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Prof. Dr. Nizamettin AYDIN naydin@yildiz.edu.tr naydin@ieee.org http://www.yildiz.edu.tr/~naydin

Biomedical Instrumentation

Lecture 3

Measurement Systems

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Biomedical Instrumentation

• Diagnosis and therapy depend heavily on the use of medical instrumentation. • Medical procedures: Medicine can be defined as a multistep procedure on an individual by a physician, group of physician, or an institute, repeated until the symptoms disappear

The Importance of Biomedical Instrumentation

• Medical procedure

1 Collection of data - qualitative and/or quantitative 2 Analysis of data 3 Decision making 4 Treatment planning based on the decision

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Biomedical Instrumentation System

**Components of BM Instrumentation System… • A sensor
**

– Detects biochemical, bioelectrical, or biophysical parameters – Provides a safe interface with biological materials

• An actuator

• All biomedical instruments must interface with biological materials. That interface can by direct contact or by indirect contact – Delivers external agents via direct or indirect contact – Controls biochemical, bioelectrical, or biophysical parameters – Provides a safe interface with biologic materials

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time response) of sensor/actuator – Provides a safe interface with the sensor/actuator – Provides a safe interface with the computation unit – Provides secondary signal processing functions for the system 7 …Components of BM Instrumentation System • The computation unit – provides primary user interface – provides primary control for the overall system – provides data storage for the system – provides primary signal processing functions for the system – maintains safe operation of the overall system 8 Problems Encountered in Measuring a Living System The scientific method… • In the scientific method.. Problem statement Review prior work State hypothesis Perform experiments • Many crucial variables in living systems are inaccessible. a hypothesis is tested by experiment to determine its validity.…Components of BM Instrumentation System… • The electronics interface – Matches electrical characteristics of the sensor/actuator with computation unit – Preserves signal to noise ratio of sensor – Preserves efficiency of actuator – Preserves bandwidth (i. • Operation of instruments in the medical environment imposes important additional constraints. – For example. – For example. Clinical diagnoses • Physicians often need instrumentation to obtain data as part of the scientific method. Then the results can be analyzed statistically to determine the probability that the results might have been produced by chance. a hypothesis is tested by experiment to determine its validity. a physician obtaining the history of a patient with a complaint of poor vision would list diabetes as one possibility on a differential diagnosis. • Experiments are normally performed multiple times. • Results are reported in scientific journals with enough detail so that others can replicate the experiment to confirm them. • Nearly all biomedical measurements depend on the energy. Design further experiments More experiments necessary Analyze data Problem solved Final conclusions 9 10 …The scientific method • In the scientific method. Chief complaint Obtain history List the differential diagnosis Examination and tests Treatment and evaluation Select further tests More than one likely Use data to narrow the diagnosis Only one likely Final diagnosis 11 12 2 . we might hypothesize that exercise reduces high blood pressure yet experimentation and analysis are needed to support or refute the hypothesis.e. • Variables measured are seldom deterministic.

acceleration. medical instrumentation may be divided into three categories: – Diagnostic devices – Therapeutic devices – Monitoring devices 15 16 Clinician Abnormal readings Patient Instrument Generalized Medical Instrumentation System… …Generalized Medical Instrumentation System… • Measurand – Physical quantity. Classifications of Biomedical Instruments • • • • • The sensed quantity The principle of transduction The organ system for measurement The clinical medicine specialties Based on the activities involved in the medical care. • Figure (b) shows that by adding the clinician to form an effective feedback system. Outputs Sensor Signal conditioning Signal processing Data displays …Feedback in measurement systems • Figure (a) shows that a patient reading an instrument usually lacks sufficient knowledge to achieve the correct diagnosis.Feedback in measurement systems… • Figure shows that the measurand is measured by a sensor converting the variable to an electrical signal. – An example of such a situation is the day-to-day monitoring of glucose by people suffering from diabetes. which can undergo signal processing. Patient Instrument Measurand Patient Feedback Effector Instrument Clinician Data storage Data communication (a) 13 (b) 14 …Feedback in measurement systems • In certain circumstances. Sometimes the measurement system provides feedback through an effector to the subject. or condition that the system measures • • • • • • • • 17 Biopotantial Pressure Flow Dimension (imaging) Displacement (velocity. property. and force) Impedance Temperature Chemical concentrations 18 3 . Such an individual will contact a clinician if there is an alert from the monitoring instrument. the correct diagnosis and treatment result. proper training of the patient and a well-designed instrument can lead to self-monitoring and selfcontrol (one of the goals of bioinstrumentation).

5 to 4 mV 5 to 300 µ V 0. industry. filter. – Digital output has poorer resolution.5 to 150 0 to 10000 0 to 50 0 to 1 0 to 2 0 to 2 0 to 40 0.1 to 5 mV 0 to 900 µ V 3 to 13 pH units 40 to 100 mmHg 30 to 100 mmHg 0 to 600 L/min 2 to 50 breaths/min 32 to 40 ° C Frequency. and government Specification Pressure range Overpressure without damage Maximum unbalance Linearity and hysteresis Risk current at 120 V Defibrillator withstand Value –30 to +300 mmHg –400 to +4000 mmHg ±75 mmHg ± 2% of reading or ± 1 mmHg 10 µA 360 J into 50 Ω …Generalized Medical Instrumentation System… • A hysteresis loop. hospitals.05 to 150 0. but does not require conversion before being input to digital computers and is more immune to interference Amplitude Amplitude Time Sensor signal Sensor signal Measurand Measurand Time (a) (b) 23 (a) (b) 24 4 .…Generalized Medical Instrumentation System… Measurement Blood flow Blood pressure Cardiac output Electrocardiography Electroencephalography Electromyography Electroretinography pH pCO2 pO2 Pneumotachography Respiratory rate Temperature Range 1 to 300 mL/s 0 to 400 mmHg 4 to 25 L/min 0. dye dilution Skin electrodes Scalp electrodes Needle electrodes Contact lens electrodes pH electrode pCO2 electrode pO2 electrode Pneumotachometer Impedance Thermistor 19 …Generalized Medical Instrumentation System… • Sensor – Converts a physical measurand to an electrical output • Should respond only to the form of energy present in the measurand • Should be minimally invasive (ideally noninvasive) • Signal conditioning – Amplify. …Generalized Medical Instrumentation System… • Most sensors are analog and provide a continuous range of amplitude values for output (a).1 Method Electromagnetic or ultrasonic Cuff or strain gage Fick. Hz 0 to 20 0 to 50 0 to 20 0. – Sensor specifications for blood pressure sensors are determined by a committee composed of individuals from academia. Sensor signal Measurand 21 22 …Generalized Medical Instrumentation System… • (a) A low-sensitivity sensor has low gain.1 to 10 0 to 0. – The output curve obtained when increasing the measurand is different from the output obtained when decreasing the measurand. match the impedance of the sensor to the display – Convert analog signal to digital – Process the signal 20 …Generalized Medical Instrumentation System… • The specifications for a typical blood pressure sensor. (b) A high sensitivity sensor has high gain. • Other sensors yield the digital output (b).

and government.05 to 150 Hz 2. Figure shows an input signal without (a) and with (b) offset. (b) The resulting amplified signal is saturated at ±1 V. (a) Continuous signals have values at every instant of time. Note that all variables are italic. computer-based systems require periodic measurements since by their nature. Amplitude …Generalized Medical Instrumentation System… • The frequency response of a device is the range of frequencies of a measurand that it can handle. are drawn from research. computers can only accept discrete numbers at discrete intervals of time. Amplitude 5 mV (a) Time -5 mV Dynamic Range Amplitude (b) 1V Time -1 V 26 …Generalized Medical Instrumentation System… • DC offset voltage is the amount a signal may be moved from its baseline and still be amplified properly by the system.0 Amplitude (a) Time Amplitude 0.5 MΩ 0. which have been agreed upon by a committee.05 Hz Frequency 150 Hz (b) Dc offset Time 27 28 …Generalized Medical Instrumentation System… • Linearity is highly desirable for simplifying signal processing (a) A linear system fits the equation y = mx + b. …Generalized Medical Instrumentation System… • All bioinstrumentation observes the measurand either continuously or periodically. (b) A nonlinear system does not fit a straight line.1 µA 1s 5000 V 10 µA 25 …Generalized Medical Instrumentation System… (a) An input signal which exceeds the dynamic range. hospitals. However. industry.1 0. Amplitude Amplitude Time Output Output Input Input Time (a) (b) 29 (a) (b) 30 5 . • Figure shows Frequency response of the electrocardiograph. (b) Discrete-time signals are sampled periodically and do not provide values between these sampling times. 1. Specification Input signal dynamic range Dc offset voltage Slew rate Frequency response Input impedance at 10 Hz Dc lead current Return time after lead switch Overload voltage without damage Risk current at 120 V Value ±5 mV ±300 mV 320 mV/s 0. • Frequency response is usually plotted as gain versus frequency. – Table shows a few specifications for an electrocardiograph – The values of the specifications.…Generalized Medical Instrumentation System… • Bioinstrumentation should be designed with a specific signal in mind.

6 to 6. For example – Movement of electrodes on the skin may cause an undesired added voltage called an artifact. • Table in next slide is an example of one of these groups of measurements.…Generalized Medical Instrumentation System… • Signal conditioning – Amplify. Visual or acoustical • Auxiliary elements – Data storage – Data transmission – Control and feedback – Calibration signal 31 32 …Generalized Medical Instrumentation System… • Panels and series • Certain groups of measurements are often ordered together because they are very commonly used or because they are related. – The differential count tells how many of each type of white blood cell there are in one microliter of blood. 33 …Generalized Medical Instrumentation System… • Complete blood count for a male subject. match the impedance of the sensor to the display – Convert analog signal to digital – Process the signal …Generalized Medical Instrumentation System… • Output display – Results must be displayed in a form that the human operator can perceive • Numerical. • An erythrocyte is a red blood cell. as shown in Figure (next slide) . filter. Graphical. which are called panels or series. Temperature changes in the amplifier electronic components may cause undesired slow changes in voltage called drift. Laboratory test Hemoglobin Hematocrit Erythrocyte count Leukocyte count Typical value 13. Errors in measurements… 24Subat2k11 • When we measure a variable. • This true value may be corrupted by a variety of errors. • This may occur even if the measurements are based on different principles or are taken with different sensors.5 to 18 g/dL 40 to 54% 4. 35 36 6 . – Electric and magnetic fields from the power lines may couple into the wires and cause an undesired added voltage called interference – Thermal voltages in the amplifier semiconductor junctions may cause an undesired added random voltage called noise. • Hematocrit is the percent of solid material in a given volume of blood after it has been centrifuged.2 × 106/ µL 4500 to 11000/ µL Neutrophil 35 to 71% Band 0 to 6% Lymphocyte 1 to 10% Monocyte 1 to 10% Eosinophil 0 to 4% Basophil 0 to 2% 34 Differential count …Generalized Medical Instrumentation System • Hemoglobin is the protein which caries oxygen in the bloodstream. • A leukocyte is a white blood cell. – Unusual values for different leukocytes can be indicative of the immune system fighting off foreign bodies. Permanent or temporary. Discrete or continuous. • We must evaluate each of these error sources to determine their size and what we can do to minimize them. we seek to determine the true value.

…Accuracy and precision… • Data points with (a) low precision and (b) high precision. (b) An interfering input may shift the baseline. 39 40 …Accuracy and precision… • Accuracy – the difference between the true value and the measured value divided by the true value.…Errors in measurements… (a) Signals without noise are uncorrupted. high resolution does not imply high accuracy. …Errors in measurements… (a) Original waveform. • Repeatability – the quality of obtaining the same output from repeated measurements from the same input over a period of time. …Accuracy and precision… • Data points with (a) low accuracy and (b) high accuracy • Obtaining the highest possible precision. • a voltmeter with a larger number of digits has a higher resolution than one with fewer digits. and accuracy is a major goal in bioinstrumentation design. repeatability. 41 42 7 . (c) A modifying input may change the gain. – High resolution implies high precision. (b) Interference superimposed on signals causes error. Frequency filters can be used to reduce noise and interference. – However. (a) (b) 37 (a) (b) (c) 38 Accuracy and precision… • Resolution – the smallest incremental quantity that can be reliably measured. • Precision – the quality of obtaining the same output from repeated measurements from the same input under the same conditions.

• Calibration curves should be obtained at several expected temperatures to determine temperature drift of the zero point and the gain. 43 44 …Calibration (a) The one-point calibration may miss nonlinearity.) . whereas the standard deviation describes the variability to be expected among individuals in future samples. Then a one-point calibration defines the calibration curve that plots output versus input (next slide). – many points should be measured and plotted to obtain the calibration curve. – its output can be set to zero for zero input. – measurements should be performed at zero and full scale for linear instruments and at more points for nonlinear instruments.Calibration… • Measuring instruments should be calibrated against a standard that has an accuracy 3 to 10 times better than the desired calibration accuracy. • If the linearity is unknown. s= ∑ ( x −x ) i 2 n −1 • Used with the mean for symmetric distributions of numerical data. for example of the weights of a population. – The simplest statistic is the estimated sample mean Output Output x= Input Input ∑x n i where i = 1. 2. • If the output cannot be set to zero for zero input. – a two-point calibration should be performed and these two points plus the zero point plotted to ensure linearity (next slide). Calibration… • If the instrument is linear. etc. (b) The two-point calibration may also miss nonlinearity. TSI. Statistics • Mean – If we make n measurements of x.…n. • The accuracy of the standard should be traceable to the institutions regulating the standards (National Institute of Standards and Technology. • If the resulting curve is nonlinear. we may wish to report an estimate of them in a condensed way. sx = ∑s n −1 47 48 8 . (a) (b) 45 46 Statistics • Standard Deviation – A measure of the spread of data about the mean is the estimated sample standard deviation Statistics • Standard deviation of the mean (standard error of the mean (SEM)) – Expresses the variability to be expected among the means in future samples.

or the incidence of light photons. or other.2 x x p 0. among other things. one of the two hypotheses must be true. which has a smaller standard deviation sx. • In reality. is a hypothesis that assumes that the variable in the experiment will have no effect on the result – Ha is the alternative hypothesis that states that the variable will affect the results. …Poisson Probability • A typical Poisson distribution for m = 3. there are two hypotheses. – H0.Gaussian Distribution… • The spread (distribution) of data may be rectangular. …Hypothesis testing… • The four outcomes of hypothesis testing.1 x x 0 0 1 2 K 3 4 5 x x • The probability that a particular number of events K will occur in a measurement (or during a time) having an average number of events m is e m p ( K . the null hypothesis. cells flowing through a counter. m) = K! −m K • The standard deviation of the Poisson distribution is m 51 52 Hypothesis testing… • In hypothesis testing. This leads to four possibilities (next slide) Correct decision Type I error. 0. Conclusion H0 true Accept H0 Reject H0 Real situation Ha true Type II error. H0 is either true or false and we draw a conclusion from our tests of either true or false. – It can describe. p = b Correct decision • For any population. Estimated mean xs standard deviation sx Frequency Population standard deviation σ f (X ) = e − ( X − µ ) 2 /( 2σ 2 ) 2π σ where µ is the true mean and σ is the true standard deviation of a very large number of measurements. p = a 53 54 9 . we obtain the estimated mean . α is the tail probability that xs does not differ from µ by more than δ. skewed. By measuring samples and averaging. 68% of the data lies within ±1 standard deviation. • The Gaussian distribution is given by …Gaussian Distribution • For the normal distribution. 49 α −σ δ µ Mean +σ x 50 Poisson Probability… • The Poisson probability density function is another type of distribution. Gaussian. • The goal of hypothesis testing is to find out which hypothesis is true by sampling the population. the probability of radioactive decay events.

negative predictive value (NPV) is the ratio of nondiseased patients to all who test negative. for example. Specificit y = TN 100% TN + FP 57 58 …Hypothesis testing… • Considering only those who test positive. a disease in a population and the success of a test in identifying it. it is the percent who test negative. Normal population Threshold • Considering only those who test negative. NPV = TN 100% TN + FN True negative False positive. • It is all diseased persons divided by all persons. …Hypothesis testing… • The terms in the Table in previous slide are useful for defining measures that describe the proportion of. such as x cases per 1000 per year. • Incidence – is the number of cases of a disease during a stated period.…Hypothesis testing… • Equivalent table of the table given in previous slide for results relating to a condition or disease. Prevalence = TP + FN TN + TP + FN + FP • Specificity Sensitivit y = TP 100% TP + FN – the probability of a negative diagnostic result in the absence of the disease. positive predictive value (PPV) is the ratio of patients who have the disease to all who test positive. it is the percent who test positive. – Among all diseased persons. PPV = TP 100% TP + FP …Hypothesis testing • The test result threshold is set to minimize false positives and false negatives. Test result No Negative Postitive Has condition? Yes False negative (FN) True positive (TP) True negative (TN) False positive (FP) 55 56 …Hypothesis testing… • Prevalence – the number of cases of a disease at a given time such as y cases per 1000. …Hypothesis testing… • Sensitivity – the probability of a positive test result when the disease is present. p = β True positive 59 60 10 . – Among all normal persons. p = α Diseased population False negative.

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