The barriers of health education between the through proper education. The purpose of
educator and general public can be: (1) health communication is to motivate the
physiological (2) psychological (3) public to translate health information into
environmental and (4) cultural. Physiological their personal behaviour and into their life
barriers can be difficulties in hearing or
style for the betterment of their health.
understanding expression. Psychological
barriers can be created by emotional Persuasion is the art of winning friends and
disturbances and level of intelligence. influencing people. Health communication
Environmental barriers are produced by noise, can influence the public to improve their life
invisibility and congestion. Cultural barriers style for better health. Counselling is a
are due to illiteracy, lower level of knowledge
process that can help people to understand
and understanding, beliefs and religion etc.
The barriers have to be identified and removed better and deal effectively with their
to maintain a good communication. problems. It can improve and reinforce
motivation to change behaviour. Counselling
HEALTH COMMUNICATION
is an important part of treatment, disease
1. The health communication is nothing but prevention and health promotion. It helps
health education. It is outward and people to avoid illness and to improve their
downward communication of knowledge. lives through their own efforts. Health
Health communication is the foundation of communication can help to raise morale of
a preventive health care system. The health the health team to work together persistently.
communication has to perform the functions Judicial use of communication media can
of :– (1) information (2) education (3) contribute to health development.
motivation (4) persuasion (5) counselling (6) Communication is the life and blood of an
raising morals (7) health development and orgaisation. Communication can move
(8) organisation. The primary function of horizontally and vetically. Communication
health communication is to impart can maintain intra and inter sectorial
information to people about health problems coordination.
and ways to maintain and improve their
OBJECTIVE TYPE QUESTIONS
ANSWERS
to display pressure, flow and temperature. electrodes so that his EEG a can be motored
In biotelemetry, the measurements as analog for any traumatic difficulty during play.
signals (voltage or current) in suitable form Biotelemetry is also used for
are transmitted which are received and electromyogram (EMG) for studies of
decoded as actual measurements at the muscle damage or partial paralysis problem.
receiving end. ECG telemetry is the Biotelemetry is commonly used in blood
transmission of ECG, form site of an pressure, blood flow and heart rate research
emergency to a hospital where a doctor can on unanesthetized animals.
interpret, the ECG and instruct suitable
BIOTELEMETRY SYSTEM
treatment for the patient. Patients with heart
problem can wear ECG telemetry unit on 1. A biotelemetry system consists of
the job which relays ECG data to the hospital transmitter and receiver. The functional
for checking. ECG telemetry unit is also used blocks of a transmitter is as shown in the
for monitoring when an athlete runs a race figure. Physiological signals are obtained
to improve his performance. Telemetry is by suitable transducer which are amplified
also used for transmission of EEG. It is and subjected to modulate the carrier
generally used for mentally disturbed waves for transmission. The receiver
children. The child wears specially designed receives the transmission and demodulates
the met known as football helmet or to separates to separate the signal from
superman’s element which has built in the carrier waves to display or record the
signal as shown in the block diagram.
B ioe le ctrical
variab le
P h ysiolog ical
A m p lifie r P ro cesso r M od ulator
sig na ls
P h ysiolog ical
Tra n sd uce r
variab le
C a rrie r w a ve
E xcita tion g en era to r
Biotelemetry Transmitter
D isp la y or
Tu ne r D e m o d ula to r
re co rd
Biotelemetry Receiver
BIOTELEMETRY 241
U n ifo rm
a m p litu de
Carrier Waves
A m p litud e
V a rie s
Amplitude Modulation
L ow H ig h
Fre q ue ncy Fre q ue ncy
Frequency Modulation
H ig h est a m plitu de
Th Tl
Th = high est du ratio n
Ti= low est d ura tion
ANSWERS
APPLICATION OF
COMPUTER IN !
MEDICINE
One of the first condition of happiness is that the link between Man and Nature
shall not be broken.
P
T
B loo d
Q S
Pr
Tim e
Pattern Recognition
(f) Initiate control : Computer can initiate (l) Formatting, printing and display :
control over other devices as per the Computer process data in digital form
programming. The input data can be which can be formatted. The raw data
compared and controlled by providing can be converted into physical data
feedback to source of the data by the which can be printed. Hence no further
computer as shown in figure. transcribing or processing is required.
Computer can present the data in the
most meaningful form. Data can be
presented in the form of graphs, charts
P a tie n t S e nso r P ro cesso r and tables.
(g) Accuracy : Computer can be used to 1. We have seen the applications of computer
control the accuracy of a device within in medicine on broad basis. Now we see
the upper and lower limits as what are the specific applications of the
programmed. computer in a hospital which are :
(h) Averaging : Computer can easily (a) Centralised data of outpatient : The
average continuous data over a certain data of an outpatient from abinitio to
time duration. This technique is used his admission and discharge including
to remove the noise signals from the his laboratory tests are fed through the
physiological signals as it is done in computers to the central data
ECG. processing system of the hospital which
(j) Calibration : Many devices have to be help in storage, quick retrieval of any
zeroed and recaliberated after certain information about the patient at any time
time intervals. Computer is used with and white billing him. It helps in the
a such devices to perform the coordination of various departments of
calibration autormatically. the hospital in carrying out the treatment
of the patient which also reduces the
(k) Table lookup : Table look up and
waiting time for the patient when his
interpolation can be performed with
treatment involves various departments.
computer. This procedure can be used
for the determination of parameters (b) Monitoring of Patients’ treatment :
which are dependent on more than one Every hospital has intensive care unit
variable. and critical care unit where continuous
monitoring of ECG waveform, blood
APPLICATION OF COMPUTER IN MEDICINE 247
8. The computer can make pattern ---------. (b) land line telemetry
(a) recognition (b) reconstruction 10. It is possible to monitor physiological events
9. --------- uses a small radio transmitter from a distance by ---------.
attached to the patient. (a) radio telemetry (a) biocommunication (b) biotelemetry
ANSWERS
D ish
D ish
tra nsm ittin g
re ce ivin g
V ide o C lip s
O nlin e E C G
A u dio
m essag es
S tore d E C G
Im a ge s
R a diog rap hy
P a tie n t
V ide o
D a ta
C o nfe re nce A rch ivin g
C T S can
A n alysis
softw are
MRI
A p plicatio n
softw are
S e rver
P a th olog ical com p ute r P rinter
re po rt o f re ce ivin g
S can n er
cen tre
P a tie n t d ata
Telemedicine System
D ia g no stic w o rk
C T S can
statio n
R a diog rap hy
images through the network using a is a good solution. However this has to done
standardized transmission protocol. The by compression of data through algorithms.
images have to be compressed to reduce the This transfer requires compression and
data as well as their time for transmission. decompression algorithms as well as error
Inorder to avoid accidental erasing, digital detection and correction devices in the
images are stored on a meduim capable of system. The transmission of images to
storing a large number of images in a read remote places has another problem. There
only memory as data base system to facilitate is complete lack of internationally accepted
fast retrieval. Images can be viewed at any standard to code the images for transmission
“image display station” or “diagnostic work and also complete lack of a communication
station”. If required, algorithms can be protocol for such coded images. The most
applied to the ‘image data’ to enhance certain appropriate communication protocol is likely
features or to interprete the clinical to be “open systems interconnection” (OSI)
information of the images. It is also possible being developed by ISO. The American
to attach reports and comments to the collage of Radiology (ACR) with the national
images. A large number of methods are electrical manufacturers Association
available for the transmission of images. (NOMA) have also prepared a standard for
Inside the hospital, local area network (LAN) image format and for communication
protocol for transmission of medical images.
Com m unication Archiving Im aging devices
& processing
N e tw ork D a ta ba se
Tra n sm issio n Im a ging E q pt
S to ra ge
p roto col fa cility
C o m p uter
Im a ge fo rm at
A lgo rith m s
U ser in terface
D isp la y
Im a ging
Im a ging de vice N e tw o rk N e tw o rk
e qu ip m e nt
inte rfa ce in te rfa ce
u nit u nit
N e tw o rk
A C R -N E M A A C R -N E M A
stan d ard stan d ard
in te rfa ce in te rfa ce
S a te llite
Fixe d statio n M ob ile sta tion
M icro ph on e M icro ph on e
A u dio A u dio
p rocessor p rocessor
S p ea ker S p ea ker
Tx Tx
D e m u ltip le xing
ECG Re Re ECG
9. The --------- is an internet resource. 10. The most likely communication protocol is
(a) international wide web (b) world wide --------- for transmission of images.
web (a) OSI (b) COI
ANSWERS
1. The collection of data usually called database 1. Various possible environments exist for a
contains information relevant to an database which can be (1) the mainframe
enterprise. The primary goal of a data base
environment (2) the client/server
management system (DBMS) is to provide
a way to store and retrieve database environment and (3) the internet computing
information that is both convenient and environment. The mainframe environment
efficient. Database systems are designed to consists of a powerful mainframe computer
manage large quantities of information. and multiple dumb terminals which are
Management of data involves both defining networked in the mainframe computer. The
structure for storage of information and dumb terminals depend on the mainframe
providing mechanisms for the manipulation
computer to perform all processing. Client
of information. In addition, the database
system must ensure the safety of server environment consists of a main
information stored despite system crashes computer, called a server and many personal
or attempts for unauthrorised access. computers that are networked to the server.
Criteria is used to retrieve information from The database resides on the server. Each user
the database. The way the data is stored in who wants access to the database on the
the database determines how easy it is to
server should have his own personal
search for information based on multiple
criteria. Database is designed such that data computer.
should also be easy to be added and removed
from the database.
256 FUNDAMENTALS OF BIOMEDICAL ENGINEERING
M ainfram e
com p ute r
Dumb
te rm in als
Internet environment is similar to client/ browser installed on the PC. The web
server computing. A user must have an browser connects the PC to the web server.
internet connection and a supported web
PC
(clien ts)
In te rne t
Client/Server Enviroment
W e b se rver
PC
ciplier text to the intelligible message as 2. Patient files on a computer can be accessed
shown in the figure. Two fundamental by anyone with sufficient know-how. The
principles are followed in cryptography : integration of medical information system
(a) All encrypted messages must contain through network makes it even more
some redundancy. difficult to secure the files against
(b) Some measures must be ensured to unauthorised access. Passwords and
prevent active intruders to play back ciphering are used to secure the data.
the old messages.
E D
N E
C C
M essag e R C ip h er text R M essag e
Y Y
P P
T T
ANSWERS
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Delhi.
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the Lower Limb.
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INDEX