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Fundamentals of Biomedical Instrumentation

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lntroduction

a Inside this
1.1. Background
1.2. Development
chapter

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1.3. Specification of Requirement
1.4. Man Instrumentation
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1.5. Problems Encountered in Measuring
a Living System
1.6. Anatomy and physiological
1.7. Summary

BACKGROUND
The prefix bio, means something connected
engineering. Biophysics and biochJmistry
with rife in biomedical
interdisciplines basic sciences
have been applied to living things. Similarly,
Bio-instrumentation means
measurement of biological variables, Trre
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fiela of measurement is referred


to as biometrics.
one of the major contributions of biomedicar engineering
sciences and clinical medicine has been to life
instrumentation. Advances in this fierd have trr.r"?r, boimedicar
resulted in i'n" development
of new types of biomedicar instruments
and the development of numerous
clinical approaches, such as electronic patient
monitoring, an important
aspect of critical case medicine, as well
as varieties of dlvices to assist
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individuals with disabilities.


Engineering Joint council committee
with Biologz and Medicine recommendated that
on Engineering Interactions
as application of the knowledge gained bybio-engineering
a
be derrned
engineering and the biorogi"d fertilization of
".J""
"Ji..r"".s so that both will be more fulry
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Fundamentals of Biomedical Instrumentation
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utllized for the beneht of a man. Biomedical engineer is a person working


in research or development in the interface area of medicine and
engineering, whereas practioner working with physicians and patients is
called a clinical engineer. Association for the Advancement of Medical

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Instrumentation (AAMI) consists of both engineers and physicians. A
clinical engineer is a professional who brings to health care facilities a

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level of education, experience, and accomplishment which will enable
him to responsibly, effectively, and safely manage and interface with
medical devices, instruments, and systems and the use thereof during
patient care, and who can, because of this level of competence,
responsibility and directly serve the patient and physician, nurse, and
other health care professional, relative to their use of and other contact
with medical instrumentation. Most clinical engineers go into profession
through the engineering degree route, but some may start out as

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physicists.
Some of the instruments like electrocardiograph were first used by
the end of nineteenth centuiy. But the progress was slow until the end
of World War-II. After the war lot of electronic equipments such as
amplifiers and recorders became available. Many technicians and
engineers started to experiment with and modified existing equipment
for medical use. The result of development did not yield good result
dueto the lack of unders-tanding of physical parameters and
communication problem with the medical professionals.
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DEVELOPMENT
During 1951-60, many instrument manufacturers entered the field
of medical instrumentation. But development was slow due to high costs
of development. The hospital staffs was reluctant to use new equipment.
Many times, the medical staff was uncooperative. In view of this, some
progressive companies decided to design instrumentation specifically for
medical use instead of modifying the existing hardware.
Help was provided by the US government, in particular by NASA. A
large number of physiological parameters needed to be monitored for the
astronauts. Hence, aerospace medicine programmes were expanded
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considerably, both within NASA facilities, and through grants to


Universities and hospital research units. Some of the concepts and
features of patient-monitoring systems presently used in hospitals all
over the world is based on astronaut monitoring system. In short, the
engineers and technicians started working with medical professionals.
, The biomedical engineering involves communication between the
engineer and the medical professional. The language of the physician is
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quite different from those of the engineer. The physician must understand
enough engineering terminologr for him to discuss problems with the
engineer. The burden of bridging the communication gap falls on the
engineer. The result is that the engineer, must learn the doctor's language,
as well as some anatomy and physiologr, in order that the two disciplines
can work effectively together.
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REQUIREMENT
Any instrumentation system generally should achieve one of the
following major categories for meeting the basic objective.

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1. Information gathering : Instrumentation is used to measure natural

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phenomena and other variables to aid man in his search for
knowledge about himself and the universe in which he lives.
2. Diagnosis : For the detection and, hopefully, the correction of some
incorrect behaviour of the system being measured the measuremens
are made. This type of instrumentation may be classified as
"troubleshooting equipment,,.
3. Evaluation : Measurements hetp to determine the ability of a system

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to meet its' functional requirements. These could be classihed as
"proof of performance" or ,,quality control,, tests.
4. Monitoring : Instrumentation helps in monitoring some process or
operation in order to obtain continuous or periodic information
about the state of the system being measured.
5. control : Instrumentation may help control of the operation of a
system based on changes in one or more of the internal parameters
or in the output of the system.
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Biomedical instrumentation involves all the objectives of the general
instrumentation system. Instrumentation for biomedical research can
generally be considered as information gathering instrumentation. It
also includes some monitoring and control devices. Instrumentation helps
the physician in the diagnosis of disease and other disorders also has
widespread use. Instrumentation is arso used in evaluation of the physical
condition of patients in routine physical examination. Special
instrumentation system, are used for monitoring of patients undeigoing
surgery or are kept in intensive care.
Biomedical instrumentation can generally be divided into following
types:
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1. Clinical instrumentation
2. Research instrumentation
clinical instrumentation is basicarly used for the diagnosis, care and
treatment of patients. But research instrumentation is used for acquiring
new knowledge pertaining to the various systems that compose the human
organism. Although some instruments can be used in both areas.
clinical instruments are more rugged and easiar to use. The main
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thrust is to obtain a limited set of reliable measurements from a large


group of patients and on providing the doctor with enough information
to permit him to make clinical decistons.
on the other hand research instrumentation is normally more
complex, more specialized and is often designed
to provide a much
higher degree of accuracy and resolution.
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Fundamentals of Biomedical Instrumentation

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Research instruments are generally operated by skilled technologists


whose primary training is in the operation of such instruments.
Biomedical instrumentation is dirrided into two categories: in vivo
and in vitro. An in vivo measurement is that is made on or within the

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living orJanism itself. An example would be a device irrserted into the
blood stream to measurc pH of the blood directly. An in vitro

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measurement is one which is performed outside the body, even though
it relates to the function of the body. In vitro rneans "in glass" i.e.,
the measurements are to be performed in test tubes. The man-
instrument system dealt in this book applies mainly to in vivo
measLlrements. However, obtaining appropriate samples for in vitro
measLlrements and in relating these measurements to the living human
being is problematic.

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1.4. MAN INSTRUMENTATION SYSTEM
Biomedical instrumentation is a set of instruments and equipment utilized
in t1-re measurement of one or more characteristics or phenomena, and
the presentatjon of information obtained from those measurements in a
forrl that can be read and interpreted by man. This is the definition of
instrument from the complete man-instrument system v,-hich must also
include the human or: subject on whom the measurement are being
macle.
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Due to special pi:oblems faced in getting data from living organism,
specialll, hr-tman beings, and because of the large amount of interaction
between 1he instrumentation system and the subject being measured, it
is necessary that the person on whom the measurements are being
made be considered an integral part of the instnrmentation sYstem. In
order to make sense out of the data obtained from the black box the
humans organism) the internai characteristic of the black box must be
considered in the design and application of any instruments. The overall
svstem, which includes both the organism and the instrumentation
required for measurement of the human is called the man-instrument
system.
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Initially, it rvas almost impossible to measure and understand the


internal relationship of the human body. The function of medical
instrumentation is to aid the medical clinician and researcher in devising
ways of obtaining reliable and meaningful measr-rrements from a living
human being.
There are problems associated u,ith such measurements. The process
of measuring must not in any way endanger the life of the person on
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whom the measurements are being made. It should not cause undue
pain, discomfort. This means that many of the measurement techniques
normally employed in the instrumentation of nonliving systems cannot
be applied in the instrumentation of huuans.
Man instrumentation system involves the measurement of outputs
from an unkno-rvn s-vstem as they are affected by various combinations
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Fundamentals of Biomedical Instrumentation \

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of inputs. The requirement is to understand the nature and
characteristics of the system. The unknown system is referred as a
black box. It has a variety of configurations for a given combination of
inputs and outputs. The end product of such an exercise is a set of

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input-output equations for the internal functions of the black box.

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These functions may be simple or extremery complex. The living human
being is one of the most complex black boxes. This black box consists
of electrical, mechanical, acoustical, thermal, chemical, optical,
hydraulic, pneumatic and many other types of systems. These systems
may interact with each other. The human being here referred to as
black box may also contain a powerful computer, severar types of
communication systems, and a great variety of control systems. However,
living black box gives risc to other probrems. Many of the important

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variables to be measured are not readily accessible to measuring devices.
The measuring device itself introduces some error.
Some other some problems in obtaining correct measurements are
(1) Safety considerations, (2) the environment of the hospital in which
these measurements are performed (3) the medical personnel usually
involved in the measurements and (4) sometimes even ethical and legal
considerations.
Basic principle of biomedical instrumentation is shown in figure 1. 1
block diagram. Here, any phiological event becomes input of a
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transducer. Transducer gives transduced electrical signal which is
subjected to signal conditioning. Subsequentity, the output signal is
displayed and or saved.
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Fig. 1.1. Basic principle of biomedical instrumentation


A human being as a whole communicates with his environment 1n
many ways which can be termed as inputs and outputs as shou,n in
figure 1.2. These inputs and outputs can be measured and analyzed. in
a variety of ways.
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Fundamentals of Biomedical Instrumentation

6 Fundamentals of Biomedical lnstrumentation

HUMAN BODY AS GONTROL SYSTEM OUTPUTS

Speeking

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Behaving

Sm ng
Looks

Exhailing
lnhaling

Movement

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Sensation ot Body
due to touching

lntake of Liquid

lntake of Food
Liquid in
Waste form
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Solid in
waste form

Fig. 1"2. Depiction of human communication with the environment


in like a control system
The man-ir-rstrument system block diagram is shown in figure 1.3,
urhich shows the components of the system. Here, a living human being
is a part of the system. The components are as follows:
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Transducer-1
Body Temperature
Signal
Conditi-
onrng
Device
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Transducer-4
Body muscles
Data processing, recording
and transmission

Fig. 1.3. Block diagram of man-instrument system

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Fundamentals of Biomedical Instrumentation t

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1.4.1. Subject
The human being on whom the measurements are made is knor,vn
as subject. The subject who makes this system different from
other instrumentation systems are treated in much greater cletaii in

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section 1.5.

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1.4.2. Stimulus
The response to some form of external stimulus is required. The
instrumentation used to generate and present this stiinulus to the subject
is an essential part of the man-instrument system whenever responses
are measured. Visual (e.g. a flash of light), auditory (e.g., a tone) tactile,
or direct electrical stimulation of some part of the nervous system of any
subject.

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1.4.3. Transducer
A transducer is defined as a device capabie of converting one form
of energ,' or signai to another. In the man-instrument system, each
transducer is used to produce an electric signal. It is in the form of
analog signal of the phenomenon being measured. The transducer may
measure temperature, pressure flow or any of the other variables that
can be found in the body, but its output is always an electrical signal.
As shown in figure 1.3, two or more transducers may be used
simultaneously to obtain relative variations between phenomena, the
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example shows four transducers.
1.4.4. Signal-Conditioning Equipment
The instrumentation system part which amplifies, modifies, or in any
other way changes the electric output of the transducer is called signal
conditioning equipment. The purpose of signal conditioning or signal
processing equipment is to process the signals from the transducers in
order to satisfy the functions of the system and to prepare signals
suitable for operating the display or recording equipment.
1.4.5. Display Equipment
The output of the signal conditioning equipment must be converted
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to some form of visual, audible, or possible tactile information. In the


man-instrumentation system, the display equipment may include a
graphic pen recorder that produces a permanent record of the data.
1.4.6. Recording, Data Proeessing and Transmission Equipment
Recording of the measured information is done for possible later usc:
or to transmit it from one location to another, whether within the hospital
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or around the worid. Equiprnent for these functions is often an important


part of the man-instrlrment system. Where automatic storagc or processing
is required or where computer control is employed, an on line analog or
digital cornputer is a pnrt of the instrumentation system. The recorder
is used in two different contexts in biomedical instrumentation. A graphic
pen recorder is actually a display device used to produce a paper record
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Fundamentals of Biomedical Instrumentation

8 Fundamentals of Biomedical lnstrumentation


are devices by which data
waveforms' The recording equipment
of analog-recorded
such as in a magnetic taPe
for future play back'
;;; ;"
recorder, etc.

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1.4.7 . Control Devices

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It it is necessary to have automati

instrument sYstem'

PROBLEMS ENCOUNT

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and physiological systern of the btdy.d",*11P^"
T:3,T*:ilT'Jlffi'"T.1t1":i';:ffi'#;i;;;;il"'^c'i"k"ltl:;
measurement on a human subJect'
t.or rllca'-ururrrvrrL rre'
measuremellt
..rpments are done on animal su 'jects' The
some measurements
below
problems are summ arized as given
:

1.5.1. lnaecessibility of Variables to


Measurement

ManY times it is not Possible t


system. In some cases, such as
.r"t ro.fr"-ical activity in the brain
transducer to make measuremen
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and some
In using
riable mus ood'

1.5.2. YariabilitY of the Data


Some of the variables measured
variables. In fact such variables s
processes. A stochastic process is-a
in a nondeterministic waY' PhY
deterministic st be rePre
or Probabilist The meas
at
not be same und'er ttre same conditions
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conditions at to another is even greater'


another time. The variability from one subject
1.5.3. Lack of Knowledge About lnterrelationship
The variabilitY in measured val
were known and understood abo
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would help use of indirect measure


System
1.5.4. lnteraction Among Physiological
number of feedb volved in the major
Due n exists both within
physiolo , a severe degree The result is that
a given
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Fundamentals of Biomedical Instrumentation
lntroduction 9

parts of that
stimulation of one part of a given system affects all other
as weil'
system in some *ay and oftEn affects other systems
1.5.5. Effect of the Transducer on the Measurement
by the presence

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Any kind of measurement is affe
complex in the-
of the measuring transducer' The

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sical presence of
measurement of living systems' In m
the transducer changes the reading significantly'
1.5.6. Artifacts
The term ar s a signal that is extlaneous
to the variable e ajor source of artifacts in
the measuring g ment of the subject'

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1.5.7. EnergY Limitation
Some physiological measurement techniques
require that a certain
amount of energr ie applitd -to the living system in order to obtain a
measurement.Forexampleresistance-",...,.".entrequiretheflowof
measured'
electric current ttrrough the tissues or blood being
1.5.8. SafetY Gonsiderations
being subjected to
There should be no danger to the life of the living
must be taken in the design
rneasuring variables. Extra caution must be
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ofanymeasulementsystemtoprotectthepatient.similarlythe
cause undue paiir'
-.."r.i..-ent should not
1.6. ANATOMY AND PHYSIOLOGICAL
being' it is necessary
In order to obtain valicl measurements from a iiving
of the subject on which the-measurements
to have some
are being m e human body one can find electrical'
mechanical, t lic, pneumatic' chernical and various other
types of sys which communicates with an external
environrnent. with the other systems of the bodl'' These
complex functions by
individual systems are orgamzed to perform many
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network' The
means of a multilevel control system and communication
va
integrated operation of all these sy
heip to srrstain 1ife. learn to perfo
ac

Anatomy of human bodY is sho


(a)

of the bodY and so cal


humane
"Y"t"rr. functional s5rstems of the body are the nervous
i"-irgrt. i.+1tt1. The human
the cardiovascular system and pulmonary sys-tem' The
"y"iJ-,
systemComponent".o,,,'...,.,,i"atern,ith",..hoth".aswellaswithexternal
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be yzed
environment. These inputs ancl outpu but
in a variety of ways. Most are r sibl
are and
some like speech, behavior ancl
interpret needing special -technologres'

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Fundamentals of Biomedical Instrumentation
10 Fundamentals of Biomedical lnstrumentation

Electro-encephalogram
(Nervous system) Electro-occulogram

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(Occular system)

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Bespiratory
Esophagus Temperature Parameter
Pulmanary system

lmpedence
Pneumography
(lungs) Blood Pressure
Phonocardiogram (Cardiovascular system)
(heart sound)

Electrocardiogram
(Heart)

Pulse-Rate
Cardiovascular system
ate Electromyogram
(muscular system)

Blood Flow
(cardiovascular
system)
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Fig. 1.4. (b) Physicology of human body and sources of biomedical


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The major role of biomed.ical instrumentation is to make possible the


measurement of information communicated by these various elements
bigger or smaller unit of body such as cellular level or even molecular
level. If ail the variables at different ievels can be measured and evaluated

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then the functions of the mind and body of man could be clearly
understood and could be completely defined by pr-esently known laws of

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physics, chemistry and other sciences. The difficulty is that many of the
inputs are not accessible for measurement. The interrelationships among
elements are sometimes very complex ancl involve so many systems that
the 'laws' and relationships thus clerived are inadequate to define them
completely. Thus the mathematicai models in use toclay contain so many
assumptions and constraints that their application is often limited.
A brief engineering oriented description of the major physioJogical

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systems oft the body are given below:
1.6.1. Biochemical System
An integrated unit of chemical systems that produce eners/ for the
actirzity of the body, messenger agents for communication materials for
body repair and growth, and substances required to carry out the various
body functions are within the body. A11 operations of this highly efficient
chemical factory are managed by a single point of intake tor ruet (food),
water and air, all the source materials for numerous chemical reactions
are produced with in the body. The body contains all the monitoring
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equipment needed to provide the degree of control necessary for each
chemical operation and it also has an efficient waste disposal system
similar to a chemical factory.
1 .6.2. Cardiovascullar System
Figure 1.5 shows a cardiovascurar system and figures 1.6 (a) and (b)
show alatomy of heart and a cutview of heart respectively. Cardiovascular
system can be considered as a complex and closecl hydraulic system with
four-chamber pump the heart connected to flexible elastic tubing blood
vessels. The arteries and arterioles tubing changes its diameter to control
pressure. Reservoirs in the veins changes their volume and characteristics
to satis$r certain control requirements, ancl a system of gates and variable
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hydraulic resistalces such as vasoconstrictors and vasodilator, continually


alters the pattern of fluid flow. 'lhe 1bur chamber pump acts as two
s5mchronized but functionally isolated two stage pumps. The first stage of
each pu'.np, i.e. the atrium collects blood from the system and pumps it
into the second stage the ventricle. 'lhe action of the second stage is so
timed that the blood is pumped into the system immediately aftei it has
been received from the hrst stage. one of the two stage pumps, 1.e., right
side of heart collects blood from the main hydraulic system, i.e., systeriric
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circuleLtion and pumps it through an oxTgenation system, Le., lungs. The


other pump i.e., left side of heart receives blood from the oxygenation
systern and pumps it into the main hydraulic system. The speed of the
pump, i.e., heart rate and its efficiency, i.e., stroke volume are constalily
changed to meet the overall requirernents of the system. The btood which
flows; in a laminar fashion, acts as a communication and supply network
forNo.
Page all parts
11ofofthe system. carriers, i.e., red, blood cells of fuel supplies and
328.
Fundamentals of Biomedical Instrumentation

12 Fundamentals of Biomedical lnstrumentation

3racil;+cepha!ic 5i Leli L*ll *crir-,*n caroti* arie!-Y

ni3hi julJlrlsr veril

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:ubcla.Jian L*lt pr,t}l,tion*tY
"*,\ ' ai'le i!'
L.*ii pi.tltttonai'Y v*ti:s

$eplur: I

'f
irici.r*i'i fi:ratietr ovaie

{JriJir-,e ci \litral valtre

ate
i116rial! vat$ faiiii la. ,1.,1 i! I O, til e
t()rx lslt ventricls
1-* pi;imli.l+.rY
, critire lr*m
riSht v*ritricie
Coeirac aiL{:ry
Sui:erior
11:esentaftc
prlery

{rirena-.1
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lJuciili
vanoSils
r!l ir:r.r

_'\i'i.i,'
ri'-^r'.,

!,tf;. ro nresrnle'ir, ar iei I

ulmbilict-is
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Lj, tl;irr ll ;lt i;i " -i


.,2 \
lJ r irar 1., bl::,:!Cet \

Fig. 1.5. Cordiovascular SYstem

waste materials are transported to predetermined destinations by


the
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fluid. The f1uid. aiso contains mechanism for repairing small system
punctui:es, i.e., arrd. for rejecting foreign elements from the system' i'e"
plrt.t"t" and white blood cells, respectively. Sensors provided to detect
in the need, for supplies, and built up of waste materials' and
"h"ng""
out of tolerance pressures in the system are known as chemoreceptors,
P"o, senSors and baroreceptors, respectively' These and other mechanisms
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lntrociuction 13

control the pump's speed and efficienc;r, the blood flow pattern through
the system, tubing diameters, and clther factors. Rs pait of the system
works against gravity, special one-way varves are piovided to pievent
gravity from pulling blood against the direction of flow between pump

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c5zcles. The variables of prime importance in this system are the pr-p,
i.e., cardiac output and the pressure, flow rate and volume of blood at

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various locations throughout the candiovascular system.
To head
To right arm
To left arm
Aortic arch to body

Lu ngs .-...-....-*"-.*. To left arm

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Superior vena cava Pulmonary vein
- Left atrium
Valve

Valve *****'***

lnferior vena
Left ventricle
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cava from body
Bight ventricle

Fig. 1.6(a). Anatomy of heart


pulmonary artery aorta
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vena Pulmonary vein

right atrio /
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ventricular valve venticular valve

right ventricle left ventricle


Fig. 1.6(b). A cut veiw of heart
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Fundamentals of Biomedical Instrumentation

14 Fundamentals of Biomedical lnstrumentation

1.6.3. RespiratorY SYstem


The card.iovascular system is the major hydraulic system in the
pump' i'e''
body, the respiratory systlm is the pneuntatic system' At air
and positive pressllres

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diaphragm, which alternatively creates negative
ln a sealecl chamber, i.e., tltotacic cavity, be suc

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the forced out of a pair of elastic bags, i' ated wi
compartment. The bags are connected to the onment
n p."".g"*ay, i.e., nlsal cavities; pharynx, larynx' trachea' bronchi and
bronchioles,whichatonepointisC)mmonwiththetubirrgthatcarries pnematic
liquids and solids to the stomach. A speciai value interrupts the
;;'."i"- whenever liquid or solid matter passes through the common
region. The passageway divides to carry air into each of
the bags' wherein
des m carry ai out f the

ate
air sP ary alve the duel
nasal an alter i'e', h for
for other special purposes' In the
use in the event of nasal blockage and
tinyairSpacesofthebagsisamembraneinterfacewiththebody,s is
hydraulic system through which certain gases can diffuse' Oxygen is
air' and carbon dioxide
taken into the blood fiom the incoming
transferred from the fluid to the air, which is exhausted
by the force of
with a two way override' An
the pneumatic pump. The pump operates
automatic control center, i.L', respiratory center of the brain maintains
rlu is aclequats n and carry
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the sYstem. s of Primary
off tory volume
im resPiratory
exPrred air' ativelY fixed
an
volurnesandcapacitiessuchastidalvolurnethevolumeinspiredor
expired during each normal breath, inspiratory reserve volume
the
additional volume that can be inspired after a normal inspiration'
expiratory reserve volume the additlonal amount of air
that can be
forcedoutofthelungsafternormalexpiration,residualvolume(amount
ofairremainingint-helungsafternormalexpiration)residrralvolurne,
i.e., amount of air remainin"g in the lungs after all possibie
air has been
plus inspiratory reserve
forced out and vital capacity, i.e., tidal volume,
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volume, plus expiratory reserve volume are contained in the respiratoy


system.
1.6.4. Nervous SYStem
system. Its
The communication network for the body is the nr:rvous
centerisaself_adaptingcentralinformationprocessororcomputerthe
brain with merno.y, ",i-prtational power, clecision rnakingincapability
that if a
ancl many input_o,1iput channels. The brain is self
adapting
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eventually take
certain section is damaged, other sections can adapt and
over at least in part thJ function of the damagecl section ' By r-lse of the
brainapersonisabletomakedecisions,solvecomplexproblems'create I
art, poeiry, music, "feel" e informat
Produce I
parts of tire body, anC coo
nication t
tehaviour. The brain has
bringsSensoryinformati.onintoancltransmitcontrolinformationoutof
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lntroduction 15

the brain. In general, these lines are not single long lines but often
complicated networks with many interconnections that are continually
changing to meet the needs of the system. By means of the interconnection
patterns, signals from a large number of sensory devices, which detect

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light, sound, pressure, heat, cold and certain chemicals are connected
to the appropriate parts of the computer, where they can be acted upon.

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Similarly, output control signals are directed to specific motor units of
the muscles which respond to the signals with some type of motion or
force. Feedback regarding every action controlled by the system is provided
to the brain through appropriate sensors. Information is coded in the
system by rneans of electrochemical pulses nerve action potentials that
travel along the signal nerves. The pulses can be transferred from one
element of a network to another in one direction only, and frequently the

ate
trensfer takes place only when there is the proper combination of elements
acting on the next element in the chain. Both serial and parallel coding
are used sometimes together in the same direction. In addition to the
central computer, a large number of simple decision-making devices
spinal reflexes are present to control directly certain motor devices from
some sensory inputs. A number of feedback loops are formed by this
method. A11 the important decision making is performed by the brain.
yM
Age of Biomedical Engineering: In I974, a society in the name of
Association for the Advancement of Medical Instrumentation (AAMI)
was formed. It gave the following definition of the clinical engineer.
'A clinical engineer is a professional who brings to health care facilities
a level of education, experience, and accomplishment which will enable
him to responsibly, effectively, and safely manage and interface with
medical devices, instruments, and systems and the use thereof during
patient care, and who can, because of this level of competence,
responsibility and directly serve the patient and physician, nurse,
and other health care professional, relative to their use of and other
contact with medical instrumentation."
Development of Biomedical Instrumentation: The development of
ud

2.
bio-medical engineering started just after \Alorld War II. With the
availability of discarded electronic circuits like amplifier, oscillators,
etc. and availability of skilled manpower due to recession. The real
:S development started when NASA was launched.
te The living human being is considered as a black box. This black box
v consists of electrical, mechanical, thermal, chemical and other type
a of systems. The function of medical instrumentation is to aid the
St

ie medical clinican and researcher in devising ways of obtaining reliable


te and meaningful measurement from a living being.
Ie The basic objective of the man instrutlentation system is one or
Lll more of the following objectives:
rl (rJ Information gathering
rt (ir) Diagnosis
of
Page No. 15 of 328.
Fundamentals of Biomedical Instrumentation
16 Fundamentals of Biomedical lnstrlrmentation

(lii) Evaluation
(iu) Monitoring
(u) Control
Ja Specification of Requirement : Instrumentation for biomedical

l
research can generally be vier,ved as information gathering
instrumentation. Although it sometimes includes some monitoring

ria
and control devices.
Biomedical instmmentation can generally be classified into following
categorles:
1. Clinical instrumentation
2. Research instrumentation
Clinical instr-umentation is bascially used for diagnosis and are rugged
in nature. The research instrumentation is normally more complex,

ate
more specialised and designed to provide a much higher degree of
accuracy, resolution.
Measurement in biomedical instrumentation can be further subdivided
into two categories in vivo and in vitro. An in vivo measurement is
made within the living organism. While the invitro measurement is
one which is performed outside the body and normally in the test
tube.
Man Instrument System: The block diagram of the man
instrumentation system can be seen in figure 1.3. The major aspect
is the inclusion of human being u.hich is named as a subject.
yM
Phisological events of human body give signals to suitable transducer.
Electrical output of transducer is passed though signal conditioning.
Subsequently, the output can be recor:ded or displayed. The stimuls
given to the subject may be in the form of visual, auditory or an
electrical impulse.
5 Problems Encountered in Measuring a Living System: The following
problems are encountered, to measure parameters correctly in a
living system.
(a) Inaccessibility of variables to measurement.
(b) Variability of the Data.
ud

(c) Lack of knowledge about interrelationship.


(d) Interaction among physiologica.l system.
(e) Effect of transducer on the measurement.
f) Artifacts.
(g) trnergz limitator.
(h) Safety consideration.
6. Physiological Anatomy of the Body: The functional systems of the
body can be further subdivided into smaller units. The process of
St

subdivision can continue upto cellular or molecular level.


A brief of the engineering oritented description of the major systems
like biochemical cardiovascular, respiratory and nervous systems are
given below.

Page No. 16 of 328.


Fundamentals of Biomedical Instrumentation t

lntroduction 17

(a) Biochen'Lical System'. The human body has biochemical system


which produces energy for the body, messenger agents for
communication, materials for growth of the body by a single
point intake, i.e., food, water and air.

l
(b) Cctrdiouascular system: Tl:'e caridodvascular system can be
explained as a complex closed hydraulic s).stem with four Chamber

ria
pump (heart) connected the blood vessels, ateries and arterioles.
the tubing changes its diameter to control pressure. It works as
a synchronised pump in which the first stage of each pump
(atrium) collects the blood from the system and pumps it into the
second stage (ventricle). The action of second stage is so timed
that the fluid is pumped into the system immediately after receiving
it from the hrst stage. Then the right side of the heart (atrium)
is to collects the fluid from the main hydraulic system and pump

ate
it through lungs for oxygenation. The other pump (left side of the
heart) received the oxygenated blood and pumps it into the main
hydraulic system to all the organs.
(c) Respiratory system is a pneumatic system where the oxygen is
inspired in the elastic bags (lungs). The lungs are connected to
outside world by nasal cavities, pharynix, larynx, trachea. The
lungs oxygenate the blood and take out carbon dioxide, which
is expired to the outside world.
la) Neruous system: The nervous system or brain just works like a
yM
computer. Its centre is a self adapting central information system
with memory, computational power, decision making capabilities
any many input output channel. The information is generally
coded in the system by means of electrochemical pulses that
travel along the nerves. Both serial and parallel coding are used
sometime in the same direction. A number of feedback loops are
formed.

txerciaea
1.1. Explain the various components of physiological system of body.
ud

(UPTU-2004\
7.2 Explain the difference between measurement in physiological system and
physical system. (UPTU'MQPI\
1a
l -.)_ Discuss the various objectives of a medical instrumentation system.
(UPTU-2OOs\
1,.4. What are the various problems encountered in measuring a living system?
Explain ARTIFACTS (LIPTU-2003\
1.5. Explain the difference between the in vivo and in vitro measurement.
St

(UPTU-MQPs)
),.6. Discuss biomedical instrumentation types nameiy for clinical and research
purposes. How they differ from each other?

AJJ
Page No. 17 of 328.
Fundamentals of Biomedical Instrumentation

l
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Bioelectric Potentials

>- faside this chapter


Introduction
Bioelectric Potentials ate
Resting and Action Potentials
Propagation of Action Potential
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Physrological Potentials-trCG, EEG, ERG and EOG
trnvoked responses
Summary

INTRODUCTION
Human cells are too small in size. They can be seen only through a
microscope. Each cell has generally one nucleous and an outer plasma
membrane. Figure 2.1. (al shows a cell in magnihed form which depits
ud

important elements.
Various signals are generated by human body in the process of
carrying out various functions. These generated signals are bioelectric
potentials which relate with nerves muscular activity, heart beat, etc.
Bioelectric potentials are consequence of chemical changes in the
associated cells.
The muscle cells can be excited chemically, and mechamically to
produce an action potential that is transmitted along their cell membrane.
St

They have a contractible machinism that is activated by action potential'


Muscle is divided into three types-skeleta, cardiac, and smooth. Skeleta
muscle makes up the great mass of the somatic musculture has well
developed cross siriations does not normally contract in the absence of
l8
Page No. 18 of 328.
Fundamentals of Biomedical Instrumentation I

Bioelectric Potentials 1g
nervous stimulation lacks anotomic

l
ria
spontancoeusly.
Smooth muscre racks cross-striations.
The type found in most hoilow
al and contains pacemakers that discharge
the eye and in some other locations is not
embles skeletal muscle.

Rough endoplsamic

ate
reticulum (RER)
Lysosome

Cytoplasm
Vacuole
Centrosome

Nuclear membrane Mitochondrion


Nuclear pores
Chromatin
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Microtubule

Smooth endoplasmic
reticulum (SEB)

Golgi complex Bibosomes

Cell membrane Agranular endoplsmic


reticulum

Fig. 2.1. (a) A magnified view of a cell

2.2. BIOELECTRIC POTENTIALS


ud

3j"',::l_:'?::^"^o^Tj-","^"9
certain
result
l:
" as :f
special type of ce ls are known
,!.
electrochemical activity or
bioelecrri" pot..rtiuf ;;#ffiJ.:i
3:H.*::":::,"'l_,:it",o-1,:-1,,?rsinto..erect,i""r;i#:;,#";ffii:
i terpreted ,""r,,ny i, ;;;;;?r ;;;;" ;i".l1i:
:?::::i:"j:1.1lg
physician in diagnosis and rreatment ,i
o, generate";ri;;";ilil:
o their own monitoring si gnal s
:.::i::, :r_"::.T:,,^1_,1various
II firnctions. rhese signals
.d. ;;;:=, #il1
St

*:i._""T:r:"::y:,1:ir ry' ":["J",1"'j:J


11:?:i1,;..^1
ionic ^io 1.",,
voltages, : :,io., potenirats.
i.e., |bioelectric " tr,.y ; ; ;;
;
".; ;.
Bioerectric
J DrBrriils are
,u
generated due potentials are
to nerve concluction, brain activity, heart bea.t,
activity, etc. muscle
special type of cerls such as nerve and muscre
are encased in a semipermeabre membrane.
celrs of human body
The semipermeable membrane
Page No. 19 of 328.
Fundamentals of Biomedical Instrumentation

20 Fundamentals of Biomedical lnstrumentation

permits some substance to pass through while others are not permitted.
This has been established through experiments'
The ions inside the membrane are called Intetnal Cell Flui.d arrd
the ions outside the membrane calied External cell Fluid as shown in

l
figure 2.r lb).

ria
External
Cell Fluid

lnternal
Cell Fluid
K'

ate
Semi permeable
Membrane
Na*
Fig. 2.1. (b) Semipermeable membrane
Whenthesemipermeablemembraneisinnorrnalcondition,the
sodium ions (Na*) remains outside the membrane. In the normal condition,
the sodium (Na;) ions cannot pass through the membrane. However,
permeability of
fotassium (K*) ions can pass through the membrane as (Na*) ions'
iotassium iX*l iorr" is too high as compared to sodium
If the membrane is stimulated or excited, the characteristics of
in
yM
nrembrane changes, therefore, the sodium ions can enter as shown
f,rgure 2.2. once the membrane is stimulated, all the sodium
ions can
eiter the membrane. At the same time, potassium (K*) ion try to leave
the cell. The distribution of ions is as follows:
Ions lnternal Extetnal
Cell Fluid lons Cell Fluid lons
Na* 60 110
K* t20 20
c1- 45 100
ud
St

Na*
Fig. 2.2. Stimulated Semipermeable Membrane
The bioelectric signals produced in human body are due to coordinated
activity of the large grouP of excitable cells. The amplitude and frequency
range of such bioelectric signals are as follows:
Page No. 20 of 328.
Fundamentals of Biomedical Instrumentation ,\
Bioelectric Potentials 21

Type of Amplitude Frequency Recording


Bioelectric Technique
Potential

l
Heart 50 pV-5 pV 0.05-100 Hz ECG
Brain 2 pV-100 pV 1-100 Hz

ria
EtrG
Muscle 20 pV-5 pV 10 Hz-2 kHz EMG

2.3. RESTING AND ACTION POTENTIALS

2.3.1. Resting Potentials


we know that some of the types of celrs of the body are encased in

ate
a semipermeable membrane whjch allow some substalces to pass-through
the membrane whereas others are not allowed to pass through.
we also know that thes-e cells of the body are surrounded by body
fluids which are conductive solutions containing charge atoms, i.e., ions.
t
The prominent ions are sodium (Na+), potassium (K*), and chloride (c1).
The membrane of the cells allow entry of potassium and chloride ions
t
f whereas blocks the entry of sodium ions. various ions seek a balance
between the inside of the cell and the outside . The sodium is unable to
penetrate the. membra.ne. This results in unbalance of ions concentration
f
and electric charge. The concentration of sodium ions inside the cell
yM
1
becomes much iower than in the intercellular fluid outside. The sodium
1

e
ions are positive, therefore, this makes the outside of the cell more
positive than the inside. In an attempt to balance the electric charge, the
additional potassium ions vrhich are positive, enter the cell, .
"^r"irlg
higher concentration of potassium on the inside than on the outside (see
figr,rre 2.3(al)
ud

K*
St

Fig. 2.3. (a) Nerve and muscle cells are encased in a semipermeable membrane
Sodium ions (Na*) are unable to penetrate

:d Thus, charge balance cannot be achieved. Hence, equilibrium is


cy achieved with a potential difference across the membranes. The inside
of the cell is negative and outside is positive. This membrane potentials
called the Resting Potential. This potential is maintainecl until some kir-rC
Page No. 21 of 328.
Fundamentals of Biomedical Instrumentation

22 Fundamentals of Biomedical lnstrumentation

of disturbance is caused to upset the equilibrium. The resting potentials


range from - 60 mV to - 1OO mV. The figure 2.3.(b) illustrates the resting
potential. A cell in the resting state is said to be polarized.

l
ria
-60to-100mV

ate
Fig. 2.3. (b) A polarized with its resting potential

2.3.2. Action Potentials


yM

Na*

Flg. 2.4. (a) Depolarization of a cell


ud

+20 mV
St

Fig. 2.4. (b) A depolarized cell showing an action potential


The excitation of a section of cell can be by using the flow of ionic
current or any externally applied ener5/. This excitation of a section of
Page No. 22 of 328.
Fundamentals of Biomedical Instrumentation L

Bioelectric Potentials 23

the cell, causes change in the characteristics of the membrane which


allows some of the sodium ions to enter. The movement of sod.ium ions
into the cell further accelerates entry of sodium ions. This leads to rush
of sodium ions inside the cell whereas potassium ions try to go outside

l
but are unable to out that fast. The net result is slightly higher potential

ria
inside the cell. This potential is known as th action potential which can
be about + 20 rnY.In other words, cell which is excited gets depolarized
and leads to action potential. The process of changing from resting state
to action potential is called depolarization. The figure 2 a@) and 2.4(b)
illustrate depolarization and depolarized state Action Potential respectively.
2.3.3. Waveform of an Action Potential

Depolarization
;-20
c
:_30
ate
yM
6
E
E -40
E
o-
-50
After potentials

-90

t (milliseconds)
ud

(a) A typical cell action potential

000436
Contraction
Potential
St

(b) Contraction anci action


potentials from a guinea pig mycardium

Fig. 2.5. Action potential duration with time


Page No. (Countery
23 of 328. Dr. Mortion Frank George Washington University)
Fundamentals of Biomedical Instrumentation

24 Fundanrentals of Biomedical lnstrunlentatioll

When the rush of sodium ions through the cell membrane stops'
a
new state of equilibrium is reached and the ionic currents that le-rwered
lhe barometer to sodium ions are nor present; the rnembrarre beharves
in its normal conditiorr i.e., sodium ions are not allowed to enterquickly inside

l
from outside. At this stage of the process, sodium ions are process

ria
tr.ansported from inside of cell to outside of cell and this
active
is known as sodium pump. Once all sodium ions are pumped outside the
fiom
cell, the cell reaches its Resting Potential. The process of change
very
Action Potential to Resting Potential is known as Repolarization'
little is known about the reason of sodium puirlp, but it can be though
to be balancing effect after ionic currents are renoved'
The time
The waveform of the action potential is shown in figure 2.5"
scale depends on the type of cell prorlucing the poiential Nene and

ate
,*'hereas heart muscle duration
muscle -ry have 1 m sec duration, com-
as high as 3OO m sec. Please note that after repolarization
may be ".11"
pletion, resting potential is named "after potentials", which reaches restinl'
potential slowlY.

2.4. PROPAGATION OF ACTION POTENTIAL

onceacellisexcitedandgeneratedactionpotential,ioniccurrents
begin to flow. This process excites neighbo cells o
with a lotrg -ring
f,rber may h
areas of the same cell. A nerve cell
yM
potential over a small segment of the fiber, but it is propagated in both
an action
directions from the origin"point of excitation. The rate at which
potential moves down a fiber or is P
propagation rate. In nerve cells the
l4O meters Per second. The ProP
slower in the range of O.2 to 0'4 m
as low as
of the heart have special cells which have propagation rate of
0.05 meter Per second.
The propagation cf action potential is explained further rvith
the help
of figure 2.6.
Local Closeci (solenoidal)
ud

External Medium Lines of Current Flovr

++++ ++++++
+++
Active region

+++71++

Resting Depolarized Repolarized


Membrane Membrane Membrane
St

Fig. 2.6. Charge distribution in unmyelinated fiber conducting an


impulse
potential'
Ionic currents flow if a cell is excitetl ernd generates an action
nerve, onlY a small Portion
noted that the membrane
active region is dePolarized
tive region is repolarized membrane'
Page No. 24 of 328.
Thechargedistributionhasclosedpathcurrents.Theflowofthese
Fundamentals of Biomedical Instrumentation \

Bioelectric Potentials 25

currents depolarizes the membrane in the region ahead of the active


region so that it becomes activated. The same current pattern flowing
behind the active region is unable to re-excite the membrane in reporting
state where the process is self-exciting. The active state of the membrane

l
is remaining only for short duration of time. After depolarization, the

ria
membrane repolarizes completely. 1'his is the way the action potential
propagates along the length of the fiber.
The myeiin sheath is interrupted at reguiar intervals by nocles known
as nodes of refiner in the case of myeiinated nerve f,rber as shown in
lrgure 2.v. Tlne sheath increases the impedances to the current flow. The
sodium ions channel have non-uniform distribution. The density is more
at the nocies.

ate
Active Myelin
Node Sheath
Periaxonal --J
Space

Cell-J \- Node of Ranvier


Fig.2.7. Local current flow in a myelinated nerve fiber
The myelin sheath reduces the leakage current and improves the
transmission properties of the fiber.
yM
The figure 2.8 shows the action potential of nerve and muscle. The
action potential causes a brief contraction and subsequent relaxation
and this response is known as Muscle Twitch.

loo1
ud

1 02 5101520
Time (msec)-------+ Time (msec)

-9'"
Fig. 2.8. Action potentials muscle of nerves and muscle
St

The twitch starts abolrt 2 msc after depolarization of the membrane


before repoTarization is complete. The fast muscle for rapid, fine and
precise movement have twitch of duration about 7.5 msec, whereas slow
muscles for strong, gross and sustained movements have twitch durations
up to 1OO msc. It has been found that the action potential in muscle
triggers an increase in the permeability of the cell membrane to calcium
Page No. 25 of 328.

.l-
Fundamentals of Biomedical Instrumentation
26 Fundamentals of Biomedical lnstrumentation

ions. The lateral components of triads release calcium ions which liberates
a substance in the muscle which subsequently activates the adenosine
triphosphatase activity of Myosyn. Nerve hbre generated action potential
can be recorded as per figure 2.9.

l
ria
Axon
Recording
Micro Pipet
Electronic
Microelectrode
Simulator

Amplifier
vo

ate
lndifferent
Electrode

Fig. 2.9. Recording of action potential of nerve axon


The nerve is excited by an electronic simulator. This gives a short
current pulse to the nerve. Micropipet is used for recording at a down
stream print. The action potention waveform is shown in figure 2.10.
yM
Overshoot Potential
A ol
l-l
Membrane I

Potential I

Resting

Fig. 2.10. Action potential recording


ud

when the tip of the micropipet is inserted through the membrane, the
movement artifact is generated. Recording is done for resting potential. The
recording is done instantaneously as the stimulus artifacts r,,",hen stimulus
is applied. The action potential travels along the nerve at a constant speed.
The latent period I is recorded as the time taken for the tralsmission of the
potential from stimulating point to the recording point.
St

PHYSROLOGICAL POTENTIALS_ECG, EEG, EMG,


AND ERG
Transducers are used to facilitate measurement of bioelectric potentials.
A transducer converts ionic potential and currents into electric potentials
and currents. Such a transducer consists of two electrodes, which pick-

Page No. 26 of 328.


Fundamentals of Biomedical Instrumentation L

Bioelectric Potentials 27

up the ionic potential difference betu.een their respective point of


application. The electric potentials picked up by the transducers through
the electrodes are basically surface pattern at the electrode points reflected
as a summation of the potentials developed. These biopotentials waveforms

l
are named on the application basis such as ECG (electrocardiogram),
EEG (electroencephalogram), EMG (electromyogram), etc.

ria
2.5.1. Electrocardiogram (ECG)
ECG are the biopotentials generated by the muscles of the heart.
This is also known as EKG (electrokardiogram in German). The action
potential in the heart originates near the top of the right Atrium at a
point called the pacemaker or sinoatrial (sA) node. The pacemakers are
a group of specialized cells that spontaneously generates action potentials
at a regular rate which are controlled by "innervation". The heart beat

ate
is the result of the action potentials generated by pacemakers which
propagate in all directions along the surface of both atria. Recorded ECG
waveforms are is shown in the figure 2.lI (a\.
yM
ud
St

Fig. 2.11. (a) ECG waveform recordings


The shape and polarity of each of these features vary from the rocation
of measuring electrodes with respect to heart. Naturally, a cardiologist
bases his diagnosis on the readings taken from several electrode locations.
Electrocardiogram signal is a quasi-periodica-l rhythmically repeating signal
which is synchronised by the function of heart which generated bioelectric
Page No. 27 of 328.
Fundamentals of Biomedical Instrumentation

28 Fundamentals of Biomedical lnstrumentation

signals. The recorded waveforms have been standardized 'uvith respect to


amplitude and phase relationship. Any deviation, is identified as
abnormality.
mV

l
ria
ate
Fi1.2.11. (b) An ECG waveform
The normal ECG has- PQRS characteristics as shown in the figure
2.ll (bl for the chest leads which are scaled. P wave is known as base
line which represents depolarization of the arterial musculator QRS
represents the repolarization of arteria and depolarization of ventricles
which occur almost simultaneously. The Twave represents repolarization
of both ventricles. U wave is the result of after potentials in ventricular
muscle. The slope and polarity of each feature varies with the location
of measuring electrodes with respect to the heart. A normal ECG patten
yM
is quantified in the figure 2.12.
R=5mV

P(<0.25 mV)
ud

0.05-1

| 0.12-0.2 I OT Duration I I
St

Fig.2.12. ECG wave pattern quantified for chest


ECG can diagnose problems of a patient. It can identiff problem of
Rhythm disturbance which may be Tachycardias due to fast heart beats,
Brady cardial due to slow heart beats or Irregular pulses. The heart
problems may be due to conduction abnormalities such as left bundle
Page No. 28 of 328.
Fundamentals of Biomedical Instrumentation L

Bioelectric Potentials 29

branch biock, Right bundle branch block, Atrio-Ventricular block. The


poor blood supply to heart muscle is termed Ischemic Heart Descase and
this leads to Angina pectons (Chest pain) or Myocardial Infarct (Heart
Attack) . llypertropy occurs due to enlargement of the heart which may

l
be left Ventricular, Left Artrial, Right Ventricular or Right Atrial. The

ria
metabolic effects lnay lead to electrolyte abnormalities, wrong medication
or thyroid disease.
2.5.2. Electroencephalogram (EEG)
The bioelectric potentiais generated by the neuronal activity of the
brain is called the EEG. The EEG waveform is very complex and more
difhcult to recognize than the ECG. A sample of the EEG is shown in
the figure 2.13. The electrodes are located on the surface of the scalp.

ate
(a)Awake and alert EEG Frequency
yM
(b) Deep Sleep EEG Frequency
Fig. 2"13. Human EEG for different stages
It may be noted that awake and alert signal frequency is very high
as compared to deep sleep EEG frequency.
Rhythmical potentials are generated by brain. These potential originate
from individual neurons of the brain. The waveform pattern is complex
is terrned electro-encephalogram (EEG). The rnillions of the cells discharge
synchronously and get summed up for the net generated potential.
The neuons are electrically polarized at rest similar to other cells.
ud

The neuron has potential of -70 mV with respect to the exterior. When
a neuron is subjected to a stimulus (above threshold), a nerve impulse
due to change in membrane potential is generated which spreads in the
cell. This depolarizes the cell and shortly afterwards repolarization takes
place.
The signal of EEG are taken from electrodes either from scalp or
directly from the cerebral cortex. The peak to peak amplitude is 100 mV
St

if picked up from cerabral cortex. The frequency varies from 0.5 Hz to


50 Hz. The basic frequency of EEG is classified into five band for analysis
purposes:
Delta 0.5H2-4Hz
Theta
- 4Hz-8Hz
Alpha
- 8Hz- 13Hz
Page No. 29 of 328.
Fundamentals of Biomedical Instrumentation

30 Fundamentals of Biomedical lnstrumentation

Beta
-13H2-22H2
Gamma 22Hz-30Hz
Alpha rhythm indicates alertness of the brain which sen'es as indicator
of anesthesia in the operating room. The waveforms can be summarized

l
as follows:

ria
Waveform Frequency Occurence

Delta waves o.5-4Hz Premature babies


sleeping adults
Theta waves 4-BHz Children and
SleePing adults

Alpha waves 8 - 73 Hz Normal

ate
Beta waves 13 - 30 Hz Normal

Under normal conditions there is generally inverse relationship


between amplitude and frequerrcy, i.e., if frequency reduces, the amplitude
increases. The increased cerabral activity leads to more desynchronized
activity of the nerve cells.
Spikes and waves of abnormal shape occur during attacks of epilepsy.
The extinction or damping of electrical activity in the cortex can be due
to tumor. The tumor presses on the neurons and destroys them. oxygen
yM
deficiency due to circulatory disturbance similar to bleeding would also
cause similar problem. Earlier damages present in the cortex in the form
of tumors or scars, may generate abormal electrical activity.
EEG is used for examination of epilepsy, brain damage, brain tumors
and other organic brain injuries. There is occasional use of trEG for
determination of level of consciousness 1.e., depth of anaesthesia. It can
also establish death of brain.
2.5.3. Electromyogram (EMG)
The muscle activity bioelectric potentials constitute EMG. Such
potentials are measured at the surface of the body near a muscle of
ud

interest or directly from the muscle by penetrating the skin with needle
electrodes.
EMG signals may be measured at the surface of the body near a
muscle under study or from the muscle by penetrating the strain with
needle electrodes. The amount of muscle activity is indicated in the EMG
rneasurement, the action potential lasting only felv milliseconds. The
potential may range from 50 pv to 5 mV with a duration of 2lo 15 msec.
lfr. BVfC amplitude is the instantaneous sum of all action potentials
St

generated at that instant. A typical EMG waveform is shown in


figure 2.14, which looks like random nolse.
Action potential is generated in both positive and negative polarities
across a pair of electrodes. These, some times add, sometimes
substract.

Page No. 30 of 328.


Fundamentals of Biomedical Instrumentation
31

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Fig. 2.14. A typical EMG waveshape

ate
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Fig. 2.15. EMG recording arrangement
ud

Spind
Conductive
Lesion
Motor
Peripheral Neuron
Nerve Lesion lesion
Neuro Muscular
Synape Diseases Muscular
Diseases
St

Fig. 2.16. Electrical connection of nervous system

Page No. 31 of 328.


Fundamentals of Biomedical Instrumentation

32 Fundamentals of Biomedical lnstrumentation

The EMG signals range from 20 pV to 5 mV and in frequency range


from 1O Hzlo 2kHz. One method EMG signal is shown in frgure 2.15.
In this case the muscle contraction gives bioelectric potential which
is aneplfied and displayed on the oscilloscope and this is also made

l
audible on a loudspeaker.
The muscular "Paralysis" can be due to a lesion in the parts of the

ria
neryous system which supply to muscle. The figure 2.16 shows electrical
connection of the nervous system.
2.5.4. Electrogastrogram (EGG)
EGG signal has basically EMG pattern. It is associated with the
peristaltic movements of the gastrointestinal tract. When surface
electrodes are placed. on the abdomen over the stomach, the signal of the

ate
gastric myoelectrical activity is recorded which is electrogastrogram. But,
EGG is not enough to diagnose stomach diseases, therefore, it requires
additional informations.
2.5.5. Electro-oculograph (EOG)
when the bio-potential generated by the movement of the eyeball is
recorded, it is known as electro-oculograph. If a small electrode is put
on the skin near the eye, it gives EOG potentials. The signal of the
vertical movements of eyeball is piked up by placing one pair of electrodes
above and below the eye. similarly, the horizontal movement signal is
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picked up by placing another pair of electrode to the left and right of the
eye. EOG is hardly used for any clinical purpose.
2.5.6. Electroretinograph (ERG)
There is an electrical potential difference between the cornea and the
body of the eye. when the eye is illuminated, this potential changes. The
recording of this change of potential is known as electro retinograph
(ERG) . For this recording, one electrode is mounted on a contact lens
which is in direct contact with cornea and the other electrode is put on
the skin adjacent to the outer corner of the eye. If needed, a reference
electrod.e may be put on the forehead. The magnitude of the signal is
dependent on the intensity and the duration of the light falling on the
ud

eye. The voltage of signal is in the order of 500 pv.

2.6. ENVOKED RESPONSES


In neurophysioloSr, we are interested in looking at the neurological
response to a particular stimulas. This response js electric in nature,
but it is very weak signal with a very poor signal-to-noise ratio. when
the stimulus is repeated, the same or very similar response repetition is
St

observed. This is known as envoked response, which becomes basis for


biopotential signal processors which can obtain an enhanced response
by means of repeated application of the stimulus. In short, it is a measure
of "disturbance" in EEG pattern that results from external stimuli like
flash light, a click of sound. The figure 2.17 sho',r's some of the envoked
responses.
Page No. 32 of 328.
Fundamentals of Biomedical Instrumentation t

Bioelectric Potentials 33

l
(a) Awake and alert response

ria
ate
response

(d) Deep sleep response

Fig. 2.17. Envoked responses


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1 Biolectric Potential: These are ionic voltages produced as a result
of the electrochemical activity of certain special type of cells.
2. Sources of Bioelectric Potentials: The sources of bioelectric are
nerve conduction, brain activity, heart beat, muscle activity, etc.
J Resting Potentials: The voltage of inside of a cell with respect to
outside of the semipermeable membrane in resting state. This is a
negative voltage.
4. Action Potentials: This is a voltage of inside of a cell with respect
to outside of the semipermeable membrane in a depolarized state.
This is a positive voltage.
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5 Depolarization: The process of changing from resting state to action


potential.
6. Repolarization: The process of change from action potential to resting
potential.
7. After Potentials: After tepolarization completion, the resting potential
is named "after potentials" which reaches resting potential slowly.
8 Propagation Action Potential: The movement of action potential
St

from its origin to neighbouring cells. The nerve cells propagation rate
is 2O to 140 meters per second, whereas heart muscle cell propagation
rate is slower in the range from O.2 to 0.4 meters per second.
9 ECG: These are the bipotentials generated by the muscles of the
heart known as electrocardiogram.

Page No. 33 of 328.


Fundamentals of Biomedical Instrumentation

34 Fundamenta!s of Biomedical lnstrumentation

10. EEG: These are the bipotentials generated by neuronal


activity of the
brain known as electroence phalogram.
11.EMG: These are bipotentials generated by muscles known as
electromyogram.

l
12. EGG is the recording of the signal generated due to the gastric

ria
mvelectrical activity.
13. EOG is the recording of the signal generated due to the movement
of the eye ba11.
14. ERG rs the recording of the signal generated due to the illumination
of the eye.
15. Envoked Responses: These are EtrG signals in the various state of
humans such as being awake, light sleep, deep sleep, etc.

ate
C
(;IrClded
2.1. What do you understand by bioelectric potential and how is it useful?
2.2. How are the bioelectric potentials measured? Name some of the equipments
using such measurement.
2.3. What are the sources of bioelectric potentials and why are these present
in the body?
2.4. Explain Resting and Action Potentials. (UPTU-2003\
2.5. trxplain and draw diagrams for trCG, EtrG and EMG. (UPTU-2004)
yM
2.6. Draw an active potentiai waveform and level thq Amplitude and Time
values. (uPru-MQP4
2.7. Explain polarization, depolarization and repolarization. (UPTU-MQP2)
2.8. Explain propagation of active potential. (UPTU-2004\
2.9. What is EtrG? Why is it much more difficult to recognize than ECG? How
can certain characteristic EEG waveforms be related to sleep?
(UPTU-2004\

trtrtr
ud
St

Page No. 34 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Transducers
a Inside this chdpter
3.1.
3.2.
3.3.
3.4.
3.5.
Introduction

Active Transducers
Passive Transducers
ate
Transducer and Transduction Principles

Transducers For Biomedical Applications


yM
3.6. Pulse Sensors
3.7. Respiration Sensor
3.8. Transducers with Digital Output
3.9. Summary

INTRODUCTION
Medical instruments are generally electronic devices, therefore, they require
an electrical signal as an input. A physical event of the body represents
a parameter which has a transducible property. This is transformed into
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an electrical signal by some device or process which is a transduction


process. Thus, transducer for of converting the transducible physiologrcal
property into an electrical signal which can be an input to an instrument.

3.2. TRANSDUCER AND TRANSDUCTION PRINCIPLES


Transducer is a device which converts one form of energr into electrical
form. Because of the advantages of electric and electronic method of
St

measurement, it is an usual practice to convert all non electric


phenomenon of physiological events into electrical quantities. Numerous
methods suitable to various applications have been developed by applying
basic principles of physics. Physiological variables occur in many forms
such as hydraulic pressures and flows, mechanical movements,
temperature variations, chemical reactions, etc.
Page No. 35 of 328. 3.5

i
-t
Fundamentals of Biomedical Instrumentation

36 Fundamentals of Biomedical lnstrumentation

In Biomedical Instrumentation the main concern is conversion of


Bioelectric signal to electric signal. Here transducer is a component
which has a nonelectrical variable as its input and an electrical signal
as its output. To conduct its function properly, one (or more) parameters

l
of the eiectrical output signal in the form of voltages, current frequency
or pulse width must be a nonambigrious function of the nonelectrical

ria
variables at the input. Ideally the relationship between input and output
should be linear. A linear relationship is not always possible, but the
reiationship between input and output should fo1low some rules like
logarithmic function or square 1aw. As long as the transduction function
is nonambiguous it is possible to detelmine the magnitude of the input
variable from the electrical output signal at least in principle. Certain
other variables may interface with the transduction process such as
hysteresis error, frequency response and base line drift.

ate
There are two different principles used to convert nonelectrical
variables into electrical signals. One of these is energy conversion
transducers based on this principle are called active transducers. The
other principle involves control of an excitation voltage or modulations
of a carrier signal. Transducers based on this principle are called passive
transducers. The two transducer types will be described separately in
the following sections.

AGTIVE TRANSDUCERS
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A11 physical principles can be employed for converting nonelectrical activity
in active transducers. But, not all principles are of practical importance
in the design of actual transducers, specially for biomedical applications.
In active transducers, in some cases the same transduction principle
used to convert from a nonelectrical form of ener$i can also be used in
reverse direction to covert electrical ener5/ to nonelectrical forms. Say,
a magnetic loudspeaker can also be used in the opposite direction as a
microphone. There are severatr names used to refer to the same effect
$rhen used in opposite direction because two applications were discovered
by different persons' Few methods of eners/ conversion used in active
tranducers are given in table 3.1.
ud

Table 3.1. Few Methods of Energy Conversion Used in Active Transducers

Energg Form Transduced Form Deuice ar Effect Reuersible

Mechanical Electrical N{agnetic induction Yes


Electrical lnduction
Thermal Electrical Thermoelectric Yes
Pressure Electrical Piezoelectric Yes
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Light radiation trlectrical Photoelectric No


trlectrical Light LED No
Chemicai Electrical Volts No
Electrical Chemical Electrical polarization No
Sound Electrical Microphone Yes
Sound L,oud speaker
[ Electric
Yes
=r"".r- _
Page No. 36 of 328.
Fundamentals of Biomedical Instrumentation I

Transducers 37

3.3.1. Magnetic Induction


Linear movement of an electricar conductor in a magnetic field in
such a way that the magnetic flux through the conductor is changed, a

l
voltage proportional to the rate of change of magnetic field is induced.
If a current is sent through the same conductor, a mechanical force is

ria
developed which is proportional to the current and magnetic field. The
result which depends on the polarities of voltage and current on the
electrical side or the direction of force and motion on the mechanical
side is a conversion from mechanical to electrical energz or vice_versa.
A11 electrical motors, generators, solenoids and loudsp"r1..." are based
on this principle of magnetic induction.

ate
yM
Fig. 3.1. lnductive transducers with rotary movement
one basic configuration of transducer that use the principle of
magnetic induction for the measurement of rotary motion is shown in
hgure 3.1. The output voltage in each case is proportional to the linear
or angular velocity. The most important biomedical applications are:
I (a) Heart Sound Microphones
t
(b) Pulse Transducers
i (c) Electromagnetic Blood Flow Meters.
3
Magnetic induction has an electrostatic equivalent called electric
induction. condenser microphone based on this principle is not widely
ud

used due to its wide frequency response and high sensitivity.


3.3.2" Thermoelectric Effect
Two wires of different material, i.e., irort and copper are connected
so that they form a closed conducting loop as shown in figure 3.2, then
a voltage proportional to the difference in temperature of junction is
developed. The polarity depends on which of the junction is warmer. 'rhe
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device formed in this fashion is called a thermocouple as shown in


figure 3.2.
The sensitivity of a thermocouple is small and amounts to only 40
microvolts per degree centrigrade (pv/"c) for a copper-constantan and
53 (pv/"c) for an iron-constantan pair (constantan is an alloy of nickel
and copper).
Page No. 37 of 328.
Fundamentals of Biomedical Instrumentation

38 Fundamentals of Biomedical lnstrumentation

The thermocouple measures the temperature difference between the


junction
two functions. one junction should be kept at o"c. by pr-rtting the
junction
in ice bath. Frequently instead. of an ice bath for the reference
an electronic compensating circuit is used. The incorivenience of having

l
to make the whole circuit f?om the two metals used in the thermocouple
can be overcbme by using a double reference junction that connects

ria
to
copper conductors as shown in the figure 3'2'
Metal B

ate
Copper
Junctions
Fig. 3.2. Thermocouple with double reference junction to connect to
measurement circuit using copper wtre
Duetotheirlowsensitivitythermocouplesarenotusedinthe
measurement of physiological temperatures'
The thermoelectric effect to convert from thermal to electrical enerSr
peltier
is called the seebeck effect. In the reverse direction it is called the
effect where the flow of current causes one junction to heat and the
other to cool. The peltier effect is sometimes used to cool parts of
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instruments.
3.3.3. Piezoelectric Effect
If pressure is applied to certain nonconductive materials so that and
d.eformation takes plu."., a charge separation occurs in the materials
an electrical voltage vp, cant be measured across the material. The natural
crystals
material where piezoeiectric effect can be observed are slices from
of q'.artz (Si O2i or Rochelle Salt (Sodium potassium tartrate, KNaCoHoOu'
+rrrol which liave been cut at a certain angle with respect to the crystal
axis. Piezoelectric properties can be introduced into wafers of barium
titanate.
ud

Force
St

Transducer AmPlifier

Fig. 3.3. Piezoelectric transducer equivalent circuit connected


to an amplifier

Page No. 38 of 328.


Fundamentals of Biomedical Instrumentation \

Transducers 39

l
-------> Trace 1

Time i

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Trace 2

ate
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Trace 4

Fig. 3.4. Output signal of a piezoelectric transducer under different conditions


Trace 1 : Force at the input of the transducer
frace 2 : Output signal when the product of R and C is much larger than T
Trace 3 : Output signal when the product of R and C is much smaller than T
Trace 4 : Output signal if the product of R and C is equal to T
The electrical equivalent circuit of a piezoelectric transducer is shown
in figure 3.3, is that of avoltage source having avoltage 7p, proportional
to applied mechanical force connected in series with a capacitor, which
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represent the conductive plates separated by the insulating piezoelectric


material. The capacitive properties of the piezoelectric transducer
interacting with the input impedance of the amplifier to which they are
connected effect response of the transducer. This effect is shown in
figure 3.4. The trace 1 shows the force applied to the transducer, which
after time I is removed. While the electrical field generated by the
piezoelectric effect and the internal transducer voltage V, rn trace 2
follows due to the applied force. The voltage 7o measured'at the input
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of the amplifier depends on the value of transducer. Now, the capacitance


C and the ampiifier input impedance R are subjected to the applied
voltage Vo for the duration of time L If the product of R and C is much
longer than 7, then the voltage division between the two can be neglected
and the measured voltage can be considered proportional to the force
applied. This is shown in trace 2. To meet this conduction for a large
Page No. 39 of 328.
Fundamentals of Biomedical Instrumentation

40 Fundamentals of Biomedical lnstrumentation

value of I the input imped.ance of the amplifier should be very large. As


an alternative, a capacitor may be connected in parallel with the ampliher
input. This increases the capacity of the ampliher, but decreases the
sensitivity of the transducer. In case of piezoelectric transducer where

l
the output voltage is quite high this approach may be permissible.
If the produet of resistance and capacitance is made much smaller

ria
than T, the voltage at the amplifrer input is proportional to the time
derivative of the force at the transducer or proportional to the rate at
which the applied force changes as shown in trace 3. If the product of
R and c is of the same order as 7, the resulting voltage is a compromise
between the extreme of two previous traces shown in trace 4. As any
mechanical input may contain various frequencies, a distortion of the
waveform of the resulting signal can occllr, if these relationships are not

ate
taken into account.
The piezoelectric principle is used in measurement of heart sound or
other atoustical signals .from within the body. The piezoelectric
transducers are used widely in ultrasonic instruments as transmitter
and receiver of ultrasonic signals. Principle of ultrasonic instrument is
discussed in other chapters of the book.

PASSIVE TRANSDUCERS
A or an ac carrier signal ]Jtllize the principle of
d.c excitation voltage
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controlling passive transducers. The transducer consists of a usually
passive circuit element which changes its value as a function of the
physicd.l variable to be measured. The transducer is a part of circuit
element, normally an arrangement like Wheatstone bridge, which is
powered by an ac or d.c. excitation, signal. The voltage at the output
ieflects the physical variable. There are only three passive circuit elements
which can be utilized as passive transducers namely: resistors, capacitors
and ind.uctors. It may also be noted. that active components like transistors
can also occasionallv be used. The active and passive have different
meaning in components and transducers. Passive transducers cannot be
operated. in the reverse direction unlike active transducers'
ud

3.4.1. Passive Transducers Using Resistive Elements


Resistive element that changes its resistance as a function of a
physical variable can be used as a transducer for that variable' An
trJirr".y potentiometer for example can be used to convert rotary motion
or displaciment into a change of resistance. A special linear potentiometer
can be used to convert linear d.isplacement into a resistance change for
such transducers.
St

In some semiconductor material such as cadmium sulphide the


conductivity is increased by light striking the material. This work as
photo-resisiive cells a form of photoelectric transducer. This has good
s

t
sensitivity but bad frequency response. A different type of photoelectric (
transduclr is photo diode, which utilises charge carriers generated by
incident radiation in a reverse-biased diode function. Although less s

t
Page No. 40 of 328.
Fundamentals of Biomedical Instrumentation t

Transducers 41

ls sensitive then the photoresistive cer1s, the photodiode has improved


er frequency response. A photo diode can aiso be used as a photoelectric
le transducer without a bias voltage. In this case it operates as an active
re
transducer.

l
The transducer in most of the cases utilize a resistir.e element called
lr

ria
the strain gauge.
IC

rt
If an axial force is applied to the olement to cause it to stretch, its
iength increases by an amount. This stretching causes the cross sectional
rf
area of the cylinder to decrease. trither an incr-ease in length or decrease
ie
in cross section area result in increase of resistance. ,ihe ratio of the
v resulting resistance change. AR/R to the change in length LLI L is called
e
gauge factor, G. Thus,
rt
AR/R

ate
c_
rf LLIL
C
The strain gauge principle can be utilized for transducers in a number
r of different ways. In the mercury strain ga.-rge which is sometimes called
s
whitness Mercury Strain Gauge named afier its inverter the resistive
material consists of a column of mercury enclosed in a piece of silicon
rubber tubing. There use is limited in the measurement of physiological
rzariables due to the dimension of such gauges. This type of g^rg1 i"
used in plethysmograph.
f
The metaliic strain gauges are extensivery used rather than rnercury;
yM
the possible amount of stretching and the corresponding resistance
t
changes are much more limited. Metal strain gauges are of two different
types: unbounded and bonded. In the unbounded strain gauge a turn
I
wire is stretched between insulating posts. By connecting the four strain
i
gauges into a bridge circuit, all resistance changes influence the or,rtput
voltage in the same direction increasing the sensitivities by a factoi of
i
4. The resistance change due to ter,perature is compensatecl. The
unbonded strain gauge is basicary a force transducer. The same principre
is also used for other variables. The blood pressure transducer uses the
unbound strain gauge.
In bonded strain gauge, a thin wire shaped in zigi.g pattern is
ud

cemented between two paper covers or is cemented to r,he surface of a


paper carrier. This strain gauge is then cemented to the surface of a
structure. Any changes in surface dimensions of the structure clue to
mechanical strain are transrnitted to the resistance wire, resulting increase
or decrease of its length and a corresponding resistance change. The
bonded strain gauge is a transducer for surface strain as shown in
figure 3.5.
A small slice of ,silicon replaces the wire as a conductor in
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semiconductor strain gauges. By varying the amount of impurities in the


silicon its conductivity can be controlled. Due to modern manufacturing
techniques developed in the area of semiconductor production the size
of semiconductor strain gauge has been substantially reducecl. If tkre
structure whose surface strain is to be measured is also mace of silicon
then the strain gauge can be made even sr,arler by making a resistive
Page No. 41 of 328.

L
Fundamentals of Biomedical Instrumentation
42 Fundamentals of Biomedical lnstrumentation

pattern on the silicon surface. Such strain gauge uses photographic and
diffusion techniques which is used in the manufacturing of integrated
circuits. The gauges are isolated from the silicon substrate by reverse
biased diode junction. Due to changes in the resistance of the

l
semiconductor strain gauge due to temperature change, at least two
strain gauges rare used. One strain gauge is used for temperature

ria
compensation.

ate
Strain Gage Wire
Grid
(this is cemented
between the bottom
and top covers when
assembled)

Fig. 3.5. Typical bonded strain gauge configuration

3.4.2. Passive Transducers Using lnductive Elements


The inductance of coil can be changed either by varying its physical
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dimension or by changing permeability of its magnetic core. The latter
can be achieved by moving a core having permeability higher than air
through the coil. This arrangement is similar to that of inductive
transducer. However, in the inductive transducer the core is a permanent
magnet which when moved induces a voltage in the coil. In this passive
transducer the core is made of a soft magnetic material which changes
the inductance of the coil when it is moved inside. The inductance then
can be measured by using an a-c signal.
ud
St

Fig. 3.6. Differential transformer schematic


Other type of passive transducer involving inductance is the variable
reluctance transducer, in which the core remains stationary but the air
Page No. 42 of 328.
Fundamentals of Biomedical Instrumentation 1

Transducers 43

gap in the magnetic path of the core is varied to change the effective
permeability. The same principle is used in active transducers in which
the rnagnetic path includes a permanent rrragnet.
The change in inductance in these types of transducers is not

l
related linearly to the displacement of the coi1. This difficulty is overcome
in the linear variable differential transformer (LVDT) . It consists of a

ria
transformer with one prirnary and two secondary windings. The
secondary windings are connected so that their induced voltages oppose
each other. If the core is in the centre position, the voltages in the two
secondary windings are equal in magnitude and the resulting output
voltage is zero. If the core is moveci upward as indicated by the arrow
in figure 3.6, the voltage in secondary 1 increases while that in secondary
decreases. The magnitude of the output voltage changes with the amount

ate
of displacement of the core from its central or neutral position. Its
phase with respect to the voltage at the primarv- winding depends on
the direction of the displacement. The non linearities in the magnitudes
of the voltages induced in the two output coils compensate each other,
the output voltage of the differential transducer is proportional to the
core movement.
3.4.3. Passive Transducers Using Active Circuit Elements
Active' and passive' distinction when ursed for circuit elements is
based on a different principle than that which is used for transducers.
yM
Active circuit elements are those which provide power gain for a signals
as in case of a transistors. The active circuit elements are normally used
in passive transdurcers.
The application of active circuit element in passive transducers is in
the area of photo electric transducers. The efficiency of photo diode can
be increased if we make a photo transistor.
Hall generator is another semiconductor transducer element which
provides an output voltage that is proportional to both applied current
and any magnetic field in which it is placed.
3.4.4. Passive Transducers Using Capacitive Elements
ud

A plate capacitor capacitance can be changed by varying the physical


dimensions of the plate structure or by varying the dielectric constant
of the medium between the capacitor plates. Both effects have occasionally
been used in the design of transducers for biomedical applications.

3.5. TRANSDUCERS FOR BIOMEDICAL APPLICATIONS


St

In biomedical applications many variables of interest like pressure and


fluid or gas flow which can not be measured by standard transducers
are converted to one of the variables for u,hich basic transducers are
available. The basic transducers for biornedical applications are listed in
Table 3"2.

Page No. 43 of 328.


Fundamentals of Biomedical Instrumentation

44 Fundamentals of Biomedical lnstrumentation

Table 3.2. Basic Transducers

Physical variable Type of Transducer

l
Force (or pressure) Piezoelectric
Strain gauge

ria
a
Surface strain Strain gauge
Velocity Magnetic induction
Displacement Variable resistance
Variable capacitance
Variable inductance
LVDT
Mercury strain gauge
Temperature Thermocouple

ate
Thermistor
Light Photovoltaic
Photoresistive
Magnetic field Ha1l effect

3.5.1. Force Transducers


A basic design element for conversion of variables is the force bearing
member. The bending of the spring due to force, results in a surface
strain which can be measured by means of a bonded strain gauge as
yM
shown in figure 3.7. Measurement of the displacement voltage is done
by using a differential transformer transducer is already explained.

Fig. 3.7. Force transducer with bonded straln gauge

3.5.2. Transducers for Displacement Velocity and Aeceleration


ud

Displacement velocity and acceleration are linked. If any one of the


three variables can be measured, it is possible at least in principle to
obtain the other two variables. Both operations can easily be performed
by electronic methods operating on either analog or digital signals.
As explained in earlier table, transducers for displacement and velocity
are readily available. The principle listed for these measurements, require
that part of the transducer be attached to the body structure whose
d.isplacement, velocitSr or acceleration is to be measured ald that a reference
St

point be available. Since these two conditions cannot always be met in


biomedical applications, indirect methods sometimes have to be used.
contactless methods for measuring displacement and velocity, based
on optical or magnetic principles, are occasionally used. Magnetic methods
usually require that a small magnet or piece of metal be attached to the
body structure. Ultrasonic methods are frequently used in actual practice.
Page No. 44 of 328.
Fundamentals of Biomedical Instrumentation a

Transducers 45

3.5.3. Pressure Transducers


Pressure transducers are related
to force transducers. pressure
transducers utilizing flat diaphrams normally have bonded or
semiconductor strain gauges attached directly to the diaphragms. Flat or

l
corrugated diaphragms have also occasionally been used in transducers

ria
which employ tfre variable reluctance or variable capacitance principles.

SENSORS
Each time heart muscle contracts, blood is ejected from the ventricles.
consequently, a pulse pressure is transmitted through the circulatory
system. This pulse causes vessel-wall displacement while travelling
through the vessels. The displacement is measurable at various points

ate
of the peripheral circulatory system. The pulse sensing can he clone by
placing finger tip over the radial artery in wrist or some other location
where an artery is just below the spin. The pulse pressure can be
measured by various transducers such as:
(z) Photoelectric pulse transducer.
(ir) Piezoelectric arterial pulse receptor.
(lir) Strain gauge pulse transducer.
3.6.1. Photoelectric Pulse Transducer
Pulsatile blood volume changes are detected by photoelectric method
yM
using photo-resistors. The methods used are:
(rj Transmittance method.
(izJ Reflectance method.
Transmittance method has a miniature lamp and photo-resistor
mounted in an enclosure which files over the tip of subject,s finger. Light
is transmitted through the finger tip of the patient's finger ana tne
resistance photo-resistor is determined by the amount of light reaching
photo-resistor. The figure 3.8 shows this method.
Photo-resistor
ud
St

\rr r

Lamp
Fis. 3.8. Transmission method of pulse sensing
Page No. 45 of 328.
Fundamentals of Biomedical Instrumentation

46 Fundamentals of Biomedical lnstrumentation

Blood is forced to the extremities and the amount of blood in finger


increases with each contraction of heart. This alter optical density and
consequently the light transmission through the finger reduces and
accordlngly the resistance of the photo-resistor increases. The photo-

l
resistor is a part of a voltage divider circuit which produces a voltage'
The voltage varies with the amount of blood in the finger. This voltage

ria
closely foilows the pulse pressure and its wave shape can be recorded
or displayed on an oscilloscoPe.
In reflectance method, the photo-resistor is placed adjacent to the
exciter lamp. Only a part of light rays, emitted by the lamp, is reflected
and scattered. from the skin and tissue is made to fall on photo-resistor'
Figure 3.9 shows the reflectance method. The blood saturation of the
calpillaries determine the quantity of light reflected. The resistance of the

ate
photo-resistor varies due to above. The voltage across the photo-resistor
which is connected as a voltage divider, varies in proportion to the
volume changes of blood vessels of the body of the subject'

Finger
\tlr
yM
Photo-resister
Fig. 3.9. Reflectance method of pulse sensing

3.6.2. Piezoelectric Arterial Pulse Receptor


It consists of piezoelectric crystal clamped in a hermetically sealed
capsule which is subjected to the displacement stresSes. The displacement
is iransmitted to the crystal through a soft rubber diaphragm. The pulse
pressure waveform is recorded by connecting the crystal to ECG recorder.
ihe volume of blood in the finger, varies during cardiac cycle which
cause change in the size of the finger. These changes al.e transmitted as
ud

pressure ,r"ri.tior," in the air column inside the plastic tubing. At the
lnd ofthe tube, a piezoelectric transducer converts the Dressure changes
to electrical signal. This electrical signal is amplified and displayed or
recorded.
3.6.3. Strain Gauge Pulse Transducer
Displacement of the vessel wall is transferred to semiconductor strain
gage uy mans of a feeler pin and a leaf spring. Figure 3.1O shows the
St

It.li" !.rg" firmly attached to the leaf spring on one side and to feeler
pin on tn" otfr"t side leaf. One ring around the feeler pin of the transducer
irelps in minimizing the interference caused by unsteadiness of application
of transducer to subjects skin. The transducer output range is of 50 mv
for 0.1 mm displacement. The internal resistance and resonant frequency
of undamped mechanical system are 1 kw and 150 Hz respectively.
Page No. 46 of 328.
Fundamentals of Biomedical Instrumentation

Transducers 47

Feeler pin

l
ria
Fig' 3'10' Strain gauge purse transducer
(courtesy Herren and Beneken,lgTo)

ate
RESPIRATION SENSOR

en array.galbon dioxide in the respiratrion


}HH ;T:,1."-':_r,q:i ii_q_s_t
action is contiolied by musc"t". ;;;;":;';".;
:Sl- ^ll:_1...^lhl"g i":* 3s e and a..,."". to ;"d;"; ;;.
:::y:: E.lf i -1.,
".,..r"r" ",f; , * f;,,: .Tff ;l:
i- "1 ":";T, ":::i1Tr
:: il,T,,:i,*::1.::T T:1 " Itvpes
a o,
_T:"i "
:'i:""1 i:::1?1-:T::
measurement
or
1*o rate, which
of respiration ";";;;;;";; ;il;,:'7,.J'1T:
"
are:
(l) Strain gauge based chest transducer
(ir) Thermistor based transducer.
yM
3.7.1. Strain Gauge Type Chest Transducer
Thor:acic volume change is
sensed by means of a disilace This is
gauge. An elastic Uana rrolas the
fftfr:

3.7.2. Thermistor Based Transducer


ud

nce in temperature of inspired


a thermistor placed in front of
e. If the difference
sma1l, thermistor
the variation of it
St

TRANSDUCERS WITH DIGITAL OUTPUT


Biomedical rnstrumentation systems
are utilizing digital methods for
processlng of data which require
Page No. 47 of 328. that any data entered into the system
Fundamentals of Biomedical Instrumentation

48 Fundamentals of Biomedical lnstrumentation

be in digital rather than in analogue form. Analogue to digital converters,


can be used to convert an analog transducer output into digital form.
The transducer whose output is in digital form uses encoding disks or
rulers with digital pattern, photographically etched on glass plates. A

l
light source and an array of photodetectors, usually made up of photo

ria
diodes or phofio transistors are used to obtain a digital signal in parallel
format that indicates the position of the encoding plate and thereby
represents the displacement being measured.

1. Active Transducers: Transducers can be broadly categorized in two


categories one is active transducers and second is passive transducer'

ate
The active transducers convert non electrical activity to electrical
activity. In most of the cases the action is reversible. The important
acrive transducers uses magnetic induction. Under this category the
biomedical applications are :
(o) Heart Sound MicroPhones
(b) Pulse Transmitters
(c) Electromagnetic Blood Flow Meter
The other effect used. are thermoelectric effect, piezoelectric effect'
2 Passive Transducers: The passive transducers are those transducers
which utilize the principle of controlling a dc excitation voltage or an
yM
ac carrier signal.
transducer the most important is a resistive element
auge. Usually, two types of strain gauge is unbounded
form is used. The gauge factor is defined as the ratio
of resulting resistance change to the change is length G can be
written as
AR/R
^ _ LLIL
L'J-
The gauge factor for metals is of the order of 2, whereas the gauge
factor for silicon (a crystalline material) is about 120'
ud

Passive transd.ucers also use inductive element as in LVDT, etc.


3 Transducers for Biomedical Applicatiofls: In biomedical applications
force transd.ucer with strain gauge is extensively used. other
parameters velocity and acceleration are related to each other. If one
parameter can be measured then with the help of analogue electronic
circuit other parameter can be calculated.
Some transducers using A to D converters are also available. The
transd.ucer whose output is in digital form uses encoding disks on
St

rulers with digital pattern, photographically etched on glas plates'

t*ercidra
1. Discuss four different
3. types of transducers, explaining what they measures
48 oftheir
Page No. and
princiPles.
328.
Fundamentals of Biomedical Instrumentation I

Transducers 49

3.2. What do you understand by the term "gauge factor"? (UPTU, MQP-I)
3.3. Discuss the relationship among displacement, velocity, acceleration and
force.
3.4. What are the various effects of a transdrlcer on various biomedical

l
measurements? (UPTU-2OO3)
3.5. List and {iscuss briefly the various t5rpes of transducers used for Bio-

ria
medica-l applications. (UPTU-2OO4)
3.6. What is the difference between active and passive transducer? Explain
working principle of any active transducer. (UPTU-MQP, 1)
3.7.. Write in detail about underlying principles in different types of transducers.
Also discuss their function in the Bio-medical instruments.
(uPru-MQP,2)

aa]

ate
yM
ud
St

Page No. 49 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Electrodes

>* fnside
4.
this chapter
1. Introduction
4.2. Electrode Theory
4.3. Biopotential Electrodes
4.4. Biochemical Transducers
ate
yM
4.5. Exampies of Eiectrodes
4.6. Summary

Interface between the body and electronic measuring device is required


to measure and record bio-potentials. This interface function is achieved
through electrodes. In order to measure, signal current has to flow
through the circuit, therefore, electrodes must have capability of
ud

conducting a current across the interface between the electronic


measuring circuit and the body. The electrode actually carries out a
trairSducing function where current flows in the body by ions, along with
the current flow in the electrode by electrons.
The bioelectric potentials generated in the body are ionic potentials
produced by ionic current flow. Measurement of these ionic potentials
require conversion into electronic potentials. Accordingly development of
the modern noise-free and stable measuring devices are available. The
St

devices that convert ionic potentials into electronic potentials are called
electrodes. The design of electrodes are dependent an understanding
bioelectric potentials in general and measurement of pH, Po, and P"o,
of the blood in particular.

Page No. 50 of 328.


Fundamentals of Biomedical Instrumentation

The measurements of ionic potential and the rneasurement


of erectric
irrents in body need some interface between the body and the electronic
' .casuring instrument. This
function is achieved ihrougrr bipotential
-:ctrodes. Potential measurement is done through current flow

l
-.-:asuring circuit for some in the
time over which the Leasurement is done.
- ideal conditionsn, this current should

ria
be very small. The electrodes
'--ould have the capability of conducting a current across
the interface
::ween the body and electronic measuring circuit.
The electrode carries rout a transducing function since current
is
':ried out in the body through ions. It is carried in the erectrodes ancr
'' lead wire by electrons. trlectrode has a transducer to change
an ionic
-rrent into an electric current.
1'he figure 4.1 illustrates the erectrode-electrolyte interface. The

ate
.:ctrode to the electrolyte net current flow consists of:
iiJ electrons moving in a direction opposite to that of the
correction
the electrode.
irl Cations i.e., C* moving in the same direction as the current.
Anictn i.e., A moving in opposite direction of the current.
"rl
C
C -------+
(_e <-._-
A
C
{ft?3
yM
+_e C
---_->
C
<-A-
(_e
C-

Electrode Electrolyte
Fig. 4.1. Electrode_electrolyte interface
These are no free electrons for charge to cross the interface,
i.e., no
.e electrons in electrolyte or no free cations or anions in the electrode,
-.:refore, chemicai reactions occur
at the interface:
Ca)Cn* +ne
ud

Am- _rr
ABES LIBRARY
-) a- me Acc
rvhere n = Valence of C
m = Valence of A
It is presumed that the erectrode is made up of some atoms of the
:re material as the cations ancl this materiar in the erectrode at the
-erface can be oxidized to from
a cation and some free electrons. The
'ion is discharged into the erectrolyte. The erectron serves as a charge
St

:rier in the electrode.


An anion coming to the erectrode-erectroryte interface can be
oxidized
-r rreutral atom after giving one or more free electrons to
the electrocle.
Both reactions are reversible and the these reactions occur even
en no c,rrent is crossing the electrode-electrolyte interface.
However,
: net transfer of charge across the interfa". i" ,".o as the rate of
Page No. 51 of 328.
Fundamentals of Biomedical Instrumentation

52 Fundamentals of Biomedical lnstrumentation

oxidations re
is crossing th
the oxidation

l
direction, the reduction reactions dominate'

ria
t
4.2. ELECTRODE THEORY
The interface of metallic ions in solutions with their associated metals
gives an electrical potential which is called the electrode potential' The
Electrode potential i" . of the difference in diffusion rates of
"ot."qence
ions into and out of the metai. The formation of a layer of charge at the
interface is created due to equilibriam. It is a double layer charge' The
layer nearest to the metallic is one polarily and the layer next to the

ate
is opposite polarity. Hydrogen is non-metalic and this also has
"olrtion
electrode potlntial *h"., it is interfaced with associated ions in solution'
It is not ptssible to determine the absolute electrode potential of a single
electrod,e since measurement of potential across the electrode and its
ionic solution would need placement of another metallic interface in the
solution. Hence, all electrode potentials are actually relative values and
accordingly must be stated with respect to some reference. Hydrogen lu
electrode considered stand.ard is assigned zero volts. The Table 4' 1 gives r
electrode potentials. ust
yM
Table 4.1. Electrode Potentials (examples)
*r
K, +K* - 2.925

CcL 1_) Ca2* - 2.870

Na a----+ Yo+ - 2.774

Cr Cr2* - 0.913
------>
Zn<-> Zn2* - 0.762
ud

Cdl----->g4zl - o.402

Co7-Co2* - 0.277

Ni < -> Ni2* - 0.250

Fe<--> P"3+ - 0.036

H2< +H+ 0.000


St

Cu, ---+gu+ + 0.521

Hs< +Hg22 * + 0.789

Agl- Ag* + 0.799


+ 1.68
Page No. 52 of 328. Aua-)Au+
Fundamentals of Biomedical Instrumentation 4

Electrodes 53

l
ria
_ = tGT\ (c^, \
E - [ #,1'" u*.i a bvorts
I
.or "
G = gas constant (9.315 x 107 ergs/mole/degree kelvin)
7 = Absolute temperature, <J.egrees kelvin
n = valance of the ion ie number of electrons added or
subtracted to ionize the atom.

ate
F = Faraday constant (96500 coulombs)
ca, cb = two concentrations on both sides of the membrane.
: fo, fo = respective_ activity coefficients of the ion on both
I sides of the membrane.
e 1 standard volt = 108 abovolts.
I urement of
I known
is electrodes occurs
S :: an electro ducers
-se both membrane barriers and metalelectrolyte interfaces.
yM
BIOPOTENTIAL ELECTRODES
: -opotential electrodes have metalelectrolyte
interface. Electrode potential
: developed across the interface which is proportional to the exchange
- ions between the metal electrolytes of the body.
ud

gl---------o
Body of
Electrode

, ,,, Flg,.' 4.2; (a) Equivalent circuit of biopotentiql electrode interfqpe


St

AdiVit tace witfiiir


I n airid S'noise on
: No.
Page 53 ofced by
328. trf mhterial
Fundamentals of Biomedical Instrumentation

54 Fundamentals of Biomedical lnstrumentation

such as coating the electrode by some electrolytic method. Such type of


electrode is prepared by electrolytically coating a piece of pure silver with
silver chloride.

l
Ror (body fluids)

ria
ate
Fig. 4.2. (b) Equivalent circuit for measurement of biopotentials with two electrodes
The figure a.2@l and (b) represent the impedence of electrodes which
is frequen-cy dependent because of the effect of the capacitance. In addition
both the elecrode potential and the impedence vary due to effect of
polarization. Polarization is due to direct current passing through the
metal-electrolyte interface. The net effect is similar to charging of a
e
a
yM
battery u,itJr the polarity of the charge opposing the battery with the
polariiy of the charge opposing the florv of current that generates the
.t If the amplifier to which the electrodes are connected have very
^rg".
high input impedance, the effect of polarizatl.on is minimized. Larger
etectrodes have lower impedance , i.e., 2 to 1o kQ. The bipolar electrodes
are of three types-micro electrodes, skin surface electrodes and needlr:
electrodes.
The interface between the electrorle-electroJyte and the skin should be
understood to have clear picture of the behaviour of electrodes. A
transparent electrolyte gel containing cl- as the principal anion is used
to couple an electrohe to the skin. The gel gives a good contact. Similarl1'
an electrode cream containing C1- rnay also be used. A brief understanding
ud

of skin structure is necessary to understand electrode-electrolyte skin


interface.
Figure 4.3 gives a cross sectional diagram the skin. The skin consists
of thiee layers which surround the body to protect it from the
environment. Skin also serves as an appropriate interface. The outermos:
layer known as epiclermis plays dominant role in the electrode-skin
i.nlerface. Layers ctnsists of three sublayers which constantly keep
or
St

revieving itselr. trrus epidermis is a constantly changing layer of the


skin, the outer surface consists of dead material having differen;
characteristics from live tissue.
The layers do'vn below epidermis layer contain the vascular and
nervous components of the skin in addition have sweat glands, swe
ducts, and hair follicles. The sweat glands do not follow anY uni
Page No.electrical characteristics on the skin.
54 of 328.
Fundamentals of Biomedical Instrumentation

Electrodes 55

Stratum Corneum
e
"Barrier"
-<:*-:-t/

a
//
/t I
Stratum Granulosum

l
',- /)
Stratum Germinativum

ria
Corium
Eoidermis
Pore
{ Papillae
Capillary Loop
I
oermis
J
Sweat Duct
i
I

L Sweat Gland

ate
Fig. 4.3. A cross-section diagram of skin
The electric connection between the electrode and the skin through
::ectrolyte gel is sho,*,n in figure 4.4. Tihe electrode-electrolyte interface
:quivalent circuit is also shown side by side and details of the same are
-s follows:
yM
R. = effective resistance associated with interface effects of
the gel between the electrode and the skin.
ud

R1

Dermrs and
Subcutaneous Laryer
St

{
Fig. 4.4. A body-surface electrode placed against the skin. Electrical equivalent
lircuit elements are approximately the same level at which physical process exists
&" = potential difference due to ionic concentration across
epidermis or atleast stratum corneum as a semipermeable
membrane.
Page No. 55 of 328.
Fundamentals of Biomedical Instrumentation
56 Fundarnentals of Biomedical lnstrumentation

Parallel RC = epiderrnal layer impedance


For I cm2 skin impedance reduces from 200 kO at I Hz to 200 (l
at 1 MHz.
The dermis and the subcutaneous layer behaves as pure resistance.

l
The effect of the stratum corneum may be reduced by vigrous rubbing
with a pad sbaked in acetone or abrading the stratum corneum with

ria
sanclpaper to puncture it. This process shorts 8"., C" and R" for stability.
The fluid secreted by sweat glands contains Na*, K* and Cl- ions and
concentrations differ from those in extra cellular fluid. Hence, there is
potential difference between luman of the swert duct and dermis and
subcutaneous layers. There are also a paraiiel Rrc, combination in
series with this potential that represents the wall of the sweat gland and
duct, These components are generally neglected when we consider

ate
biopotential electrodes.
If a polarizable electrode is in contact with electrolyte, a double layer
of charge forms at the interface. The movement of electrode with respecr
to electrolyte mechanically disturbs the distributjon of potential until
equilibrium can be reestablished. If a part of electrodes is in a electrolyte
and one moves whole of the other remains statinary, a potential differerrce
appears between the two electrodes during this movement. This potentiai
is called motion artifact which can be a serious cause of interference in
the measurement of bio-potentials.
The motion artifacts results primarily from mechanical disturbances
yM
of the distribution of charge at electrode-electrolyte interface. It is
reasonable to expect that motion artifact is minimal for nonpoiatizable
electrodes.
4.3.1. Microelectrodes
These have tips small enough to penetrate a single cell and as such
readings from within single cell can be obtained. Microelectrodes are of
two types-metal and micropipet. Metal microelectrodes are constntcted
by electrolytically etching the tip of a fine tungsten or stainless steel wire
to the ciesired size. Subsequently the wire is coated almost to the tip
with insulating material. Special electolytic processing is also done on
ud

the tip to lower the impedence. The ion-metal interface happens at the
point of contact betweenmetal tip and the electrolytes either insicle or
outside the cell.
The micropipet type of electrode is actually a glass micr:opipet rr,ith
the tip of the desired stze (i.e. about 1 micron).
The micropipet is filled with an electrolyte suitable "vith cellular
fluids. Such microelectrode is having dual interface. One interface is
comprised. of a metal wire in contact with the electrolyte solution inside
St

the micropipet and the other is the interface between eJ.ectrolyte inside
the pippet and the fluids inside or immediately outside the cell.
One microelectrode is shown in figure 4.5.
A thin film of precious metal is bonded to the outside of a drawn
glass microelectrode. Such microelectrodes are very reliable and having
Page No. 56 of 328.
Fundamentals of Biomedical Instrumentation
Electrodes 57

very good performance. The impedence of microelectrodes is in megaohms.


)'laturaliy,'this demands amplifiers of very very high impedance to avoid
loading the circriit.
Drawn Glass lnsulation

l
t

ria
I
Metallic
Resin lnsulatron Thin Film
i Gold Plateci Pin Connector
5
Fig. 4.5. Microelectrode with metal film on glass
i
l 4.3.2. Body Surface Electrodes
i These are used to get bioelectric potentials from surface of the body
r and are available in different sizes and forms. Larger electrodes are

ate
generally used in ECG as localZation of the measurement is not important.
r Smaller electrodes are suitable in EEG and EMG measurements.
r
,] Floating electrode is available. This electrode practically eliminates
ii
.novement of artifact by avoiding any direct contact of the rnetal with the
i'
skin. The electrolyte paste or jelley serves as condnctive path bet.veen
t :he metal and skin. The ligure 4.6 shows a floating electorde. Spraton
Ll
:lectrodes are made for astronauts. Other special surface electrodes are
n
iisposable electrodes and ear-dip electrode. etc.
S Plastic or Rubber
yM
Lead Wire
S
Support and Spacer

e
Space for Sudace
Electrode Jelly
Fig. 4.6. Floating electrode

h 4.3.3. Needle Electrodes


rf
d
Very small size needle electrodes are used for trtrG as shown in
:rgure 4.7. These are simply inserted through a small section of the skin
e
p
ust beneath the surface and parallel to it.
n
ud

re
)r
Fig. 4"7. Needle electrode for EEG
h For EMG applications, needle electrodes are basically of hne insulated
..r'ires placedso that their tips (base) are in contact with the nerve,
IT nuscle or the tissue from whose measurement is to be made. The
1S :emaining wire is insulated to avoid shorting. Wire electrodes of copper
le :r platinum are used for EMG pickup from specific muscles.
St

le Needle electrodes are less susceptible to movement of artifacts than


surface electrodes. The direct contact with the tissue or the intercellular
-1uids, needle electrodes have lower impedances than surface electrodes
'n rf comparable interface area.
rg

Page No. 57 of 328.


Fundamentals of Biomedical Instrumentation

58 Fundamentals of Biomedical lnstrumentation

4.4. BIOCHEMICAL TRANSDUCERS


Biochemical transduces are designed to measure the concentration of an
ion or of a certain gas dissolved in blood or some other liquid. Normal

l
method of such method is that one electrode used is sensitive to substance
or ion being qLeasured and the second electrode used is insensitive to

ria
that substance or the ion being measured. The second electrode is known
as reference electrodue whereas hrst electrode is known as active electrode.

4.4.1. Reference Electrodes


The hydrogen gas/hydrogen ion interface works as the reference and
is assigned zero volts. Platimum (an inert metal) metal can absolute
hydrogen gas. If platinum is partially immersed in the solution containing
hydrogen ions and also is exposed to hydrogen gas, this creates an

ate
electride potential. The reference electrode basic conhguration is shown
in figure 4.8.
yM
lnternal Ag/AgCl
or Colonel

Filling Solution
ud

Liquid Junction

Fig. 4.8. Basic configuration of reference electrode


The silver-silver chloride electrode is considered to be quite stable.
r\nother popular reference electrode is Calomel electrode. Calomel is a
trade name for mercurous chloride is a chemical combination of mercun'
and chloride ions.
4.4.2. The pH Electrode
St

TkIe pH of blood and other fluids is very important indicator of chemical


balance. The pH is directly related to the hydrogen ion concentration in
the fluid. It is related as per following formula:

pH :- logro [H*] : fogro pf


Page No. 58 of 328.
Fundamentals of Biomedical Instrumentation

Electrodes 59

The pH is a measure of the acid-base balance of a fluid. A natural


solution has a pH of 7.
T}ee pH of normal arterial blood may be from 7.38 to 7.42. A thin
glass membrane allows passage of only hydrogen ions as shown in figure

l
4.9. Inside the glass blub a highly acidic buffer solution is put. A silver-

ria
silver chlorode e'kctrode is used in this case. The pFr measurement is
done by using glass electrode for pH measurement as shown in the
figure 4.9 along with reference elecrode already described. A combination
electrode as shown in the figure 4.10 is available having both pH glass
electrode and reference electrode.
The impedences of pH electrodes vary from 50 to 500 MQ. The input
impedence of ttre meter must have extremely high value for proper
measurement.

ate
To Meter for To Meter for
Measurement Measurement
yM
Reference

Ag/AgCI
Wire Contact
pH Glass

Buffered
Solution

Fig. 4.9. Glass electrode for Fig. 4.10. Combination electrode for
pH measurement pH measurement
ud

4.4.3. BIood Gas Electrodes


The partial pressures of oxygen and carbon dioxide in the blood are
important physiological chemical measrement. po, (partial pressure of
oxygen)also called o,rygcntension can be measured both in vitro and in
vivo. The principle of m:asurement is shown in figure 4.Il.If a voltage
of approx 0.7 V is applied between the platinum wire and reference
St

electrode, reduction of the oxygen takes place at the platinum cathode.


This results in an oxidation-reduction current proportional to the partial
pressure of the diffused oxygen, which can be measured.
In some applications, measurements of Po, and pao, are combined
into a single electrode that also includes a common reference half-cell.
The combination electrode is shown in figure 4.12.
Page No. 59 of 328.
Fundamentals of Biomedical Instrumentation

60 FUndamentals of Biomedical lnstrumentation

Microammeter

lnsulatron

l
Ag/Agcl Reference
Electrode

ria
Electrolyte Solution
where in O, can diffuse

Platinum Wire

Membrane through
which C, can Ciffuse

ate
Solution in which
Measurement is Made

Fig. 4.11. Po, electrode with-platinum cathode demonstrating principle of operation

4.4.4. Practicability in Using Electrodes


No parts of the lead wire should be exposed to the electrolyte all of
the same material. A third material say solids should not be used to
connect the electrode to its lead wire unless it is certain that this
material wiil not be in contact with the electrolyte. The lead wire be
i
yM
welded to electrodes or from a mechanical bond through crimping or
peening. Dissimilar metals should not be used in contact because their
i,att ce'it potentials are different. An electrochemical rear:tion will be
setup beiween them which can result in additional polarization and
often in corrosion of one of the metals. This tends to make half cells
potential less stable and contributing to increased electric noise from the
eiectrode.
In detecting surface potentials on the bodv or internal potentials
within it rvhile using pairs of electrodes for measuring differentials' it is
better to use same material for each electrode since half cell potentials
are approximately equal. This implies that the net dc potential seen at
the input to amplifier connected to the electrodes is relatively small, may
ud

be zeio. This minimizes possible saturation effects in the case of high


gain direct co,;pled amPlifrers.
Electrodes hxed on the skin's surface have a tendency to come off.
This is due to a loss cf effectiveness of the tack on the tape holding them
in place. This is no problem if electrodes are well designed, i"e., lead
wires should be extremely flexible but strong'
The point at which electrode lead '"rrire enters the electrode gets
St

broken due to frequent flexing at this point. Strain relief be provided at


this point. A tapeied region of insulation thai gradually increases from
the diameter of the wire to one cl0ser to that of the electrode reduces
this problem and distributes the flexing forces over a greater portion of
the wire.

Page No. 60 of 328.


Fundamentals of Biomedical Instrumentation
Electrodes 6'l

The insulation of the lead rvire and the electrode is aiso a protliern"
The environment around electrodes is very humici or continualil, 5o.i."o
in extracellular fluid or even in cleaning solution. These insulations are
mace of polymeric material so that it can absorb water. It is important

l
that the insulation material used with electrode shourd be pr-oper to
ar.roid such prpblems.

ria
ELECTRODES
Figure 4.12. shows body surface biopotentiai electrodes. Metal-plate
electrode is used for application to limbs. Metal-disk electrode is used
with surgicai tape. Disposable foam-pad electrodes are frequently used
with electrocardiographic monitoring equipments.

ate
The disposable foram-pad type electrode consists of a large disk of
plastic foam material with silver plated disk on one side attached to a
silver-plated snap similar to that used on clothing in the center of other
side.
Figure 4.13 shows a metallic suction electrode. It is a modification
of the metal-plate electrode that requires no staps or ad.hesives for
holding it in place. It consists of a hollow metallic cylindrical electltode
which makes contact with the skin at its base.
yM
Foam Pad

Metal Disk and Electrolvte

Adhesive Tack on
ud

(Top) (Bottom) Surface of Foam Pad


(c)

Fig. 4.12. Body surface biopotential electrodes (a) Metal-plate electrode,


(b) Metai-disk electrode, (c) Disposable foam pads
Figure a.A@l shows floating metai-body surface electrodes. These
are recessed electrodes with top-hat structure. Cross-sectionai view of
the electrode is also shown for the same. Another cross-sectional view
St

of the electrode is also shown in figure 4.14(b). Another cross-sectional


view is given in figure a.74(c) for a disposable recessed electrode of the
similar general structure. The recess in this electrode is formed from an
open foam disk which is saturated with electrolyte gel and is placed over
the metal electrode.

Page No. 61 of 328.


Fundamentals of Biomedical Instrumentation

62 Fundamentals of Biomedical lnstrumentation

l
Rubber

ria
Buib

Lead Wire--r
T-"rr-rnal

ContarJ

ate
S urface

Fig. 4.13. Metallic suction electrode

lnsulating
Package

Electroyte Gel
in Recess
yM
(b)
(a)

Snap Coated with Ag-AgCl


Gel-coated Sponge
Plastic Cup Plastic Disk

il n nn
Dead Cellular Material

CaPillary LooPs Germinating LaYer


(c)
ud

Fig. 4.14. Floating metal-body electrodes: (a) Recessed electrode with top-hat
structure, (b) Cross-sectional view of above, (c) Cross-sectional view of a disposable
recessed electrode of similar type
Figure 4.15 shows flexible body-surface electrodes. These ale carbon
filled siticone rubber electrode and flexible thin-film neonatal electrode.
cross-sectional view of the thin-film electrode is also shown. A pin
connector is pushed into the lead connector hole of hgure a.15(a). Flexible
St

electrodes are important for monitoring premature infants'


Figure 4.16 shows needle and wire electrodes for percutaneous
measurement of biopotentials. These are insulated needle electrode, coaxial
needle electrode, bipolar coaxial electrode and fine-wire electrode
connected to hypodermic needle before being inserted. It also shows
cross-sectional view of the skin and muscle with coiled fine-wire electrode
Page No. 62 of 328.
Fundamentals of Biomedical Instrumentation '
Electrodes 63

rn place. The needle is usually rnade of stainless steel and is insulated


rvith insulating varnish. Only the tip is left exposed. Such electrodes are
used in electromyography.

l
ria
Pin Connector

(a)
Lead Wire

ate
AgCl Film
Ag Film
13-p{hick
Mylar Substrate
Conducting (c)
Adhesive
Fi9.4.15. Flexible body surfface electrode (a) Carbon-filled silicone rubber electrode,
(b) Flexible thin-film neonatal electrode, (c) Cross-sectional view
yM

Hypodermic Wire
ud

Needle
Hypodermic
Electrodes Needle
Uninsulated
Barb

(- Coiled Fine Wire

Skin
St

Muscle

(e) (0
Fig. 4.16. Needle and wire electrode (a) lnsulated needle electrode, (b) Coaxial
electrode, (c) Bipolar coaxial needle electrode, (d) and (f) Method of uses in skin
Page No. 63 of 328.
Fundamentals of Biomedical Instrumentation

64 Fundamentals of Biomedical lnstrumentation

Figure 4.17 shows electrodes for cietecting totai electrocardiogram


during labor by means of intracutaneous needles. There are suction
electro,les whose cross-sectional view of the in place showing penetration
of probe through epidermis. Helical electrode is also shown which is

l
attached to fetal skin by corkscrew type action. The peak amplitude

ria
.roltage in such cb.ses is 50-700 pV.
Suction Cup
F tal Skin

Electrode

Referenc:
Electrode Electrode
-

ate
Lead Wire

\(b

(c) ""-@
Fig. 4.17. Electrodes used during labor (a) Suction electrode,
(b) Cross-sectional view of ahove, (c) Helical electrode

i
yM
il

1. Electrode: The devices that convert ionic potentials into electronic


potentials.
2. Bioelectric Potential Electrodes: Electrodes used for the
measurement of bioelectric potential.
3 Microelectrodes: Microelectrodes are of two types--metal and
micropipet. Metal electrodes are constructed by electrolytically ethcing
the tip of a fine tungsten or stainless steel wire to the desired size.
The wire is coated almost to the tip with insulating materials.
Micropipet type electrode has micropipet filled with an electrode
suitable with cellular fluids. It has dual interface-one is metal wire
incontact with electrolyte solution inside of the micropipet and the
ud

other is the interface between electrolyte inside the pipet and the
fluids inside or immediately outise the cell.
4 Body Surface Electrodes: These are electrodes which are used to
get bioelectric potentials from the surface of the body and are available
in different sizes and forms.
Biochemical Transducers: Biochemical transducers measure the
concentr:ation of an ion or of a certain gas dissolved in blood or some
St

other liquid.
6 Reference Electrodes: The hydrogen gas/hydrogen ion interface works
as the reference and is assigned zero volts.
The pH Electrode: The pH rneasurement is done by using glass
electrode along with reference electrode. A combination electrode for

Page No. 64 of 328.


Fundamentals of Biomedical Instrumentation

Electrodes 65

8 Blood Gas Electrodes: The partial pressures of oxygen and


carbondioxide in the blood are measured using blood gas el:ctrode.
Combination electrodes for P"o, and po, are availabie.
9 Practicability in using Electrodes: No parts of the lead rvire should

l
be exposed to the electrolyte all of the same material. A third material

ria
say solids shduld not be used to connect the electrode to its leaci ""vire
unless it is certain that this material will not be in contact with the
electrolyte.
10. Examples of Electrodes: Electrodes used for application limbs,
surgical tape, disposable electrodes, electrodes for infants,
intracutaneous needle electrodes, and suction electrodes used during
labour pain are available.

ate
OXerCkle,J

4.1. Differentiate between microelectrodes and body surface electrodes.


(UPTU-2004\
4.2. Name the three basic types of electrodes for the measurement of bioelectric
potentials. For a patient, which types of electrode would be least traumatic?
(UPTU-MQP3I
+.3. What do you understand by the term "reference electrode"?
+.4. What is a glass electrode used for?
yM
+.5. What is the hydrogen ion concentration of blood with pH 6.8?
(UPTU-MQP1)
+.6. what is the major advantage of floating type skin surface electrode?
+.7. why are the partial pressure of oxygen and the partial pressure of carbon
dioxide useful physical parameters? Explain briefly how each can be
measured.

JJJ
ud
St

Page No. 65 of 328.


Fundamentals of Biomedical Instrumentation

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Cardiovascular Measurements

'lr

ll
1[

,{i
i
5.2.
5.3.
5.4.
chapter
ion
Cardiovascular System
Electro Cardiography
ate
Blood Pressure Measurement
yM
5.5. Measrrrement of Blood Flo,"r, and Cardiac Output
5.6. Measurement of Heart Sound
5.7. Plethysmography
5.8. Sumrnarl'

The use of engineering methods and the development of instrumentation


have contributed significantly in r':ducirrg death from heart diseases.
ud

Blood pressure, flo'w and volume.are measured by using engineering


techniques. The electrocardiograrl, echo cardiogram and continuous ECG
recording (Holter recording) are measured and recorded with electronic
instruments. A Holter machine block diagram and usage is shown in
figu.re 5.1. Intensive and coronary care units nol,v available in many
hospitals rely on bioinstrumentation for their working. There are also
cardiac assist devices such as electronic pacemaker and detibrillator
which are extensively used in patient care.
St

66

Page No. 66 of 328.


Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 67

l
ria
ate
Fig. 5.1. Hofler machine usage and block diagram

CARDIOVASCULAR SYSTEM
re cardiovascular system is known as circulating system. It transports
.'ltrients, gases and wastes to and from cells oruoay. The cardiovascular
'-"
stem is composed of the heart, brood vessels, cefls and plasma which
--ake up the blood. A cardiovascular system is shown in figure 5.2 (a)
=:d figure 5.2 (b) shows a basic analogr of cardiovascular system.
yM
The heart is like a two stage pump, physically arranged in parallel
: :t with the circulating blood passing through t-he pumps
in a series
::quence' The right half of the hea't is the pump thal suppries blood
-:--: rest of the system. to
The circulatory path for blood-flow through the
-:-rgs is called the pulmonary circulation and the circulatory system
-' at supplies oxygen and nutrients
to the cells of the body is cauea tne
i stemic circulation. Figure 5.3 shows a cutway view of heart with blood
: :ulation.
The systemic circulation is a high resistance circuit with a large
:-:ssure gradient between the arteriels and veins. The pump constituting
- -. left heart
may be considered 6rs a pressure pump. The muscle
,: :traction of the left heart is larger ,and stronger than tirat of the
ud

-: :r-t because of the greater pressur: right


required for systemic circulation.
- - : volume of blood delivered
per urft o] ti-" by the two sides is the
s'.'::e when measured over a sufficie:ntly long interval. The left
heart
::-,'elops a pressure head sufficient to cause blood to flow to all
the body
:':r:s. contraction of the heart muscles surrounding each chamber of
--- - heart is the pumping
action. Thesr: muscles ,"".ir. their own blood
* -:p1y from the coronary arteries.
St

The pipes which in this case are ar-teries and the veins are not rigid
-- t-lexible. They are capable of helpinl3 and controlting blood circulation
-reir own muscular action and thei,r ,wn valve and receptor system.
'd is not a pure Newtonian fluid; rrrther, it possesses properties that
rot always comply with the rawsi governing hydrauric motion. In
: :.:ion the blood needs the help of the lungs for
- the supply of oxygen.
-s the system can not be oversiml:rified and could teah to error.
Page No. 67 of 328.
Fundamentals of Biomedical Instrumentation

68 Fundamentals of Biomedical lnstrumentation

l
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Carotid arterY
Jugular vein (also subclavian
(also subclavian
artery to arms)
vein {rom arms)

ate
Pulmonary
artery

Superior
vena cava

lnterior
vena cava
yM
mesenteric
hepatic vein
arteries

hepatic
portal vein
SU
ud

renal artery
rh
be
rto
--ts
a1s
thi

:11(
ric
St

:lo
1.runk and legs
'al
'r-h

Fig. 5.2. (a) t)ardiovascular system


:ell
Page No. 68 of 328.
Fundamentals of Biomedical Instrumentation

Cardlovascular Measurements 69

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ate
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A = atrtum V = Ventricle R=Right L=Lefr


Fig. 5.2. (b) Basic analogy of cardiovascular
system
Blood enters the heart on the right side through
two main veins: the
' -:perior vena-cava, which leads from the body,s
ud

:- : inferior vena-cava leading from *o.. extremities and


the body, extremities
:*.ow the heart. The incommlg Ulood fills
-.ht atrium. In addition to the two veins mentthe er and the
l-:c empties into the right atrium. The coronary nary sinus
sinus
:' :t has been circulating via the coronary loop through contains the blood
the heart itserf.
If the right atrium is furl it contracts and forces
*--:uspid valve brood through the
into the right ventricle, which then contracts
: ::,d into the pulmonary to pump the
circulation svstem.
St

\n exchange takes place in the arveoli of the lungs.


-s are recharged with oxygen and give up The red blood
Page No. 69 of 328. their carbon dioxide. The
Fundamentals of Biomedical Instrumentation

70 Fundamentais of Biomedical lnstrumentation

pulmonary artery divides many times into smaller and smaller arteries'
which becomes arterioles with extremely small cross sections. These
arterioles supply blood to the alveolar capillaries, in which exchange of
oxygen ,rra .aruo, dioxide takes place. On the other side of the lung

l
in which s fed into tiny
-^i i" a sin-rilar construction

ria
veins. The tiny veins combine to form larger n turn combine
until ultimateiy all the oxygenated blood is the pulmonary
vein to the heart.
From the pulmonary vein the blood enters the left atrium and from
there it is pr-rmped thrtugh the mitral or bicuspid valve, into the left
ventricle by contraction oithe atrial muscles. when the left ventricular
muscles contract, the pressure prod.uced by the contraction mechanically
closesthemitralvalveandthebuiltupofpressureintheventriclethe

ate
forces the aortic valve to open, causing the blood to rush from
1

t
ventricle into the aorta. It may be noted that this action takes place (
synchronously with the right ventricle' 1
Theheartpumpingcycleisdividedintotwomajorparts:systoleand t
diastole. Systole is a"fr.t"a as the period of contraction of the heart
muscle, specifrcally the ventricular ruscle at which time blood is pumped
into the pulmonary artery and the aorta. Diastole is the period of
{ 1
I

dilation oi tft" heart cavities as they fill with blood'


S-
f-
I
ll
8t
yM
br
Arch of Aorta as

Deoxygenated
blood 5;
Superior lungs Left subclavian arterY
{
To left lungs :h,
To right lungs,J rit
From left lungs
lr
From right rfr
LA
lungs th,
:n(
ud

_f,
Aorta

De oxygenated Oxygenated blood to arteries/


blood arterioles/capillarY bed
(trunk and lower limbs)

Fig. 5.3. Cutway view of heart with blood circulation


St

once the blood has been pumped into the arterial system, the hear
relaxes the pressure in the hiart chambers d.ecreases the outlet valves
closes and ln a short time the inlet valve open again to restart the
diastole and initiate a new cycle in the heart'
The b100d reaches the brain and other extremities after passlx
through many bifurcations of the arteries' The last stage is gradu
Page No. 70 of 328.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 7'l

decrease in the cross section and the increase in the number of arteries
until the smallest type which is called arterioles is reached. These feed
rnto the capillaries where oxygen is supplied to the cells and carbon
dioxide is received from the, cells.'

l
Some values of interst in the cardiovascular system in engineering

ria
are: the heart beats ab an average rate of 75 beats/minute in a normal
adult. The heart rate increases when a person stands up or do some
:xercise, decreases when he lies down. The normal range is between
c0 to 85. on the average it is higher in women. In an infant the heart
-ate may be as high as 140 beats per minute under normal conditions.
lhre heart rate also increases with heat exposure and other physioiogical
.rd psychological factors.
The heart pumps about 5 litres of blood per minute, the average

ate
--ood volume in average adult is about 5 to 6litres. Thus approximately
--e whole blood is circulated every minute during rest. with exercise
the
-:culation rate is increased 'considerably. At any given time, about
-r-80% of the blood volume is in
- e remainder jn the capillaries. the veins about 2o./o in arteries and
Systolic blood pressure in the normal adult is in the range of 95 to
:lJ mm of mercury (Hg) with 120 being average. These figures are
i -.'cject to much variation with age, climate, eating habits and other
'---tors. Normal diastole pressure ranges from 60 to
90 mm of Hg and
: mm of Hg being average. This pressure is usually measured in the
yM
: -=chial artery in the arm. The normal value of blood pressure is given
i -rvstole pressure/diastoic pressure as l2Ol80.

:;-l E IECTRO CARDIOG RAP HY


.:aphic recording or display of the time-variant voltages produced by
: :re&rt during the cardiac cycle the electi:ocardiogram (ECG or EKG).
r-:e 5.4 (a) shows a typical normal electrocardiogram. The peRS and
' =r'es reflect the rhythmic electrical depolarizatron ancl repolarization
--','ocardium associated with the contraction of the atria and ventricles.
- electrocardiogram is used clinically in diagnosing various diseases
-, :onditions associated with
ud

the heart. Figure 5.4(b) showns the origin


:art beat and electrical activity of the heart.

10 mm
(1 mV)
St

----------)Time
Fig. 5.4. (a) A typical normal electrocardiogram
Page No. 71 of 328.
Fundamentals of Biomedical Instrumentation

72 Fundamentals of Biomedical lnstrumentation

SA node
Aotron potential
Superior vena cava Atrial muscle

l
,AV node
Sinoatrial node

ria
LAF
lnte rnodal
path\i!ays Cr:r-nrnoir bunCle

Atr loveirtricu!ar-j-
node
BLINclIE OT HIS
I
-..,.
Right bundle

ate
branch
Purl" inje
5\rsielr)
I aTi noslci"tor
a 2 0.4 0.6

scicle Time (s)


ia t,
Fig. 5.4. (b) Original the hearl beat and electrical activity
As already explained, the P wave represents depolarization of the
atrial musculature. The QRS complex is the combined result of the
repolarization of the atria and the d.epolatization of the ventricles which
il;
,i
,(
o"..r, almost simultaneously. The T wave is the wave of ventricular
{ll repalarization whereas the U wave, if present is generally believed to be
yM
the result of after potentials in the ventricular muscle. The P-Q interval
represent the time during which the excitation wave is delayed in the
fibers near the AV node.
The shape and polarity of each of these features Vary with the location
of the measuring electrodes with respect to heart. In general the
carcliologist looks critically at the various time intervals, polarities and
amplitudes to arrive at his diagnosis.
Few normal values for amplitudes and duration of ECG parameters
are given below:
Amplitude P wave 0.26 mY
R wave 1.50 mV
ud

Q Wave 25ok of R Wave


T Wave 0.1 to 0.J mV
Duration P-R interval 0.10 to O.2O sec
Q-T interval 0.34 to 0.45 sec
S-T segrnent 0.05 to 0.15 sec
P Wave interval 0.10 sec
QRS interval 0.08 sec
St

Page No. 72 of 328.


Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 7i
-: AV node. A heart block might be indicated of one or
more of the basic
:atures are missing in ECG.

: fifl:';e,s:h:?:::i:tJ,hffTtriil11i:#iil

l
r.rr.r,"." tr,. .r""tri'"1?T,:t* HsH:I (whether erect or recumbent)

ria
An instrument used to obtain electrocardiogram is calred an
r':ctrocardiograph. The electrocardiograph was tite first
:::tronic device to find widespread rs. i,,medical diagnosticselectrical/
and still
-,-.: most important
toor for diagnosis of cardiac disoriers. Although it
:--r'ides invaluable diagnostic information in case of arrhythmia
and
tit
s.T

ate
for

fJ 1. ECG Amptifiers
-\ormal electronic amplifiers are norma-[y referencedto ground through
:-: power supplies. Thrs creates an interference prob[m
::irfiers are used to measure smal bioelectric potentials. when such
r -ally employed not only in electrocardiography
ihe technique
'-:surement of other bioelectric signals in the use but arso in the
of a
::-:fier. The principar of differential amplifier can be explaineddifferential
with the
yM
-- of figure 5.5.
ud

Bioelectronic
srgnal I

V*
St

! 5. The differentialamplifier (a) represent as two amplifiers with separate


mp
:-l common output, (b) as used for amplificailon of bioelectric
signals
Page No. 73 of 328.
Fundamentals of Biomedical Instrumentation

74 Fundamentals of Biomedical lnstrumentation

TwoamplifierswithseparateinputsbutwithaCommonoutput is a
terminal which delivers the sum of two amplifiers output voltages
gain, but
differential amplifier. Both the amplifiers have the same voltage
phase with
one amplifier ls inverting (outpul voltage is 180" out of

l
respecttoinput)whiletheotherisnon_inverting(inputandoutput to the

ria
;;ii"g." .r" 1, prrasel. If the two amplifier inputs are connected
be zeto'
same input source, the resulting common mode gain should
becausethesignalsfromtheinvertingandnon-invertingamplilrerscancel
the two amplifiers
each other at the common output. However, the gain of
isnotexactlyequal,thiscancellationisnotcomplete.Asmallresidual
inputs is
common mode output remains. when one of the amplifier
grounded and a ,roliage is applied only
input' the
amp amplifrer'
input voltage appears ,t tn" output

ate
to the called the
The ratio of the differential galn
in modern
which
common mod.e rejection ratio-of the differential amplifier
amplihers can be as high as 10,OO,OOO:1'
Measurementofbioelectricsignalsthatoccurasapotentialdifference
The bioelectric
between two electrodes is an input to a differential amplifier'
inputs of the amplifrer'
signals are between the inverting and non-inverting
as though they
For the interference signal, hotiever, both inputs appear
smaller common
were connected togeth.i to '' common input source' Much
signal'
moa" gain amplifiers the common mode interference
divider
The electrode impedances R.* and R"- each form a voltage
yM
of thE differeniial amplifier as illustrated in
with the input ir.rp.d.r-r"e
figure 5.5(b).
signals
If the electrod.e impedance are not identical, the interference
lnpu amPliher
at the not take
may b egree
ances qual' the
place.
highcofadifferentialamplilrercanonlybe
realize impedance much higher as compared
to the imped.ance of the electrodes to which it is connected'
5.3.2. Electrodes
ud

A num usually five are afixed to the body of the


patientforG.Theelectrod.esareConnectedtotheECCwhich come
machine b of electrical wires' These wires
from electrodes to the ECG machines are called leads. The
electrode
appliedtotherightlegofthepatientforexampleiscalledtheRLleac
or one electrodt
For the record.ing of thE electrocardiogram two electrodes
and connected t:
and an interconnected group of electiodes are selected
the input of the recording amplifier'
St

Thepumpingactionoftheheartwhichgeneratsthevoltageisactual..
avectorquantitywheremagnitudeaswellasorientationchangeswi-- applied ::
the time because the ECG signal is measured from electrodes
rhe surface of the body, the"waveform of this signal is very depende:-:
ot the trace mai
on the placement of the electrode' Some of the segment
however,alrnostdisappearforcertainelectrodepositionwhereasothg
Page No. may
74show up clearly on the recording' For this reason 1n a norr-
of 328.
Fundamentals of Biomedical Instrumentation
75 Fundamentals of Biomedical lnstrumentation

electrocardiographic examination the electrocardiogram is recorded from


a number of different leads, usually 12 to ensure that no important
detail of the waveform is missed. The placement of the electrodes and
the names and configuration of the leads have become standardized. The

l
colour codes are used to identify each electrode
In this experimerrt, Einthoven had found it advantageous to record

ria
the electrocardiogram from electrodes placed vertically as well as
horizontally on the body of the patient. The leg selected was the left leg
probably because it terminates vertically below the heart. The early
electrocardiograph machine thus employed that electrodes of which only
two are used at one time. With the introduction of electronic amplifier
an additional connection to the body was needed as a ground reference.
It becomes a convention to use the free right leg as reference although
an electrode could have been positioned almost any where on the body'

c
(Brown)

ate
yM

RL (Green) L (Bed)

Fig. 5.6. (a) Abbreviations and colour codes used for ECG electrodes
ud

5.3.3. Leads
Four electrodes are used to record the electrocardiogram as shown
:: hgure 5.6 (a). The electrode on the right leg is only for ground reference.
Jtcause the input of the ECG recorder has only two terminals, a selection
:-ust be made among the available active electrodes. The 12 standard
=ads used most frequently are shown in figure 5.6 (b). The three
bipolar
-rb lead selections first introduced by Einthoven shown in the top row
St

.: hgure as given below:


Lead I : Left Arm (LA) and'Right Arm (RA)
Lead II : Left Leg (LL) and Right Arm (RA)
Lead III : Left Leg (LL) and Left Arm (LA)
Above leads are called bipolar because for each lead the
.-ectrocardiogram is recorded from two electrodes and the third electrode
Page No. 75 of 328.
Fundamentals of Biomedical Instrumentation
76 Fundamentals of Biomedical lnstrumentation

is not connected. In each of there positions the QRS of a normal heart


is such that the R wave is positive t
Bipolar Limb Leads t
Lead I Lead ll Lead lll t

l
V

ria
V
a
E
a
al
fo
sl

"ii,
lr
,l
,il,
1il
ate
(Augmented) Unipolar Limb Leads
Lead aVF
yM
ud

V, Fourth intercostal space,


at right sternal margin. Unipolar chest leads

Vz Fourth intercostal space, Vr-Vo


St

anterior axillary line.


Vo Same level as, V4 on mid-
axillary line.
Fig. 5.6. (b) ECG lead
Page No. 76 of 328.
Fundamentals of Biomedical Instrumentation
Cardiovascular Measurements 77

Einthoven postulated that at any given instant of the card.iac cycle,


:he frontal plane representation of the electrical axis of the heart is a
:rvo-dimensional vector. The ECG measured from any one of the three
oasic limb leads is a time variant single dimensional component of that

l
'.-ector. The assumption is made that the heart, i.e., the origin
of the
'.-ector is near the-,center of an equilateral triangle,
the apexes of which

ria
,re the right and left shoulder and the crotch. with this assumption the
-cG potential at the shoulders are essentially the same as the wrists
and that the potentials at' the crotch differ little from those at either
.nkle, he let the points of this triangle represent the electrode positions
:rrr three limb leads. The triangle known as the Einthoven triangle is
:hown in figure 5.7.

ate
yM

Left Leg

Fig. 5.7. The Erainthroven triangle


The three projections of the ECG vector are measured along the sides
-:re triangle. The instantaneous voltage measured from any one of the
ud

-- limb lead positions is approximately equal to the algebraic sum of


=e
-: other two, or that the vector sum of the projections on all three lines
:qual to zero. The polarity of the Lead II measurement must be
=rsed for these statements to actually hold true.
-ead II produces the greatest R wave potential. Therefore, when the
-':litudes of three limb leads are meastlred, the R-wave arSrplitude
-ead II is equal to the sum of the R-wave amplitudes of Leads I
- . III.
St

- he remaining leads are the unipolar type. For unipolar leads, the
' - -rocardiogram is recorded between a single exploratory and the
, :al terminal which has a potential corresponding to the center of
- cody. This central terminal is obtained by connecting the three
- '.'e limb electrodes together through resistors of equal size. The
-.:-tial at the connection point of the resistor corresponds to the
Page No. 77 of 328.
Fundamentals of Biomedical Instrumentation
78 Fundamentals of Biomedical lnstrumentation

mean or average of the potentials at the three electrodes. In the


unipolar limb leads one of the iimb electrodes is used as an exploratory
electrode as well as contributing to the central terminal. In augmented
unipolar limb leads. The limb leads, the limb electrode used as an

l
exploratory electrode is not used for the central terminal, thereby
increasing the amplitude of the ECG signal without changing its

ria
waveform appreciably. The leads are designated as VR, VL and VF (F
as foot).
A single chest electrode is instead of the unipolar chest leads
sequentially placed on each of the six predesignated points on the chest
for the unipolar chest leads. These chest positions are called the precordial
unipolar leads and are designated 7, thrcugh Va. A separate chest
electrode is used as an exploratory electrode and all three active limb
electrodes are used to obtain the central terminal.

ate
The record of electrocardioolam from these 12 lead selections are
shown in figure 5.8(a) . It can be seen that the trace from lead selection
I or II resembles most closely the normal electrocardiogram waveform.
Appearance of some of the other traces are quite different.

,1,

tl
t;
\
xI
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\ 5.
t
oVu
ud

5
pe
CA
fr<
1n
str
1S

SC

an
St

irc
SO

of
aVF
:ht
Fig. 5.8. (a) Typical Patient ECG
In
Page No. 78 of 328.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 79

There are certain additional lead modifications that are of considerable


use in the coronary care unit. The most widely used modification for on
going ECG monitoring is the modihed chest lead I (MCL1) also called the
Marriott lead, named after its inventor. Some practical ECG records are

l
shown in figure 5.8(b), (c) and (d).

ria
Fig. 5.8. (b) ECG recording with regular spreading of the curve with super imposed

ate
50 Hz power line intederence signals

Fig. 5.8. (c) Recording with irregular trembling of the ECG trace without wandering
of the base line but otherwise normal ECG trace
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Fig. 5.8. (d) ECG trace without wandering of the base line

5.3.4. ECG Recorder Principles


A block diagram of an ECG recorder is shorvn in frgure 5.9. The
=tient electrodes connecting wires originate at the end of a patient
ud

--

cle, the other end of which plugs into the ECG recorder. The wires
_.

-:m the electrodes connect to the lead selector switch, which also
'.:orporates the resistors necessary for the unipolar leads. A
:-ndard.ization voltage of 1 mV to standardize or calibrate the recorder
. lsed.. An artifact on the recorded trace is introduced by changing the
. :ing. From the lead selector switch the ECG signal goes to a pre-
:-.ciiher, a differential amplifier with high common mode rejection. It is
St

:oupled to avoid problems with small dc voltages that may originate


- r polarizatron of the electrodes. A variable sensitivity adjustment,
::-.etimes marked as standardization adjustment is provided. By means
:ris adjrrstment the sensitivity of the ECG recorder can be set so that
r standardization voltage of 1 mV causes a pen deflection of 10 mm.
::odern amplifiers the gain usually remains stable once adjusted, so
Page No. 79 of 328.
Fundamentals of Biomedical Instrumentation

80 Fundamentals of Biomedical lnstrumentation

that continuously variable gain control is now frequently a screwdriver


adjustment at the side or rear of the ECG recorder.
The preamplifier is followed by a power amplifier, which provide
power to drive the pen motor that records the actual ECG trace. The

l
ECG recorder can be used to record the output of other devices such as

ria
electromotograph which records the Achilles reflex. A position control on
the pen amplifier makes it possible to center the pen on the recording
paper.
Heat sensitive paper may be used ald the pen is actually an electrically
heated stylus, the temperature of which can be adjusted with a stylus
heat control for optimal recording trace. Normally, electrocardiograms
are recorded at a paper speed of 25 rr,rrrls, but a faster speed of 50 mm/s
is provided to allow better resolution of the QRS complex at very high

ate
heart rates or when a particular wave form details are required.
The protection of the electrocardiograph from damage during
defibrillation is a sevore problem. The voltages ihat may be encountered
in this case may be several thousand volts. Thus special protection must
be provided into the electrocardiograph to prevent burnout of components
a-nd its damage.
,rl.

lr
rll

\
yM
Driven
right leg
circuit

Amplifier
protection
circuit
ud

Parallel circuits for slmultaneous recordings from different leads

Operator
display
St

ECG analysis
program

Fig. 5.9. Electrocardiograph recorder block diagram

Page No. 80 of 328.


Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 81
t
r Few modern ECG machines do not connect the right leg of the
patient to the chasis, but utilize a "driven right leg lead". This involves
a summing network to obtain the sum of voltages from a-11 other electrodes
F and a driving amplifier, the output of which is connected to the right leg

l
F
of the patient. This arrangement gives a reference voltage at the right leg
F

ria
tr equivalent to the sum of voltages at the other electrodes alongwith a
a driver's amplifrer. This arrangement increases the common mode rejection
ratio of the overall system and reduces interference. It also has the effect
of reducing the current flow in the right leg electrode and thereby making
rB if safer. An ECG machine mechanism is shown in figure 5.10'
IA
ls

ate
D

la
d
Et
ts

Write
edge or
platen
yM

(a) Block diagram


ud
St

Permanent magnet

(b) PMMC galvanometer


Fig. 5.10. ECG machine mechanism (Courtesy of Hewlett-Packered)

Page No. 81 of 328.


Fundamentals of Biomedical Instrumentation

82 Fundamentals of Biomedical lnstrumentation

5.3.5. Types of ECG Recorders


5,
Al through, there are numerous types of ECG recorders and some of
these are portable units while others are part of permanent installatiops.
Only commonly used types are discussed here. On ten patient ECG T1

l
blcok diagram is shown in figure 5.11. br

ria
o
1' o) ' qQ r
'iEdPcE
=E
6 o-fxo
c)
J E=E6E grgE
a*-
rOf 3a= N u.rE t Satac**
aoo goo F-----O
-E
-Ll- c
BH*
o-E
,igEEo
E(!
Yir t-
oaE = o an
5EE
o
An
=
.oE

ate
(6tr re(
0-8
tin
lea
aul
pal
all
t, sut
,I
.t;
toi
\; o a A\ , c -.]
be
\ - the
=EH#d E
yM
EBaH$ EC(

qEe 5.3
-i5H bE
6z= g;
-^ ::z L
P
:naE
rypf
:arc
E ald
c :SA
0)
o
c
o
rrth
o Cimt
ud

= rp1
cein
:ispJ
:acl
i'hic
o
o
Y
r
-E 60I
-E
ot
ol
I
are
::gni
:tect
i

o 1i EE
St

J
-g tr 0) ECI oo-
0) EE 8q)
C E op
()E o-c
0)
(!
-J
t o)E
oo
o.p
L (E(d o
EE
Fig. 511. Ten patient electrode (12-lead) ECG block diagram
Page No. 82 of 328.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 83

5.3.5.1. Single Channel Recorders


single channel ECG recorder is the portable singre channel unit.
rhis ECG recorder is mounted on a cart so that it can be wheeled to the

l
redside of a patient conveniently.

ria
In case, the ECG'of a patient is recorded in the 12 standard lead
:onfiguration, the resulting paper strip is from 3 to 6 feet long. It is very
rconvenient for the physicial to analyze the ECG.
5.3.5.2. Three Channel Recorders
The three channel recorder record the output of three leads at a time
':Ld there is automatic switching to record output of next three channels.
-.r electrocardiogram with the 12 standard, leads therefore, can be

ate
-=corded automatically as a sequence of four groups
of three traces. The
- re required for actual recording
is only 10 seconds. The groups of
=ads recorded and the time at which the switching occurs are
rtomatically identifred by code markings at the margin of the recording
:rDer. At the end of the recording standardizatron pulses are inserted in
.-- three channels. Although the actual recording time is reduced
;:bstantially compared to single channel recorders, more time is required
apply the electrodes to the patient because separate electrodes must
-. used for each chest position. It is much easier to read the output of
-.: three channel ECG recorder as compared to single channel
yM
:- - G recorder.
5 3.5.3. Vector Electrocardiographs (Vector cardiographs)
The voltage generated by the heart is described as a vector where
-.snitude and spatial change with time may be of importance. In the
- -: of ECG recorders described above only magnitude is recorded. vector
' ciography on the other hand presents an image of both the magnitude
, - :
the spatial orientation of the heart vector. The heart vector, however,
a three dimensional variable and three "views" or projections on
--:ogonal planes are necessary to describe the variable fully in two
': -:nsional figure. Special lead placement systems must be used to pick
: -he ECG signals for vector electrocardiograms, the Frank system
ud

:'* ,-g the one most frequently employed. The vectorcardiogram is usually
: ':.ayed on a cathode-ray tube similar to those used for patient monitors.
I : .:: QRS complex is displayed as a sequence of loops' on this screen,
't'
- -'h is then photographed with a polaroid camera. vector-cardiograms
r :lso available that use computer techniques to slow down the ECG
---.ils and to allow the recording of the vectorcardiogram with a
* :anical X-Y recorder.
St

!tr.3.5.4. Electrocardiograph Systems for Stress Testing


.: the electrocardiogram is taken at rest the coronary insufficiency
- -:flected. In the masters test or two step exercise test, a physiologicalis
rr-':s is imposed on the cardiovascular system by letting the patient
"' " .,:edly walk up and down a special pair of a inch high steps prior
-':crding his ECG. Based on the same principle is the exercise stress
Page No. 83 of 328.
Fundamentals of Biomedical Instrumentation

84 Fundamentals of Biomedical lnstrumentation

test in which the patient walks at a specifred speed on a tread mill


whose inclination can be changed. \
Stress test system based on exercises consists of the following parts: k

l
1. A treadmill with automatic capability to change the speed and o
inclination in order to apply a specific physiological stress'

ria
S

2. An ECG radiometry system to allow recording of the ECG without


artifacts while the patient is on treadmill. o

3. An ECG monitor with a cathode ray display and heart rate meter. ry
br
4. An ECG recorder. S(
5. An automatic or semiautomatic sphygmomanometer for the indirect C(
measurement of blood Pressure. ht
A dc def,rbriller is usually kept available while the test is being

ate
m
performed. As the exercise stress test involves risk for patients with di
known or suspected cardiac disorders. aF
5.3.5.5. ECG Clinical Applications pa
rel
ECG can determine several defects and damages in human body.
Po
ECG can detect hypertrophy and atrial enlargement, atria-ventricular
CO:
conduction defect, intraventricular conduction defect, myocardial damage,
myocardia interaction and arrhythmta.
an
Interpretations of unsatisfactory ECG records help diagnosing above
clinical problems. The post-exercise judgements also come under clinical
yM
5.3
applications of ECG. ECG applications for clinical purposes are based on
the following techniques: act
(i) Vectror CardiograPh (VCG) cor
This helps in extracting cardiac activity of heart which is important of<
diagnostic information useful to doctors, before treating the patients. In of,
\rCG case, ECG is obtained along three axes at right angles to one con
another. Display oL x-a oscilloscope of any of these ECG as a vector is his
known as VCG. VCG gives a vectorial representation of the distributiot: The
of electrical signals generated by the heart and produces loop type patterns and
on the cRT screen. Norrnally a photograph is taken of each cardiac :he
& and ?vector loops are lc(
ud

cycle. The magnitude and orientation of P, Q, S


determined from these pictures. The direction of depolatization ani JCAI

repolarization of the arteria and ventricles can be found out form vcc _tse(

vcG is capable of detecting arterial and ventricular hypertrophY -: ttle


sensitivity in identification of myocardial infraction. It is capable c: -lec1
diagnosing multiple interactions in the presence of fascicular and bundlr .ke
branch blocks. :n e
JO
(ii) PhonocardiograPh (PCG)
St

-.:rh.
The oldest method of clinical detection of heart sounds is the acoustica
stethoscope. A better technique but less dependable is the electron:'
stethoscope having a microphone, an amplifier and head set'
tll
The phonocardiograph is the latest instrument which records souni. - 100(
connected with pumping action of heart' -1VS-
:.OOC
Page No. 84 of 328. ntr
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 85

The heart sounds give indication of the heart rate and its rhythmicity.
valve action and effectiveness of blood pumping informations are also
known from PCG. The heart sound is produced prominently by closure

l
of the ratios between upper and lower chambers of the heart. These
sounds have the frequencies ranging from 3O Hz to IOO Hz.

ria
one important aspect of PCG is the type of microphones. It is based
on the design such as the contact microphone or the air coupled
inicrophone. one of the microphones types can be piezo-electric crystal
based which generate potentials due to mechanical stresses due to heart
sounds. The other type of microphone is dynamic type based on a moving
:oil having fixed magnetic core inside it. The coil movement is with the
:reart sound which produces potential because of its interaction with
nagnetic flux. Another acoustic sensor is a polymer based adherent

ate
lifferential output sensor having thickness of just 1.0 mm. It can be
:pplied to the skin gel and two-sided adhesive material which fits the
:atient's body contour. This seirsor detects the motion of the skin which
. esults from acoustic energz incident upon it from within the soft
tissue.
?olyvinylidene fluorrde (PVDF), a piezo-electric polymer is the main sensing
, rmponent.
The amplitude used for PCG has a frequency range of 20 Hz to 2 kHz
..:rd suitable frequency bands are selected by using appropriate filters.
3.5.6. Gontinuous ECG Recording
yM
5
A normal electrocardiogram represent only a brief sample of cardiac
' tivity, arrhythmias which occur intermittently only under certain
-rditions such as emotional stress are frequently rnissed. The technique
'' continuous ECG recording makes it possible to capture these kinds
arrhythmias. This was introduced by Norman Holter to obtain a
a :-tinuous ECG the electrocardiogram of a subject is recorded during
s ' s normal daily activity by means of a special magnetic tape recorcler.
* --:
tr smallest device of this type can actually be worn in a shirt pocket
il - : allows recordings of the ECG for four hours. other recorders about
- - size of a camera case are worn
rE over the shoulder and can record
f ' i for upto 24 hours. The recorded tape is analyzed using a special
ud

d =:-ning device which plays back the tape at a higher speed than that
':: for recording. In this way a 24 lno.ur record can be reviewed in as
- : as 12 minutes. During the play back the
beat to beat interval of
- -rocardiogram is displayed on a cathode ray tube as a picket fence
'- lattern in which arrhythmic episodes are clearly visible. once such
, risode has been discovered the tape is backed up and srowed down
:tain a normal ECG strip for the time interval during which the
' ',thmias occurred.
St

:,T BLOOD PRESSURE MEASUREMENT


.: pressure which can be quite readily measured is one of the
variables to indicate the status of cardiovascular system.
-: -,logical
- -Jressure may give early indication of several serious diseases. If
Page-No.
.led it 85 of save
can 328. the patient from severe disease latter.
Fundamentals of Biomedical Instrumentation

86 Fundamentals of Biomedical lnstrumentation

Blood pressure is usually measured by means of an indirect method OI


w
using a sphygmomanometer. The word sphygmomanometer is derived
wl
from the Greek worcl sphygmos which means pulse. This method is easy

l
br
to note and. can be automated. It has some disadvantages in that it does
not provide a continuous recording of pressure variations and its practical
th

ria
..p"1io.r rate is limited. Furthermore, only systolic and distolic arterial SO

pr.""r.. readings can be obtained with no indication of the details of ar


ih" p."""rre waveform. The ind.irect method is subjective and does not
give proper result if the blood pressure is very low. m(
prr
Direct blood pressure method of measurement, on the other hand do
he
provide a continuous read out or recording of the blood pressure waveform
ber
and are co-siderably more accurate than the indirect method. They thr
require a blood vessel to be punctured in order to introduce the sensor

ate
to proper output. This limits their r-rse to those cases in which the be
inc
condition of patients warrants invasion of the vascular system.
rec
5.4.1. lndirect Measurement
The familiar indirect method of measuring blood press!-rre involves
the Llse of sphygmomanometer and a stethoscope' The
/ur
sphygmomanometer composed of a inflatable pressure crlff and a
,,-,.r.,-.r,v or aneroid barometer to measure the pressure in the cuff' The
cuff has of a rubber bladder inside an inelastic fabric covering that can
yM
$ be rvrappe,:l arouncl the upper arm and fastened with either hooks or
a velcro fastcner. The cuff is inflated manually with a rubber bulb and
deflated s1orr,,ly through a needle valve. A walmounted
sphygmomanometer is shown in figure 5.12 (a). These devices are also
manufactured as portable units for the ease of usage'
ud
St

Fig. 5.12. (a) Wall mounted sphygmomamometer


Page No. 86 of 328.
Fundamentals of Biomedical Instrumentation
Cardiovascular Measurements 87

The principle of sphygmomanometer is that when the cuff is placed


on the upper arm and inflated, arterial blood can flow past the cuff only
rvhen the arteriai pressure exceeds the pressure in the cuff. Moreover,
rvhen the cuff is inflated to a pressure that only partially occludes the
brachial artery, turbulence is generated in the blood as it spurts through

l
the tiny arterial opening during each systole. This turbulence korotkoff

ria
sounds generated can be heard through a stethoscope placed over the
artery downstream from the cuff of the patient.
A sphygmomanometer and stethoscope method of a blood pressure
:rleasurement. The pressure cuff on the upper arm is first inflated to a
lressure well above the systolic pressure. At this point no sound can be
ieard through the stethoscope which is placed on the brachial artery,
lecause that artery has been collapsed by the pressure of the cuff. When
.re pressure is reduced through needle valve korotkoff sounds begin to

ate
:e heard throu.gh the stethoscope. The pressure of the cuff that is
.::dicated on the manometer when the first korotkoff sound is heard is
:corded as the systolic blood pressure.

cuff pressure sYstolic


120

100

80
yM
r
o)
Drastolic
E60
E

! Xirr r
ud

t-

200
160
Cuff pressure 3
St

Start of
120 3
deflation
Diastolic
-
(o

Fig. 5.12. (b) lndirect measurement of blood pressure (courtesy EEIM)


Page No. 87 of 328.
Fundamentals of Biomedical Instrumentation
88 Fundamentals of Biomedical lnstrumentation

The pressure in the cuff continues to be dropped the korotkoff sounds of


continue until the cuff pressure is no longer sufficient to occlude the sit
vessel during any part of the cycle. Below the pressure the korotkoff cat
sounds disappear marking the value of the diastolic pressure, see hgure un
s.t2

l
(b\.
The familiar method of locating the systolic and diastolic pressure DTC

ria
values by listening to korotkoff sounds is called the auscaltory method rfl
of sphygmomanometry which a famolar method locating. las
Thi
5.4.2. Automated Indirect Method 24
Due to the trauma imposed by direct measurement of blood pressure
5.4.
and the lack of a more suitable method for indirect measurement, attempts
have been made to automate the indirect procedure. As a result, a
number of automatic or semiautomatic systems have been developed.

ate
Most devices are of a type that utilizes a pressure transducer
connected to the sphygmomanometer cuff, a microphone placed beneath
the cuff (over the artery) and a standard physiological recording systerc
on which cuff pressure and the Korotkoff sounds are recorded. The trasic
proced.ure parallels the manual method. The pressure in the cuff is
,,| automatically inflated to about 22a rnr..;l of Hg and allowed -to dellate
t,
I
slowly. The microphone picks up korotkoff sounds from the artery
I near the surface, just below the compression cuff. The pressure reading
,t/ at the time of first sound represents the systolic pressure, the diastolic
$;r! pressure is the point on the falling pressure where the last sound is
yM
sensed.
Some of the cornmercially available automatic blood pressure meters
work well when demonstrated on a quiet, healthy subject but fail when
used to measure blood pressure during activity or when used on patients
in circulatory shock. Methods other than detecting korikoff sound utilizing
ultrasonic Doppler method are useful in these situations.
While the clinical diagnostic value of systolic and diastolic blood
pressure has been clearly established, the role of mean arterial pressure
(MAP) as an indication of blood pressure trend has become more widelr-
accepted with the expanded use of direct pressure monitoring using
arterial cannulae with electronic transducers and displays. Most electrical
ud

monitors now provide both diagnostic systolic/diastolic waveform


information and the added option of a singie value MAP indication. It is
now generally recognized that MAP is a direct indication of the pressllre
available for tissue perfusion and that a continuously increasing or
decreasing MAP can ultimately result in a hypertensive or hypotensive
arls1s.
Mean arterial pressure is a weighted average of systolic and diastolic
pressure. A simple formula for calculating MAP is as follows.
St

MAP = |{.r.,o,t" - cliastolic) + diastolic


Because in most clinical situations systolic and diastolic pressures
correlate with each other and MAP determined from the systolic pair-
critical patient arterial pressure trends can be monitored by observatior-
Page No. 88 of 328.
Fundamentals of Biomedical Instrumentation
Cardiovascular Measurements 89

rf MAP limits. Adjustable alarm limits as required for a given clinical


:ituation can then alert staff of possible patients problem. These units
:an be used in operating rooms, recovery rooms and intensive care
-rnits.
A system that can measure blood pressure automatically at pre-

l
lrogrammed time on a continuous basis and during the normal activities

ria
'l patient. Such machine can measure blood pressure on a continuous
:asis for 100 pre-programmed time alongwith a Holter electrocardiograph.
.:ris way the physician can get information of the patient health on a
--1 hours basis.
5.4.3. Direct Measurement
The blood pressure is measured using one of the following methods:
(i) Percutaneous insertion

ate
ii) Catheterization
:ii) Implantation of a transducer in a vessel or heart.
Figure 5.13, gives a general idea of both the methods. For a
-.::cutaneous insertion a locai anesthetic is injected near the site of
-','asion. The vessel is occluded and a hollow needle is inserted at a
.ght angle toward the vessel. When the needle is in place a catheter is
r through a guide. When the.catheter is in place in the vessel the
-:dle and guide are with drawn. For some measurement a typical type
reedle attached to an air tight tube is used, so that the needle can
yM
'' .eft in the vessel and the blood pressure sensed directly to by attaching
-:ansducer to a tube. Other types have the transducer built into the
: of the catheter.

Superior
Vena Cava

light Pulmonary
Artery
Pulmonary Trunk
Right Otrium
ud

Tricuspid Valve
St

Boslic Vein

Fig. 5.13. Cardiac catheterization


The tube is shown entering the basilic vein in this case
Page No. 89 of 328.
Fundamentals of Biomedical Instrumentation
90 Fundamentals of Biomedical lnstrumentation

Apart from obtaining blood pressures in the heart chambers and


great vessels, catherizations technique is a1so used to obtain blood samples
from the heart for oxygen-content analysis and to detect the location of
abnormal blood flow pathways. Also catheters are used for investigations
with injection of radio opaque dyes for X-ray studies, coloured dyes for

l
indicated dilution studies and of vasoactive drugs directly into the heart

ria
and certain vessels. A catheter is a long tube that is introduced into
heart or a major vessel by way of a superficial vein or artery.
A catheter technique of measurement of blood pressure is done in
the following ways. A sterile saline solution is introduced into a catheter
so that the fluid pressure is transmitted to transducers outside the
body. A complete fluid pressure system is set up with provision for
checking against atmospheric pressure and for establishing a reference
point. The frequency response of this system is a combination of the

ate
frequency response of the transducer and fluid column in the catheter.
In the second method the pressure measurements are obtained at the
source. Here the transducer is introduced. into the catheter and pust'ed
to the point at which the pressure is to be measured or the transducer
is mounted at the tip of the catheter. This device is called a catheter Lip
f:/
blood pressure transducer. An unbounded strain gauge or a variable
Tti,
inductance transducer is used for mounting catheter tip blood pressure
transducer. 1

i Major surgery is needed for implantation technique. Therefore, this 1

technique are normally employed only in research experiments. They (


yM
have the advantage of keeping the transducer fixed in place in the
appropriate vessel for long period.
1

5.4.4. Specific Direct Measurement Techniques \,

The four different categories of direct measurement of blood pressure E


are as follows:
(rJ A catheterization method involving the sensing of blood pressure
through a liquid column. In this method the transducer is external
to the body and the blood presslrre is transmitted through a saline I
solution column in catheter to the transducer. This method uses \\
an unbounded strain gage to sense the pressure or a linear variable k
ud

differential transformer. u
(irj A catherterization method involving the placement of the transducer p
through a catheter at the actual site of measurements in the p
bloodstream, i.e., to the aorta or by rnounting the transducer on tl
the tip of catheter. ol

(iirJ Percutaneous methods in which the blood pressure is sensed tt


in the vessel just under the skin by the use of a needle or
catheter. ill
St

bl
(iu) Implantation technique in which the transducer is more permanentil-
put in the blood vessel or at the heart by surgical methods. SC

sl
ri
:]I

Page No. 90 of 328.


Fundamentals of BiomedicalCardiovascular Measurements
Instrumentation 9:l

-..1 organs of the body require a71 acTecluate blooct sttpply' infact if the
.rod supply to a pariicular organ is not ad.equate then that particular
' g," not functiott ptop"t5'' The ability to measure blood flow in
^ay
:-.- \'essel that supplies Utood to a particular organ would'
therefore' be
. great help in diagnosing such diseases' It is not very easy to measure

l
lod flow.

ria
Gasinapipeortherateofflowofaliquidisexpressedasthe
lume of the substance that passes through a pipe in a given unit
of
per minute or
.:^re. Flow rates are, therefore, usually expressed in liters
'..[i.meter per minute (cm3/min).
Physically all the blood flow meters currentiy used in clinical
and
.:earch aPPlications are as follow:
liJ Electromagnetic induction
irl Uitrasound transmission or reflection

ate
iiz) Thermal convection
.1,) Radiographic PrinciPle
u) Indicator, i.e., dye or thermal dilution
Magneticandultrasonicblooclflowmetersmeasurethevelocityof
.. e blood stream. Therefore, these transducers are to be placed in exposed
Detection
.-rod vessel, these transducers are mainly used during.-surgery'
flow measurement
,struction of blood vessels where quantitative blood
,:e not required can be done by using ultrasounds'
Segrrents, can be used to the measure of the flow of blood
in the
yM
...,bs-canbeindicatedbyaplethysmographwhichactuailyindicates
,Iume changes in bodY.
5.5.1. Magnetic Blood Flow Meters
When an electric conduction is moved through a magnetic f,reld
a
Jltage is induced in conductor proportional to the velocity
of its motion'
-." Ju.-" principal is applicable when the rnoving conductor is not a
,,':re,butratheracolumnofconductivefluidthatflowsthroughatube
catedirrthemagneticfield.Figure5.l4showshowthisprincipleis
,.sed in magnetic btod flow meters. A permanent magnet
or electromagnet
_ositioned around the blood vessel generates a magnetic field
blood flow. The induced voltage in
_"i."ai."lar to the direction of the
ud

with stationary electrodes located


.le'moving blood column is measured
at proportional to the direction of
.r opposite sides of the blood vessel
re rnagnetic field.
The implantable magnetic blood flow probes are shown in
.3ure 5.15. The clip on tne C type is applied by squeezing an excised
:|oodvesseltogetherandslipprrrgitthroughtheslotoftheprobe.In
=,:me transducer models the siot is then closed by inserting a keystone
protruding
.haped segment of plastic. contact is provicled by two slightly
St

,:iatinum disk thatiouch the wall of the blood vessel. The orihce of the
--robe must fit tightly around the vessel
for proper operation'

Page No. 91 of 328.


Fundamentals of Biomedical Instrumentation
92 Fundamentals of Biomedical lnstrumentation

l
ria
F

Blood Flow
Fig. 5.14. Magnetic blood flow meter principle TJ

tl

ate
a
flr
of
UI

,|
/,,
yM

Fig.5.15'samplesoflargeandsmallhumandiametersbloodflowprobe
catheter tip transd.ucer used the magnetic blood flow transdllcers
principle. It is essentially turned 'inside out' with the electromagnet
temgiocated inside the catheter, which has the electrodes at the outside'
Catheter transducer can be calibrated in flow units'
ud

A magnetic blood flow transd'ucer is very small, output voltage of 5.5


typically in the order of microvolts. For recovering the signal in the
p.""".r." of the error voltage, amplifiers with large dynamic range and
pt r"" sensitive or gated ditectors have to be used' To minimize the _o

problem several different waveforms have been advocated for the magnet - -li
current as shown in figure 5.16. With a sinusoidal magnet current, the
induced voltage is also sinusoidal but is 90" out of phase with the flow
_
\)

signal. With ; suitable circuit, similar to a bridge the induced voltage :ST
St

u" partially balanced. out. with the magnetic current in the form of ':e
"""., wave the induced voltage shall be zero once the spike from the
"polarity
"qrr".L reversal has passed. These spikes are often of extremely high -:lr
ampttlde and the cir-uitry response tends to extend their effect. As the " i:J

use of magnet current having a trapezoidal waveform. A dehnite superiority -'.a


is not achieved.
Page No. 92 of 328.
Fundamentals of Biomedical Instrumentation
Cardiovascular Measurements 93

Magnet
Current

ii(a))(c)

l
/'^
\_tu_,

ria
Fi9.5.16. Waveforms used in magnetic blood flow meters and error signals induced
by the current: (a) sine wave; (b) square wave; (c) trapezoidal wave
Figure 5.17 shows the block diagram of a magnetic blood flow meter.
. he oscillator which drives the magnet and provides a centrol signal for
-re gate operates at a frequency of between 60 and 4OO Hz. The use of

ate
,.- gated detector made the polarity of the output signal reverse when the
'.ow direction reverses. The mean or average flow can be derived by use
: a low pass filter. The frequency response of this type of system is
-sually high enough to allow the recording of the flow pulses.
yM

Pulse Average
o.'iI#'

Fig. 5.17. Magnetic blood flow meter, block diagram


ud

5.5.2. Ultrasonic BIood FIow Meter


A beam of ultrasonic energr is used to measure the velocity of flowing
-ood. This can be done in two different ways. In the transmit time
:ltrasonic flow meter, a pulsed beam is directed throw a blood vessel at
, shallow angle and its transit time is then measured. When the blood
'.tws in the direction of the energz transmission, the transmit time is
.ss. The transit time is lengthened. If it flows in the opposite direction.
St

Doppler principal ultrasonic flowmeters is also used. An oscillator


cerating at a frequency of several meghacycles/sec, a piezoelectric
-:alsducer (usually made of barium titanate) is coupled to the wall of an
-rposed blood vessel and sends an ultrasonic beam with a frequency F
.to the flo'wing blood. A small part of transmitted energr is scattered
ack and is received by a second transducer arranged opposite the first
Page No. 93 of 328.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 95

An electric heater is placed between two thermocouples or thermistors


in an another method that are located some distant apart along the axis
of the vessel. The temperature difference between the upstream and the

l
downstream sensors is a measure of the blood velocity. If called a
thermostromuhr. Thermal convection methods for blood flow

ria
determination have ceased to exist.
5.5.4. Blood Flow Determination by Radiographic Method
By the injection of a contrast medium into blood vessel, i.e., arr
iodated organic compound the circulation pattern can be locally visible
rvhich is not normally visible on an X-ray image because it has about
the same radio density as the surrounding tissue. On a sequential record
of the X-ray image, either photographic or on a videotape recording, the

ate
progress of the constant medium can be followed, obstructions can be
detected and the blood flow in certain blood vessels can be estimated.
Ihe techniqtle, known as cine'or video angiography can be used to
assess the extent of damage after heart attack or a stroke.
The injection of a radioactive isotope into the blood circulation, which
allows the detection of vascular obstruction i.9., in the lung with an
-mage device for nuclear radiation such as a scanner or gamma camera.
Measuring differences in the skin temperature caused by the reduced
:irculation the vascular obstructions in the lower extremities can
yM
sometimes be directed.
5.5.5. Measurement by Indicator Dilution Methods
This method really measures the blood flow and not the blood
'elocity. In principle any substance can be used as an indicator if it
::rixes readily with blood and its concentration in the blood can be easily
letermined after mixing. The substance must be stable but should not
re retained by the body and side effects must not exist.
Cardiogram an indocyanine dye, used in a isotonic solution was long
:avoured as an indicator. Its concentration was determined by measuring
he light absorption with a densitometer (colorimeter). Radioactive isotopes
,-.ave also been employed for the purpose. The indicator most
ud

::equently used today, however, is isotonic saline, which is injected


.t a temperature below the body temperature. A sensitive thermistor
-rermometer cietermines the concentration of the saline after mixing
rith the blood.
Figure 5.19 is shown the principle of dilution method. The upper
-:awing shows a model of a part of blood circulation under the (very
'-mplihed) assumption that the blood is not recirculated. The indicator
St

r injected into the flow continuously beginning at time t at a constant


-fusion rate I grams per minute. A detection measures the concentration
:rwnstream from the injection point. Figure 5.18(a) shows the output of
: recorder that is connected to the detector. At a certain time after the
..lection, the indicator begin to appear, the concentration increases and
-rally it reaches a constant value C, (milligrams per liter). From the
-.easures concentration and the known injection rate, I in milligrams
Page
.:r No. the
minute 94 flow
of 328.
can be calculated as follows:
Fundamentals of Biomedical Instrumentation

96 Fundamentals of Biomedical lnstrumentation

I (milligrams per minute)


F (liters per minute) =
C" (milligram per liter)

l
ria
,{
4:

'llit
tl
ate
Fig. 5.19. Flow measurement by indication dilution methods, principle.
The indicator is injected at time t = i
yM
MEASUREMENT OF HEART SOUND
The heart sound listen by the physician by putting his ear near the
chest of the patient. This is taken over by the stethoscope, which is a
device that carriers sound ener5/ from the chest of the patient to the ear
of the physician via a column of the air. There are many forms of
stethoscope but the familiar conhguration has two earpieced connected
to a common bell of chest piece. The system is strictly acoustical. Only
a small portion of energz of the heart is in audible frequency range.
A graphic record of heart sound is called phonocardiogram is very
successful. The instrument for producing this recording is called a
phonocardiograph. A pressures, ECG transis and heart sound over time
ud

are shown in figure 5.20.


The transducer used for the phonocardiogram is a microphone having
the necessary frequency response generally ranging 5 Hz to above 1000
Hz. An amplifier with similar response characteristics is required, which
may offer a selective lowpass filter to allow the high-frequency cut-off to
be adjusted for noise and other considerations. In one instance when the
associated pen recorder is not inadequate to reproduce higher frequencies
an integrator is employed and an envelope of frequencies over 80 Hz is
St

recorded alongwith actual signal below 80 Hz.


Most pen recorders have a limitation of around 100-200 Hz
photographic or light galvanometric recorders are required for faithful
recording of heart sounds. However, heart sounds fall well within the
frequency range of pen recorders, however, the high frequency murmers
that are often important in diagnosis require the greater response of the
Page No. 95 of 328.
photographic device.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements 97

40
-o)

l
E
E

ria
o
f

frro
o-
t(o
o
-c

.9
cEN
14Or

ate
Maximum
120 ejection
6
I
E 100
tr
E.^
q
o
o60
E
E
(u
0)
f,40
.c
.9)
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G
20

Heart
sounds

, 150
4: rzo
E* so
g5 60
5E 300
ud

02 08
Time (s)
St

Diastole Systole Diastole

Fig. 5.20. Pressures ECG trancings, and hear shown opver time
Multichannel physiological recording systems of the phonocardiogram
:: one of the measurement is available. With a microphone amplifier
::-d a pen recorder to record upto 2OO Hz of frequency.
Page No. 96 of 328.
Fundamentals of Biomedical Instrumentation

98 Fundamentals of Biomedical lnstrumentation

The high frequency, ri.e., murmers in the phonocardiogram indicates


a possible heart disease. A spectral analysis of heart sounds can provide
a useful diagnostic tool for diagnosis of normal and abnormal heart. A

l
digital computer'with a high speed analog to digital conversion capability
and some form of Fourier transform software is required.

ria
Phonocardiogram are designed to be placed on the chest over the
heart using microphone. Heart sounds sometimes measured from other
points, for this purpose, special microphone transducers are placed at
the catheter to pick up heart sounds from within the heart chambers or
from the major blood vessels, near the heart. Frequency response
requirement of these microphones are abor.rt the same as for cl
phonocardiogra ph microphones.
ct
The apex cardiograph and the vibrocardiograph which measure the

ate
ch
vibrocardiogram and apex cardiogram respectively also use microphones pr
as transducers. But, these measurements involve the low frecluency CU
vibrations of the heart against the chest wall, hence, the measurement ab
is normally one cf the displacement of force rather than sound. Thus the ve
microphones used must be a good transdr,rcer of force with suitable low
w1
frequency coupling from the chest wall to the microphone transducer.
be
For the apex cardiogram, the microphone must be coupled to a point
between the ribs. Good result for this purpose can be achieved.
Using the apex cardiogram and the vibrocardiogram do not conlain
the high frequency components of the heart sounds, these signals can
yM
be handled by the same type of amplifiers and recorders as the
electrocardiogram. Often these signals are recorded alongwith channel of
ECG data to maintain time reference. In this case one channel of a
multichannel trCG recorder.
The Korokoff sounds can be recorded used from a partiallv occluded
arlery.a microphone is usually placed beneath occueing cuff or over the
artery immediately downstream from the cuff. The waveform and frequency
content of these sound are not as important as the simple identification
of their pressure, so these sounds generally do not require high frequency slol
response specified for the phonocardiogram. Automated indirect- ACC
measurement of blood pressure circuitry for these is same. dur
ud

PLETHYSMOGRAPHY
The measurement of blood flow is the measurement of volume changes
in any part of the body which result from the pulsations of blood occurring
with each heartbeat. These measurements are useful in the diagnosis of
arterial obstructions as well as pulse-wave velocity measurements.
Instruments measuring volume changes or providing outputs that can
St

be related to them are called plethysrnographs, and the measurement of


these volume changes or phenomena related thereto is called
plethysmography. It responds to changes in volume. (

It consists of a rigid chamber placed over the limb in which the (

volume changes are to be measured as shown in hgure 5.21. The chamber (

is tightly sealed to the member to be measured so that any changes of (

Page No. in97the


volume 328. reflect as pressure changes inside the chamber. Fluid
of limb (
or air can be used to filI the chamber.
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements gg

l
To

ria
Recorder

Airtight Seat

Fig. 5.21. plethysmograph


re or constant volume within the
t the
the

ate
pressure is calibrated by use of a cali line
cuff which is ptacea sngttty ,p"tr"ril'
above venous pressure, arterial blood ; ,11:
*'enous brood cannot leave. As a , ,fr"
result the rimb i.r"...s.s its vorume
*'ith each heartbeat by the volume of the blood
beat' The output trace of measurement ..rt..irg during that
is shown in figure 5.22.
yM

the
the
off
ud

SUMMARY
Biomedical instrumentation speciarly for
cardiovascurar system, herped
a lot in reducing untimely death iue
to heart failures.
St

organs of the body by left ventricle.


clearly seen in figures 5.1 and 5.2.
contraction of the heart muscles.
)rgans then the blood pressure is c
rf dilation
Page No.of the98heart
of 328.
cavities as
Fundamentals of Biomedical Instrumentation

100 Fundamentals of Biomedical lnstrumentation

Some important average value of blood pressure which in written as


systolic/iistolic is t2Ol80 mm of Hg. Normalty 5 litres out of total
6 lit.." of blood in an adult is circulated per minute. During exercise
the circulation rate increases. At any give to me about 75-8O%o of the

l
b100d volume is in the veins about200k of the blood is in arteries and
remaining in caPalaries.

ria
3. Electrocardiography: The electrocarcliography is used clinically in
diagnosing,..io,"diseasesandconditionsassociatedwiththeheart.
tn"trregraphicalrepresentationofECGthePwaverepresents
depolarizati.on of the artrial musculature' The QRS complex is the
combinedresultoftherepolarizationoftheateriaandthe
repolarization of the ventricles which occur almost simultaneously'
The T wave is the wave of ventricular repolarization. In diagnosis
of
of beats per
heart the heart rate should be in the range 60-100

ate
minute, the heart rate slower than this is called bradycardia and
higher rate as tachycardia. Physician then see if the cycles are evenly
sp"aced. If the cycles
- are not evenly spaced then the condition is
called arr then O'2 sec' it can suggest
blockade idual ECG remains fairlY'
,t,
constant instrument used to obtain
r,
{l
t;
electrocardiogram is called an electrocardiograph'
dr In biomedical electronics we have to measure bio-electric potentials'
fr
t( For this purpose normal ampliher where the reference is through
ground of tn" power supply ari not suitable. In this case a differential
yM
\
Implifier witkr a frigh input gain and high common mode rejection
ratio of the order of 1O,OO,00O : 1 are used'
I

To record an ECG a number of electrodes usually five are applied


to 6. 1

I
thesurfaceofthebody'Theelectrodesappliedtothebodyarethe
named as RA, LA, RL, Ll and c. The wires which comes from
electrodes to the ECG machines are called leads. The four electrodes
except electrode RL (right leg) which is ground are used for the
by
.".oidi.rg of electrocr.riiog."-. The other system introduced are
Einthroven may be seen in frgure 5'6' The arrangement of leads
suchthatinatlthepositionstheRwaveofQRSispositive. .T

In the ECG recorder the leads from the patient are connected to the
ud

of ir
ECG recorder through a selector switch. A standardization voltage t
paper
1 mV is used for calibration of the recorder. The recording L
used is a heat sensitive paper where the stylus is electrically heated f(
For recording.
is
Normally, electro cardiograms are recorded at a PaPer sPeed of
25 mm/sec but faster sPeed of 50 mm/sec is also available. The
C

higher speed of 50 mm/sec allows better resolution of the QRS


T
T
complex at very high heart rates'
St

The following types are ECG recorders are available:


tl
a
(a) Single channel ECG recorder. IN
(b) Three channel ECG recorder
M
(c) Vector electrocardiograPhY S(
(d) Electrocard.iography systems for stress testing' ht
99 of 328. ECG recording (Holter Rct'r'rding)'
Page No.(e) Continuous
Fundamentals of Biomedical Instrumentation

Cardiovascular Measurements
101
are^used to- determine several
LT":ll,:"",.i#l:"1,^.:s
damages is human toay. ecC-"".i'I,*"'ru,ne
severat defects and
and
:tect hypertrophy and arterial
enlargement. ,tJ,,,^h+ri^^r^-
:l..ll?":..1j::d;il;il'Jff
:;ilT""f, :::"?lli:X;i::l#

l
:HH1Tl;"*#Ii:,gH1;;+:;;.:"Til,1X8::i,H":'# :J,j3l,i:,."?,,, clinical
:::1##,:orheart""a-pCil;T&;,,,ffi

ria
applications.
+. Blood pressure M t:
indication of sever
di
patient from severe
n
measured by means of
sphygmomanometer. There
ar
measurement one is indirect
and
of blood pressure.

ate
r In the indirect method the measur
which consists of a cuff *friJ
yM
d Cardiac. Output: The normally
the following types:
(zJ Erectromagnetic induction
(izJ Ultrasound transmission
or reflection.
(ilzJ Thermal convection
(iu) Radiographic principle
(u) Indicator dilution
The magnetic blood flow
meter are normally used by
ud

-nplantation. These types are normally surgical


:esearch purpose. used during surgery for
'-ltrasonic brood flow meter in
:or the measurement-of blood the transmit/receive mode are used
:s to use ultrasonic flowmeters
no* *i".rrement. The other method
b";;
rthermethodsarebloodfl o*_.r"r;";'.:,?:r,Ij1;:#;r":,;"ection.
lhe o.ther important method i" ,raio."tive
lhe blood flow mee isotope.
':ermporta,,t-.tiJ"l:.t+:"",:::"Hf:T#":f$ffI,,::;,f
St

= rsotonicsorution was used as an in"drctor.


The principal of dilution
--.ethod may be seen at figure S.19.
lleasurement of Hgart sound:
'' und are made with the help of The normal measurement of heart
-:art sound are measurea .-","irro""ope. The problems
with th" h;ip of a phonocardiogram.in the
Page No. 100 of 328. This
Fundamentals of Biomedical Instrumentation

102 Fundamentals of Biomedical lnstrumentation

uses a microphone having a frequency response between 5 Hz to


1OOO Hz. An ampliher with similar freq. response is required. A E
photographic or light galvanometer recorder are required for recording

l
of heart sound.
The high frequency sound from heart is known as murmurs indicate

ria
, po""ibl" heart disease. For this reason a spectral analysis of heart
sound.s can provide a useful diagnostic tool for diagnosis of normal
and abnormal heart.
g. Plethysmography: Plethysmography is used for the measurement of
volume changes in any part of the body that result from the pulsations
of blood occurring with each heart beat, Such measurements are
useful in the diagnosis of arterial obstructions as well as pulse wave

ate
velocity measurement.
The plethysmograph consists of a rigid chamber placed over the limb
in which the volume changes are to be measured'
\
,ij|
txerciae,t
(
l:, 5.1. wirat is electrocardiography? Discuss various characteristic featr-lres of (
r$
trCG amplifiers. (UPTU 20031
(
Jr to the body of the
il S 2. Discuss about the electrodes and leads that are fixed
patient in order to record an electrocardiogram' (UPTU' 2OO3t e
yM
[n 5.3. i)iscr-t: ' 1-wo commonly used ECG recorders briefly' (UPTU' 2OO3' c

5.4. I{rrrr. :an electrocardiography be used for stress testing? (UPTU' 2003 6
5.5. Djo^,.rss an automated indirect method of blood pressure measurement' 6
(UPTU, 200s 6
5.6. Explain the ultra-sonic method of blooci flow measurement.
(UPTU, 2003
5.7. Explain the trCG recorders, (r) three channel, (ir') vector cardiograph'
(UPTU, 200/
I
5.g. Explain briefly the ECG system used for stress testing. (UPTU' 2004 .1e
5.9. trxplain a method of heart sound measurement' (UPTU' 2O0t -j lul
5.10. Explain main parts of electrocarcliogram. How can you determine the fse
PPTU, MQP '
ud

heart rate? I
5.1 1. Discuss measurement of blood pressure and possible error due to traumz _ tcu
or other physiological effect on patient. (UPTU' MQP '
:- a]
5.72. Describe the three methods used to measure the blood pressure. r:e(
(UPTU, MQP : -
T
5.13. What is the importance of blood flow? Discuss the biomedical instrumen:s : -)fr
that are used to measure the blood flow' (UPTU' MQP )t
. -..clt
5.14. Draw an electrocardiogram (in lead II), labelling the critical features'"
:S
include typical amplitudes and time interval for a nominal person. Expl
St

the most important part of ECG for determining heart rate'


(UPTU, MQP
5.15. Explain the clinical application of a multichannel trCG' (UPTU' 20C

Page No. 101 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Patient Care and Monitoring

.-.
6"1.
6.2.
6.3.
6.4.
fnside this ehapter

Patient \4onitoring Disp1a1,s ate


Elements of Intensive-Care Monitoring

Diagnosis, Calibration and Repairabilir! of Patient-Monitoring Euipment


Other Ins[rr,rmentation for Monitor:ing Patients
yM
6.5. Organization of the Hospital for Prrtient-Care Monitoring
6.6. Pacemakers
6.7. Defibrillators
6.8. Summary

Patient monitoring is very familiar part of biomedical instrumentation.


ne continuous watch over the patient is possible because of electronic
-:uipments" Careful and accurate monitorin,g of the patient in intensive
-.se units is feasible due to these electronir: medical instrumentation.
ud

If a heart attack or stroke occurs, serious imbalance in the body


-curs, hence, need of patient's monitoring. It may be surgical operation,
: all cases continual monitoring of the patient, the problems can be
.':iected and remedial action taken.
The biomedical engineer is responsible for not only designing
rropriate and safe equipments, but gets tht:se manufactured in quality
- rde. Subsequently, he trains usage, oper-'ation and maintenance of
:se biomerlical monitoring equipments.
St

ELEMENTS OF !NTENSIVE-CARE MOhIITORING


-.: 24-hour nursing for critically ill patien L in the hospitals are some
ihe essential needs and naturally this c eills for intensive-care and
103
Page No. 102 of 328.
Fundamentals of Biomedical Instrumentation

104 Fundamentals of Biomedical lnstrumentation

patient monitoring. The technologr advancement have lead to equipment


design and manufacturing which are reliable and accurate for extensive
E
care monitoring of the patient. The nurses have at their disposal powerful V
tools for acquiring and assimilating infbrmation about the patient. This

l
o
leads to rendering better service to a large number of patients, able to
react promptly and properly to an emergency situation. Such a capability

ria
provides an immediate alarm in the event of certain abnormalities. The
monitoring equipment makes it possible to call a physician or nurse in
time to administer emergency aid before permanent damage can occur.
The availability of electrocardiograrn record just prior to, during, after
the onset of cardiac difficulty, the prompt monitoring and warning system
enables the physician to give the patient the correct drug rapidly. In
many cases, their process can b,e automated. There are differences of
opinions about the physiologica.l parameters to be measured among

ate
physicians. The monitoring of s,everal parameters are very expensive,
therefore, it is necessary to choose only essential parameters. However,
continuous monitoring of heart tJerough electrocardiogram is quite normal
in any intensive care unit. Temperature measurement is quite frequent.
There are several parameters sr,rch as blood pressure may be measured
not so frequently. However, if ccrntinuous measurement of blood pressure
is the need, it requires catheterization of the patient which requires
experience of catheterization, arrd also in many cases may affect condition
of the patient. This is also painful to the patient.
yM
The development of electrir: equipments which are capable of reliable
measurement and display, c:oncept of intensive care-monitoring has
become feasible. These unitsr are installed along 'the bed side of the
patient. The facilities inch.rde electrocardiogram, heart rate and
informations from bedside in. all other monitored parameters.
The basic elements of in1:ensive care monitoring unit are: JD
(r) Skin electrodes to pick'up ECG potentials. -.1 c
(iz) Amplification unit for r:lectrocardiograph. : ata
(rfl CRT display for observation of ECG waveforms. The central nurses !::ltr
station normally can lhave CRT display of several patients on the
same screen. i
ud

(lu) A rate meter to indicate heart beat, it can have continuous indicatior:
;
with audible beep or flashing light at each heart beat. =:tl
(u) An alarm system is actuated by the rate meter to alert the nurse.
;::a
rl
(rri) A direct wired-up derrice for electrocardiograph.
(uil A memory tape to rer:ord the playback of ECG for 15 to 6O sec.
(uiiz) Additional alarm syst,ern triggered by ECG parameters.
(rx) Electrical circuit to indircate that electrode connections have become
disconnected which rrLe5r be due to mechanical failure.
St

(x) A closed circuit monit oring system is also employed to provicie


visual coverage using cameras focused on each patient. Noise ali
movement of artifacts may give false alarms sometimes. Specia-
measures such as elecl-rode placement patterns can be looked inl:
to improve. There is n o standard pattern existing.
Page No. 103 of 328.
Fundamentals of Biomedical Instrumentation

Patient Care and Monitoring 105

Patient-monitoring equipments is generally specihed as a system.


Sach manufacturer and each hospital staff has its own ideas. A wicle
of configurations can be seen in the hospitals. Figure 6.1 shows
"'ariety
rne of the patient care monitoring system block diagram.

l
ria
Measuring
Devices and its
Analog lnteface
Display

Analog Process Video


Multiplexeis lnterrupts Processor Analog O/P

ate
Display Digital
Alarm etc.

fuD
I-other -_l
Converter I ortprt I

High pertormance Serial


RAM CPU lntedace
{
RCM Printer I
i
yM
Data Keyboard
Storage

FiE. 6.1. Patient care monitoring system block Diagram


The communiction channel from the central station to each bedside
:idirectional so that data and control signals can flow freely in each
: ::ction between micro computers. The patient care stations accept
: .-a in general upto eight patients. It may provide single or dual channel
.:-chart recordings.

rll pnleNT MoNrroRlNG DrspLAys


ud

i:.-,hful reproduction of ECG, arterial blood pressure and other valuable


: :--imeters are essential. The CRT displays are of three types:
' Conventional display: This is conventional CRT with horizontal
sweep driven by a slow-speed sweep generator which causes the
electron beam to move from left to right at an predetermined rate
say 25 to 50 mm/sec.
' Bouncing ball display: This is also CRT arrangement wher.ein
St

sweep rate is very high such that display appears to be continuous


display. Each spot of light seems to be bouncing up, hence, bouncing
ball display name.
' Nonfade display: It also uses CRT display, but the electron
beam
rapidly scans the entire screen of the CRT in a television like raster
cattern. The beam is brightened only when a brightening signal is
No. to104
Pageapplied of by
CRT 328.X-axis modulation. This gives trace pattern, i.e.
Fundamentals of Biomedical Instrumentation

1OO Fundamentals of Biomedical lnstrumentation

a series of dots on the screen, see figure 6.2. Tl'je brightening


that is
signal is applied only rvhen beam passes a certain location
tJcorrtain part of the displayed wave, form at which time it produces t
a dot on the screen.

l
6

ria
,l
tl
/l ,'a E
tt.-
I t a-,'----r' e(
---/ \' ar
Fig. 6.2. ECG Pattern made of dots It
in which
The brightening signals are produced from a digital memory
several seclonds ol da-ta from each channel of the patient monitor are
tt

ate
stored.
oneoftheimportantfeatureofanypatient-monitoringsystemisits
particular
th
ability to display the physiological waveforms or condition of
a
orgat. The principat display devices are th hr
small single or dual channel display at th ar
display monitors for various requirements io
tror"
,(t'.
Biside monitors are available in a variety of conhgurations importanr
cf
t,, d ure gned to monitor different T}
.-{,, p as and heart rate' etc' One s"rch rf
,c: I

; be 5'3 as block diagram' \11


yM
qn MICBOPROCESSOR BOARD :a
lp
E.C.G.
Amplifier
with
OPTO
e,
MtrE-- sh it
nn
lr(

EEEE
lsolation rate ::.e
.--a_

F*"t"s'f
lk
ud

rm

Memory L

Hold
Cr-rc

ilE-t l
L.o.T. br

C R.TUBE 1 031 contr


St

C R.T. Raster Board

Fig. 6.3. Bedside patient monitor block diagram


The instruments included are pressure, temperature and respiration
rate monitoring.

Page No. 105 of 328.


Fundamentals of Biomedical Instrumentation
Patient Care and Monitoring 107

Various signal conditioner units are available in modular construction


and slide into to integrate with the main instru-mentation system as per
requirements.

l
6.3. DIAGNOSIS, CALIBRATION AND REPAIRABILITY OF PATIENT.

ria
MONITORING EQUIPMENT
:ngineers and technicians need to diagnose the problems
of monitoring
:luipments. It is essential that equipments are operational and calibrated
.:curatel5r. Many electronic units are available for calibration purposes.
can have built in calibration leature, i.e., ECG may have 1 mV
-.libration voltage avnilability.
Ntlany medium units have built in diagnostic feature to trouble shoot

ate
:-e equipmenr malfunctions. Generally these are manufactured such
.^at ease of replacement or repair or both exist.
The spread of medical instruments with high degree of complexity
..s created a great demand for effective and efficient trouble shooting
:--d maintenance. The effective methods of maintenance have been evolved
meet the challenge of complexity. Depending on the conceived scope
'lhe
maintenance function, needs very because of the technical realities.
-.ere are several major activities involved in the process of installation
a large expensive biomedical instrumentation such as X-ray, CT scan,
lRI, etc. The installation and cummissining must be well planned with
yM
.:h detail. Plan some trials, just after installation. Select and train
::rators of the equipments and setups. some basic trouble shooting
-,C maintenance training is essential to avoid costly long
time
-.akdowns.
The manuals must be obtained for installation, operation, and
-:rntenance, Critical spares may be procured if backup by supplier is
,:d to get Potential maintenance points:
il Environment conditions of the instrumentation would generarly be
good, however, temperature, dust, humidity should be in tolerance
limit.
:N No heavy machinery should be around like presses, compressors
ud

and such other machines which generate and transmit vibrations.


-rJ It should not be connected to the same electrical line v,,hich supplies
power to machines drawing heavy intermittent currents.
rhe electrical power supply should be stable, balanced, and preferabry
r -.r'r\-nS from the connected secondary of the transformer. To minimize
--. effects of electrical noise a separate electrical grounding should be
- -. ided for each instrumentation system.
The basic electrical equipments required for installation and
St

-aintenaflce are:
:r Multimeter
:rl Oscilloscope
:t Temperature controlled soldering equipments
, t Extender cards and spares

Page No. 106 of 328.


Fundamentals of Biomedical Instrumentation

108 Fundamentals of Biomedical lnstrumentation

(u) Digital multimeter and ammeter S

(uz) Logic probes n


Miniaturization of electronic components has reduced the bulk of ti:
n1
electronic hardware components of the system, thus improving the overall

l
reliability. Modular concept in the system design has further strengthened dr

ria
the hands of maintenance engineer
The number of printed circuit board modules have reduced Str

considerably due the use of microprocessors as the main processing unit re


cir
of the instrumentation, and as such better reliability.
Potential maintenance points are continuously monitored and tri
CO
identified by code numbers. The response of the system to a fault is
or
governed by the degree of seriousness. It may be warning or fault
arl
indication and or subsequent automatic shutdown.

ate
Real time diagnostic are active during system usage: Though real
time diagnostic gives an indication of the problem, special skill is still
required to prqbe further and findout the ultimate caurse.
There are some offline diagnostics which guide the maintenance
engineer through a step-by-step process analysis of the instrumentation
.ai"
system. The off-line diagnostic which can be used to call one programme
lr (i
lr at a time, like:
fr CPU diagnostics
- Memory diagnostics
- CRT diagnostics 64
yM
,il
- D/A and A/D diagnostics
- I/O diagnostics -re
:ht
- Remote diagnostics involve the use of the phone data. A link is
64..
established between the computer in the instrumentation system and to
the main-computer in the hospital. It performs both static and dynamic
tests. This is an effective tool for solving even intermittent problems. :-ar
This is used in preventive maintenance also. I
Vibration and Oxidation: The biomedical instrumentation suffer when ::lv
subjected to excessive vibration: :,]II
(zJ Friction connections (circuit board socket or piug socket) can move
ud

from areas of low resistance (good connectior-rs) to oxidized high it lJ


'_::u
resistance (bad connections).
(rzJ Circuit boards can gradually vibrate out of their sockets. $ 1.2
(iir') Lead connections can be sheared.
It
The remedy against vibration is to place vibration-absorbing mounting ; 'r-tTl
pads under the sy5fsm control panel or to use rubber-center vibration ;F:: D
isolating bolt mounts.
Oxidized friction contacts may result from simple aging as well as
St

V .',-e1
vibration-induced movement. A contact cleaner and deoxidation treatment
helps. Erasers should not be used to clean connector pins because thel- ' . :::1
are likely to abrade away the thin silver or gold plating, thus, ruining
the conductive surface. f43,
Power-supply conditioning: The most effective action to ensure
instrumentation system reliability is to protect them with new generatior- I - : t''
Page No. 107 of 328.
Fundamentals of Biomedical Instrumentation
109 FunCamentals of Biomedical lnstrumentation

solid-state transient suppressors. Without such suppressors, transient


roise or voltage spikes can enter a system via power supply or signal
,:nes and cause both disruption and destruction. Good suppression
retwork, responding 1O to 1OO times faster to transients than older type

l
levices, are now available.
Even if power supplied to the hospital is relatively clean, voltage

ria
rcikes and other transients are generated within the hospital itself as a
:esult of operating motors; fluorescent lights, solenoids, SCRs, switching
:rcuits, etc. As these are switched on and off, surges or spikes are
-:ansmitted to power or signal lines. If these transients get into
-:mputerized equipment, they may be misinterpreted as digital commands
: other information, therefore, must be avoided. The various devices
: :e:

ate
ll Inductiue-capacitiue filters: Reduction of radio frequency noise of a
known bandwidth but do not clamp fast transients.
iirl Resis/once-capacitance filters: Medium speed and capability, but
like inductive capacitive filters, don't clamp fast transients.
iil Metal-oxide Vaistor (MOV): Suppressor have semifast response
capability.
iu) Isolation transformer: The main equipments are given supply through
isolation transformer which separates circuits.

44. OTHER INSTRUMENTATION FOR MONITORING PATIENTS


yM
--ere are several
other special medical instrumentation in use which are
' -rer than bedside of the patient. The important ones are:
E 4.1. Surgical Monitoring System
There are large multichannel oscilloscopes with an EEG record on
,art also.
Such equipments have plug-in signal conditioning modules that
:-.r'ide versatility and choice of measurement of parameters. These
: :nedical signal conditioner units include an universal unit for bioelectric
.
=als, an ECG unit, an EEG unit, a biotachometer, a transducer unit,
: - integrator, differentiator, and an impedance unit. All these units are
ud

=patible.
t rt.2. Arterial Diagnostic Unit (ADU)
It provides automated pressure-cuff inflation for rapidly determining
l,-=:nental pressures and post-exercise pressure trends in non-invasive
:*:--pheral arterial evaluations. The strip chart is used for recording
i :pler-flow pulse waveforms, ECG traces and other physiological
St

r =','eforms. It has a heated stylus strip-chart recorder, a bidirectional


,, :cler-flow meter with external loudspeaker and head phones, an ECG
"' :netry transmitter, a non-fade two channel oscilloscope.
fi.r.3. Catheterization Lab
-t is a lab where cardiologists perform diagnostic catheterization. For
i :atient having blockage in one of the coronary arteries, must be
Page No. 108 of 328.
Fundamentals of Biomedical Instrumentation

110 Fundamentals of Biomedical lnstrumentation


a catheter
brought into the cath lab. Catheterization techniques introduce
this catheter to inject a radioPaque dYe into (

into ihe heart and through 1

the cardiac chamber.


catlteterizationisadangerousprocedure,therefore,patientmustbe

l
I
units capable
monitored continuously. Geieralty these are computerized

ria
ofmonitoringallthevariablesusuallynecessaryinthecathlab.It
and ECG' Multiple t
includes cardiovascular pressures, cardiac output' (
strip charts, ar-rd
channel of analog data can be recorded on continuous t
computer generated rePorts can
*"r"fot-". Calculated resuits, d (

practical representation of heart


Lt.. "u.., be incorPorated in the
patient's name, physiological data-

ate
bCG *u.r.forms are also disPlaYed
or call any data on screen for instant display'

6.5. oRGANIZATIoNoFTHEHoSPITALFoRPATIENT.CARE
MONITORING
organtzation
The technical personnel must be farniliar with the hospital
suchaswhichdiagnosticequipmentsareavailableinwhatpartofthe lines:
rr""pit"r. Generally-equipmenti are divided, on the following
(if Surgical equiPments
yM
These are placed in the operating room 'uvhere surgery
is actually
performed.
(ii) Non-surgical equiPments
The monitoring equipments made available in operation various
room are
d' arterial blood pressures' ECG' EEG'
heart like
respir ' It may also have emergency equipments
ers, stimulation equipments' etc'
dehbr
The in ich is generally post surgical follow-
upcontaiS,nurse,scentralcontrolunitsto
monitor p uslY'
ud

(CCU) and
Heart-attack patients are placed in coronary care-unit units ma]'
sometimes called cardiac carelunit (CCU). The
monitoring
havebloodpressure,heartrateandECGmeasurementequipments.
ediate coronarl'-
After some recovery CCU patient may mo like telemetq''
c..e unlt (ICCU). This unit may have
ambul atient has hear:
equipments to monitor patients from
attackathome,mobileemergencycareunitCoruesintoservice.These
may have cardi y resuscitation technique experts rn'ith
similar to the ones used in the intensive
St

equipments and
care units of the

PAGEMAKERS
Therhythmicactionoftheheartisduetoregularrecurringactlc: at the sinitorj
potentials originating at natural card.iac pacemaker located
Page No. 109 of 328.
Fundamentals of Biomedical Instrumentation

Patient Care and Monitoring 11'l

(SA) node. Heart block occurs whenever the conduction fails to transmit
the pacing impulses from artria to the ventricles properly. In such cases,
an artifrcial method of pacing is generally required to ensure the heart

l
beats.
A device capable of creating artificiar pacing impulses and delivering

ria
them to the heart is known as pacemaker system or just pacemaker. Ii
contains pulse generator and suitable electrodes. The pacemakers are of
two types;
(if Internal pacemakers

ate
yM
(a) Mycardial generator implanted in abdomen

--t
\_,,
ud

(b) lmplanted pacemaker with electrodes catheter


St

Fig. 6.4. Pacemaker lmplantation


Internal pacemakers as the one
=:de the body. These ar with the pul
.-:ed in a pocket below left clavicle,
-':-r FigLrre 6.a@) shows implanted pacemakers in various
conditions.
:he above case internal leads connect to electrodes that contact
Page No. 110 of 328.
Fundamentals of Biomedical Instrumentation

112 Fundamentals of Biomedical lnstrumentation

inside of the right ventricle or the surface of the myocardium. An


implanted standby pacemaker with catheter electrodes inserted through a
the right cephalic vein are shown in the figure 6.4(b). The frgure 6.5 S
shows pacing electrodes attached to the Myocardium.

l
(ii) External pacemakers 6

ria
These are used on patients with temporary heart irregularities. This A,
may be due to coronary patient and heart blocks. This may also be used p(
in post operative periods after cardiac surgery. External pacemakers hr
include pulse generators located outside body which are normally ve
connected through the wires introduced into right ventricle via a cardiac th
catheter. The portable pulse generator is hangs on the body fixed with AC
some straps. sy
The pacing technr'ques employed are as follows:

ate
1S

Pacing Modes CO
tw
AS

Competitive
vel
0. no
fib:
,.t atr
F Ventricular programmed Arterial programmed the
for use in demand or
stand by mode
lrrf
yM
{fi fibr
rnt
Asynchronous mol
Demand Stand by Synchronized fixed rate for
B-waveinhibited R-wave P-wave of ECG elderly people
triggered hav
app
The block diagram of various functions of the units are as follows: suff
StlIT
:he
subr
=ho<
::le
ud

:-n e
-r tl
:ntii
:ehb
-=ad
:nC
h
::teI
St

Implanted units have lithium-iodine battery which last for 5 years. ,rnn
The sources of electromagnetic ener$/ such as microwave ovens a_ffect
t cal
----:ou
implanted or external pacemakers, i.e., patients are advised to keep
away from sources of electrical interference such as microwave ovens. ': SS I

Page No. 111 of 328.


Fundamentals of Biomedical Instrumentation
Patient Care and Monitoring 113

A pacemaker is shown figure 6.6. This is external pace-tnaker showing


adjustment control. Some of the pacemakers available in the market are
shown in figure 6.7.

l
DEFIBRILLATORS

ria
.\ction of the heart muscle fibers if precisely synchronized leads to proper
cerformance of heart in its pumping function. The two chambers of the
reart contract together and pump blood through the two atrioventricular
,.-alues into the ventricles due to rapid spread of action potentials over
:he surface of the atria. The ventricular muscles are synchronously
activated to pump blood through the pulmonary and systemic circulatory
s\.stems. The condition under which the necessary synchronism is lost
-s known as fibrillation. During this period, the normal rhythmic

ate
:ontractions of either the atria or the ventricles become rapid irregular
:*,itching of the muscular wall. Fibrillation of artrial muscles is known
.s arterial frbrillation, whereas fibrillation of the ventricles is called
',.entricular fibrillation. Atrial hbrillation leads to irregular rhythm and
:on-synchronized bombardment of electrical stimulation from the
:-crillating atria. Most the blood flow into the ventricles occurs before
.:rial contraction, therefore, blood for the ventricles to pump is still
.rere. The sensation generated by the fibrillating atria and subsequent
-egular ventricular action is quite painful for the patent. Ventricular
' orillation leads to ventricles inability to pump blood and if not corrected
yM
:- time can cause death within few minutes. Such patients need careful
:-onitoring of cardiac.
Heart massage (a mechanical method) for defibrillation of patients
-:r,e been quite common. However, most successful method is the
.:plication of an electric shock to the area of'the heart. In this case
i:tficient current is applied for a brief period and then released. It
r:::nulates all musculature of the heart simultaneously which makes all
':-e heart muscles fibers to enter refractory periods together and
-: csequently normal heart action may start. The duration of the electrical
i-.rrck is 0.25 sec to 1 sec at 50 Hz ac at an intensity of about 5 A to
-: chest of the patient through appropriate electrodes. This method of
ud

, - electrical shock to resynchronize the heart is also called countershock.


-. :he event of patient not responding, the electrical shock is repeated
- .ril defibrillation starts. This method of defibrillation is called ac
:':-:brillation. Attempts to correct artrial hbrillation by ac method may
-'d to more serious ventricular flbrillation and, therefore, ac dehbrillation
, 10 more used.
ln 1962,Bernzard Lown of the Harward School of Public Health and
:- :r Bent Brigham Hospital developed dc defibrillation which has become
St

these days. A dc defibriliator circuit is shown in figure 6.9.


. =mon
:apacitor is charged to a high dc voltage which is rapidly discharged
-:rugh electrodes across chest of the patient. The dc method requires
'-, s repetitions and is less harmful to the patient.

Page No. 112 of 328.


Fundamentals of Biomedical Instrumentation

'114 Fundamentals of Biomedical lnstrumentation

Charge..-

l
ria
Fig. 6.5. Circuit of dc defibriilator var
disr
The electrical eners/ discharged by the capacitor may vary between

ate
knc
100 to 400 W-sec or ioules anci duration of the effective period of
diar
discharge may be about 5 m sec. The energz delivered is as shown in
-{ p,
figure 6.6. The plot of current Vs time has peak value of current of jelly
20 A. The wave is essentially monophasic as most of its excursion is and
above baseline.
rl
l, The peak voltages may be as high as 6000 V which endanger the
swit
myocardium and the chest walls. This risk can be reduced by increasing
It waveform duration to 10 m sec with dual peak'ulraveform as shown in
figure 6.7. --oul
1! :efo
yM
h 20
6 :iscl
q)

g_ 16
-npl,
E :efib
(E
4.10u
=12
C
I t
38 =:rh]
q)
:o- --- su
4
o_- ::cm
:ust
:::SUl
-
-- \rel
ud

Fig. 6.6. Discharge waveform of dc defibrillator ..1:S


tr

oo 1200 Pr
3 goo
:-schr
0)
o)
:-::plil
E
o
600 :,. Che
D 300 _-. _tmr
.o :=:lbri
o
o-
Fis
St

Time (milliseconds) -r , crd


..:
Fig. 6.7. Dual peak dc defibrillator discharge waveform _ :laf
Effective defrbrillation in adults can be achieved in lower energ,- .-: VOI

levels 50 W sec to 2OO W sec. The voltage can be further lowered b1- Thr
truncated waveform as shown in figure 6.8. :'. Q lr

Page No. 113 of 328.


Fundamentals of Biomedical Instrumentation
Patient Care and Monitoring 115

1200
t
o 900
o)
=o

l
600
D
.9 300

ria
a.
o_

0 5 10 15
Time (milliseconds)
Fig. 6.8. Truncated dc defibrillator discharge waveform
The amplitude of this waveform is nearly constant, but duration is
'aried to make up the amount of energz required. A large current
:ischarge is achieved-through the skin electrodes. These electrod.es are

ate
':nown as paddles which are having metal disks of 8 to 10 cms in
-:ameter for external use, but for internal use smaller paddles are used.
-. pair of electrodes is press fixed against the patient's chest. conductive
:lly or a saline-soacked gauze pad is applied between each paddle surface
.:-ld the skin to prevent burning.
special insulated handles are used to avoid. electric shock. Thumb
;'.,.-itch if used in handles is useful to control discharge.
The methods of discharge are programmable and include watt-sec. or
. , ule meter to indicate the amount of energz stored in the capacitor
- =fore discharge. There is some eners/ loss and all energr is not
yM
:-scharged. Due to large amount of eners/ release in discharge, an
-olanted pacemaker pulse generator located immediately beneath a
:':-rbrillator paddle may be damaged during discharge, therefore, care
, ruld be taken in such cases.
Defibrillators are also helpful to convert other potentially dangerous
"--::ythmias to the manageable case and this is known as cardioversion.
- such cases, to avoid the possibility of ventricular fibrillation resulting
: :r the application of the dc pulse in the cardioversion, the discharge
r -st be synchronized with the electrocardiogram. The synchronization
-'- : lres safety during the heart's vulnerable period.
Heart is succeptible
'r ','entricular fibrillation by the introduction of artificial stimuli, during
ud

:.' = period since it is partially refractory.


Present day defibrillators include provision of synchronizing the
r : - narge pulse with the patient's ECG. The ECG signal is input to an
u-:liher from an electrocardiograph or a patient monitor. The defibrillator
ut' -rarges only at the desired portion of the ECG waveform. If the
ii ,::',b switches are closed on the paddles applied to the patient lets the
u* '-::-illator to at the next occurrence of the R.
::gure 6.13 shows a portable defibrillator. It has ECG monitor and
St

"P :Cer with digital display of energr and heart rate. This operates on
?* - -rgeable batteries and as such uses dc-dc converter for stepping up
'h' tltage required for charging the storage capacitor.
-:-e maximum ener$/ devered is about 300 watts delivered into
;r -- road which is equivalent to about 400 watts of stored ener$/.
Page No. 114 of 328.
Fundamentals of Biomedical Instrumentation
116 Fundamentals of Biomedical lnstrumentation

Figure 6.9, shows a defibrillator of latest model available in a nearby


hospital.

l
ria
I
:(

ate
r
i
:I
li
a
,!l,l
-D
!ir o.
y, Fig. 6.9. Latest defibrillator
w
"21 Figure 6.10 shows electrodes used in cardiac defibrillation. A spoon- Si
yM
q; shaped internal electrode is shown which is applied directly to the heart lr
when it is surgically exposed. It consists of the metal electrode itself 1o
having spoon-shape. Side by side a paddle-type electrode is shown which EC
is applied against the anterior chest wall. ar

L ter
I
\
r.

v
ud

(r
Eleckode
l1

\\
Control
D
Switch

;
lnsulated
Handles
l
St

Fig. 6.10. Cardiac defibrillation electrode I

.a
li
1. IntensiveCare Monitoring: Critical patients such as pre-heart attaclc ::]
post-heart attack and post-surgical operation require continuous .-::

Page No. 115 of 328.


Fundamentals of Biomedical Instrumentation

Patient Care and Monitoring 117

l
ria
. Patient Monitoring Displays: Various types of CRT display_
conventional bouncing barl and non-fade types, other anarog and
digital display devices are used in patient health care.
' Other Instruments for Mo q,,--,^^, equipments'
arterial diagnostic units and ^l:r:1
equtpments for patient
parameter monitoring inclu

ate
yM
ing patients: Surgical monitoring
it, catheterization lab equipments
for monitoring of patients.
'
i ircide,J

acemakers and defibrillators.


of intensive care monitoring. Also ex
ud

a) Pacemakers
St

| ,;,'hat part of electrocardiogram is the most


usefur for determining heart
-.te? trxplain.
I l:scuss possibre causes of a patient-monitoring
system falsely indicating
.:: excessive high heart rate.
:scuss instrumentation and methods for rapid diagnosis
and repair of
strumentation in an intensive_care unit.
Page No. 116 of 328.
Fundamentals of Biomedical Instrumentation

118 Fundamentais of Biomedit'l lntt'uT"nt'ti*


iagnostic catheterization laboratory?
6.11.
6.12.
. Show all rooms in a laYout Plan'
Ystem bY block diagrams' f
., 1 -- :.^^1.,1^f-^ilitics
of a smali hospital to include facilities

l
6.13.
rgery, and dia[nostics' Specify all the-
incl-uding the possibility of

ria
necessary,
emergencles.

aaa

t(
F'l
s
q
ate \
1
yM
1

l
ud
St

Page No. 117 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Measurements in The

ate
Respiration System

. Inside this chapter


i.1. The Physiolory of the Respiratory System
- 2. Tests and Instrumentation for
yM
the Mechanics of Breathing
-.3. Respir-atory Therapy Equipment /o
- 4. Sumrnary

Respiration is the exchange of gases in any biological


process. For
: human body must take in o*yg.r, which combines with
lrogen and various. nutrients to produce heat and energu carbon,
-ormance of work. As a result of this proc:ess of metabolism,
f", tf*
which
'!::s place in the cells, a certain rmou.rt of water is produced along
:-r the principal waste product, carbon dioxide
(cor)i Respiration is
ud

= entire process of inharing in oxygen from th"e environment,


:-sporting the oxygen to the cells, removing the
CO, from
-- the cells,
: exhausting this waste product into the .f-o"pfr.L,
rhe tissue cells are generally not in clirect contact with
their external
' -:onment. Instead the cels are bathed in fluid.
The tissue fluid can
- cnsidered as the internar environment.
of the body. The celrs
i
'en from this fluid.. The circulating btood is the "medium byabsorb
,:en is brought to the internal which
St

The carbon dioxide is


"r'oiro.,.rrr.nt.
r:--ed from the tissue fluids by the same
mechanism. Externar respiration
:-': exchange of gases between the b100d and the external
environment
=s place in the lungs.
-ungs oxygenate the blood and to eliminate carbon
::olled manner. During inspiration fresh air enters dioxide in a
the respiratory
Page No. 118 of 328. 119
Fundamentals of Biomedical Instrumentation

120 Fundamentals of Biomedical lnstrumentation

tract, becomes humidihed and heated to the body temperature, and


mixed with the gases already present in trachea and bronchi region.
Oxygen diffuses from the alveoli to the pulmonary capillary blood supply
whereas carbon dioxide diffuses from the blood to alveoli. The oxygen is

l
carried by the lungs and distributed among the various cells of the body
by the blood circulation system, which also returns the carbon dioxide

ria
to the lungs. This whole process of inspiring, expiring air, exchange of
gases, distribution of oxygen to the cells and collection of CO, from the
cells form pulmonary function. Pulmonary function test is measuring
the various components of the process are called.
Complete measurement cannot be done by a pulmonary test. The
pulmonary tests are divided into two categories-the Iirst no single
laboratory is to measure the mechanics of brea[hing and physical

ate
characteristics of the lungs, the second category is involved with diffusion
of gases in the lungs, the collection of carbon dioxide and the distribution
of oxygen.

THE PHYSIOLOGY OF THE RESPIRA-I-ORY SYSTEM


.$t

Yr,
The nasal cavities, larynx, trachea, bronchi and bronchioles as shown in
ls, figure 7 .1 are the body parts through which air enters the lungs through
Jr the air passage which include.
The lungs are like elastic bags locaterd in a closed cavity called
q
yM
thoracic cavity. The right lung consists of tttree lobes, i.e., upper, middle
and lower and left lung has two lobes up[)er and lower.
The larynx, known as the troice box', is connected to bronchi through
the trachea sometime called the windpipe. Whenever a person swallows
the food and liquids are directed to the esophagus that is connected to
stomach rather than into the larynx and trachea, the laynx hits epiglottis.
a valve that closes.
The trachea is about 1.5 to 2.5 cm in diameter and approximatelv
11 cm long, extending from the larynx to the upper boundary of the
chest. Here it is divided into the right an<I left main stem bronchi. Each
bronchus enters into the corresponding lung and divides like the limbs
of a tree into smaller branches. The branch diameter reduces to about
ud

0.1 cm, the air-conducting tubes are called bronchioles. As they continue
to decrease in size to about 0.05 cm in diameter, they form the termina.I
bronchioles, which branch again into the respiratory bronchioles, where
some alveoli are attached as small air sacs in the walls of the lungs.
After some additional branching, these z:-ir sacs increase in number-
becoming the pulmonary alveoli. The alve<tli are each about O.O2 crn in
diameter. According to rough estimate some 300 million alveoli are found
St

in the lungs as shown is figurr: 7.2.


The pleura a thin membrane covers the lungs, which passes from the
lung at its root into the interior of the chest wall and upper surface of
the diaphragm. The two sacs so formed are called the pleural cavities-
one on each side of the chest, between the lungs and the thoracic
boundaries.
Page No. 119 of 328.
Fundamentals of Biomedical Instrumentation

Measurements in The Respiration System 121

l
ria
Pharynx
Entrance of air

Gullet or esophagus
Larynx

Windpipe or lrachea

r eural cavity

Righl
ate Pleura covering the lung

Alveoli

Space occupied
by heart

Left lung cut open


yM
external vievr6!
ud
St

Fig. 7.1. Respiratony System

Page No. 120 of 328.


Fundamentals of Biomedical Instrumentation

'122 Fundamentals of Biomedical lnstrumentation

Ci
Smooth h,
Muscle tt

l
Alveolar di

ria
Capailary Pulmonary
CA
Network Venule
of

Alveolus Respirators 7.t


Bronchiole

Th
atr

ate
Alveolar Capulaves Th
duct diz
IT1L
Alveo ar
be
Sac
hal
Fi1.7.2. Alveoli and capillary network per
Accomplishment breathing by musculature that literally changes the of1
volume of the thoracic cavity and in doing so creates negative and anc
positive pressures that move air into and out of the lungs. Two sets of :nsl
muscles are involved: those in and near the diaphragm that causes the anc
yM
diaphragm to move up and down, changing the size of the thoracic 7.2.
cavity in the vertical direction, and those that move the rib cage up and
down to change the lateral diameter of thorax.
A special dome or bell shaped muscle, i.e., the diaphragm is located --rnl
at the bottom of the thoracic cavity, which when pulls downward to :Il 1

enlarge the thorax. This action is the principa-l force involved in inspiration aa:
or inhaling. At the same time as the diaphragm moves downward, a
group of external intercostal muscles lifts the rib cage and sternum' Due :9,
to the shape of the rib cage, this lifting action also increases the effective
diameter of the thoracic cavity. The resultant increase in thoracic volume -:fS
creates a negative pressure (vacuum) in the thorax. Since the thorax is :SP
ud

a closed chamber and the only opening to the outside is from the inside 1
of the lungs, the negative pressure is relieved by air entering the lungs. , rIL
The internal pressure of air in the lungs, which is greater than the : '-Dlr
pressure in the thorax outside the lungs. expands the lungs, i.e., passive- T
On release of the inspiratory muscles, the elasticity of the lungs anc ,: th
rib cage combine with the tone of diaphragm, reduces the volume oI T
thorax, thereby developing a positive pressure that forces air out of the :-: e:
lungs. In forced expiration a set of abdominal muscles pushes
St

.--- C

the diaphragm upward very powerfully while the internal intercosta- -:-:aS
muscles pull the rib cage downward and forces air out by applying tht ,-- s p1l
pressure against the lungs. T]
Normal inspiration the pressure inside the lungss is about - 3 mr -:.gs
of Hg, whereas during expiration the pressure becomes about +3 m= ::AC
Hg. The ability of the lungs and thorax to expand during breathing :s '::l ,

Page No. 121 of 328. ..:dr-


Fundamentals of Biomedical Instrumentation

Measurements in The Respiration System 12I


called the compliance, which is expressed as the volume increases in the
lungs per unit increase in intra-alveolar pressure. Airway resistance is
the resistance offered to the flow of air into and out of the lungs.

l
The interchange of the oxygen from the lungs to the blood and the
diffusion of carbon dioxide from the blood to the lrrrg. takes place in the

ria
capillary surfaces of the alveoli, The alveolar surface area is about Bo m2
cf which more than three fourths is capillary surface.

TESTS AND INSTRUMENTATION FOR THE MECHANICS OF


BREATHING

- he ability of a person to bring air into his rungs from the outside
,tmosphere and to exhaust air from the lungs the mechanics of breathing.

ate
- nis abili[z is affected by the various components of air passages the
::aphragm and associated muscles, the rib cage and associated
:--usculature and the characteristics of the lungs themselves. Tests can
:: performed to assess each of these factors, but no single measurement
--as been devised that can adequately and completely
evaluate the
::rformance of the breathing mechanism. This section rlescribes a number
: the most prominent measurements and tests that are used clinically
,::d in research in connection with the mechanics of breathing. The
:'.strumentation required for these tests and measurements is d.escribed
.:--d considered.
yM
- 2.1. Lung Volumes and Gapacities
In the basic pulmonary tests are those designed for determination of
-::g volumes and capacities. These parameters, which are a function of
. -- :ndividual physical characteristics and the condition of his breathing
- -:hanism, are given in figure 7.3.
The tidal uolume (TV), i.e., normal depth of breathing, is the volume
"as inspired or expired during each normal quite respiration cycle.
Inspiratory reserue uolume (IRV) is that extra volume of gas that a
i*:son can inspire with maximum effort after reaching the normal end
-,::ratory level reached at the end of a normal quite inspiration.
ud

-he expiratory reserue uolume (ERV) is that extra voiume of gas that
. -- ce expired with maximum effort beyond the expiratory level. The end
"' : -- atory level
is the level reached at the end of a normal, quite expiration.
-'te residual ualume (RV) is the volume of gas remaining in the lungs
, ' .: end of a maximal expiration.
- ee vc or uirtua.l capacitg is the maximum volume of gas that can
r' :i.pelled from the lungs by forceful effort after a maximal inspiration
.L: - :he residual volume. This is measured independent of time of
St

: ' : : -lrerrnt. The


vital capacity is also the sum of the tidal volume,
,:: :.:atory reserve volume and residualvolume.
. -re TLC or totctl lung capacilg is the amount of gas contained in the
r -.- at the end c'rf a maximal inspiration. It is the sum of the vital
-r , . ri1- and residual volume. Total lung capacity is also the sum of the
:lume, inspiratory reserve volume, expiratory reserve volume and
"' -.--.1
Page No.volurne.
122 of 328.
Fundamentals of Biomedical Instrumentation

124 Fundamentals of Biomedical lnstrumentation

The IC or inspiratory capacity is the maximum amount of gas that


can be inspired after reaching the end expiratory level. It is the sum of
the tidal volume and the inspiratory reserve volume.
The FRC or functional residual capacitg is the volume of gas remaining

l
in the lungs at the end of expiratory level. It is the sum of residual

ria
volume and the expiratory reserve volume.
The FRC can also be calculated as the total lung capacity minus the
inspiratory capacity and is also considered base line from which other
volume and capacities are determined. The FRC is considered to be more
stable than the end inspiratory level.
Several dynamic measures are important because breathing is a
dynamic process and the rate at which gases can be exchanged with the
blood is a direct function of the rate at which it can be inspired or

ate
expired.
The net measure of output of the respiratory system is the respiratory
minute volume. This is a measure of the amount of air inspired during
one minute at rest. It is obtained by multiplying the tidal volume with
.ti number of respiratory cycles per minute.
.ari
Several forced breathing tests are used to assess the muscle power
l' ,',1
I'i required with breathing and the resistance of the airways. Forced uital
I
y'l
capacitg (FVC), which is really a vital capacity and measurements are
taken as quickly as possible. As the name suggests the FVC is the total
amount of air that can forcibly be expired as quickly as possible after
yM
\ taking the deepest possible breath. If the measurement is made with
respect to the time for the process, it is called a timed vital capacity
measurement. A measure of the maximum amount of gas that can be
expelled in a given number of seconds is called the forced expiratory
uolume (FEV). This is usually given with a subscript indicating the number
of seconds over which the measurement is made. For example FEV,
indicates the amount of air that can be blown out in 1 sec and following
a maximum inspiration, while FEV. is the maximum amount of air that
can be expired in 3 seconds. FEV is sometimes given as a percentage of
the forced vital capacity.
The forced vital capacity measurements are many time encumbered
ud

by patient hesitation ald the inertia of the instrument, a measure of the


maximum midexpiratory flow rate may be taken. This is a flow
measurement over the middle half of the forced vital capacity (from the
25 percent level to the 75 percent level) . The corresponding FEV
measurement is called FEV2sy _ 7sok.
Flow measurement is the maxima) expiration llow (MEF) rate, which
is the rate during the first liter expired after 2OO ml has been exhausted
at the beginning of the FEV. It differs from the peak flow, which is the
St

maximum rate of airflow attained during a forced expiration.


Maximal breathing capacity (MBC) or maximql uoluntary uentilation
(MW) . This is a measure of the maximum amount of air that can be
breathed in and blown out over a sustained interval, such as 15 or 20
seconds. A ratio of the maximal breathing capacity to the vital capacity
is a-lso of clinical interest.
Page No. 123 of 328.
Fundamentals of Biomedical Instrumentation
Measurements in The Respiration System 125

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Page No. 124 of 328.


Fundamentals of Biomedical Instrumentation

126 Fundamentals of Biomedical lnstrumentation

An obstruction of the small airways in the lungs, is defected by a


procedure involving measulement of closing volume is often used. The
ilosing volume level is the volume at which certain zones within the lung
cease to ventilate.

l
In the presentation of various respiratory volumes, the term BTPS is

ria
often used. This indicates thqt the measurements tuere made at bodg
temperature and ombient pressure, utith the gas saturated tuith uater
,opour. Sometimes to use these values in the reporting of metabolism,
they must be converted to standard temperature and plessure and dry
measurement conditions, indicated by the term STPD'
Most of the air enters the lungs to fill the alveoli after each breath.
A certain amount of air is required to fill the various cavities of the air
passages. This air is called tl:re dead-space air, and the space it occupies

ate
i" fi:,e d-ead space. The amount of air that actually reaches the
"atGa
alveolar interface with the blood stream with each branch is the tidal
volume minus the volume of the dead space.
7 .2.2. Mechanical Measurement
,4"
r"' compliance or performance which has been dehned as the volume
i'/
St
increase in the iungs per unit increase in lung pressllre, requires
measurement of inspired or expired volume of gas and of intrathoracic
#,
?.).
pressure. Normally compliance is a static measurement. However, in
actual practice two types of compliance measurement, static and dynamic
q
yM
are made. Static compliance is determined by obtaining a ratio of the
difference in lung volume at two different volume levels and the associated
d,ifference in intra-alveolar pressure. For measurement of dynamic
compliance, tidal volume is used as the volume measurement, while
intrathoracic pressure measurements are taken during the time when
the airt'low is zero, which occur at the end inspiratory and expiratory
levels with each breath (refer figure 7.3). The performance or lung
compliance varies with the size of the lungs: a child has a smaller
compliance than an adult. Furthermore, the volume-pressure curve 1s
not linear. Therefore, compliance does not remain constant over the
breathing cycle, but tends to d'ecrease as the lungs are inflated'
ud

Fortunaiely, over the tidal volume range in which compliance


measurement are usually performed, the relationship is approximately
linear and a constant compliance is assumed. Liters per centimeter of
HrO gives the performance or compliance figure'
Airway resistance, which is a pneumatic analog of hydraulic electrical
resistancl, and as such, is a ratio of pressure to flow. Thus for the
d.etermination of airway resistance, intra-alveolar pressure and airflow
measuremelts are required. As was the case with compliance, airway
St

resistance is not constant over the respiratory cycle. As the pressure in


the thoracic cavity becomes more negative, the airways are widened and
the airway resistance is lowered. conversely, during expiration, when
the pressure in the thorax becomes positive, the airways are narrowed
and resistance is increased. The intra-alveolar pressure is given in
centimeters of HrO and the flow in liters per second: the airway resistance
PageisNo.expressed
125 of centimeters of I{rO per liter per second'
in328.
Fundamentals of Biomedical Instrumentation
Measurements in The Respiration System 127

7.2.3. lnstrumentation for Measuring the Mechanics of Breathing


The measurement of lung volumes at various levels and conditions
of breathing, pressures within the lung and the thorax with respect to
outside air pressure and instantaneous air flow give all the parameters

l
dealing with mechanics of breathing. The complexity of pulmonary

ria
measurements lies not in the variety required but rather in gaining
access to sources of these measurements, and in providing suitable
conditions to make them meaningful in measurement.
All lung volumes and capacities that can be obtained by measuring
the amount of gas inspired or expired under a given set of conditions or
during a specified time interval can be obtained by the use of the
spirometer. The timed vital capacity and forced expiratory volume
measurement can be obtained with the help of spirometer. The only

ate
"'olume
and capacity measurements that cannot be obtained with
spirometer are those requiring measurement of gas that cannot be expelled
'rom the lungs under any conditions. The residual volume, fr.rnctional
:esidual capacity and total lung capacity are included in such
:rreasurements. A recording spirometer is shown tn figure 7.4.

Other Signal

Processing
yM
Kymograph

Strip Charl
ud

Fiecorder

lvlouthpiece

Thermometer for
Spirometer Gas
Temperature
St

Fi1.7.4. A water sealed spirometer


Spirometer composes of a movable bell inverted over a chamber of
.ter. Inside the bell, above the water line, is the gas that is to be
: :athed. The bell is counter balanced by a weight to maintain the gas
-.s:de at atmospheric pressure so that its height above the water is
--:portional to the amount of gas in the bell. A breathing tube connects
- -. mouth of the patient with the gas under the bell. In this case nose
Page No. 126 of 328.
Fundamentals of Biomedical Instrumentation
128 Fundarnentals of Biomedical lnstrumentation

of the patient is blocked. Thus as the patient breathes into the tube, the
bell moves up and down with each inspiration and expiration in proportion
to the amount of air breathed in or out. A pen attached to the balancing
weight mechanism and writes on the paper attached to the drum recorder

l
called a kymograph. As the kymograph rotates, the pen traces the
breathing pattern of the patient. Sometimes a rotational displacement

ria
sensor is attached to the drum mechanism. The output of the rotational
displacement sensor is fed to an operational amplifier which can be
connected to an electronic strip chart recorder.
Several bell volumes are availabre but 9 and 13.5 liters are most
common. A well designed spirometer offers little resistance to air flow
and the bell has little inertia. various paper speeds are available for
}<ymographs with 32, 160,30o and 19oo mm/min are most common.
The 9 liter spirometer is most common and can be used in laboratory

ate
or in the physician's chamber.
A waterless spirometers, operate on a principle similar to the
spirometer just described above. one such type is called wedge spirometer.
Some instruments, called electronic spirometers, measures airflow
and by use of electronic circuitry calculates the various volumes and
capacities. Block diagram of such a device can be seen in figure 7.5 (a).
This instrument provides both a graphic output similar to that of a
standard spirometer and a digital read out of the ciesired parameters.
Figure 7.5 lb) shows a typical spirogram. Various types of airflow
yM
transducers are used. A small breath driven turbines and heated wires
that are cooled by the breath are used as transducers.

Signal ,.nd
conditioning
--lm
lrol
::OI
,:e
: flfl
ud

Monitor
display
result
with digital
report
St

Fig. 7.5. (a) A block diagram of an electronic Spirometer

Page No. 127 of 328.


Fundamentals of Biomedical Instrumentation
Measurements in The Respiration System 129

l
FJ'.J

ria
MVV
ate o
FEV, VC
yM
Medium Fast Slow

Fig. 7.5. (b) A typical Spirogram


.A' broncho-spirometer is a dual spirometer. It measures the volumes
.---c capacities of each lung individually. The air input device is a double
--:ren tube that dMdes for entry into the airway to each lung and thus
:-:r-ides isolation for differential measurement. The main function of the
:r:ncho-spirometer is the pre-operative evaluation of o4ygen consumption
:r :ach lung. The usual output of a spirometer is the spirogram. Some
r;:ometer, however, provides spirograms with inspiration towards the top.
The patient is asked to breath through the mouthpiece of the
ud

r; -:ometer. His nose is blocked with a clip so that all breathing is


':- " :'ugh the mouth. The recorder is first set to a
slow speed to measure
*-'l capacity. The patient breathes quitely for a short time at rest so as
'r: :rovide a baseline. He is then asked to exhale completely and to
:: -ale as much as he could. This process produced the vital capacity
r- -:d at the extreme right of the frgure. with his lungs at the maximal
,ri,::rational level the patient held his breath for a short time while the
t- :der was shifted to a higher chart speed (e.g. l92O mm/min). The
St

:iii--:nt is then asked to blow out all the air he could as quickly as
'us=:ble to produce FEV, (forced expiratory volume after 1 sec.). To
;r: '-rlate FEV1, a 1 second interval was measured from the beginning
'm --: by extending the maximum slope. Sometime, it is necessary to
==nine the beginning point by extending the maximum slope to the

Page No. 128 of 328.


Fundamentals of Biomedical Instrumentation
130 Fundamentals of Biomedical lnstrumentation

level of maximum inspiration. This step ensures that the initial friction
and inertia of the spirometer have been overcome and compensates for p
error on the part of the patient in performing the test as instructed. V

Generally respirometry tests are repeated two or three times, and the w

l
maximum values are used to ensure that the patient performed the test h
to the best of his ability. Although some instruments are calibrated for rn

ria
direct read out, other require that the height of the tracings be converted al
to llters by use of a calibration factor for the instrument, called the in
spirometer factor. is
he
Output including digital readouts are available particularly from
lu
electronic types of spirometers. Some instruments even have built in
ch
computational capabilities to calculate automatically the required volumes
vol
and capacities from the basic measurements.
at

ate
7.2.3.1. Measurement of Residual Volume
7.2
The outputs spirometer and of some of the other instruments described
above, all the lung volumes and capacities can be determined except those
me,
that require measurement of air still remaining in the lungs and airways
anc
,) at maximum expiration. These parameters, which include the residual Cire
rt volume, FRC and total lung volume can be measured through the use of
-he
l foreign gas mixture. A gas analyzer is required for these tests.
trei
i
Rebreathing from a spirometer charged with a known volume and :orn
,' concentration of marker gas, such as hydrogen or helium. Helium is "olu
yM
usually used, involves a closed circuit technique. After several minutes .: tl
{ of breathing, complete mixing of the spirometer and pulmonary gases is .r tl
assumed and the residual volume is calculated by a simple proportion : atit
of concentrations and gas volumes. atir
-
Nitrogen washout the open circuit method involves the inspiration of :ata
pure oxygen and expiration into an oxygen purged-spirometer. If the ,fd
patient has been breathing air, the gas remaining in his lungs is
78 percent nitrogen. As he begins to breath the pure oxygen, it will mix
with the gas still in his lungs and a certain amount of nitrogen will T1
\rash out' with each breath. By measuring the amount of nitrogen in ,1:ch
each expired breath, a wash out curve is obtained from which the volume ::tlV(
of air initially in the lungs can readily be calculated. The end expiratorl-
ud

=:bO
level is the preferred breathing ievel for beginning this measurement. .- rap
Tlre functional residual capacity (FRC) (from which residual volume l- : IfL
can also be calculated by subtracting the expiratory reserve volume) can :1Ce.
be measured by using a plethymograph. This instrument is an airtight r .-eIC
box in which the patient is seated. Utilizing Boyle's law the ratio of . .::atr
change in lung volume to change in mouth pressure is used to determine
- 3,1.
the thoracic gas volume.
St

The patient breathes air within the box through a tube which contains inl
a transducer and shutter to close off the tube for certain portion of the "' '. ap
test. Pressure transducer measure the air pressure in the breathing tube i,,.Sta
on the patients side of the shutter and inside of box. The amount of air
in the box, including that in the patient lungs, remaining constant. rH ::1pt
since there is no way for air to enter or escape. However, when the oI
Page No. 129 of 328.
Fundamentals of Biomedical Instrumentation
Measurements ir: The Respiration System 131
:atlent compresse"
.,
tlume is reduced, totalbody
''''hen the patient "ConverselY
in racic region
-.:s body volume
in The FRC is
rLe?Sllrd with the breathing tube closed. With no air

l
,-lowed to flow the mouth pressure
(sensed by the pressure
---- the tube) can be assumed to

ria
equal the alvetla, p;;";;."
. instructed to breathe at the siow rate against
the closed
expands and compresses the air in his
s in mouth pressure and corresponding
e it is possible to calculate the intrathoraciJ
me is equal to FRC' If the test is performed
the end expiratory level.
' 2.3-2. lntraarveorar and rntrathoracic pressure

ate
Measurement
It used to measure intraalveorar and intrathoracic
. .:a pressures. These
mportant in the determination of toth compliance
] ce, since inaccessibility of tfr""e .hl_bers
makes
mpossible. For measureme
.hutter in the breathing tube is opened to pressure
,:he air from within th! closed Uix. Since
-' a cl0sed system containing :i5:Y
a lixed amount of gas, pressure and
=e variations in the box are the inverse of the pi""".r." variations
lungs as the gas within the rungs expands
-:= positive and negative pressur." andis compressed due
yM
':--:s breathing tube is brocked
i., th" lungs. por cariu.ation the
for a few seconds, during which the
:.: is asked to breathe while mouth pressur" i"
:an be used in calibration of measurement. _.r".rred. These
Since mouth pressure
_ ,lng pressure are the same when
there is no airflow.

RESPIRATORY THERAPY EQUIPMENT


r :anical assistance must be provided so
that
':ed to the organs and tissues of the body andsufficient
."""""irr.
oxygen is
- - r dioxide levels of
are not permrtted to accumulate when a patient
,:able of adequate ventilation by natural proc is
ud

. -:mentation involved in providing


cedure and
mechanica and higher
:ntration o>gzgen or other therapeutic gases
''-l knownofas respiratory- therapy. ,r" instruments for
constitutes
' -'py are inhalators, ventilators, respiratory
humidifiers and nebulizer.
- I i. lnhalators
':haiators indicates a device
-'peutic gas to a patient who used to supply oxygen or sor,e other
St

is able to u..airrl without


>iance' As a rule, inhalators are used
-':r when r "poitrr."orsryof oxygen
'- than that of air is required. The inhaiators"o.r""rrir"1ion
consist of a source of
apeutic gas, equipment for reducing pressure
of the gas and a device for administering th" and controlling the
;; Devices for

Page No. 130 of 328.


Fundamentals of Biomedical Instrumentation

132 Fundamentals of Biomedical lnstrumentation

administering o>grgen to patient include nasal cannulae and cathers,


face masks that cover the nose and mouth. By adjusting the flow of gas t
irito the mask, the oxygen concentration presented to patient is controlled. C

l
7.3.2. Respirators and Ventilators
e
Respirators and ventilators are used interchangeably to describe

ria
tt
equipment that may be employed- continuously intermittently to improve
,r"rrtit.tion of the lungs and to suppty humidity or aerosol medications 1S
to the pulmonary tree. Most of the ventilators.in the clinical settings use br
positivL pressure during inhalation to inflate the lungs with various CI
gu.""" or mixture of gases (air, oxygen, carbon dioxide' helium etc')' re
IJnder certain conditions pressure may be applied during the expiratory VC
phase, but expiration is usually passlve' l-lI
Generally respirators in com on use are classified as assistor-

ate
re
controllers, and can be operated in any of three different modes. These of
modes differ in the method by which inspiration is initiated. ve_
Inspiration is triggered by the patient in the assist mode. A pressure
sensor responds to the slight negative pressure that occurs each time de.
the patient attempts to inhale and triggers the apparatus to begin inflating
the lungs. Thus the respirator helps the patient to inspire when he
wants to breathe. A sensitivity adjustment is provided to select the
amottnt of patient effort required to trigger the machine. The patients
who are able to control their breathing but are unable to inhale a
yM
sufficient amount of air without assistance or for whom breathing require
too much effort the assist mode is used'
A timer set to provide the desired respiration rate is controlled in the
control mode breathing. controlled ventilation is required for patients
who are unable to breathe on their own. In this mode the respirator has
complete control over the patients respiration and does not respond to
P(
\eur
any respiratory effort on the part of the patient'
The apparatus is normally triggered by the patient's attempt to breathe
in the assist control mode as in the assist mode. However, if the patient
fails to breathe within a predetermined time, a timer automatica]ly triggers
the device to inflate the lungs. Thus, the patient controls his own breathing
as long as he can, but if he should fail to do so, the machine is able tc
ud

take over for him. This mode is most frequently usel.-t in critical care
settings use this mode quite frequently' '.3.3
Many respirators can be triggered manually by means of a control or- T
the panel in addition to above. : lrll
once inspiration has been triggered inflation of the lungs continues - -ralr
unless one of the following condition occurs: '-^.: a.

(rJ The delivered gas reaches a predetermined pressure in the


proxima-
St

orupperairways'Aventilatorthatoperatesprimarilyinthismanne: If
is said to be Pressure-cYcled. i sp
of gas has been delivered to the patien: :
' A predetermined volume
(ii) -lse
This is the primary mode of operation of volume cycled ventilators -, tci
(iirJ The air or oxygen has been applied for a predetermined period
f
time. Thus the mode of operation for time c1'cled ventilators' :- cle
Page No. 131 of 328.
Fundamentals of Biomedical Instrumentation

Measurements in The Respiration System 133

use can be categorized by


, positive pressure assistor
ly from a source of gas and

l
erectricaly powered compressor or carr be used;il"5:B#f,"
ffiE'i3X

ria
to permit ventilation with ambient air.
The volume-cycled ventilator is the second category of
respirator. It
is called a volume respirator. This type of device ,_,"""
Lith". a piston or
bellows to dispense a precisely contio[ea volume for
each breath. In the
critical care setting where patients have purmonary abnormalities
and
require predictable volumes and concentrations of g.",

;'"11 this type of


ffilJT5:i,#tr#:ffii#?i'"#Tr*r:

ate
:esp perated and provide a much greater d_egree
rf control over the ventilation than the pr.""r-r.. cycled types. An ICU
.'entilator is shown in figure 7-6.
Adjustable pressure limit and alarms for safety are available
:evices of this type.
in most

Pneumalic
yM
Control
signals

Trained
network
weights

Training
data and
control

Lung Air pressureTap


pressure
data
ud

Fig. 7.6. An tCU Ventilator


'3 3. Humidifiers and Nebulizers and Aspirators
St

Page No. 132 of 328.


Fundamentals of Biomedical Instrumentation

134 Fundamentals of Biomedical lnstrumentation

The ultrasonic nebulizer is more effective and tnore expensive type of


nebulizer. This electronic device produces high-intensity sound ener$/
well above the audible range. when applied to water or medication,
ultrasonic ener5/ vibrates the substance with such intensity that a high

l
volume of minute particles is produced. Such equipment usually consists
of two parts, a generator that produces a radio frequency current to

ria
drive the ultrasonic transd.ucer and the nebulizer itself, in which the
transducer generates the ultrasound enerSr and applies it to the water
or medicatlon. ffre ultrasonic unit d.oes not depend on the breathing gas
for operation. The therapeutic agent can be administered during oxygen
therapy or mechanical ventilation procedure'
To remove mucus and. other fluids from the airways aspirator and
other types of suction apparatus are used'

ate
7.4. SUMMARY

1. The entire process of inhaling from the atmosphere, transporting the


oxygentothecells,removingtheCO,fromthecellsandexhasting
/ this waste product into the atmosphere is called the respiration.
In the hr.rman body tissue cells are not in direct cotrtact with their
t
I
external environment. The circulating blood is the medir-rm by which
i th.eoxyugenisbroughttotheinternalenvironmentandbythesame
t;: rnechanism carbon dioxide is carried out. The exchange of gases
yM
betweerr the blood and the external environment takes place in
the
{ external expiration'
lungs ancl is known as
2.ThePhvsiologyoftheRespiratorySystem:Airentersthelungs
which behaves as elastic bags located in a closed cavity called thoracic
cavi[z through nasal cavities, pharynx, larynx, brochi and bronchioles'
During normal inspiration the pressure inside the lungs is -3 mm ol
ug and during explration it is +3 mm of Hg. The ability of lungs ani
the thorax to expand is called the compliance'
The mechanics of breathing is the ability of a person to bring air intc
his lungs from outside atmosphere and to exhaust air from lungs
This ability is affected by the various components of air passages
ud

the diaphram and associated, muscles and the characteristic of thr


lungs.
The various capacities of pulmonary system are descrined in deta-
The measuremlnt of these capacities are both static apd dynam:;
The dynamic capacity is forced expiratory volume (FEV) which :s
taken by measuring the air that can be blown out in 1 sec time r':
is written as FEV,-. This value can be given as percentage if r:c
St

measurement are taken ones the middle half of the forced r','-a']t
capacity from 25oh to the 75o/o level'
Another i nt is maximal expiration flow rate (N{E-tr-
Other im t is maximum breathing capacity (NI
or maximal voluntary ventilation (MW) This is a measul:e of:
maximum amount of air that can be breathed in and blown o\-e:
Page No. 133 of 328.
Fundamentals of Biomedical Instrumentation

Measurements in The Respiration System


135
sus al as 15 to 20 second. A ratio of the
maximal
cap vital capacity is also of clinicar interest. breathing
The used for measurement of breathing is
a spirometer.

l
The standard spirometer consists of a
movabre berl inverted over a
chamber of water inside the bel,, above

ria
the water line, is the gas that
is to be breathed. A pen is attatched to the
balancing arrangement
is called a Kymograph. Sometimes a rotational
dispracement sensor
is attatched to the drum mechanism for the
output to be connected
to the pen recorders.
The other instruments are water ress spirometer
sprrometer.
known as wedge
To produce a spirogram the patient is
aksed to breath through the

ate
mouthpiece. The recorder is first set to
a slow speed of 32 mmr/min
to measure th
patient is
line. He was th
aked ,'Jo'L?,^ ff:.i;::,::i: r[rl.":;rJ::
xhale completely and to inhale as much
as he could' This process produces
thl vital
""p..rty ."cord on the
t rb"r"..iJTjl1l"T"";*ffi],,1:
speed of l92O mm/min.
r W) record the chart speed is set
yM
t r a short rest a few cycles of resting
:espiration were recorded then the patient
rut for 10 seconds producing MV record.is asked to breath in and
i(ow-a-days electronic sparometer are
arso available. For calcurating
- lnctional residual capacity
can be measured from a plethysmograph.
Respiratory Therapy Equipment: If a patient
':ntilation is incapabre of edequate
by natural process, mechanical
::ovided' so that sufficient oxygen is deliveredassistance must be
.ssues of the body.
to the organs and
' ie instruments for respiratory therapy
are inhalaters, ventilators,
tmidifiers and neubulizers.
ud

' -:e inhalators generalry supply oxygen


or other therepeutic gas to a
-.iient who is able to breath
:ntilators and respirators are "po.rlr.orsly without assistance.
used to improve ventilation of the
rgs and to supply humidity or aerosol mecrications.
rtilators in the crinicar settings use positive pressure Most of the
::alation to inflate the lungs with various during
gases. Expiration is usually
' "sive. Most respirators in common use are classified
as assitor_
St

:::rolled and can be operated in any of


three different modes clehned
' assist mode inspiration, control mode breathing
- .te. and assist
control
patients or oxygen given
., must be hus, virtually all
nd respir y must include
Page No. 134 of 328.
Fundamentals of Biomedical Instrumentation

136 Fundamentals of Biomedical lnstrumentation

equipment to humidify the air either by heat vapoutization or by 7


bubbling an air stream through a jet of water.
when therapy requires that water or some type of medication be

l
suspended in the inspired air as an aerosol, a device called nebulizer
is used. In a nebulizer t]rle water or rnedication is picked up by a

ria
high-velocity jet of oxygen (or some other gas) and thrown against 7.

one or more baffles or other surfaces to break the substance into


controllable-sized droplets or particles which are then applied to 7.
7.
patient via a respirator.
A more effective and more expensive type of nebulizer is the ultrasonic
nebulizer. This ultrasonic enerSr produces to produce minute volume
of water or other medication.

ate
Aspirators are used to remove muscus and other fluids from the
airways.

6xerri,ted
l,t'
r/ 7.1. How many loves are there in lungs? Define the important lung capacities
I and explain them. (UPTU-MQPl)
i 7.2. Boyle's law is an imPortant 1aw of physics. How does it relate to breathing
i (UPTU-MQP1)
process.
yM
For what measurement spirometer can be used? what basic lung volumes
D\
7.3.
rt and capacities cannot be measured with spirometer? Why?
(UPTU-MQP1)
7.4. Write in detail about the instrumentation used for measuring the
mechanics of breathing. (UPTU-MQP2)
7.5. Explain d.ifferent respiratory therapy equipment normally used.
(UPTU-MQP3)
7.6. Explain the operation of a pulmonary measurement indicator?
(UPTU-MQP3)
7.7 . Using the correct anatomical and physical terms, explain the process of
respiration, tracing the taking of a breath of an air through the mouth.
ud

(UPTU-MQP3)
7 Explain the physioloSr of a respiratory system. Discuss various parameters
.8.
which are a function of individual's physical characteristics and condition
of breathing mechanism. (UPTU-2003t
7.g. what are plethysmographs? How can they be used for measurement of
intrathoracic pressures? Expiain the methods of airway resistance
measurement
7.10. Discuss various respiratory therapy equipments. what are Nebulizers?
(UPTU-2003,
St

Explain the working principle of ultrasonic nebulizer'


7.11. Explain calibration and repairability of patient monitoring equipment.
(UPTU-2004
7.12. Describe and explain humidifiers, nebulizers and aspirators.
(UPTU-2004
7.13. Describe and explain physiolory of respiratory system' (UPTU-200'
Page No. 135 of 328.
Fundamentals of Biomedical Instrumentation

Measurements in The Respiration System 137


14' Describe and explain measurement
of breathing mechanics and spirometer.
-.15. (UPTU-2O04)
nd physical terms, explain the process of

l
of a breath of air through the mouth for
blood in the muscle of an

ria
_.16. athlete's leg.
een death by carbon monoxicle poisoning and
death by strangulation? Explain.
17' Explain the operation of a purmonary
measurement indicator.
18' what causes the rungs to expand
and contract in breathing inspite of the
lungs containing no musculature.

AJJ

ate
yM
ud
St

Page No. 136 of 328.


Fundamentals of Biomedical Instrumentation

CO

bc
It
NC

l
ob

ria
Diagonstic Techniques

t'
I
I
t
lr',:
:r fnside this
8.1.
8.2.
8.3.
8.4.
chapter

Ultrasonic Diagnosis
ate
Principles of Ultrasonic Measurement
llltrasonic Imaging

X-Ray and Radio-lsotope Instrumentations :he


yM
:TIC
8.5. CAT or CT Scan
{ 8.5. Emission Computerized Tomography
.l t
:o
6.t. MRI
8.8. Summarv
aas
tol_
lro
Diagnostic techniques involve measurements to help in detection of some 111

malfunction of the system of the body. Such instrumentation may also : et'
be called troubleshooting equipment. The diagnostic equipments and .he
their underlying principles related with ultrasonic, X-ray, Radio-isotopic, -ah
cAT scan, Emission computerized Tomography and MRI techniques are
ud

discussed here. These techniques of diagnostic does not involve getting


inside the body physically or invading it, therefore, these are known as
Non-invasive diagnostic techniques. The non-invasive diagnostic
techniques are not traumatic for the patient and do not have any
determinental side effects on the patient. The non-invasion techniques
are very sophisticated which offer accurate results without invasion of
the body" Usual method of blood pressure measurement is non-invasive
which has been around for years.
St

PRINCIPLES OF ULTRASONIC MEASUREMENT


Ultrasound is sonic ener$/ at frequencies above the audible range, i.e.,
greater than 20 kHz. Ultrasound exists as a sequence of alternate
138
Page No. 137 of 328.
Fundamentals of Biomedical Instrumentation
DiagonsticTechniques 139

:ompressions and rarefactions of a suitable medium, i.e., air, water,


rone, tissue, etc. It;is propagated through the medium at some velocity.
-t is also frequency (wavelength) and medium density dependent. In
rormal applications, ultrasound is actually focussed into a beam which

l
--beys laws of reflection and refraction as shown in figure 8.1.

ria
Reflected wave

Medition 2 --'
lntedace

ate
Medition 1 Transmitted wave

Fig. 8.1. Ultrasound reflection and refraction at an interface between


media of two densities
The reflected energr is dependent on the difference of densities between
-: two media and the angle at which the transmitted beam hits
- :dium. Higher the difference in media, the higher will be the reflection.
the
yM
:he angle of incidence between the beam and the interface is closer
90", the reflected portions would be more.
If the media difference is high i.e., tissue and bone or tissues and
r:S. rrrost of the energ/ will be reflected and almost no energz will
rtinue through the second medium. In other words, ultrasound
: - pagation path must not include bone or any gaseous medium or air.
" - airless contact is produced through using an aqueous gel or a waterbag
r-.rseen the transducer and the skin for application of ultrasound.
- -:
density and the important properties of materials are shotwn in
'-
=:le 8.1(a)
ud

Table.8.1. (a) Ultrasonic characteristics of some selected materials

Materlal Temperature ("Cf Density (S/cme1 Velocity (m/secl


'rYater 40 o.992 529
3rain J/ 1.030 510
l,luscle 37 7.O70 570
-- at J/ o.97 440
3one 1.77 360
St

The velocity of sound propagation through a medium is dependent


' :ensity of the medium, its elastic properties and the temperature.
-'-'.'elocity of most body fluids is around 1550 m/sec, i.e., higher than
r,'.: The velocity of through bone is 3360 m/sec whereas through fat
.:ch lower l44O m/sec.
Page No. 138 of 328.
Fundamentals of Biomedical Instrumentation

140 Fundamentals of Biomedical lnstrumentation

The depth of penetration at which the ultrasound energr is attenuated (iul


to half the app'lied amount, is known as half-value layer of the material,
i.e., tl:re half-valuer of the medium is the indicator of absortion capacity
spe(
of ultrasound energr. The Table 8. 1(b) shows ultrasound absorption

l
mea
capacity of the materials. frorr

ria
Table 8.1. (b) Ultrasound Absorption

Type of material Frequency Half-value Layer (cm) 82


Blood 1.0 35.0 The
Muscle 0.8 2.1 of ul
Fat 0.8 .).J asa
Bone 0.8 o.23 dispJ
:larn

ate
An important characteristic of ultrasound frequency used in biomedical AVOlC
instrumentation is the Doppler effect. If the frequency of the reflected
h
ultrasonic eners/ is increased or decreased by a moving interface, the
frequency shift is given as:
fopr
tne (

,,, Lf=?
')t
t4 A-
for = reflected- wave frequency shift T
t / :r-ans
I u = interface velocity
::ace
)" = transmitted ultrasound wavelength
i

t: :eflec
yM
In other words, the frequency increases if the interface moves towards
{ the transducer and decreases when moves away. If ultrasound is reflected
from a moving object, the measured frequency shift is proportional to
velocity.
The ultrasound is transmitted in various forms. The modes of
transmission are:
(i) Pulsed Ultrasound
It is transmitted in pulsed form at a frequency from I to 12 kHz
Pulse duration is about 1 p sec. The returning echoes are displayed with
respect to time and echoes are proportional to the distance from the
source to the interface. It is used in most of the irnaging applications
ud

F
(ii) Continuous Doppler (b)
Continuous ultrasound signal is transmitted and a separate receivinE
transducer picks up the returning echoes. The frequency shifts rif) M-
due to moving interfaces are detected and the average velocity of the Tre
targets is determined as a function of time. It is used in blood flos- :,'lses
---,: ver
measurements.
s set
St

('iiif Putsed Doppler E_ 10es


Similar to pulse ultrasound in this case also short pulses of ultrasounc :.i1 C(
are transmitted. The returning echoes are received. The frequency shii :1 re
is observed. In other words, the velocity and distance of moving targe
are measured.

Page No. 139 of 328.


Fundamentals of Biomedical Instrumentation

Diagonstic Techniques'141

(iuf Range-ghted pulsed Doppler


Gating circuit is used for measurement of velocity of targets
;:ecific distance from the transducer. The velocity of blood canatbea

l
::easured as a function of time and also as a function of the distance
:.:m the vessel wall.

ria
ULTRASONIC IMAGING

ate
Imaging systems are comprised of the pulsed urtrasound or pulsed
l ppler mode. The received information is amplified and displayed in
: of several display modes:
A-scan display
Transmitted pulses trigger the sweep of an oscilroscope. The D
-:rsmitted pulses and echoes are displayed as vertical defections on the 4.
a
.--e. The figure 8.2(a) shows typical A-scan. Ehoes cause vertical
:lection of oscilloscope.
yM
Transmitted
pulse

(b)
ud

Fig. 8.2. (a) Echoes display as vertical deflection of oscilloscope pattern,


c) Echoes control brightness of oscilloscope bean corresponding to Fig. (a)
M-scan display
St

: es. The figure 8.3 shows M-scan of moving and stationary target
--corresponding A-scan. A stationary target trace is a straight line
- respect to time.
B-scan display
is a two-dimensional image of a stationary organ or body structure.
:rightness of the oscilloscope is controlled by ieturning Lchoes. The
Page No. 140 of 328.
Fundamentals of Biomedical Instrumentation

142 Fundamentals of Biomedical lnstrumentation

B-scan tralsducer is moved with respect to the body and vertieal deflection
of the oscilloscope correspond to the movement of transducer.
Echo from

l
moving target

ria
Transmitted Echo from
pulse stationary
target

ate
M-scan

Corresponding A-scan

Fig. 8.3. M-scan of moving and stationary target with corresponding A-scan
yM
/ ULTRASONIC DIAGNOSIS
4.3.1
u
The ultrasonic diagnosis techniques are used in cardioiogr, abdominal
imaging, brain studies, eye analysis, obstetrics and gznaecologr. The
record may be named using echo or sono words such as echocardiogram
is record of ultrasonic measurement of heart. The echoencephalogram is
a record of ultrasonic measurement of the brain. For eye analysis it is
ultrasonogram. The ultrasonograph is used for imaging of the organ
from several positions and help in visualisation of all four chambers and
all four values of the heart, and also the great arteries and the great
verns.
systems for ultrasonic applications are inclusive of a generator for
ud

the electrical signal, a transducer, necessary amplifiers and severa-l


electronic processing and display devices. The transducer converts the
electrical signals into the mechanical vibrations which in turn give he
acoustic waves. The acostic wave enters the body through the spin
surface and is propagated in a predetermined beam pattern. If the
ultrasonic wave strikes an acostic interface such as the boundary of an
organ, some ener$/ is reflected. Transducer picks up the reflected eners,-
and is amplified, processed, displayed or recorded. The transducers are =9.8
St

available to suit various frequencies upto say 5 MHz and in various sizes
to suit applications. Microprobe needle transducers are also available. TI
- -Jf
Figure 8.4 shows block diagram M-made scanner block diagram. ----er
.:lu
: ::91

Page No. 141 of 328.


Fundamentals of Biomedical Instrumentation

Diagonstic Techniques 143

l
time^sweP of

ria
start pulse tor

ate
Fig. 8.4. M-mode scanner block diagram
yM
X : '1. Echocardiography

-tr *'
ud

..'.'*
l'
St

is superimposed on the tracing


-,: echocardiogram finds major application in cardiovascular
, -- -sis which utilizes M-scan technique. Movements of the valves and
.- :arts of the heart are displayed as a function of time usually in
rtion with electrocardiogram. A typical electrocardiogram is shown
.
' :. 8.5. This type of electrocardiogram is useful in interpreting
the
:nts
Page No. of the mitral valve with respect to time. The mobility of the
142 of 328.
Fundamentals of Biomedical Instrumentation
144 Fundamentals of Biomedical lnstrumentation

value is given as the displacement of the echo per unit time. The
transducer is placed such that the beam crossed the chest wall into the st
right ventricle, through the septum, into the left ventricle and then tl
through the left atrium. The image of aorta and mitral valve are also TT
obtained in this technique.

l
pr
Echocardiography can be used to detect fluids presence surrounding

ria
the heart due to pericardium inflamation and escape of fluid. It may be
noted that transducer selection is depend.ent on the type of investigation
to be performed, physical size of the patient, the anatomic area involved,
the type of tissue to be encountered and the depth of the organs
to be studied.
8.3.2. Echoencephalography
Echoencephalography is ultrasonic imaging using A-scan mode of

ate
display for determination of the location of the midline of the brain. The
transducer is held against the side of the head to measure the distance
to the midline of the brain. The midline echoes from both sides of the
head are displayed on the oscilloscope simultaneously. one side gives
upward deflection of the beam and the other side gives downward (a)
deflection.
If these two deflections line up, then, distance from the midline to
each side of the head is equal. If it is nonaligned, possibility of tumor
or disorder exists. Ultrasound eners/ is upto 1o MHz and pulse rate is
per
yM
1O0O sec.
t 8.3.3. Opthalmic Scans
opthalmic scans are used for the eye. An ultrasound machine block
diagram shown in figure 8.6.
ud

TGC

(b)

Spectral
doppler
processrng
(D mode)
St

Fig. 8.6. An ultrasound machine block diagram

Page No. 143 of 328.


Fundamentals of Biomedical Instrumentation
Diagonstic Techniques 145

l
ria
ate
B-mode ultrasound before treatment of a 75 year old female patient with scleritis
and myositis in both eyes. The patient's left eye has been made visible on
ultrasound The sclera is thickened with 3.0.1 mmm D = distance
yM
ud

*
r" .,j!,a
"-. .-,i

: Ultrasonography shows a questionable thickening of the mass beneath the RpE


St

(c) An ultrasound image of a normal eye with lens


Fig. 8.7. An ultrasonogram of the eye or optholmic scans
Page No. 144 of 328.
Fundamentals of Biomedical Instrumentation
146 Fundamentals of Biomedical lnstrumentation

8.4. X.RAY AND RADIO.ISOTOPE INSTRUMENTATIONS


X-rays can penetrate opaque objects and provide an image of their inner V
structures. These imagings are used for medical diagnosis. X-rays are Vi
ir

l
also used for therapeutic purposes. This is the domain of the medical
speciality known as radiologz. X-ray equiprnents are major part of medical t

ria
instrumentation. in
m
8.4.1. Basic Definitions fo
X-rays are electromagnetic waves which have a much shorter
wavelength than radio waves or visible light. The X-ray wavelength can CO

vary between 10 6 and 10-10 cm, i.e. fre[uen"y..rrg" of betweJn 1010 VE


and lO1a MHz. (cz
thr

ate
8.4.2. Generation of lonizing Radiation r 11.

when fast-moving electrons are suddenry decelerated by impinging 50i


on a target, X-rays are generated. Figure g.g shows X-ray tube which is shr
a high vacuum diode with a heated cathod.e located opposite a target
anode. The intensity of X-rays u
(,tj depends on the current Heater with Concentrator
t,' through the tube. The
a wavelength of the X-rays
Heater Anode
depends on the target materia_l
connectors
and velocity of the electrons Connectors
yM
h holding the target. X-ray Glassenvelope
equipment for diagnostic
purposes uses target voltages Electrons
x-rays
in the range of 30 tolOo kV,
whereas, the current is in the Fig. 8.8. Principle of operation of X-ray tube
range of several hundred milliamperes.
8.4.3. X-ray lnteraction with Body, Film construction and Instrumentation
Bones, metallic parts, air-filled cavities have different densities from
the surrounding tissue, therefore, X-ray machines are able to show up
well the high density parts, 1.e., bones, metallic parts, air-filled cavities.
ud

The X-ray machines are based on principles shown in the Iigure g.9.

T1
' :l-le
St

HV supply :.. I
: --1O(

X-ray
rmagtng
l4 4.
device X-rays tube

Fig. 8.9. X-ray film construction


Page No. 145 of 328.
Fundamentals of Biomedical Instrumentation

Diagonstic Techniques 147

once X-rays penetrate a body part, internal part structure absorbs


amount of radiation. The radiation thai leaves the body has
'arying intensity
of images on the screen. The X-rays are visualised for
'arying
:maging by techniques such as fluoroscopy (radiation effect of

l
certain
netal salts), photographic emulsions (X-ray effects of some films) and
;

ria
-mage intensifiers (fluoroscooic image is made brighter). TV camera,
=ronitors, tape-recorders and mobile x-ray machineJ are also available
:or diagnostic purposes.
Special techn grids (scattered X-rays are absorbed),
:ontrast media (fr es of brain with air), angiography (blood
.'essels filled with ials by injection), cardiac catheterization
:atheter insertion through an artery or vein to diagnose valve defects of
::re heart) and three-dimensional visualization are available in X_ray

ate
:-achines. The X-ray naturally, then is also able to diagnose other than
:'lnes or metallic parts. A typical block diagram of X-ray machine is
:.rown in figure 8.10.
yM
o
o
=
a
Mains c
supply kV indication .9
o
C
o
-c
.9)
I
ud

Fig. 8.10. Block diagram of a basic X-ray machine


lne diagostic X-ray machine has high mA large current for heating
--:nt, and low exposure time. The therapeuti" pr_,rpos. X_ray machine
St

, .ow mA, and high KV potential difference between anode and


-- -de.

r X-ray Film Processing


i--:ays have quite shorter wavelength than
visible light. It reacts with
' : graphic emulsion in a similar fashion as that oi tigt t. once it is
Page No.in developing
'ssed solution, a film that has been exp-osed to X-rays
146 of 328.
Fundamentals of Biomedical Instrumentation

148 Fundamentals of Biomedical lnstrumentation

shows an image of the X-ray intensity. As the X-ray film is insensitive T


to X-rays, therefore, sensitivity is improved by first producing a visible rr.
image io which film is exposed. For achieving this, intensifying screens ir
are used which consist of a layer of fluorescent material bonded to

l
to
plastic base. The X-ray film is sandwitched between two screens and di

ria
i<ept in a light tight cassette. Therefore, the film is exposed to X-rays as
*"jl r" to the ight from the fluorescence of the screen. These are SO
intensifying screens. wi
The most commonly used material is calcium tungstate which emits TT
a broad spectrum of light of low intensity in blue wavelength. Before by
coming to the actual exposure, the hlm materials must have been kept
in the darkroom during the past 12 hours, this is considered best pr(
preparation. The adaptation to a new temperature is quite fast and

ate
t1n
t""Lr." within few minutes. It can take several hours for a f,rlm to get ter
dimensionally stabilized after a change in relative humidity.
The storage of the hermetically scaled film packages is usually done 8.4
in a refrigeru.tor. This maintains the f,rlm characteristics even beyond the
expiry date which usually applies for storage under room conditions at lis
ZO"C-. If the package is opened, it can be put back into the refrigerator :ntt
after sealing again. he
The developer is as per recommendation of the film manufacturer. All
)u the parameters during lilm development is kept constant so that a negative
with the same exposure will produce the same quality of negative at
yM
ft anytime. A bath thermometer is used to check the temperature of the
developer. Temperautre of 20 + 2'C for ordinary developer gives best
resulti if kept constant. At room temperature between 18 and 24"C, the
working solution will maintain its properties in an open tray for just
4 hours. The stack solution, kept in a stoppered bottle will preserve
the properties f<rr 2 months if the bottte is half full and upto 6 months
with a rul uottte. These shelf life figures can be improved by keeping the
solutions in the refrigerator and are reduced at higher temperatures.
A developing tray large enough to enable film handling with ease is
selected sufficient dlveloper is put in the tray such that the Iilm can be
completely covered with it. A11 the handling the film is one by touching
ud

only the comes with suitable forceps. No forceps is changed from one
tray to another.
Slide the exposed hlm sheet with emulsion down through the solutior'
and turn it quickly and place it into the solution and start immediatell'
to lift the tray roiationally an each side by about 2 crn. This shoulc
occur in a rhythm of about 5 sec for one full cycle and should continue
for whole developing period. The best development of hlm is done at 20'C
whereas, initially r""t*-.rrded time is to be followed and it is modifi'ec
St

after sufficient exPerience.


After the film development, the film is gripped with the forcep on ont
edge and lifted above the developing tray for about 3 secs. to enable
the
developer to drop. Soon after that, the frlm is immersed into th: .{l
"*J"""
stop bath, keeping the emulsion side upward to avoid mechanical damages a:tc
o.,th. softened emulsion. The stop bath stops the development actior-
Page No. 147 of 328.
Fundamentals of Biomedical Instrumentation

Diagonstic Techniques 149

l
ria
After washing, a dip in a wetting
-:ocess. Drying should take place slo
.-::re is about one hour at a relative

ate
-::rrperature.

3.4.5. Radioisotope lnstrumentation


s are based on clear
: in a radioactiv time
. detectors used ilize 7a
-_ y radiation in 4.
yM
Sample
E

Scientillation
detector
Crystal Window Threshold
photomultipler
ud
St

o
Start
oo

Fig. 8.11. rnstrumentation system for radioisotope measurement


-:r n system ioisotop
-
| '. Scintill
1. re used
.: gh which passed
Page No. 148 of 328.
Fundamentals of Biomedical Instrumentation

150 Fundamentals of Biomedical lnstrumentation

The amPlitude of the radiation is


radiation' This helPs to reduce
analyzer. The electronic circuit
itude range. Adjustment in the

l
onlY Pulses from the radioisotoPe

ria
used can Pass.
InaradioisotopeScanner,thedet-ectorsarealsoavailable,whichis
slowly moved over the area which is to be examined
for images'
atr
RadiationtherapyisanotherareaofX-rayapplication'Theionizing
CO
effectofX_rayisutllizedintreatmentofdeep_seatedtumor.Insuch
cases very haid X_rays are generated for case of
tumors. Soft X-rays are AC

used for treatment of skin'


CO
Ft1

ate
8.4.6. Digital Radiographic Diagnostic and Therapeutic cr(
This facilitates
Radiography has a digital image stored in a computer'
m(
siE
syt
un
t!
tl 8.4
I
niPulations.
i
Digital X-ray imaging systems comprise of two parts as follows: al
(r) iransducer for X-ray imaging or data collection' lim
yM
(ii) Data slorage, processing and display' :ad
tr The lransducer for X-ray imaging are of two types: :he
(r) Image intensifier TV sYstem' lse
(ii) Radiographic, i.e-, fikn' replacement systems' :ne
a lev
he :nei

::
t of soft tissue' Iodine compound is
a catherer of diamete;
used as contrast material which is injected through
vessels can be
1 to 3 mm. Radi,ogi"prric images or tn" contrast-filled video'
ud

viewed on a TV o. using either film or


"""*.t '""oid"d
St

Position
contrast
Fig. 5.12. (a) X-ray transmlsslon cross-section with
Page No. 149 of 328. enhanced vessel images superimposed
Fundamentals of Biomedical Instrumentation
DiagonsticTechniques 151

(6
c
.?
a

l
ria
Position
Fig. 8.12. (b) Subtracted profile with uniform background to vessel image
Digital subtraction angiography (DSA) is the most important
application. A preinjection image (mask) is acquired. The injection of
:ontrast agent is performed and then images of the opacified vessels are
acquired and subtracted from pre-injection image (mask). This helps in
:ontrast enhancement which increases contrast sensitivity.
- igure 8.72(a\ represents the transmitted X-ray intensity through the

ate
:ross-section of a patient. The small contrast changes due to vessels are
:reshed by a large anotomical background contrast image. It these small
.ignals are attempted to be amplified, it gives to saturation of the display
:r-stem by the large background signals. The subtracted profrle with
,-niform background to vessel image is shown in figure 8.12(b\
3 4.7. Fundamental of Radiation Therapy
4.
Large number of cancer patients receive radiation therapy either as
. primary or adjunctive treatment. The easily X-ray devices were of
.nited use in treating many types of carrcer as the penetration of the ::-,
yM
-:diation was inadequate to treat deep sealed tumours without damaging
.e healthy normal tissues overslying the tumours. These X-ray machines
- sed to be voltages in the range of 400 kV and correspond to a single
-::erg/ of about 133 KeV. Subsequently direct acceleration methods were
-:r'eloped to achieve energies I or 2 million electron volts (MeV). However,
-.ese were cumbersome devices to use, therefore, failed to be used.
ud
St

Fig. 8.12. (c) Linear accelerator machine block diagram


Page No. 150 of 328.
Fundamentals of Biomedical Instrumentation
152 Fundamentals of Biomedical lnstrumentation

Some betatron units were developed which provided electron energies


upto 45 MeV and they had greater penetration through thick body sections d
and were suited for treating tumours of the trunk and pelvis. However, \
these had serious drawbacks of being larger, heavy and cumbersome n

l
devices. S

Cobalt machine was developed which was simple, compact and reliable o

ria
low-energr radiation treatment device using a pellet of radioactive cobalt p
isotope as a source of radiation. This machine survived for 30 years and sl
they had the tremendous advantage of producing a completely predictable, vl
steady, reliable beam of relative high-energr radiation. It was easy to b
repair and maintain. pr
Today, most of the radiotherapy treatments are carried out using d
conventional radiotherapy linear accelerations. Linear accelerator portion II
accelerates electrons to the required level of ener$/. In short, complete

ate
b.
machine is referred as accelerator. It is designed to deliver a mega- rn
voltage X-ray beam suitable for modern radiotherapy techniques. It is S1

comprised of gantry and stand, treatment couch; and control console. It rll
produces ener5/ ranging from 4 to 20 MeV. The block diagram of
accelerator is shown in figure 8.12(c\
/,_.,
The range of technologies used in the linear accelerator system is
t/
il very wide. It requires high power electronics in the order of megawatts.
I The dose monitoring system has to measure currents of the order of
,t
IA-72 amps. Microprocessor technologr is used. Safety interlocks, gantry
yM
?,:
and patient, support call high technologr and precision.
s
Computerized Axial Tomography (CAT) or computed tomorgraphy (CT)
scanning combines X-ray imaging with computer techniques. CAT permits
visualization of internal organs with greater clarity. The X-ray photograph
is a shadow of all organs and structures in the path of the rays. Whenever
two radiopaque objects lie; one behind the other, in the X-ray path.
the smaller of the two may be completely hidden by the larger, see
figure 8.12(d).
:x
ud

';,-i

a-a

-;,_1

:S
\t*o=: -:
St

Fig. 8.12. (d) X-ray imaging of two objects, one behind the other

Page No. 151 of 328.


Fundamentals of Biomedical Instrumentation
DiagonstlcTechniques 153

If the X-ray source and hlm are simultaneously moved in opposite


directions, for a given combination of source and film velocities, objects
rvill appear to remain stationary with respect to the film during the
novement in one single plane perpendicular to the path of the rays. The

l
shadows of the objects at all other distances from the source will move
rn the film and produce a blur. See figure 8.13, the sphere lies in the

ria
:lane that appears stationary, but cube does not. The shadow of the
sphere is hence reinforced as the X-ray vintage point is changed. The
,'intage points for axial tomography are taken around the axis of the
:ody. A very narrow pencil-like X-ray beam scans a single slice
:erpendicular to the body's axis. By scanning two or more slices, a three
rimentional representation can be created. The measurement is done by
:reans of one or more sodium, iodine or calcium chloride crystal detectors
:i- scintillating in proportion to the intensity. The scintillation light is

ate
:--easured by photomultiplier tubes. X-ray source and film move
..multaneously in opposite direction. One plane appears stationary on
---m and small sphere lies on.the same plane.

4.
--
yM

Fig. 8.13. Linear tomography X-ray source and film move simultaneously in
opposite direction. One plane appears stationary on film and small sphere
bias on the same plane
Present day CAT scanners use X-ray sources which provide fan beams
-: multiple detectors to simultaneously measure the density across a
ud

, :r position of the slice. The figure 8.14 shows the fastest instruments
':.:ng a fan beam that covers the complete width of the slice. Several
' -:-dred detectors are used to measure the density pattern of the slice
; --- good resolution. The time for co:mplete scanning of a slice is as low
i'/, secs. High scanning rates are feasible which permit scanning
-,-1 sections of the body and the p,atient is made to hold the breath
-
- ,ie completely still for few seconds in order to complete the scanning.
- :hronizing scans with the ECG helps to reconstruct slices of the
St

,.:: in various phases of the cardietc cycle.


lhe CAT scanners can provide irrformation about internal organs
' : cody structures which could n,ot be done by conventional X-ray
' :-graphs. It is regarded as one of the major developments in medical
':-:mentation.

Page No. 152 of 328.


Fundamentals of Biomedical Instrumentation

154 Fundamentals of Biomedical lnstrumentation

l
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Gr

ate
X-ray source

Scanners fan beam covers complete cross-section of the


- 8.14. Modern cATbody
Fig.
with large number of detectors
f+
yM
)\.
8.6
H :]^
-:t e

]I
:.S
.r_-(

.:
ud

47.

Fig' 8.15. Block diagram of CT scanner


The block diagram of cAT or CT scanner is shown in hgure 8.15.
The
X-ray
St

is pla
throu
detector. The source of made moving or detector or both across
the sectior'
of the body. The measurements are rnade at regular intervals. An electron
beam CT scanner is shown in frgure 8'16'

Page No. 153 of 328.


Fundamentals of Biomedical Instrumentation
Diagonstic Techniques't55

l
Crystal

ria
Focus coil

Deflect on
corl

3un

ate
Fig. 8.16. An electron-beam CT scanner
yM
!6 EMISSION COMPUTERIZED TOMOGRAPHY
;-.lioactive isotopes of certain elements can be used to trace the
-.:abolism, pathways, and concentrations of the body parts. Emission
=puterized tomography can provide detailed three-dimensional
: .:ribution map of an isotope which is injected into the body and
r .',\-ed to distribute itself. The three-dimensional image is created by
r::--fl9 scans of several slices. Naturally instrumentation for emission
::-puterized tomography is very sophisticated. such methods are being
l' tloped for ultrasonic imaging of the heart and abdominal organs.
ud

l: MRt
l{t.i:etic Resonance Imaging (MRI) is based on the nuclear properties of
T- :-rgen atoms in the body. Elements having odd number of protons
'l:'' ,-'-rcleus have magnetic properties. Such elements are hydrogen in
-1,
:n -13, oxygen -17, sodium -23, Fluorine -19, phosphorus _3 1, etc.
, gen atom nucleus has a single proton which being odd number
::re property of spin as given in figure 8.17. This works like magnet
--. the patient is placed in a strong magnetic field, the magnetic
St

'l: -:nts of protons align with or against the field lines of the magnet
-r,$rn in figure 8.18.

Page No. 154 of 328.


Fundamentals of Biomedical Instrumentation
156 Fundamentals of Biomedical lnstrumentation

I I t

l
I t t

ria
3

I I t t
I 1I
Main magnetic field a

ate
p
Fig. 8.17. Spinning of hydrogen protons Fig. 8.18. Alignment of hYdrogen
spinning off its vertical axix protons
-top
A small excess of magnetic moments of protons align with the field 8

so that a net magnetic vector NMV is created' 1

lrf, If RF pulses of the same frequency as the precessing nuclei are


applied at right angles to the main static magnetic field, the hydrogen
ii' nuclei tissues get disturbed. They absorb ener$/ and change their
Ilr orientation with respect to the magnetic field and are lifted to the higher
91. eners/ state. Now, if the held is put off, the hydrogen nuclei go back to
yM
their low ener$/ state after emitting eners/ they had received. All this
H process is known as nuclear magnetic resonance. The emitted enerry
Lan be detected, digitised, amplified, encoded and transformed by
computer into cross-sectional images. The MRI images are accurate for
visualization of tumours, inflammatory and vascular abnormalities.
MRI scan is a radiologr technique combining magnetism, radio waves
and computer to produce images of organs.
The MRI scan schematic diagram is shown in hgure 8.19. The patient
is in a magnetic field. created by a magnet. The RF transmitter sends
waves through the patient and RF receiver detects the signa-l. The intensifi'
of these signals are converted into image.
ud

RE.
T)Ureceiver
St

Fig. 8.19. MRI lnstrumentation


Page No. 155 of 328.
Fundamentals of Biomedical Instrumentation
Diagonstic Techniques 157

There are several MRI techniques:


(4 ECG gated spin echo which provides static images with high signal
to noise ratio for evaluating anatomic problems.
(n) ECG referenced gradient echo for dispraying the intimal flap and

l
the extent of the dissection within aorta.
(iif cine gradient echo for assessing cardiac contractile function.

ria
(iu) cine MRI gives tomograms of heart beats in a cinematic format.
(u) Velocity encoded cine-MRI to estimate heart beat gradient across
valvular stenosis and blow flows in heart.
MRI is a noninvasive technique with excellent soft tissue contrast.
l,lRI is a slow process, relatively expensive. It can not image bones. MRI
s used for soft tissues-brain, vessels of brain, eyes, inner ear, heart,
,rdominal vessels, kidney, etc. Naturally it is able to diagnose related

ate
::oblems of the organs.

SUMMARY
Non-invasive diagnostic: It does not involve getting inside the body
physically or invading it while conducting the diagnostic. These are
not traumatic for the patient and do not have any determinant side ,
4.
effects on the patient.
asonic measurements: When sonic energr at
KHz (i.e. above audible range), the reflected energr
yM
e difference of densities between the two media
and the angle at which transmitted beam hits the medium. Higher
the difference in media, the higher will be the reflexion.
Doppler effect is an important characteristic of ultrasound frequeuncy.
The modes of ultrasound transmission are pulsed ultrasound used
lor imaging applications, continuous doppler used for blood flow
neasurement, Pulsed Doppler for measurement of velocity and
distance of moving object and range-gated pulsed doppler used for
clood flow rate.
ultrasonic Imaging: Ultrasound imaging systems are comprised of
he pulsed ultrasound or pulsed doppler mode. The information
ud

:eceived is amplified and displays in modes such as A-scan, M-scan,


3-scan displays.
Llltrasonic Diagnosis: The ultrasonic diagnosis techniques are used
:rr heart problems through echocardiogram and similarly brain
::oblems through echoencephalogram, used for eye problems through
:thalmic scans, etc.
x-ray and Radiostope Instrumentation: X-rays ca, penetrate opaque
:iects and provide an image of their inner structure. The medical
St

- agnosis or therapeutic uses are on X-ray principles. X-rays can


.r:ntify bones, metallic parts, air filled cavities, etc.
: -dio isotope techniques are based on
counting the number of nuclear
' rntegrations that occur in a radioactive sample during a certain
:-e interval. The ionizing effect of X-ray is used in treatment of
Page No. 156 of 328.
Fundamentals of Biomedical Instrumentation
158 Fundamentals of Biomedical Instrumentation

deep-seated tumour. In such cases very hard X-rays are generated


for case of tumours. Soft X-rays are used for treatment of skin.
6. CAT or CT Scan: Computerised Axial Tomography (CAT) or computed
tomography (CT) scan combines X-ray imaging with computer

l
techniques. The CAT scanners can provide information about internal
organs and body structure which corrld not be done by conventional

ria
X-ray photographs.
7. Emission Computerised Tomography: Radioactive isotopes of certain
elements can be used to trace the metabolism, pathways and
concentrations of the body part. It can create 3-dimerrsional image
for diagnostic purposes.
8 MRI: Magnetic Resonance Imagaing (MRI) is based on nuclear
properties of hydrogen atoms in the body. The MRI images are accurate

ate
for tumors, inflammatory and vascular abnormalities.

6xercidea
8.1. What do you understand by the term "noninvasive methods"?
8.2, What is meant by uitrasonic imaging? Compare ultrasonic diagnosis with
X-ray diagnosis. (UPTU-MQPI)
8.3. What do you mean by diagnosis? Expiain X-ray diagnosis technique.
What is the difference between X-ray and radioisotope methods for
diagnosis? (UPTU-MQPI)
yM
8.4. Explain the principle of CAT scan and compare its visualisation method
H with conventional method. (UPTU-MQPL)
8.5. Discuss the principle and use of the ultrasonic measurements in medical
diagnosis. (UPTU-MQP21
8.6. Write a shot note on the instrumentation for the medical use of
radioisotopes. (UPTU-MQP2)
8.7. Discuss the properties of ultrasound and how ultrasound can be used for
diagnosis. (UPTU-MQP21 .'\'h
8.8. Explain the principle of computerised axial tomography and compare its
:-e
methods of visualisation with conventional X-ray methods. (UPTU-MQP3.r
flo
8.9. What is echocardiography? (UPTU-MQP3I
8.10. Explain the working principle of CT scan with block diagram. (
ud

(UPTU-200s (r

8.11. What are the properties of ultrasound? Discuss the basic modes oi
transmission of ultrasound? (UPTU-2003 tll
8.12. Discuss various types of ultrasound imaging. Explain its application in ttt
ophthalmic scans and echoencephalography. (UPTU-2003 (r
8.13. Explain and describe emission computerised tomography. (UPTU-2004 tu
8.14. Explain and describe echo-encephalography. (UPTU-2004
8.15. Explain and describe CAT scan. (UPTU-2004
St

3.1.

Jia ::Ot
--:et
-:al
-. c
::t
Page No. 157 of 328.
Fundamentals of Biomedical Instrumentation

l
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Biotelemetry

':-Inside this chapter


9.1. Introduction to Biotelemetry ate
9.2. Physiological Parameters Adaptable to Biotelemetry
9.3. The Components of Biotelemetry System
9.4. Implantable Units
c1f
yM
9.5. Telemetry for ECG Measurements During Exercise
9.6. Telemetry for Emergency patient Monitoring
9.7. Summary

'henever
it is necessary to monitor physiological eve.ts from a distance,
of biotelemetry becomes important. The requirements which need
iotelemetry are:
(rJ Monitoring of astronauts in space by radio-frequency
transrnissions.
ud

izr) Monitoring of patients while exercising since conne cting leads are
cumbersome and dangerous.
iiz) Monitoring of patient in an ambulance.
iLr) Medical data transmission from home or office.
tLr) Research on unanesthetized animals
ilrJ Isolation of an electrically susceptible patient.
St

INTRODUCTION TO BIOTELEMETRY
:telemetry is the measurement of biological parameters over a distance.
.thoscope is the example of biotelemetry of simple nature. In this case
art beats are amplified acoustically and transmitted through a hollor,r,
:e system which is picked up by the ear of the physician for inter-
Page No. 158 of 328. 159
Fundamentals of Biomedical Instrumentation

160 Fundamentals of Biomedical lnstrumentation

The telephone lines were used in certain applications of biotelemetry.


The telephones were "hardwired" earlier but not now. However, we are
concerned with the use of telemetry using which biological data are
converted into suitable form to be radiated by an electromagnetic field,

l
i. e., radio transmission.

ria
9.2. PHYSIOLOGICAL PARAMETERS ADAPTABLE TO BIOTELEMETRY
The space programme at NASA facilitated use of telemetry. Electro-
cardiography by surface electrodes, indirect blood pressure by contact
microphone and culf, etc. are examples of telemetry.
However, present technologr allows that aly measurement is adaptable
to telemetry. This can be divided in two categories for medical applications:

ate
(0 ECG, EMG and EEG bioelectrical variables. CA,
(it) Transducers based physiological variables for blood pressure, blood an
.tIow, temperatures, etc. In the first category, the electrical signals lm
are directly available whereas in the second category electrical
t1 signals are outcome of transducers. Most widespread use of
biotelemetry for bioelectric potentials is in the transmission of
electrocardiogram. Biotelemetry experiments have been conducted
almost on all animals.
yM
9.3. THE COMPONENTS OF BIOTELEMETRY SYSTEM
k A simple system of biotelemetry will be considered. The telemetry system
transmitter is illustrated in figure 9.1.
ud

Fig. 9.1. Biotelemetry transmitter


Physiological signals are received from human/animal body, i.e
subject by means of appropriate transducers. The signal from transduce:
is amplifred, processed and subsequently carrier modulation is done fo:
St

transmission.
The receiver circuit is shown in figure 9.2.It has a tuner for selectio=
of tuner frequency a dernodulator to separate the signal from the carrir
wave. It also has some method of recording or displaying the signat.

Page No. 159 of 328.


Fundamentals of Biomedical Instrumentation

Biotelemetry 161

Receiver Antenna

l
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Fig. 9.2. Biotelemetry receiver system
Biotelemetry systems use radio transmission. A radio-frequency (RF)

ate
:arrier is a high frequency sinusoidal signal when applied to appropriate
=:rtenna gets propagated in the form of electromagnetic waves. Some
---:rportant terminologz are:
R""nge-{he distance the transmitted signal can be received..
Modulotion-Process impressing information upon the carrier.
Demodulation-Recovery of the signal from RF carrier.
|1
The Figure 9.3 shows various stages of the waves and two basic .{-
:'.'stems of modulation.
yM
Signal

Carier wave
ud

Amplitude modulated
(AM)

Frequency modulated
(FM)
St

Fig. 9.3. Two basic modulations


Amplitude modulation-Amplitude of the carrier is made to vary with
information being transmitted.

Page No. 160 of 328.


Fundamentals of Biomedical Instrumentation

162 Fundamentals of Biomedical lnstrumentation

Frequencg modulation--The frequency of the carrier is made to vary


with the modr-rlated signal.
The another method of modulation is pulse modulation and in this
case transmission carrier is generated in a series of short bursts or

l
pulses. One simple pulse modulation is shown in hgure 9.4.

ria
Pulse Pulse

(iii

Fig. 9.4. Pulse modulation


A system for monitoring blood pressure is shown in figure 9.5. The
flush diaphragm type strain gauge transducer is represented by bridge

ate
circuit. The stage amplfication and demodulation is also shown.
Transducer bridge
yM
Fig. 9.5. Blood pressure telemetry transmitter
In the figure subcarrier is low frequency, generally audio range of
frequency.
The signal is picked up by receiver. Composite signals are separated.
reformed and demodulated. The syn-signal separator and amplifiers are
used. Finally simple integration yields the original data.
5.i TI
ud

!MPLANTABLE UNITS
Sometimes it is desirable to implant the telemetry transmitter or receiver
in the subject. Generally implanting of transmitters is done in animals
for experimentation purposes. Stimulation of nerves in the patients is
done through implanted receivers. While planning implantation it is
important to know that surgery is not complicated and there is no risk
involved on the patient. Once the implanting is done, it is not taken ou:
for servicing, hence, it must be reliable and battery should have long life
St

Generally implanting is with complete system, but in some cases partia-


implanting is done. One such example is for monitoring where the
electrodes are implanted into the brain and the telemetry unit is implantec
within and top of the skull. Some of the important aspects of implanrs
are:

Page No. 161 of 328.


Fundamentals of Biomedical Instrumentation

Biotelemetry 163

l
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A complete set of imprantable

ate
unit comprises of transducer,
-:i' power source and necessary leads. The implantable transmitter
' : single-channer blood pressure transmitter, temperature
units
urrrLo in use
rrt qJc

transmitter.
" =:e are several implantations on dogs for experiment.,i,r.
prrpo""".
rqlyvevo.
relemetry of ECGs from extended coronary
care for cardiac patients
'ry much in use' In this arrangement, each
:'d securely to his chest' The electrodes patient has ECG electrodes
U UTSU
are connected to a sma,
LI ULTCS

' -smitter unit having signal conditioning equipments. The transmitter 4.


is fastened to a special belt worn -.or-,.rd the patients
':retry receiver for each monitored patient waist. A
-.r:orlng system. The output is inciuded as part of
yM
each receiver is connected to one of the
, channels of the patient monito

: e transmitting antenna is a flat disk which is taped on the skin


--re subcutaneous
receiver by disposable adhesives.

TELEMETRY FOR ECG MEASUREMENTS


DURING EXERCISE
ud

'' such a disease require


e exerci
The connecting
' le exerc The transmitter
,I1ul'rrrleo on tne belt and the electrodes
:. requlrements are as described earlier. are fixed on the body.
-ELEMETRY FOR EMERGENCY
PATIENT MONITORING
St

.:-ces need to be equipped with telemetry


: other physiol0gical data to be transmittedequipments to allow
to near-by hospital
::retation' Two way voice transmission in conjunction'witrr
-' is used. These transmitters are very powerful bio,
,:le units. Emergency medical care is an important compared 1o

.alth care system. part of the


Page No. 162 of 328.
Fundamentals of Biomedical Instrumentation

164 Fundamentals of Biomedical lnstrumentation

l
Calvarium4
i- Dura mater

ria
Cortex
lnsulation Wire
Evelet Ag sphere
(a) Q)
cluster of Fine (b)
Wires, lnsulated

9.1

ate
))
)3.
electrodes (a) wire loop electrode, (b) silver-sphere cortical-
- 9.6. lmplanatable
Fig.
surface potential electrode, (c) Multielement depth electrode
<4-

:6.
yM
*
SUMMARY
1 Biotelemetry: Biotelemetry is the measurement of biological param
over a d.istance. Stethoscope is the example of biotelemetry of sin
nature where in heart beats are amplihed acoustically and transmr
through a hollow tube system which is placed up by the ear of
physician for interpretation. Present day, biological data are conve
into suitable form to be radiated by an electromagnetic held,
radio transmission, is the high tech example of biotelemetry use
biomedical instrumentation.
Physiological Parameters adaptable to Biotelemetry: ECG'
ud

2.
u.t a BUC bioelectrical variables, also transducer based
phy
variables for blood pressure, blood flow, temperature, etc'
J. Components of Biotelemetry System: It has two maJor F
tranJmitter which comprises of Electrodes Transducer, Amp
Processor, Modulator, Carrier and transmitting antenna, and rece
antenna, tuner, demodulator, tape recorder, chart recorde:
oscilloscoPe.
St

4. Implantable telemetry units: Implantable telemetry units mus


small, the outercase and wiring must be impervious to body tru
and moisture for this reason plastic potting compounds or si
encapsulation is in use. Lithium battery is used as a power
for lor,g life.

Page No. 163 of 328.


Fundamentals of Biomedical Instrumentation

Biotelemetry 165
5. Telemetry for ECG measurements during excerise:
while exercising
on a treadmill, the transmitter unit is Lounted on the belt and
electrodes are fixed on the body.
Telemetry,for

l
6.
toring: Ambulances need to
oe equtpect w to allow ECG and other

ria
physiological
intlrpreta=tion. In addition two way rroi". trrT";r*:ffT
for the benefrt of the patient.
ff?*;ii:
C
O.E erci,1e,J

; 1. what do you mean by bio-telemetry? List the advantages


of bio-telemetry.

ate
(UPTU_MQP1)
:2. Explain how four physiorogical parameters can
telemetered simultaneously.
be monitored and
ppfu_Mepl)
Discuss telemetry as an emergency tool. ppTu_Mepl)
what are the components of a bio-telemetry system? what
applications of telemetry in emergency patient monitoring? are the
(upru-MQp2)
Pl""]:: various applications ef bio-telemetr5 Explain the
Bio-LINK PWM transmitting system. working of a
(U1TU_20O3)
9a How can telemetry be done for ECG measurements
from extended coronary care patients?
durii! exercise and
ppTU_20O3)
yM
p1r1"l" the components of a bio-telemetry system with the help of neat
labelled diagram.
Draw a block diagram of a system to send an electroca
,orr*r'.!{{r"'rfo^11
ambulance to a hospital by telemetry.

JJJ
ud
St

Page No. 164 of 328.


Fundamentals of Biomedical Instrumentation

cal
cor

l
ria
Therapeutic and

:* fnside this
Prosthetic Devices

cll.,c,Ptcr
10.1. Aucliometers and Hearing Aids
ate
yM
10.2. MYoelectric ARM
10.3. LaParoscope
10.4. Summar5'

The
:\'It!
medicine' Most of r -.stacl
A major use of medical electronics is in diagnostic
carryout some procesl .--e ty-n
instruments sense various physiological signals' -
:it#-;;;;j., ai"pr"vt' "Jo'd them' rhere is a class of med
;"; the
electronic devices that are Lseful therapeutically
or as prostheses' ,-:Toufi
1 1.
----! 1.:le on
examplesareelectricsimulators,incubators'ventilators'heart-lu:
ud

aids,and -y:-"-l:t: -.: sizr


machines, artificial kidneys, audiometers' hearing .
arms r.ater
;fi;;;t""".p", Rudiometers' hearing aids' myoelectric 1

","'
are covered here'
i:,_ n tht
LaparoscoPe -:''- :luid
l'e :he ba
loll] AuDloMETens axo neantxc nlos .,- sensl
:s ln
10.1.1. Mechanism of Hearing ::lC I
St

The figure 10.1 shows the anatomy of the


human ear' Sound rr :::crat
are longitudinal waves in which the motion
of each particle of mec -::eres
alnr
and forward
^.'^*A aLo
in which the wave is travelling, moves backward
,1
i_ -:tg.
propagated' The pi:"" :Se
line, in the direction in which the wave is "!1 O

H;";;;;;;^A"t some of the scattered eners/ enters the a .r. Ti

Page No. 165 of 328. t66


Fundamentals of Biomedical Instrumentation
Therapeutic and Prosthetic Devices 167

canal and pushes against the tympanic membrane during a wave


compression.

l
ria
Semicircular
canals
,,
Vestibular
nelve
,//

Tympanic
membrane
ate Eustachian tube
.ft,--
i.l

li
a-
-
yM
Fig. 10.1. Anatomy ()f the human ear
The tympanic membrane separates the ear canal from middle ear
:avity which is exposed to atmospheric pressure only through the
:ustachian tube, which connects it to the pharynx and nose or mouth.
- he tympanic membrane transmits
.l the middle air, to the receptortht: sound ener$/ through the cavity
ct:lls in the inner ear, which are
.urrounded by fluid. All these are coulrled to the oval window, j.e., total
:rrce on the oval window is the same as that on the tympanic membrane.
ud

lh.e size of the window is very small , therefore, if experiences much


per unit area. One of the b,ones, known as the stapes, rests
=eater force
-pon the lower end of the cochlea and pzrsses the vibrations directly into
:re fluid within. Most of the pressure wer,e received by cochlea transmitted
::r ffis basilar membrane surrounding th,e fluid. The membrane contains
:-re sensitive receptor cells, which transforms sound ener$/ or pressure
;.'aves into action potentials. These potentials are propagated along the
:,rostic nerve fibres to the brain with a. speed of 1OO m/sec. The
St

:lpreciation of sound is mainly a cer.ebreil function. Anything which


-:terferes with the conduction of sound waves to the cochlea affects
:-earing. The defect may be in ear drum., disease of the middle ear or the
:rsease of the cochlea itself or its co,nnection in the central nervous
=-,-stem. The human ear responds to vil:rations ranging from 20 Hz to 20
..lfz.
Page No. 166 of 328.
Fundamentals of Biomedical Instrumentation

168 Fundamentals of Biomedical lnstrumentation

10.1.2. Audiometer ;
Ior-
The device, used to test the auditory response is known as audiometer.
ou
A basic audiometer is an oscillator driving a pair of earphone and is wit
calibrated in terms of frequency and acoustic power, which cart be adjusted

l
over the audio range. Aud.iometer also provided with a calibrator, noise
ofr

ria
source and bone-conductor-vibrator. It has two channels-first channel
tha
has pure tone or speech output and the second channel has either
.r"..o* band. or wide band marking signal. Independent attenuator and to(
transducers exist for each channel. 10.
Transmission of sound through the external and middle ear to internal
ear is called air conduction. The transmission of sound to the internal
ear via an electromechanical vibrator applied to the mastoid bone is
called bone conduction. Bone vibrator contains a piezoelectric transducer.

ate
Loud speakers d.eliver auditory stimuli which converts electrical signals
to audible vibrators. A permanent record of an audiometer is called
audiograph.
Audiometers are classified as:
(r) Rrre tone audiometer
(ir) Speech audiometer.
10.1.2.1. Pure Tone Audiometer
It generates test tones in octarre steps from 125 Hz to 8 kHz with
signal intensity ranging from 10 dI3 to l2O dB. Hearing loss, associated
yM
$
*itt -iadte ear disease, can be evsluated with pure tone more accratel]-
than speech test as the frequency and intensity can be controlled with T]
high degree of precision. Pure tor:e audiometer is composed of an LC M
o"Lillrto. which is controlled to an output current amplifier stage to A(
produce the necessary power lerrels. Ladder attenuators are used ic LI
these instruments of nominal impedance of 1O ohms. The output signa'
is coupled to a small loudspeaker or an earphone which helps in hearing MJ
by aii conduction and a tone vibrator for hearing by bone conduction RI
10.1.2.2. Speech Audiometer AN
Speech audiometer is used in the differential diagnosis of hearing Th
disorder and in the assessment of social handicap. Pre-recorded speecb - lifl
ud

is used, as a test signal. A doubl'a band tape recorder is used to interfacl -::st
the two channel audiometer units. Two head phone of L.S. of 25 warrs, lE:em
for each channel are available. r::ed
:+ -.i'or
&l -st(

lhe
St

: :-eC1
'stl
30 to 5o percent sensory cells in the inner ear may have gone l--- r

irrepairable structural damage r>r missing. In such circumstances, -E :'lnS


only choice available for hearing impaired individuals is to wear a hear ll
aid. Hearing problem is caused. by either loss in sensitivity or loss
Page No. 167 of 328.
Fundamentals of Biomedical Instrumentation
Therapeutic and Prosthetic Devices 169

the ability to discriminate different speech sounds or both. Loss of


loudness may be due to increased mechanical impedance between the
outer ear and inner ear. Loss of discrimination ability may be associated
rvith damage to the sensory organ.

l
The invention of semiconductor electronics have enabled development
of small and efficient integrated circuits which can be packed in a form

ria
that frts behind or in the ear. The primary function of a hearing aid is
:o compensate for the 10ss of sensitivity of the impaired ear.
10.1.3. 1. Conventional Hearing Aid
A basic hearing aid is shown in frgure 10.2.

ate
yM
Fig. 10.2. Conventional hearing aid and block diagram
The functional parts are:
MlC-microphone and associated preamplifier.
-\GC-automatic gain control circuit.
LPF and HPF-a set of active filter.s, i.e. low pass filter and high pass
:f.
\{ixer-a mixer and power amplifier.
REC-a transducer or receiver.
.\M / PR-audiometer/ programmer.
The complete circuit works on a battery. The multiple channel helps
:ifferent frequency range which can be adjusted with potentiais.
ud

-:st hearing aids are electronically programmable. The programmable


:imeters are downloaded from a computer based system and are
:d in digitial registers. The register output helps to switch register
;.orks which control various analog circuitry. The active filters are
-sted to provide frequency attenuation since most of the hearing aids
.:re high frequency gain.
- re microphone is a transducer in the hearing aid. The receiver is
St

'-ectromagnetic device which drives a miniature cliaphragm to produce


-sric output. output is routed through a flexible tubing
'---: ear and ponse is altered to boost high frequency
:,-:rse. This i tapering its inside diameter from the ear
,-.j back to the receiver part end.

Page No. 168 of 328.


Fundamentals of Biomedical Instrumentation

170 Fundamentals of Biomedical lnstrumentation

The complete electronic circuitary is packaged in a miniature housing sl


for htting on the ear. The miniature sized hearing aids can be either put s1
in packet or fixed on the belt and connected to the ear. CI
However, most comfortable design is to frt behind the ear or inside a1

l
the outer ear. th
ul

ria
10.1.3.2. Digital Hearing Aid th
It gives greater dynamic range with less power consumption and 1n
greater complexity. A digital hearing aid block diagram is as shown in
figure 10.3.
MIC-microphone
ADC-analog to digital converter
DSP-digital signal processor

ate
REC-receiver
AM / PR-audiometer/ programmer

{
\
yM
$
Fig. 10.3. Digital hearing aid and block diagram
The soundwaves are picked up by the microphone which is
transformed into electrical signals. The electrical signals are converteC
into digital form. The digital processing device contains an array to :_tn(
adders, multipliers and resisters to provide the fundamental operations .nd
for implementing various digital algorithms. The digital technologr is
implemented with CMOS technologr. The digital hearing aids provide 10.2
capabilities of ease of fitting and stable superior long term performance 1
-fmi
ud

_ata
1- SO
The difference between inanimate and animate objects is that the animate : lra.
move, i.e., respond to their environment and show changes in their bodl
functions. These properties are called behaviour which are controlled [r : ntle
the nervous system known as neurologz. The body parts are connecteC ,:eri
to the brain through nerve hbers. Nerves that carry sensory information
from the various parts of the body to the brain are called afferent nen-es =:e l
-
- ,lol
St

and the ones that carry signals from the brain to operate various musc '---p
are called efferent nerves. [,::e i

Countless feedback loops control the action of muscles. The muscl ---:cu
them selves contain stretch and position receptors that permit prec:
control over the operation. Many of the routine muscular movements
the body are not controlled by the brain at all but are reflexes of
Page No. 169 of 328.
Fundamentals of Biomedical Instrumentation
Therapeutic and Prosthetic Devices 171

spinal chord. The spinal chord gives almost automatic response to input
stimuli through nuclei of neurons. In short, the muscles of the hand
create bioelectric potentials which in turn create motor actions of gripping
and rotation of the hand. Myoelectric arms are based on the principle

l
that bioelectric potentials serve as input signals which is taken by the
unit for action and once action is complete, feedback signal is given to

ria
the hand for being fed to nerve f,rber. The myoelectric arm can be divided
in two parts.
(zJ Animation control systems (ACS)
(irJ Prosthesis configuration units (PCU)

ate "l **$$ ,fl,


ir..
d.

6
yM
Fig. 10.4. Animation control system (ACS) components
The ACS components mount inside the prosthesis and control all the
'-.nctions of the patient, controlling the hand and wrist, battery charging
,:-d energz management (see figure 10.4).
'A.2.1. Prosthesis Gonfiguration Unit (PCU)
The PCU devices are basically a window into the prosthesis, they
-irmunicate with ACS via wireless communications limbs to gather
ud

-.^:a from the arm and display it during experimentation. The PCU is
, =o used to diagnose the prosthesis and to "fine-tune" the operating
; .:ameters to match the patient. The PCU allows the medical professional
'see" what is happening inside the prosthesis, in real time, while
; '.rent is wearing the myoelectric arm. All parameters relating to the
.ration of the arm can be monitored and adjusted from the PCU
'.= figure 10.4). A digital wireless communication link allows the PCU
r,rmmunicate with the prosthesis upto about 50 feet away. This allows
St

': patient to use the prosthesis in a normal manner without restrictive


' -: and cable connected to the prosthesis. A11 functions are accessed
- -rugh simple menu driven screens.

Page No. 170 of 328.


Fundamentals of Biomedical Instrumentation

172 Fundamentals of Biomedical lnstrumentation

oF
Realtime Monitor
ac
SER 11

Status : Closing
w(

l
E th,

ria
tl thr
H

po'
als
ma

Fig. 10.5. PCU disPlaY 1o.

ate
10.2.2. Animation Control System (ACS) Lar
difi
The ACS monitor and control all the functions related to the operation rnn
of the hand and wrist. These are microcomputer based systems which The
interpret patient commands, determine the best method of operating the are
'/ hand and wrist to match the command, and then drive the hand or wrist :ap
in an energr efficient manner. These are unique methods of interpreting
the patient sensors which allows the system to adapt to virtually any
a_re

patient signals. Various control strategies using techniques, algorithms


lov(
and strategies of control are pre-programmed in the ACS system and are
:uII
used to custom fit the prosthesis operation to the patient'
yM
& A patient is started with a minimal myoelectric signals, then as the
:re
patieni signal levels increase, the system is moved to voluntary open and
voluntary close with onloff control. Further progression of the patient :ld
would lead to proportional control and ultimately allow hand and wrist
:rot
:Inl
operation. nCS is normally designed to operate with lithium-ion and
liihium-polymer batteries to optimize the operation in an ener$/ efficient
(i,
marrner.
ACS use radio telemetry to transfer information to and from the (n'l

prosthesis. The ACS module is round and mechanically designed to snap iit)
into the wrist of a prosthesis designed. A plug-in adapter with gold- 'l
plated connections allows direct contact to the slip-ring contacts on the (0
ud

hand to canneet to many other hands and wrists. rnJ

in)
10.2.3. Rechargeable Lithium Battery
ir)
Animate prosthesis use rechargeable lithium battery. The rechargeable
lithium batteries have proved to be the best choice primarily because
they have two to four times more eners/ for a given size and weight thar-
technologies such as nickel cadmium and nickel metal hydride. These
batteries do not have the "dreaded effect" and can be recharged at an1
St

point of discharge. The recharge time for a fully discharged battery is


abotrt2to3hours.
Each time the charge cycle starts, the ACS performs an analysis o:
the battery to determine the proper method of charging. A precisio:
charge is applied to the battery to make sure that it will always have tl]t

Page No. 171 of 328.


Fundamentals of Biomedical Instrumentation
Therapeutic and Prosthetic Devices 173

optimal charge. This allows the battery to perform properly daily and
achieve its overall life.
The ACS should shut off the battery if it detects a problem that
would waste ener5/ or otherwise damage the battery. The circuitry inside

l
the battery provides automatic protection from external problems that
the ACS can not control that would physically damage the cells.

ria
The charging of the battery is simply pluging the connector from the
power source supplied to with the ACS into the charging part which can
a-lso have indicating lights. Small size batteries are available which can
match the size, weight and energr to the prothesis and patient.

ate
Laparoscopic surgery is very intensive technologically and is completely
Cifferent approach to operative intervention. The response to this
-nnovative method of instmmentation has revolutionized the medicare.
The vigrous research, development and challenging problem solving efforts
ere continuing in this field. The technological growth in this area is
:apidly expanding. The discussion of some of the available equipments
-e being taken up here.
Laparoscopy has played a major role in grnological surgcries initially
:overing tubal ectopic pregnancy, but subsequently in wider use in ovarin
:-rmors and laparoscopic hysterectomy.
yM
l,aparoscopic surgery reduces post operative pain. Narcotic analgesics
-e seldom required. Padent recovery is fast and he cal be discharged early
:-ed can go back to work quickly. It is especially superior and wound
::oblems like hematoma, infection, scar h5pertrophy and hernia are
--jnimum. The laparoscopic surgery can be for diagnostic purposes such

(r') Diagnosis of occult abdominal parn.


ir') Assessment for resectability of tumors.
iirJ Assessment of abdominal tramma.
The therapeutic uses of laparoscopy:
rJ Gynaecological surgery of hyterectomy.
ud

iil Thorax video assisted thoracoscoplc surgery.


:ir') Retroperitoreal surgery
: :') Abdomen----cholecystectomy, appendicectomy, inguinal hernia repair,
fundoplication, small bowel, and large bowel resection, splenectomy,
etc.
!0 3.1. Basic lnstrumentation Configuration
The surgical theatre becomes intra-abdominally, therefore, it has to
St

ru:.'s 5pzgs for visualization and movement of instruments. It also requires


n.:ging system, manipulating surgery instruments to cut, management
rn :[eeing, stiching techniques, etc. Before going into details of exact
rr:-.-.niques of laparoscopic system, it is essential to go through important
urr:tcts of instmmentation and facility development in the field.
Page No. 172 of 328.
Fundamentals of Biomedical Instrumentation
174 Fundamentals of Biomedical lnstrumentation

10.3.2. lmaging System


10
The laproscopic telescope provides the means of acquiring an image
of the abdominal cavity. Light is sent into the abdominal cavity through
the fiber bundle surrounding the rod lens. The light comes out of the an

l
scope as a ring at the tip of the instrument. The diameter of the telescope an
used these days are 5 or 10 mm instrument.

ria
ele
The telescopes are either forward viewing or oblique. A O-degree
instrument provides an image. Oblique viewing scopes have an angle of l.e,
30 degrees to 45 degrees off the center lines of the instrument. It is used ex(
for areas not accessible such as over the dome of the liver.
A the proximal end of telescope, there is an eyepiece which is used Ge
as an attachment for the camera. arI
-{s
The adapter, which joins the camera and the telescope by means of r

ate
COI
a C-mount, also contains a focusing lens. The telescopes have been
designed with camera as an integral part. Laparoscopic system with
distal lens washing as well as an irrigation channel directed toward the anc
operative site are available. The
:Tte(
Miniature light weight camera weighing 40 gms or lesser are used.
It has CCD chip of size Yz" having 3O0,OOO light sensitive pixels. 10.:
Each pixel responds electrically in proportion to the number of photons
to which it is exposed. .'.itt
Light source is generally either Xenon or metal halide bulb having ',,,-itl
yM
life of approx. 250 hour. The light is provided to the laparoscope througL- .rd
k hberoptic cable. _':lto
-,:e(
10.3.3. lnsufflator and lrrigator
The exposure is achieved by insufflation of the peritoneal cavity wir-
: le(
gas such as carbon dioxide (CO2) .This permits safe introduction an; - r-af
manipulation of cannals to accomodate the laparoscopic telescope an: a- co
laparoscopic instruments. The flow of carbon dioxide creases automatical-.
when a preselected intra-abdominal pressure is achieved. A rearculatir:; ..t
1

pump exchanges and hlters carbon dioxide to remove smoke and debris. --u-
i.1atr
It simultaneously maintains stable intra-abdominal distention pressure
: -:cl
Display of carbon dioxide pressure and flow rates are available.
ud

, _:h
Management technique of bleeding is done by an effrcient high flor
irrigator f aspirator unit. It has the ability to direct a forceful fluid strea:: '0.3.
coupled with rapid aspiration of clots and fluid. It is best accomplished dol'-g
L
two jobs with the same tube by alternating the suction and irrigation fi.mctior-:
.-lL
Operating rooms are as usual equipped with nitrogen as a pressu= ,_rc
source. The nitrogen powered irrigation system is used for laparoscorr:
Ir
irrigation which provides a fluid stream from a 80 psi source and is se- '-- a(
-'t
effective in hydrodissection. Standard irrigation bags are connectrd
St

l- ::I-1
through the disposable diaphragm pump. Some irrigationi units a-= * 1t
structured to accept an electrocautery or laser probe without interpret: r.:11
with the irrigation/suction function. rl-l I

Page No. 173 of 328.


Fundamentals of Biomedical Instrumentation

Therapeutic and Prosthetic Devices 175

10.3.4. Dissecting and Manipulating lnstruments


Laparoscopic surgeon has choice of a several number of instruments
and many a times in combination to perform the tasks of manipulation

l
and dissection. Many instruments have connectors and are insulated for
electrocantery.

ria
The multipurpose tools are single instrument serving several functions,
i e., retraction, aspiration, irrigation, and electrocantery. Instrument
exchange time is minimized and less access ports are required.
Any type of effector tip can be placed at the end of an instrument.
General purpose grasers and dissectors have relatively short narrow
arms capable of performing with teasing, tearing or streching maneuvers.
.\ssorted reusable graspers and dissectors with various handle

ate
--onfiguration.
Enopath bowel instrument are an Endo Babcock and Allis grasper,
:nd an occlusive bowel clamp, a kelly clamp, and a right angle dissector.
lhese have features of fiongeitip shaft rotation and a jaw locking
rechanism.
10.3.5. Suturing and Ligation lnstruments
Intracorporeal suturing and knot tying instruments are available
;.ith laparostopic system. Absorbable ald non-absorbable suture materials
;.ith short ski and straight needles have been made available. A suture
yM
.rd need.le combination is either free standing or attached to a disposable
,-rot pusher. A single use devices are available which include a curved
-eedle with needle driver and pretied knot.
A pretied suture loop can be applied if a free pedicle requires ligation,
r:ecially useful for structures which are not suitable for clipping for
:\ample, the appendiceal base or larger blood vessles. The ligature is
--corporated into its own plastic holder with a preformed loop'
These devices available for laparoscopic use deliver a large staple
-:-d-on in a fashion similar to a skin stapler. The stable crimps to a box
::tape, providing a firm non-necrosing approximation of the tissues.
: -ich devices are being used for mesentric closure and for hernia repair
ud

i -.:h mesh.

'0.3.6. Applications of Laparoscopic System


Laparoscopic equipments are very expensive as surgeon has to operate
':::rote from surgical field using imaging system with hand-eye
.rrdination. Naturally, it is still not widely available.
In view of high grade of sophistication and supporting instruments
::-:1g fira-rry, the operating room configuration and placement of
St

-.:rumentation for laparoscopic uses are to be decided by surgeon with


i-:at caution so that while operating he is able to do manipulation
,, .ions skillfully. The figures 10.6 a1;1d lo.7 show such arrangements
, - - placements.

Page No. 174 of 328.


Fundamentals of Biomedical Instrumentation

176 Fundamentals of Biomedical lnstrumentation

Anesthesia Anesthesiologist
Equipment
A
Video
U

l
or Monitor

ria
FA

ate
lnstrument Table

Fig. 10.6. Team members and equipment position for laparoscopic


Laparoscopic cholecy-stectomy is a treatment of gall stone disease.
Repair of inguinal hermias, gastro-oesphageal reflux disease affecting
gastrointestinal system and haematological disorders, etc. are some more
6.
I

l
1

I
I
I
t
yM
areas of uses of laparoscopic system. Improvements in such l
instrumentation for the benefit of Bio-medical uses are under continuous I
development for the patient care.
q
OEE

^ 0.1.
coz
lnsufilaor '-0.2.
0.3.
1 Surgeon
Assistant ^
-z
surgeon HF Bipolar - 0.4.
ud

Coagulation
lrrigation - 4.5.
Aspiration
_16.
Scrub Nurse

lnstrument Table
St

Fig. 10.7. Laparoscopic appendectomy positioning of team and equipment

Therapeutic devices are electric simulators, incubators, ventilators.


etc. The Prosthetic devices are hearing aids, myoelectric arms, etc
Page No. 175 of 328.
Fundamentals of Biomedical Instrumentation

Therapeutic and Prosthetic Devices 177

Laproscopic system is useful both as therapeutic as well as prosthetic


device.
l Audiometer is for testenga the audiotory response and hearing aids.
Hearing aids compensates for the loss of sensitivity of tne impaired

l
ear.

ria
l. conventional hearing aid is These are lithium operated, programmable
electronic circuit which is packaged in a miniature housing for fitting
on the ear.
Digital hearing aid: gives greater dynamic range with less power
consumption, but with greater complexity. It is cMos technoloSr
device which fits on the ear'
Myoelect ciple that bioelectric potential
as by the unit for action' Once

ate
serve
action is iven to the hand for being fed
to nerve fiber. It has two parts namely Animation Control System
(ACS) and Prosthesin configuration Units (PCU). It is backed by
rechargeable lithium battery.
yM
pregnancy, overin tumers and laparoscopic hysterectomy, etc'

J-,xerci,le,l

, -)1. What do you understand by therapeutic and prosthetic devices? Explain


in detail.
.).2. Write notes on hearing aids describing all aspects'
_ I 3. what do you understand by myoelectric arms? Explain
underlying
principle with an examPle.
.4. What is Laparoscopy? Describe laparoscopic system use in surgery and
-)
ud

its benefits over normal surgery.


- 5. Describe complete laparoscopic system.
_ 6. Explain the prosthetve devices libe Hearing aid, and Myo-electric Arm.
(UPTU, 2006)

aiJ
St

Page No. 176 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Nervous System

(:''
t'
:e. fnside this chaPter
11.1. Introduction
tL.2. Anatomy of Nervous SYstem
r 1.3. Central Nervous SYstem
ll .4. Brain Organisation
ate
yM
1 1.5. Neural Communication
1 1.6. Neuronal Firing Measurements

lt.7 Eeg Block Diagram, Rhythms and Eeg Diagnostics


.

i 1.8. Summary

11.1. INTRODUCTION

The nervous system is responsible for controlling various functions c'i


the body. It coordinates them into an integrated living organism, therefore
ud

,r"*or" system is the most complex of all the systems of the body, set
figure 11.1 (o) and 11 (b).
Nervous system has the following attributes:
(r) Consists of brain.
(ir) Numerous sensing devices.
(iii) A high-speed communication network which links all parts of re
body.
St

(iu) Nervous system influences all other systems of body'


(u) It is also responsible for the behaviour of the organism 1.e., abta
to learn, remimber, acquire personality, and interact with its sociery
and the environment, see figure 11.1(c).

t78
Page No. 177 of 328.
Fundamentals of Biomedical Instrumentation

Nervous Systern 179

From spinal cord, Cranial nerves


nredulla, hypothalamus

l
ria
ganglion
Spinai nerves

gangilon

SYMPATHETIC DIVIS]ON

ate
PARASYMPATHETIC DIVISION
Fig. 11.1. (a). Automatic nervous system, pre, preganglionic neuron; post.
postganglionic neuron, RC, ramus communicates

Clliary ganglion

Midbrain I
'il,
) cl.
lvledulla
I

\ E
yM
Lg

Spina
cord
ud

T)
St

4'' 11.7. (b) Diaqram of the efferertt autornatic path,u;ays, pregangrionic


:
are shou;n as solid rines, and postganglionic neurins as d_aslted line
eaug hnes cre parasAmpathetic fi.bres, the ligltt lines are sympathetic
'cl and reproduced, with permi.ssion,
from youmans, w : piniamentals
of Huma.n Physiolagg, 2rtd Dcj. uear book. j9d2
Page No. 178 of 328.
Fundamentals of Biomedical Instrumentation

180 Fundamentals of Biomedical lnstrumentation

PLAN EXECUTE

l
ria
Fig' 11.1. (c) Control of voluntary movement

ate
yM
li
*
Cell
nucleus Cell body

Axion
hillock
ud

FiS. 11.2. Association neuron


The concepts and theories are very much simplified to make
St

presentation more useful in the study of biomedical instrumenta


Such simplilication also facilitates visualisation of an extremely co-
system. Ii provides a better perspective for further detailed s
needed.
Axion billock portion immediately next to the cell body'
Page No. 179 of 328.
Fundamentals of Biomedical Instrumentation

Nervous System 181

l
ria
Nissl substances

Mylin (dendrite coating


with fatty insulating
substance)
Coating-mydin sheath
Fiber - myelenoid
Axon
bush

ate
Node of Banvier
Axon (nyllin sheath interuptional of
bush regular intervals) help in speed
of transmission of
Nucleas of schwannal

Neurilemma
(insulatory material surrounding
--4
===) -::::
--:: --
myelin sheath)

:#
_--
---1
I
-J-_

Hu= is
--I:l
yM
Fig. 11.3. Spiral motor neuron
ud
St

Fig. 11.4. Skin related neuron


Page No. 180 of 328.
Fundamentals of Biomedical Instrumentation

182 Fundamentals of Biomedical lnstrumentation

ANATOMY OF NERVOUS SYSTEM


Neuron is the basic unit of the nervous system. Neuron is also knou.::
I(iil
as the ,,soma,,. A neuron is a single cell with cell body having one o:

l
more dendrites input fibres and the axort i.e., a long transmitting fibre
NIany times the axon branches into two or more terminals near ending= ,i0

ria
of the axon.
Figures I1.2, 11 .3, 11.4, show three different types of neurons. It -= tt)
important to note some of the aspects in the figures.
(r) Axon hillock is the portion of the axon immediately adjacent to ti-:
cell bod5r. At this point action potential are generated many times
(rl) Collaterals are the branches which leave the main axon'
(iii) Some types of neurons have axons or denoted coating of a fa:1

ate
insulting material known as myelin. This coaiing is known as mye-l
sheath and the fiber is considered to be myelinated'
(iu) To hetp the speed of. transmission of information along the nen':
in some cases, the myelin sheath is interrupted at regular inten',
by the nodes of Ranvier.
(rr) Myelin sheath is surrounded by another insulting layer know-r:
neurilemma outside of the central nervous system. Neurilemma
mad.e up of thin cells known as Schwann cells. This layer.
thinner then the myelin sheath and is continuous over the
of Ranvier.
yM
(ui) It is difhcult to identify a dendrite from an axon just by appearr-
The function of fibre and the direction in which it comes
information with respect to ceIl body gives the main differe
between a dendrite and an axon.
luii\ A bundle of individual nerve fibres is known as nenre. Nerve {l:
are basically axons and dendrites. Sensory information from diffe:
parts of the body to the brain are through afferent nerves. Effe:
different nerve signal muscles from the brain for operating'
Myelinated ltbre i.e. axons or dendrites exist in some type:
neurons. Myelination is a coating with fatty insulting subs::
known as myelin. The coating is known as myelin sheath'
ud

11.3. I CENTRAL NERVOUS SYSTEM


An enlarged collection of celi bodies and fibres inside the skull is k
as brain. It is protected from the shocks, light, physical, chemi:;+
temperature. The lower end of the brain is connected with the spina-
The spinal cord also comprises of several ceil bodies and fibre bu:
The central nervous system (cNS) and the main divisions of ne:
St

system comprise of the brain and spinal cord' A summery of ner'


-,-.I

system in shown in figure 11.5.(a) . The anatomy of the brain is =


in figure 11.5(b) which is a side view of the brain and spinal chor-
figure ll.6(a\ and (b) shows a cutway view of some of the main stn:c
The important aspects of central nervous system (CNS) ':
follows:
Page No. 181 of 328.
Fundamentals of Biomedical Instrumentation

Nervous System 183

(d Fresh brain cell bodies and smalr fibres are gray


in colour and are
known as gray matter.
(ifl Larger fibres having the myelin coating
look white in colour and

l
are known as white matter.
iil) central nervous system has collections of neuronal

ria
cell bodies which
are known as ganglia.
ru) Most of the structures of the central neryous
system are anatomically
duplicated on both sicles 1.e., bilateralry symmetrical. Inspite
of this
many functions of CNS in human beings are located non_
symmetrically. Some of the functions are crossed over for function
relationship of left side and right side of the brain.
-J Peripheral nerves are outside the central neryous system. peripheral
nerves may have even cel bodies contained *ithi^ the centra]

ate
nervous system. Afferent nerves are mixed throughout their length.
The nerves that bring sensory informatio., contror motor
functions are known as afferent peripheral nerves. "ira
Afferent nerves th-at bring sensory information are called sensory
nerves, whereas afferent nerves that control the motor functions
of
muscle are called motor neryes. peripheral nerves reave the ?
sprnar
cord at different levers of spinal cord, the nerves that innervate at
a
given level of the body structure come from a given
revel of spinal 6
cord.
- Interconnections occur at or near cerl
yM
bodies and it is known as
synapses. The mammarian neurons synapse do not touch
each
other. They come in crose proximity foi aciivating the axon
of one
lerve or cell body of another which produces a chemical for
stimulating the membrane of a dendrite or cer body. one axon
rroduced chemical near another axon may be ror inhibrting
the
second axon from activating a neuron with which it communicates
rormally. It can be seen that chemical flow or communication is
-rnidirectional.
ud
St

Page No. 182 of 328.


Fundamentals of Biomedical Instrumentation

184 Fundamentals of Biomedical lnstrumentation

by thalmus and hypothalmus which form structure of cerebrum.


The cerebrum outer surface is known as cerebral cortex.
Nervous system (NS)

l
ria
Au cNS Spinal cord

sympathetic NS

ate
Metencephalon Metencephalon MYlencePhalon

ll
Telencephalon Diencephalon
I I
I
+ i i
Cerebral cortex Thalamus Tectum Pons cerebellum Medulla
basal gangilia hypothalamus tegmentum
hippocampus
amygdala
Cerebrum
yM
uioorain{viobrain ffi
Cerebellum

Hindbrain

iSpinal
jcord
ud

Sp na

CocYgea
St

Fig. 11.5. (a) Summary of Nervous SYstem

Page No. 183 of 328.


Fundamentals of Biomedical Instrumentation

Nervous System 185

l
ria
ate
Spinal Cord

,.
4
Fig. 1'1.5. (b) The brain and spinal cord I
yM
' s believed that certain functions are indicated for certain parts of the
:-.:n. However, in infant animal by remaining certain parts responsible
: - :ertain functions were removed, the animal is able to develop that
r- :tion to some extent. See figure 71.6(a) which shows cut-way section
ri' :.uman brain and hgure 11.6 (b) which shows cerebral cortex for
'il--' reference. Figure 11.6 (c) shows cerebrum with trantal, parietel,
''lr- eoral and occipital four cobes etc. General functional relationship
' brain parts are as follows:
Breathing, heart rate and kidney functions are controlled through
ud

brain stem and medulla. The figure l7.7(al shows structure of


lungs and nerves. The figure lI.7(b) shows respirator action signals.
Pons are interconnecting area having many nuclei, ascending and
Cescending fibre tracts. The pons area is responsible for functions
rf salivation, feeding, and facial expression. It also contains relays
:cr the auditory system, spinal motor nellrons and some nuclei for
:espiration.
;"
St

lerebellum is a physiological microcomputer. It intercepts sensory


=:rd motor nerves to smooth out jerlry muscle motions. It is also
:sponsible for ability to maintain balance. The block diagram of
'=edback control is shown in figure 11.8.
-:alamus manipulates all sensory information going to cerebrum.
'f relay points for the visual, auditing and somatic sensory
: =^n
-rtems exist here.
Page No. 184 of 328.
Fundamentals of Biomedical Instrumentation
186 Fundamentals of Biomedical lnstrumentation

Super or

Diencephalon
I

l
ria
_-e Posterior

Infs1i91 +

Ventral

ate
l/ledulla oblongata
I
lnferior
Caudal
Cerebellum
yM
t.: Fig. 11.6. (a) Cut-way view of the human brain
I
*
Peripheral nerve

Fourth ven

Spinal cord
ud

Third ventricle

Pulr

Thalamocortical radiations
St

Fig. 11.6. (b) Ce;'ebrai cortex and sor-ne activlty center therein

Page No. 185 of 328.


Fundamentals of Biomedical Instrumentation

Nervous System 187

Prirnary mctor
corlex
(precentral Post central
gyrus)
" gyrus (general

l
sensory projection

ria
Vision

ate
Vision
association
area

Hearing
association area

Fig. 11.6. (c) Cerebrum showing trontal, parietel, temporal, tr


and occipital four lobes, etc.
yM
Pulmonary artery

Vasomotor nerves
Bronchus
Lymphatics
ud

l-ymphatics
St

Fig. 11.7. (a) Structure of lungs and nerves


Page No. 186 of 328.
Fundamentals of Biomedical Instrumentation

188 Fundamentals of Biomedical lnstrumentation

(uii
/V/V\/V AAA

l
/*\

ria
AAAA
IX
X

*ll,'r^
XI

^'Ar\/v

ate
Vagi intact Vagi cut

Fig. 11.7. (b) Respirator action signals

External
forces
yM
c Control Muscular I +
signal +
force

y-Dynamic
control Fig.
signal

y-Static
control
signal
ud

Fig. 11.8. Block diagram of peripheral motor control system The dashed line
indicates the non-neural feedback from muscle that limits length and velocity via the
inherent mechanical properties of muscle. rd, dynamic r motor neurons rs, static r
motor neurons
(u) Reticular activation system (RAS) is non-specific sensory portior: 4
which surrounds the thalamus. When aroused, it alerts the cerebria:
cortex which makes it sensitive to incoming information. RAS keeps S
a person awake.
St

(urJ Centre for emotions hypothalamus area. It contains nucle:


responsible for eating, drinking, sexual behaviour, temperature q
regulation and emotional behaviour. It also controls automailc
nervous system. Specially sympathetic nervous system, see figurc
1 1.e(a). (
Page No. 187 of 328.
Fundamentals of Biomedical Instrumentation

Nervous System 189

(r,zz) Cerebral cortex has about 9 billion of 12 billion neurons existing


in the human brain. All sensory inputs reach the cortex where
certain regions relate sensory informations. It have several lobes
such as parietal lobe for somatic sensory such as heat, cold,

l
pressure, touch, etc., frontal lobe for primary motor neurons leading

ria
to various muscles of the body, preferential lobe for neurons of eye
movement control, temporal lobe for responding to various
frequencies of audotory nature.
Apomorphine, digitails
glycosides, copper sulphate

Chemoreceptor
trigger zone

ate
Vomiting
center

l0l

{
Vagal E
afferents
yM
lrritation
of mucosa
Fig. 11.9. (a) Afferent pathways for the vomiting reflex, showing the chemoreceptor
trigger zone in the medulla

SENSORY MOTOR
ud
St

v; I
J?i
J
Page No. 188Fig. 328. (b) Human sensory and motor functions
of 11.9.
Fundamentals of Biomedical Instrumentation

190 Fundamentals of Biomedical lnstrumentation

The spatial distribution of the sensory and motor functions on the


cortical surface are shown in figure 119(b). In each case, the figure
shows only one-half of the brain in cross-section through the indicated
region.

l
ria
11 .s. NEURAL COMMUNICATION
When neurons are excited, they generate action potentials. These action
potentials are of very short duration and are transmitted in the form of
spike discharge patterns. Figure 11.10(a). shows spike discharge pattern
from a single neuron of a cat. These are responsible for motor functions.
The sequence of spikes are transmitted down a particular neural pathway.
Figure 11.10(b) shows a burst pattern. Action potential of neuron is

ate
propagated down the axon to the axiom terminals where it can be
transmitted to other neurons. The neurons can be transmitted to other
neurons. The neurons can be triggered at any point along the dendrites,
cell body or axon. Due to the natural functions of neurons, the
cornmunication is only one way. Some of the important aspects of neural
communication are as follows:
yM
I .:'

Fig. 11.10. (a) Spike discharge pattern from a single neuron


ud

Fig. 11.10. (b) A burst pattern.


-eL
(4 There are two types of communication across a synapse-excitaton- 's
and inhibitory. The arrival of an action potential at an axon releases
a chemical acetylcholine which excites the adjacent membrance of
the receiving neuron. Some act to excite the membrane of the 1:u
-
receiver, while others tend to prevent it from being excited. The -1eI
St

neuron firing depends on the net effect of all the axons interactinE : tt(
-,-ar
with it, see figure 11.11(a).
(10 Potentials of the receiving neurons are graded and it reaches a _ ttf
---5
certain threshold; the neuron fires and action potential develops - -:l(
The action potential of a given neurons are same. An excitoq- :

graded potential is known as excitatory post synaptic potentia-


Page No. 189 of 328.
Fundamentals of Biomedical Instrumentation
Nervous System 191

(EPSP). An inhibitory graded potential is known as an inhibitory


post synaptic potential (IPSP), see figure 11.11(b).

1 Action potential arrives

l
at axon terminal

ria
Postsynaptic
dendrite membrane

ate
Antagonistic chemical Chemical transmitter
in gap breaks down is released from
transmitter during re axon terminal and
fractory period of quickly fills gap
membrane
Arrival of chemical trans
Unless inhibilited, membr ane potential mitter causes potential
change leads to generation of action change in postsynaptic
potential in postsynaptic neuron dendrite membrane d

Fig. 11.11. (a) Sequence of events during chemical transmission r


yM
across a synapse

prolactin
ft/otor nerves Motor nerves Juxta- Adrenal Anterior Posterior
to skeletal to smooth and glomerular medulla pituitary pituitary
muscle cardiac muscle
ud

cells

Fig. 11.11. (b) Neural control mechanisms. ln the two situations on the left,
neurotransmitters act at nerve endings on muscles; in the two in the middle,
'reurotransmitters, regulate the secretion of endocrine glands; and in the two on the
right, neurons secrete hormones into the hypophysial portal or general circulation.
Inhibitory axon causes a graded potential (IPSP) in the receiving
reurons which is more negative than the normal resting potential,
.herefore, it requires a greater amount cf excitation than normal resting
:otential. Inhibiting axon action is also possible based an excitary
St

::ansmitting axis, instead of after receiving neuron. A premature action


:otential in the transmitting axon is setup by inhibiting axon. Eue to
,ris, the necessary combination of chemical discharges do not occur in
=r-nchronism as it may occur without inhibition. Subsequently, synapse
:ehave like multiple input AND and NOR logic gates. Through their
Page No. 190 of 328.
Fundamentals of Biomedical Instrumentation
192 Fundamentals of Biomedical Instrumentation

widely varied patterns of excitary and inhibitory connections, a means


of switching and interconnecting parts of the nervous system is
estabilished. It has high grade of complexity which can not be imagined l
by human beings. I

l
(lil) The sequence of events during chemical transmission across a E

synapse is shown in figure 11.11(c). First action potential reaches I

ria
axon terminal and chemical transmitter is released from axon J
terminal and quickly falls gap as shown in the figure. Arrival of
chemical transmitter caltses potential change in post synaptic I
C
dendrite membrane. The antagonistic chemical in gap breaksdown
transmitter during refractory period of membrane. It is not inhibited,
membrane potential change leads to generation of action potential S
in post synaptic rreuron.

ate
Sense Afferent Synapse Efferent Neuromuscular Muscle
organ neuron neuron junction I

(lr

__-r\_ ___-/-\_-
Genrator EPSPs
potential (and IPSPs) -,.$/
yM
{lr
*il
Fig. 11.11. (c) EPSP and ,\,,1
Figures lr.l2(a) and 1\.r2(b). show correlation between behavioural
states; awake and sleeps patterns.
Thalamocortical loop Single cell propertise
F
Pyramidal cells 30-50 Hz
Awake Tonic firing gamma oscillations itt

Airtl^l1Adt/irt
20-80 Hz rhythms
'1 .6.
Cerebral cortex
ud

'-,lL

Thalamocortical cell
0.54 Hz burst firing Tonic firing r,_: S

{
Deep sleep
, .^ t,
Thalamus
rl- ..fl
St

.a(
.. ,--L
--L
Transition from steps to waking
O.54 Hz rhythms :h
Fig. 11 .12. (a) Correlation between behavioral states, EEG, and single cell r-:--1
responses in the cerebral cortex and thalamus.
Page No. 191 of 328.
Fundamentals of Biomedical Instrumentation
Nervous System 193

Awake

ff*..-.Al-q*^rrf ,f"-,"-"-J,f,

l
1
EMG

ria
CENTRAL

FRONTAL
:;;F;+,,..k!e,."r*v '--^v
^

OCCIP
Stage 2 (50 pv, 10-14H2)

Stage 1 (Low amplitude and high frequency)


..k,r$-
Te..f*

ate
ffi--+r-a.fra
*-."./.*{"fl\r-.g I^f rr"'-w*aryr^'-*'...
-jt Vf7/,-ff^**--+*-+""(*-"r'*
,v,.*r'r-.q-ar,V^.-l,r t 6',
/u'.*-&!
.d-i.$@ @,+/Frv+-

Stage 3 Stage 4
(lncreased amplitude & Lower,frequency) (Maximum slowing with Large waves)
v:,rr.r*j \A'rr\nru"f+r,-r^"'t1,,fu.,\1i"rAJ,l'.,ft .rrr{v+!.,-d,
,if.A.n_! Vf$/v' r/l$.Vh^f,4v,a / o\"1 ti',,- 1 o 1"
IrV
j1',i.;;''
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\J'lv,t/j\l\(rn' u'tt r'\.,1r,','.r\i
1 l/1I so
;F,,\r+v-. V
',^'',/,,*"S'
2s

Fig. 11 .12. (b) EEG and muscle activity during various stages of steep, EOG,
= eitro-oculogram
registering eye movements; EMG, electromyogram registering
skeletal muscle activity: CENIRA, RONIAL, OCCIP, three EEG leads

NEURONAL FIRING MEASUREMENTS


lre measurements of the electrical activity of the nervus system is
ud

-::rough the effects of the nervous system on other systems of the body.
. re individual neurons can be stimulated electrically. The muscle
:,ovement Centre is measured. Care must be taken to ensure that neurons
':e stimulated similar to natural stimulation
A gross nerve hring measurement is done when electrode of larger
-:.an 0.1 mm in diameter is placed near a nerve of a large number of
::urons. It gives summation of the action potentials from all neurons
,:ound the electrode. Single neurons action potential can be seen either
St

-]itracellularly using a microelectrode located just outside the cell


::-embrane or intracellularly by penetrating the microelectrode in the
rll.
The gross measurement of multiple unit neuronal discharge of full
-Ldth of 500 msec is shown in figure 11.13 (a) and (b). The maximum
::ak to peak amplitude is approximately 150 microvolts. The extracellular
Page No. 192 of 328.
Fundamentals of Biomedical Instrumentation
194 Fundamentals of Biomedical lnstrumentation

measurement of unit discharge from red nucleus of an animal is shown


in Fig. 11.13 (c). The peak to peak height is approximately 170 microvolts.
Intracellular measurement of antidrornic spike from abducens nucleus of
an animal. It is a part of motor control system for the eye. The spike

l
height is about 60 millivolts. Each division is 0.5 milliseconds. some of
the important aspects of neuronal firing measurements are as follows:

ria
(z) The penetrating an individual cell is limited to some speciarized
cells involving only large type of cells. The microelectrodes with tips
of about 1o mm in diameter is used for extracellular measurements
and about 1 mm for intracellular measurements are used.

ti
rl

I ate
Fig. 11'13. (a) Gross measurement of multiple unit neuronal discharge. Time span is
500 msec., having maximum peak to peaks amplitude of 150 microvolts
(li) Neuronal firing measurements range from hundreds microvolts for
single neuron in extracellular measurements to about 1oo mv for
intracellular measurements. Due to the short duration of neurona]
spikes, the amplifier should have frequency response from belos- ilrl
iu)
l

c
t
yM
7 Hz to many thousand Hz.
(iid Ordinary pen recorders are used for recording or display. Ar: clocl
oscilloscope with a camera for photographing the spike patterns or Ap
a high speed light galvanometer or an electrostatic recorder is ::nec
used for measurements. r tfat
::ctor
Sub
!-: ga
--:noI
=- po'
fror
ud

_:s o
---le r
--\ens
- ,:plie
:m/
s:gni
a-e L
--s tir
St

:-: --trol
::2. I
::en
[+_ZZOp,sec___, :._:ltm
Fig. 11.13. (b) Gross measurement of multiple unit neuronal discharge of 500 r--- ac
width The peak amplitude is 150 microsecs :=d t
Page No. 193 of 328.
Fundamentals of Biomedical Instrumentation
Nervous System 195

l
ria
\
\
J

ate
Fig. 11.13. (c) Extracellular measurement of unit discharge from
red nucleus of an animal
iu) For nerve condition time or velocity, the nerve is stimulated.
Potentials are measured from another nerve or from a muscle
actuated by the stimulated nerve. The oscilloscope helps to get the
difference of time between stimulus and the net firing measured on
the oscilloscope.

11.7. EEG BLOCK DIAGRAM, RHYTHMS AND EEG DIAGNOSTICS


yM
rr. clock diagram of EEG machine is shown in figure ll.l4.
A pattern of electrodes on the head and the channels where they are
:-nected is known as Montage which it is symmetrical. The EEG signals
: transmitted from the electrode to the Jackbox and then to montage
.:ctor.
Subsequently, each signal is passed through a preamplifier having
r gain and low noise characteristics. The amplrtier should have high
:-mon mode-rejection to rninirnize stray interference signals coming
:::r power lines and other electrical equipment being used. It should be
= from drip which prevents movement of pen on recorder due to
ud

.:ts of temperature changes, etc. It should have a gain if unbalanced


:ce resistances exist.
Sensitivity control of an EEG machine is the gain of the amplifier
:iplied by the sensitivity of the writing unit. If the writer sensitivity
cmf v, the amplifier must have an overall gain of 2O,0OO for a 50
signal.
lhe undesirable signals such as artefacts, a low pass hlter is used
-:rg time constant of 0.03, 0.1
and 1.0 sec. The upper cutoff frequency
St

,ntrolled by the high frequency filter having values 15, 30, TO and
Hz. EEG machine haves a notch filter tuned at 50 Hz to eliminate
r-erence from the frequency of the main power line. EEG are selected
:inimum noise which is specified as peak-to-peak value.
rr accurate and stable paper drive mechanism is needed which
-Jed by a synchronous motor. Speeds of 15, 30 and 60 mm/sec are
Page No. 194 of 328.
Fundamentals of Biomedical Instrumentation

196 Fundamentals of Biomedical lnstrumentation


of the paper
needed. Time pulses are usually generated independently
ce
mash due changes in
drive mechanism to avoid. difference in timing AI
paper speed of the Paper drive'

l
ria
ate :C(
:las.
..ho,
-r tl
yM
Analog to :ld
Digital lnverter

I tnt<=writins I I Chart I
I oscilloqraPh | 1 drlve I
ud

Fig. 1'1.14. Block diagram of EEG machine


rr
An array of many electrodes are used by an electroencelogram
is connected
helps in recording's.l,.tu'I signals' Each electrode upto 32 cl
St

amplifiers ancl writing systems' It may have


""p"r^t"
although 8 or 16 channels aie quite-common' Figure '-' emplol-ed
with 8 channels. Microprocessors are ':j lh
"i;'t"#',":;-;;t
most EEG machines. i---9
EEG machines are mostly PC based with latest
pentium
to EEG' The colour motor dt
with storing facility of upto 40 hours
Page No. 195 of 328.
:S
Fundamentals of Biomedical Instrumentation

Nervous System 197

can be used having 7280 x lo24 pixels. User interface is through an


ASCII keyboard.

l
F = Frontal
C = Central

ria
T = Temporal
T5 T6 O = Occipital
P = Parietal
P3 P4 A = Ear Common
A1 A2
c3 c2 C4

F3 F4

FP1 FP2

.:d 64 responses are also shown.


ate
Fig 11.15. clinical instrument with a 8-channel electrode configuration

(
L
yM

Fig. 11.16. (a) Average of single response of raw EEG


ud

Fig. 11.16. (b) Average of 8 responses


St

Fig. 11.16. (c) Average of 64 responses


- he signals are low-level, therefore, EEG equipment should have
k* --quality differential amplifiers having good-common mode rejection.
, s differential preamplifier and subsequently power amplifier
which
- -i pen mechanism for each channel. The amplifiers are ac coupled
Page No. 196 of 328.
Fundamentals of Biomedical Instrumentation

198 Fundamentals of Biomedical lnstrumentation

harring low-frequency output less than 1 Hz and bandwidth between ca'


5O to 1OO Hz. 60 Hz reiection filter 25 rnay be used to reduces
power of
resistance changes
line interference in the EEG equipment. The electrode
areovercomebyhavinghighinputimpedancei.e.,rnorethanloMW,

l
&flr
of the EEG amPlifiers. det

ria
Rhlthmical potentials are generated by brain. These potential originate als
from individual neurons of the brain. The waveform pattern is
complex is termed electro-encephalogram (EEG). The millions of the cells
discirarge synchronousl5' t"6 get summed up for the net generated
potential.
The neuons are electrically polarized, at rest similar to other cells'
The neuron has potential of -70 mV with respect to the exterior'
When
a nerve impulse
a neuron is subjected' to a stimulus (above threshold)'

ate
due to change in membrane potential is generated which spreads
in the
tepolatization takes
celt. This depolarizes the cell and shortly afterwards
place.
The signal of EEG are taken from electrodes either from scalp or
,F
clirectly from ttre cerebral cortex. The peak to peak amplotude
is 100 mY
t
if picked up from cerabral cortex' The frequency varies from 0'5 Hz lo
50 Hz. The basic frequency of EEG is classihed into hve band for
analysis t
.t
pu-rposes:
'l
Delta 0.5H2-4Hz I
- 4Hz-8Hz r
yM
Theta
- 8Hz-13Hz a
*i Alpha
L
Reta
-13H2-22H2
22Hz-30Hz
b
Gamma
- alertness of the brain which serves as indicato: S
Alpha rhyttrm indicates rA
summarisec
of anaesthe"i" i.r the operating room. The waveforms can be k
as follo'*'s: cl

Waueform Shape Frequencg Occurence w


br
Delta waves ,i*'\ " .j\.

\!'\"'j
, o'5 - 4 Hz Premature bab: br
-\ sleePing adults a1
ud

children and fu
Theta waves "i.r'\-'i*'\"'\s*')'d"'\*--r\*!''t"* 4 - 8 Hz
SleePing adults at
sy
m
gL
-It
th,
Under normal conditions there is generally inverse relationsh of
between amplitude and frequertcy, i'e', if frequency reduces' the
ampliturr
St

Ce
increases. The increased cirabral activity leads to more desynchron
an
activity of the nerve cells. col
Spikes and waves of abnormal shape occur during attacks of epile brz
The extinction or damping of electrical activity in the cortex can be rWt
to tumor. The tumor pi""i." on the neurons and destroys them.
ox-\'
deficiency due to circulatory disturbance similar to bleeding would I act
Page No. 197 of 328.
Fundamentals of Biomedical Instrumentation

Nervous System 199

cause similar problem. Earlier damages present in the cortex in the form
of tumors or scars, may generate abormal electrical activity.
EEG is used for examination of epilepsy, brain damage, brain tumors
and other organic brain injuries. There is occassional use of EEG for

l
determination of level of consciousness 1.e., depth of anaesthesia. It can

ria
also establish death of brain.

The nervous system is responsible for controlling various functions


of the body. It coordinates them into an integrated living organism,
therefore, nervous system is the most compiex of altr the systems of
the body. Nervous system consists of brain, numerous sensing devices.

ate
a high communication network which links all parts of the body. It
is also responsible for the behaviour of the organism leading to
autonomy and acquires valious traits which characterise as an
individual.
Neuron or soma is the basic unit of the r-r.ervous system. Neuron is
a single cell body having one or more dendrites input fibers and the
axon, i.e., a long transmitting Iiber. Some types of neurons have
axons or denoted coating of a fatty insulating material known as L

Myelin. The myelin sheath is interrupted at regular intervals by the c


nodes of Ranvior to help the speed of transmission of information
yM
along the nerves. A bundle of individual nerve fibers is known as
nerve. Sensing information from different parts of the body to the
brain are through different nerves. Different efferent nerve muscle
signals inform the brain for operating.
An enlarged collection of cell bodies and fibers inside the skull is
known as brain. It is protected from the shocks, light, physical or
chemical or temperature. The lower end of the brain is connected
with the spinal cord. The spinal cord also comprises of several cell
bodies and fiber bundles. Control neryous system comprise of the
brain and spinal cord. Afferent nerves which bring sensory information
are called sensory neryes. Afferent nerves which control the motor
ud

functions of the muscles are called motor nerves. Interactions occur


at or near cell bodies which is known as synapses. Automatic nervous
system is involved with emotional responses controlling smoothing of
muscles in various parts of the body, heat and secretion of several
glands.
It is believed that certain functions are indicated for certain parts of
the brain. However, it has been found that by removing certain parts
of the brain, brain develops corresponding function to some extent.
St

Cerebellum is physiological microcomputer which intercepts sensory


and motor neryes to smooth out jerklr muscle motions. Carebral
cortex has about 9 billion of 12 billion neurons existing in the hurnan
brain.
When neurons are excited, they generate action potential. These
action potentials are of very short duration and are transmitted in
Page No. 198 of 328.
Fundamentals of Biomedical Instrumentation

200 Fundamentals of Biomedical lnstrumentatlon

the form of spike di There are two types of


communication across ory and inhibitory' Action
potential releases a che which excites the adjacent 11.1
11.1

l
membrane of the receiving neuron'
6.

ria
11.1
.1.1

-1.1

- i.1

1.1',
measurements. Ord.inary pen recorders are used'

ate
7. A pattern of electrodes on the head and the channels
where they are 1.1t
connected is known as Montage which is symmetrical. EEG signals
1.1!

-2C
lt

having 1280 x 1024 Pixels.


yM
*c from va n specla-
hythmic ar brain
riginate al in' Tht
tial of - re
EEG is used for examination of epilepsy, brain damage' brain tumors
and other organic brain injuries'

arxerCi,te,J

1 1. 1. Give the anatomY of nervous system. Discuss about Neuror:=


([JPTU, 20C'i'
ud

Communication.
11.2. How neuronal firing measurements are made? Explain EPSP and IPS?
(UPTU, 20ia'
11.3. Give the block diagram of EtrG. How diagnosis is made with trEG?
(uPTU, 20'-1*
1,1.4. Give anatomy of nervous system' What is neuronal commnnicatic---:
(LrPTU, 2o.a:
Describe trMG.
ll.5.trxplaintheworkingprincipleofEEG?DrawablockdiagrarnofEE..
St

(UPTU, IIIC.P

11.6. trxplain EPSP and IPSP. Discuss neuronal firing measurements'


(UPTU, 2C'

11,7. What is the difference between alTerent and efferent nerves?


11.8. trxplain the difference between motor nerve and sensory nerve'
i1.9. Draw a sketch of a neuron and 1abel the cel1 body, dendrite, axon
Page No. axon
199 ofhillock-
328.
Fundamentals of Biomedical Instrumentation

Nervous System 201

11.10. Explain the way in which a neuronal spike is transmitted from one
neuron to another.
i 1.1 1. What are the nodes of Ranvier and what useful purpose do they serve?
11.12. What is a spinal reflex, and how is it related to the functions of the

l
brain?

ria
i 1.13. What are graded potentials?
11.14. What is a neuronal spike? Draw a typical spike showing amplitude and
duration.
-1.15. How does the action of the synrpathetic nervous system differ from that
of the parasy'rnpathetic system? Quote an example from the body.
- i.16. Explain the physiologr of nervous system. Write the factors affecting the
neuronal communication. (UPTU. MQP)
1.17. Explain with example EPSP and IPSP. Write the applications trMG for
human. (UPTU, MQP)

ate
-1.18. Give the block diagram of EEG. Explain its; Rythms. Ho'.v is it helpful in
diagnosis? (UPTU, 2004)
--.19. Explain the neuronal communication. Gitze the autonomy of nervous
systems. (UPTU, 20Os)
Explain neuronal firing and how it can be rneasured? Explain EPSP and
IPSP. (UPTU, 2OOs)
I'

JAJ E
yM
ud
St

Page No. 200 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Opthalmologlr Instruments

:s fnside this chapter


12.1. Anatomy of Vision
ate
12.2. Electrophysiological Tests
12.3. Ophthalmoscope
12.4. Tonometer for Eye Pressure Measurement
yM
12.5. Summary

12.1. ANATOMY OF VISION


Eye is an optical systr:m which focuses tight through a lens on phoi:
receptors and has a sy,stem of nerves which conducts impulses from tht
receptors to the brain. It is moved within the orbit by six colour muscles
The colour muscles iare rectus and oblique and are inverted by tF-t
oculomotor, trochlear and abducens nerves.
ud

Lens in an eye is a clear biconvex structure behind the pupil he-:


by circular lens ligament known as zonule. Cornea is a tansparer-:
continuation of sclent over front of the eye and is responsible for rocs
are extremeiy sensitive to light and hence responsible for night visio:-
They give no information about colour. Retina is shown in figure 12.),'-*
the inner most layer which consists of photoreception (rods and cones
bipolar neurons, ganglion cells, horizontal cells, amercine cells, et:
forming ten layers. T'he image is formed by retraction of light by cornes,
St

and lens of the eye, ln inverted image is formed on the retina of the er-t
'lhe rods and cones of photoreceptors consists of rods and cone:
These are distinguisleed by their shape and functions. These are shotr=
in figure 12.2. ar
202 CC

.h
Page No. 201 of 328.
Fundamentals of Biomedical Instrumentation

Opthalmology lnstruments 203

Posterior
Chamber

l
Anterior

ria
chamber

Optic
nerve

Visual
axts

ate
Aqueous
humour

l-
Viterous
humour
(
Fig. 12.1, The eye c
J
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\/

Shelves of folded
membrane
/S'_.-'-
Outer
segment

lnner
segment

oo
Qo
ud

Synaptic
regron

b9;oo 1o o o -\
St

(a) Rod (b) Cone

Fig. 12.2. Photoreceptors of eye


Colour vision depends on cones which work at high intensity of light
.nd are responsible for day vision. There are two kind of inputs to
.entral neryous system from the eye input from the rod and input from
-re cones. For colour vision red, green and blue cones are used. The
Page No. 202 of 328.
Fundamentals of Biomedical Instrumentation

2O4 Fundamentals of Biomedical lnstrumentation

response of a cone depends on how well its pigment absorbs particular al


light. ol
Green cones 1n
Blue cones

l
100
n

ria
c)
o Th
c
C6
-o re'l
bso
o (
-o
G
.C (

: (

400 500 600


12.

ate
Wavelength (nm)

Fig. 12.3. Absorption spectra for different types of photoreceptor :VE


:of
.1er
;.'itl
_-no
Optic nerve
:3Ce
:tII
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--: rt
Optic
I
chiasma
1:en
a

a
Optic tract Lateral

:l
Optic
, radjator

:/
ud

Fig. 12.4. Gross anatomy of visual pathways


St

The percentage of light absorption verses wavelength of differen:


colours of cones and rods are given in figure 12.3. lt may be noticed tha:
the blue cone light absorption at 44O nm is maximum whole the maximr.r=
light absorption at 600 red cone occur at 6OO nm. The maximum lig:;
absorption in red and green cone is at 5OO and 550 nm respectivel'.-
Visual Pathways : Each eyeball acts as a camera, it perceives the imager
Page No. 203 of 328.
Fundamentals of Biomedical Instrumentation

Opthalmology instruments 205

and relays the sensations to the brain via visual pathways which comprise
optic nerve, optic tract, and optic radiations. The pathways are shown
in figare 72.4.

l
ELECTROPHYSIOLOGICAL TESTS

ria
The electrophysiological tests of the eye allow objective evaluation of the
retinal functions. These include
(a) Electroretinogrphy (ERG)
(b) Electrooculography (EOG)
(c) Visually Evoked Response (VER)

12.2.1. Electroretinography (ERG)

ate
Electroretinogram (ERG) is a measure of response of the retina of the
:-ve to light i.e., changes in the resting potential of the eye from darkness
:o fall of light on the retina. ERG signals are more complex as compared
rerve exon signai because it is the sum of many effects taking place
*'ithin the eye. The amplitude range of ERG signal is 0.5 mV to 1 mV
end frequency from DC to 20 Hz.
The electroretinogram is composite electrical activity from the photo L
:eceptors (cones) and poterior poles of the eye and is known as cornea
. etinal potential which changes with the action of light on the retina.
)
\t rest the potential difference is 6 mv between cones and poterior pole.
yM
Normal record of ERG consists of the following waves which may be
;een in figure i2.5.
. a-wave : Initial negative wave from photoreceptors (rods and cones)
. b-wave : Large cornea-positive wave generated by Miller cells, but
represents the activity of bipolar cells.
. c-wave : It is also a positive wave with lower amplitude representing
metabolic activity of pigment epithelium.

c-wave
ud

I (proton get
o positive)
D
E
o-
E

Light stumulus

Fig. 12.5. Normal ERG Component


St

Figure i2.6 ERG component dip in the lower line shown the application
:,::nt of light stimulus.
Amplitude of a-wave is measured from the base line to the through
:: the a-wave whereas that of b-wave is measured from through of a-
,r ,r'e to peak of b-wave. Similarly, whole measuring the sequences in the
l?G wave, Latency is the time interval between start of light stimulus
Page No. 204 of 328.
Fundamentals of Biomedical Instrumentation

206 Fundamentals of Biomedical lnstrumentation

and beginning of a-wave is normally of the order of 2 m-sec. The implicit tl


time is from the starts of light stimulus to the minimum of b-wave. This w
is shown in hgure 12.6. rC

l
b-wave implicit tim

ria
I
o amplitude
E
E
-a-Wave
+
E-
E lmpact time

;h
lr
it
Fig. 12.6.

ate
rnc colrponent
In humans the ERG signals are recorded with one electrode is fited
on the cornea and is normally embedded in a contact lens one .other
Dip

electrode is reference electrode made of silver chloride and is placed on


the forehead or ear lobe which is at a potential equal to the potential of
the back of a eye. The arrangement is shown in figxe 12.7. reti
reti
yM
reti
itl
OCC-

Cornea
it is
Transparent the
contact lens isoli
Anterior chamber
etc.

Contact lens electrode 12.2


Sclera It re
Choroid
char
lvhic
ud

slgni
Fat-bone medium
of eye orbit rang
A
:nedi
T
and r

Fig. 12.7. The transparent contact lens contains one electrode, shown here on rn th
horizontal section of the right eye. Reference electrode is placed on the right tempe
St

.s at
The arrangement of recording ERG of the eye may be seen ::- :trai
figure 12.8. :ioser
The ERG is recordeC both in the lights adapted (photopic) and da:L T1
adapted (scotopic) states. In photopic ERG patient is tested with ligl-: .ight
condition to suppress rod response. Only one response (5 to 8 millic- ray
cones) is elicited giving lower amplitude and shorter implicit time. O: :lOVCI
Page No. 205 of 328.
Fundamentals of Biomedical Instrumentation

Opthalmology lnstruments 207

the other hand in scotopic ERG with dark adaptation, large amolitude
with longer implicit time is available. Here both cones (6 - g million) and
rods (125 million) contribute to response.

l
Reference
Electrode

ria
ate
ERG
signal

Fig. 12.8. Electroretinography


ERG signals are used in congential retinal dystrophies in which
retina appears normal and detecting functional abnormalities of outer
retina. It is used in diagnosis and prognosis of retinal disorders e.g.,
yM
retinitis pigmentosa, diabetic retinopathy, retical detachment, vascular
occlusions of the retina.
However, since ERG is a function of the first 2 neurons of the retina,
it is not useful in diagnosis of disorders affecting the ganglion cells or
the optic nerve, etc. Also since ERG measures diffuse response of retina
isolated diseases like muscular holes, exudates macular haemorrhage,
etc. will not be detected by ERG amplitude changes-
12.2.2. Electro Oculogram (EOG)
It records bipotentials generated by the movement of the eyeball, i.e.,
changes in the resting potential of the eye existing between cornea
which is positive and back of the retina which is negative. The EoG
ud

signal amplitude range is between 50 pV to 4ooo pv and the frequency


range is between 0.1 to 1OO Hz.
A pair of electrodes are placed over the orbitar margin near the
nedial anct lateral canthi.
The ground or reference electrode is placed on the temple or forehead
and the other surface electrode is placed on the left at right of the eye
rn the temple and nose. The EoG potential is zero with the eye position
St

-s at oo, that is in the condition when the person is looking (gazing)


straight. when the eye ball is shifted to left, the positive cornea becomes
:loser to the left electrode which becomes more positive.
There is an almost linear relationship between horizontal angle of
sight and EoG output up to approximately t 30. of arc. The electrodes
ray also be placed above and below the eye to record. vertical eye
:rovements.
Page No. 206 of 328.
Fundamentals of Biomedical Instrumentation
208 Fundamentals of Biomedical lnstrumentation

l
Eye wets
0" usual

ria
angle
1

(
t
o
V

ate
Resting potential of eye

Fig. 12.9. Electro occulogram signal


For recording EOG bipotential a DC amplitude is needed. The output 1i
is in micro volt region hence silver (Ag) or silver chloride AgCl electrodes
lir are needed to prevent drift. The noise present due to the presence of a1
EEG, EMG signals and due to inaccuracy of recording equipment and is of
lrl
4 equivalent of 1' of eye movement, hence recording of eye movement of in
less than 2' is difficult and eye movement greater than 30' do not
produce bioelectric amplitudes that are strictly proportional to eye position
frt
yM
iu
The EOG response has two components as given in frgure 12.9. pr,
* Light Peak: It is the potential rise due to light when both rods and
cones contribute. It represent the maximal height of the potential in 1n
light.
Dark Throtrgh: It is light insensitive component and occurs from reI
Retinal Pigment Epithelium (RPE), photo receptors and inner nuclear loc
layer. If represent the level of minimal height of the potential in darkness exi
Normally the resting potential of the eye decreases progressivelr- dis
during dark adaptation reacting to dark through in 8 to 12 minutes. In wh
the light the light adaptation the amplitude starts rising and reaches a 1n
light peak in 6-9 minutes. The recording is EOG is done at every minutes pla
ud

for a- period of 12 minutes. The recording is done first in the dark itr
adapted stage and then repeated in light adapted stage.
The results of EOG are interpreted by hnding out the Arden ratio as
follows:
Maximum height of light peak x 100
Arden Ratio =
Maximum height of dark through
(o) Normal curye values are 185 or more.
St

(b) Subnormal curve values are less than 150.


(c) Flat curye values are less than 125.
EOG signals shows presynaptic function of the retina any diseas:
that interferes with functional interplay between retinal pigmen:
epithelium (RPE) and photoreceptors will produce an abnormal or abser-: l
-UITIT
Page No. 207 of 328.
Fundamentals of Biomedical Instrumentation
Opthatmoiogy lnstruments 209

light rise in the EOG. The EOG is affected in diseases such as


pigmentation, vitamin A deficiencies, retinal detachment.
EOG is more sensitive in certain conditions but normally it serves as
supplementary and complementary to ERG test.

l
ria
OPHTHALMOSCOPE
Ophthalmoscope is a clinical examination of the interior of the eye by
means of an ophthalmoscopy. It is primarily done to assess the conduction
of fundus and defect the opacities of ocular media. The cphthalmoscope
was invented by Von Helmholtz in 1850. Three method of examination
are ln use:
(a) Distant Direct Ophthalmoscope (DDO)

ate
(b) Direct Ophthalmoscpy
(c) Indirect Ophthalmoscopy.
12.3.1. Distant Direct Ophthalmoscopy (DDO)
It should be performed routinely before the direct ophthalmoscopy
and gives a lot of useful information. It can be performed with the help
of a self-illuminated ophthalmoscope or a simple plain mirror with a hole
in the centre.
The light is thrown in the patient's eye siting in a semi-darkroom
from a distance of 20-25 cm and the features of the red glow in the
yM
pupillary area are noted.
With the help of distant direct ophthalmoscopy the following defects
in the eye are detected.
To diagnose the opacities in the refractive media. Any opacity in the
refractive media is seen as a black shadow in the red glow. The exact
location can be determined by observing parallactic displacement. For
exact location of the opacity can be determined by observing the parallactic
displacement. For this the patient is asked to more the eye up and down
while the Doctor (observer) is observing the pupillary glow. The opacity
in the pupillary plain remain stationary, those in front of the pupillary
plain more in the direction of the movement of the eye and those behind
ud

it will move in opposite direction. This maybe seen in figure 12.1.0.


St

Fig. 12.10. Parallatic displacement in distant direct ophthalmoscopy


Distant direct ophthalmoscopy is to recognize detached retina or a
umour arising from the fundus. A greyish reflex seen on the distant
Page No. 208 of 328.
Fundamentals of Biomedical Instrumentation
210 Fundamentals of Biomedical lnstrumentation

direct ophthalrnoscopy indicate either a detached retina or a tumour


arising from the fundus.
12.3.2. Direct Ophthalmoscopy

l
If is the most common method for routine fundus examination. The
modern direct ophthalmoscope shown in figure 12.11 works on the

ria
optical principle of glass plate ophthalmoscope invented by Von Helmholtz.
Optics of direct ophthalmoscopy is depicted in hgure 12.12.

ate 12.3.

now
Ir
yM
T]
righll
Fig. 12.11. Direct Ophthalmoscope
:hat t
A convergent beam of light is reflected to the patient pupil shown by asal
dotted lines in figure 12.12. The emergent rays from any point on the :ye w
patient's fundus reach the observer's (Doctor's) retina through the viewing Tt
hole in the ophthalmoscope. This is shown by continuous lines in the :lagnr
figure 12.12. The emergent rays from the patient's eye are paralle1 and -ens,
brought to focus on the retina of the patient's eye, when accommodation ragnl
is relaxed. However if patient orf and the Doct-or is/are amtropic a :i]age
correcting lens (equivalent to the sum of the patient's and Doctor's
refractive error) must be interposed (from the system of plus and minus
ud

lenses, in built in the modern ophthalmoscope).


The direct ophthalmoscopy should be performed in a semi-darkroorr,
with the patient seated and looking straight ahead slightly over to the
side of the eye to be examined patient s right eye should be examined
by Doctor's right eye at left eye with the left.
The observer (Doctor) ..should reflect beam of light from the
ophthalmoscope into patient's pupil. Once the red reflex is seen the I
St

observer's (Doctor) should move as close to the patient's eye as possible.


Once the retina is focussed the details should be examined systematicalh-
(
starting from the blood vessels the four quadrants of the genera:
background.

Page No. 209 of 328.


Fundamentals of Biomedical Instrumentation

EE. M rror
-E

l
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Patient Eye Observer
(Doctor's eye)

\i

12.3.3. lndirect Ophthalmoscope ate


Fig. 12.12. Optics of direct Ophthalmoscope

Indirect ophthalmoscopy was introduced by Nagel in 7g64. This is


now very popular method for examination of the posterior segment.
yM
The optical principle <if indirect ophtharmoscopy is to make the eye
highly myopic by placing strong convex lens in front of patient,s .y"
that the emergent rays from an area of the fundus are brought to iocus"o
as a real inverted image between the lens and the observeris (Doctor,s)
tye which is then studied. The arrangement is shown in figure 12.73'.
The image formed in indirect ophthalmoscopy is real, inverted and
magnifred. Magnification depends on the dioptric power of the convex
hns, position of the lens in relation to the eyeball. About 5 times
magnification is achieved by a + 13 D lens. With a stronger lens the
image will be smaller but brighter and field of vision will be more.
ud

+
E
St

Patient's eye

Convex lens
Fig. 12.13. Optics of indirect ophthalmoscopy
Page No. 210 of 328.
Fundamentals of Biomedical Instrumentation
212 Fundamentals of Biomedical lnstrumentation

Indirect ophthalmoscopy should be done in a dark room' The pupil


of the patient should be dilated.
The patient is mode to lie on the examination table with one pillow.
The examiner (Doctor) through the light into patient's eye from an arm's

l
distant (with the self illuminated ophthalmoscope).
In practice binocular ophthalmoscope with head band or mounted on

ria
the spectacle frame, is employed most frequently keeping his eyes on
the reflex the examiner then interposes the condensing lens (+20 DS,
routinely) in the path of beam of light, close to patient's eye and then
slowly moves the lens away from the eye (towards examiner's or Doctor's)
until the image of the retina is clearly seen. The examiner moves around
the head of the patient to examine different quadrants of the fundus.
The indirect ophthalmoscopy is essential for the assessment and

ate
management of retinal detachment and other retinal problems.
The technique of indirect ophthalmoscopy is difficult and cannot be
mastered without much practice.
The advantage of the indirect ophthalmoscopy is the in built
illumination is strong and its intensity can be changed. It allows
lr!
stereoscopic view of the image.

4
12.4. TONOMETER FOR EYE PRESSURE MEASUREMENT
The intraocular pressure (IOP) is measured with the help of an instrument
yM
u
called tonometer. Two basic types of tonometers available are Identation
b (Schlotz) Tonometer and Applanation (Goldmann) Tonometer.
12.4.1. ldentation (Schlotz) Tonometer
Schlotz tonometer shown in figure 12.14 consist of (a) handle fo:
holdings the instrument vertical position on the cornea (b) a foot plate z 4.2.
which rest on the cornea (c) plunger which moves inside the foot plate Thi
(d) bent lever whose short lever rest on plunger and long arm acts as ::n I
a pointer needle. The degree to which plunger indents the cornea is .of
indicated by the movement of needle on a scale. (e) 5 gm is permanentli Jor
fixed to the plunger and is increased to 7.5 or 1O gm. -l: -}
ud

The foot plate of Schlotz tonometer and lever of the plunger shoul.c
be sterilized in hot water for 30 minutes.
The eye whose intraocular eye pressure is to be measured :s
anesthizing the cornea by 2'k topical xylocane, patient is made to lie c-
a couch. The tonometer is held in the left hand and the -ioot plate ;"
made to rest on the cornea. The reading on the scale is recorded by r-:t
needle becomes steady.
It is customery to start with a -weight of 5 gm. However if the sca"le
St

reading is less than 1' then the weight may be increased to 7.5 gm :E
10 gm. If weight is increased then a conversion table should be use:
The advantage of using Schlotz tonometer is that it is very hanrt
The main disadvantage is that it cannot be used in abnormal h:!m
pressure.

Page No. 211 of 328.


Fundamentals of Biomedical Instrumentation

Opthalmology lnstruments 21g

l
ria
ate \''t
yM
':1..'

1.2. Applanation (Goldmann)


Tonometer
rhis is most popular and accurate
tonometer. It consists of a double
'n mounted on a slit lamp. The prism applanates the cornea
- of 3.06 mm diameter. is an
.-or measuring eye pressure the
- o xylocine the patient is asked
ud

' .ea and biprisms


are illuminated
.amp. Biprism is then advanced
u

I
St

l
1

I
5

Page No. 212 of 328.


Fundamentals of Biomedical Instrumentation

214 Fundamentals of Biomedical lnstrumentation


3.r
n
p
fl

l
\\ n

ria
b
L
D
1n
pr
8
AT
T}

ate
Nr
+. o1
th
Th
F an
0
Th
op
1
It
t,
Fig.' 1 2.1 4. Technique of applanatlon tonometry Th
opl
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t C-i
ex
qui
Ini
strr
frot
Doc
abc
1nv(
Fig. 12.15. Showlng end point of app-lanation tonometry; by,
(A) too smail; (B) too large; (C) end point
The
mar
ud

,12.5.1SUMMARY Ton
tEo
l.AnatomyofVision:Eyeisanopticalsystemwhichfocusesligh''i
photo receptors and has a system-of nerves *11:^,:"11Y::: '*:i
The
is a clear bic \pp
from the receptors to the brain' Lens in an eye
ligament kno
structure behind the pupil held by circular lens
The
shol
zonule. )o/
Each eyeball acts as a cornea, it pelceives the
imSF:" 1 /O

which i1*:ii::
St

pathways comp reed


to the brain via visual feu
".rr".tiorr"
optic nerve, optic tract and optic radiations'
The,
2. Electroretinographs: Electroretinogram is a measut:,of
to the :l
fall of :onol
the resting potentiJ of the eye from the darkness (pho torn(
on the retina. The ERG is recorded both in the light
adapted
and dark adapted (scotopic) states'
Page No. 213 of 328.
Fundamentals of Biomedical Instrumentation

Opthalmology lnstruments 215

3. Electro-Oculogram (EOG): It records bipotential generated by the


movement of the eye ball, EOG measures the changes in the resting
potential of the eye between cornea, which is positive and back of the
retina which is negative. The EOG of eye movement less than 2' is

l
not possible. The eye movement of rnore than 30" do not produce

ria
bioelectric amplitudes that are strictly proportioned to the eye position.
Light peak represent the maximal height of the potential in light.
Dark through represent the level of minimal height of the potential
in darkness. Normally the resting potential of the eye decreases
progressively during dark adaptation reaching to dark through in
8 to 12 minutes. In the light adaptation the amplitude start rising
and reaches a light peak in 6-9 minute.
The result of EOG are interpreted by finding out the Arden ratio.

ate
Normal Arden values are 185 or more.
a. Ophthalmoscope: The ophthalmoscopy is primarily done to assess
the condition of fundus and detect the opacities of ocular media.
There are two types of ophthalmoscopy. The Direct ophthalmoscopy
and Indirect ophthalmoscopy.
The distant direct ophthalmoscopy is done by self illuminated
ophthalmoscopy or a simple plain mirror with a hole in the centre.
It is used to detect opacities in the refractive media.
This method is also useful to detect detached retina. The direct
ophthalmoscopy is very useful and is routinely done by the Doctor's.
yM
C-ice the light beam is focused on the retina the details should be
examined systematically starting from the blood vessels, the form
quadrant of the general background.
In indirect ophthalmoscopy the eye is made highly myopic by placing
strong convex lens in front of patient's eye so that the emergent rays
irom an area is focused as an inverted image between lens and the
Doctor's eye. The image formed in indirect ophthalmoscopy is real,
:nverted and magnified. Magnihcation is about 5 times and is achieved
f,ya+13Dlens.
The indirect ophthalmoscopy is essential for the assessment and
:rranagement of retinal detachments and other retinal problems.
ud

Tonometer for Eye Pressure Measurement: The intraocular pressure


EOP) is measured with the help of an instrument called tonometer.
-he basic type of tonometer's available are identation (Schlotz\ and
rpplanation (Goldmann) tonometer.
lhe foot plate and lever of the tonometer should be sterilized and
.hould be placed on the cornea of the eye, which is anaesthetizedby
-?/o typical 4ylocane. The intraocular pressure is noted when the
St

:-eedle of the tonometer becomes steady. The Schlotz tonometer cannot


:e used in abnormally high eye pressure.
. he Applanation (Goldmann) tonometer is most popular and accurate
-rnometer. It consists of a double prism mounted on a slit lamp. The
,lrnea and biprism are illuminated with the cobalt blue lamp.

Page No. 214 of 328.


Fundamentals of Biomedical Instrumentation

216 Fundamentals of Biomedical lnstrumentation

oxercded
12.1. Explain Electro Retinogram (ERG). (UPTU, 2004)
72.2. Dxplain Electrooculogram.

l
(UPTU, 2OO4)
12.3. Describe Ophthalmoscope. (UPTU, 200s, 2006)

ria
72.4. Explain Tonometer for eye pressure measurement. (wTU, 200s, 2006)
12.5. Explain the working principle of Electro-retinogram with block diagram.
(UPTU-MQP)
12.6. Name the instrument for measurement of eye pressure and explain with
diagram in detail. (UPTU-MQPI

AJJ

ate )9.

13
13.
13.
13.
yM
13.
13. r

I10
|
U-

l1
r 3.1.

.reat i
,ud a
ud

-Ieat l
r-- ihe
.L:-d fai
qi the
brdv tr
ri-iS 1S
::h th
per,
St

The
:lorn
3-37
pera
Page No. 215 of 328.
Fundamentals of Biomedical Instrumentation

l
ria
Some General Topics

'i. fnstde this chapter


13.1. Body Temperature
13.2. Reproduction System
I3.3. Laser Applications in Medical Field
13.4. Diathermy
ate )
yM
13.5. Clinical Laboratory Instruments
i3.6. Biomaterials DI
13.7. Stimulators
13.8. Summary

TEMPERATURE
:--:at is produced in the body by assimilation of food, muscular exercise
::-d all the vital processes that contribr,rte to the basal metabolic rate.
ud

:-.:at loss occurs due to conduction, radiation and vapourization of water


=- the respiratory, passages and on the skin. Heat is also lost with urine
a-.d falces, though in small amount. The body temperature is determined
: the delicate balance between heat production and heat loss. Normal
:, dy temperature depends upon a relatively constant body temperature.
T-ris is so because of the fact
that the speed of chemical reactions varies
n.:h the temperature and t}:.e enzyrl:e systems of the body have narrow
i:nperature ranges in which their function is optimal.
St

t3.1.1. Normal Body Temperature


The traditional normal value for the orai temperature is 37'C (98.6"F).
- normal young adults, the morning oral temperature may vary from
3-37.1'C (97.3-98.8"F). Not all parts of the body are at uniform
:rperaturc. The magnitude of the difference in the temperatures of the
Page No. 216 of 328. 277
Fundamentals of Biomedical Instrumentation

2'18 Fundamentals of Biomedical lnstrumentation

various parts of the body varies with environmental temperature. The


temperature of the serotum is meticulously regulated at 32"C. The rectal frr
temperature is representative of the temperature at core of the body and NC
varies least with the changes in the environmental temperature. The oral

l
temperature is normally 0.5"C lower than the rectal temperature, but it ter

ria
is affected by many factors, including ingestion of hot or cold fluid3, gum 1S
chewing, smoking and mouth breathing. alr
In human, the normal temperature undergoes a regular circadian tra
fluctuation of 0.5-0.7"C. The individuals who sleep at night and are rvh
awake during the day, it is the lowest at about 6 AM and highest in the rnd
evenings. During sleep it is lowest. It is slightly higher in the awake :VC
state but relaxed state, it rises with activity. In the case of women, owing :lea
to ol.ulation, there is an additional monthly cycle of temperature variation :ffe

ate
characterized by a rise in basal temperature. In young children, -igh
temperature regulation is less precise and they may normally have a
temperature which is about 0.5'C above the established form for adults. he
The heat produced by muscular contraction gets accumulated in the :em
t
body, during exercise, and the rectal temperature rises as high as 40'C Ita
(104"F). This rise is due to in part to the inability of the heat dissipating .cI
to handle the greatly increased amount of heat product. But there is an :IlVl
al
evidence that in addition there is an deviation of body temperature at ',
apc
which the heat dissipating mechanisms are activated during exercise. r:lVli
Rise in body temperature can take place by emotional excitement, probabll-
yM
_1e
g) owing to unconscious tensing of muscles. Chronic elevation by 0.5"C apo
occurs when the metabolic rate is high and lowered whether metabolic ::lV1I
rate is low. Few normal adults chromically have a temperature above the ::cli
normal range.
' 3.1 .,
13.1.2. Heat Production
T
A variety of chemical reactions contributed to body heat production ::e 1r
at all times. The major source of heat is the contraction of skeletal .clur
muscle. Endocrine mechanisms can vary heat production in the absence -rSpC
of food intake or muscular exertion. A slowly developing but prolonged
increase in temperature is attributed to thyroid harmones. The source ' eict
::laf,
of heat in infants, is brown fat. This fat has a high rate of metabolism.
ud

- : SpOr
it's thermogenic function is like an electric blanket. -:los
13.1.3. Heat Loss Bc
: _:vel
Heat is lost from the body when the environmental temperature is :-:c c
below the body temperature. The processes by which heat loss takes
place is listed below in the Table 13.1.
Table 13.1. Body Heat Production and Heat Loss Me
St

Inc
Body heat is lost by Percentage of heat
lost at 21'C
Radiation and conduction 70
Vapourization of sweat
Respiration 2
Page No. Urination and defecation
217 of 328. I
Fundamentals of Biomedical Instrumentation

Some General Topics 219


Radiation is the transfer of heat by infrared electromagnetic radiation
from one object to another at a different temperature with which it is
not in contact.
Conduction is heat exch.alge between objects or substalces at different

l
:emperatures that are in contact with one another. when an individual

ria
:s in a cold environment, heat is lost by conduction to the surrounding
air and by radiation to cool objects in the vicinity. conversely, heat is
rransferred to al individual and the heat load is increased by the processes
',r'hen the environmental temperature
is above body temperature. An
:ndividual can feel chilly in a room with cold walls blcause of radiation
:ven though the room is relatively warm. on a cold but sunny days the
:eat of the sun reflected off bright objects exerts an appreciabll warming
:ffect. The heat reflected from the snow makes skin possible in fairly

ate
:ght clothes even though the air temperature is below freezing.
The other major heat transfer process in hurnans is vapourization of
:ee water in the form of sweat on the skin. vapourization of 1 g of water
:.moves about 0.6'c kcal of heat. A certain amount of water is vapourized
=tt all times. This water loss amounts to 50 ml/h in humans. ThL degree
r which the sweat vapourizes depends upon the humidity of 1ne
=:rvironment, when the sweat secretion is increased. Decreased
apourization of sweat leads one to feel hotter on a humid day. As the
::rvironmental temperature changes, the relative contribution of each of
-re processes that transfer heat away from body
also changes. The
yM
apourization is a minor component in humans at rest at 21"c. As the
=rvironmental temperature approaches body temperature, radiation losses
::cline and vapourization losses increase.
' 3.1.4.Temperature Regulating Mechanisms
The reflex and semi-reflex thermoregulatory responses in humans
r--e mechanisms activated by, hot and cold as shown in
Table 13.2. They
-clude autonomic somatic, endocrine and behavioural changes. ThL
-:spcnses which increase heat loss and
decrease heat production and
i:rich decrease heat loss and increase heat production rnay be grouped
'.carately. In general, exposure to heat stimulates the former group of
ud

':sponses and inhibits the latter whereas exposure


to cold does the
--posite.
Body surface exposed to the environment decreases by curring up.
:--lvering is an involuntary response of the skeletal muscles, nuicoia
,-:o c&uSeS a semiconscious general increase in motor activity.
Table 13.2. Temperature-Regulatory Mechanisms
Mechanism Activated by cold
St

Increase Heat Production


Hunger
Shivering
Increased voluntary activity
Increased secretion of morepinephrine and epinephrine.

Page No. 218 of 328.


Fundamentals of Biomedical Instrumentation

220 Fundamentals of Biomedical lnstrumentation

Decrease Heat Loss


Curling uP
Horripilation

l
Cutaneous vasoconstriction
Mechanisms Activated BY Heat

ria
Increase Heat Loss
Sweating
Increased respiration
Cutaneous vasodilation
Decrease Heat Production
Anorexia
Apathy and inerti.a

ate
Examples includ.e dancing up and down and foot stamping on a cold
day. An important end.ocrine response to cold is increased catecholamine
secretion. Thermoregulatory adjustments involve local responses as well
as more general reflex responses. Cutaneous blood vessels become more
+
I
sensitive to catecholamines and arterioles and venules constrict when
bloocl vessels are cooled. This local effect of cold directs blood away from
the skin.
The reflex responses activated by cold are controlled from the posterior
I
j
hypothalamus. Activated by warmth, they are controlled primarily fron:
: the interior hypothalamus although some thermoregulation against hea:
yM
l\ still occurs after decerebration at the load of the postal midbrain
Stimulation of the anterior hypothalamus causes cutaneous vasodilatior
and sweating and lessons in this region cause hyperthermia, with recta-
temperatures sometimes reaching 43"C (109.4'F).
13.1.5. Afferents
The hypothalamus integrates body temperature information fro=
sensory receptors (primarily cold creptors) in the skin, deep tissues c: refc
spinal cord, extra hyperthermic portions of the brain, and hypothalamus len
itself. Each of these contributes about 2Ook of the information that :s
-4r11

integrated. Threshold temperatures exists for each of the mai:, :tar


ud

temperature regulating responses, and response begins when ti-.: -oe


threshotd is reached. The threshold temperature for vasoconstriction :s ::rn
36.8.C, 36.C for nonflowering thermogenesis, 37'C for sweating a-'-: ::ve
vasodilation and 35.5'C for shivering. 13.1.
13.1.6. Fever 13. I
Fever is the most universally known hallmark of disease. Pathogeness S
of fever is summarized in the figure 13.1. Toxins from bacteria such -rf,
St

endotoxin act on monocytes, amorphases and kuffter cells to produ=


cytokines that acts as endogenerous pyrogens. This leads to activat::rr ::i-IC
oi th" preoptic area of the hypothalamus. Fever produced by cytokr:-:r _:Tln
is due to local release of prostaglandins in the hypothalamus'
Intra-hypothalamic injection of prostaglandins produces fever. To c'-t
EJ
-.:fIT
flever, antipyretic effect of aspirin is exerted directly on the hypothalar:----r*
Page No. 219 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 221

and aspirin inhibits prostaglandin synthesis. Fever has evolved and


persisted as a response to infections and other diseases, which makes
it beneficial. Many microorganisms grow best within a relatively narrow
temperature range, and a rise in temperature inhibits their growth. In

l
addition to this, antibody production is increased, when body temperature

ria
is elevated.

Endotoxin
lnflammation other
pyrogenetic stimuli

ate
Monocytes
Maerophages
Kuffler cells

Cytokines

Prepic area
of hypothalamus

Prostaglandins

Raise temperature
yM
set point

Fever

Fig. 13.1. Pathogenesis of fever


Fevers were artificially induced for the treatment of neurosyphilis
before the advent of antibioties. This proved to be benefrciat. Hyperthermia
benefits individuals infected with pneumococcal, anthrax, leprosy, and
i-arious fungal rickettsial and vital diseases. Tumour growth slows down
:hanks to hyperthermia. However, very high temperatures over 41.C
ud

106'F) are harmful and if it persists for prolonged periods, some


)ermanent brain damage results, when it is over 43"C, heat stroke
Jevelops and death is common
13.1.7. Temperature Measurement
13.1.7.1. Measurement of Systematic Body Temperature
Systematic temperature is the temperature of the internal regions of
:he body. If continuous recording of temperature is not required, the
St

:nercury thermometer is the standard method of measurement. These


cevices are inexpensive and sufficiently accurate, therefore, they are in
:ommon use.
Electronic thermometers are available as replacement for mercury
:hermometer. Two types of electric temperature censoring devices are
Page No. 220 of 328.
Fundamentals of Biomedical Instrumentation

222. Fundamentals of Biomedical lnstrumentation

used. They are the thermocouple, a junction, and the thermistor'


a
semicond.uctor element whose resistance varies with temperature'
with
reading
disposable tips, these instr-uments requirement much less time of
and.mucheasiertoreadthanconventionalthermometer.Ifcontinues

l
record.ing and greater accuracy of temperature is needed' more

ria
sophisticated measuring instruments must be used'
Care must be taken to rninimize current through the thermocouple
circuit, for the current not only causes heating at the junction but also
additional error due to the Peltier effect, wherein one junction is warmed
and other is cooled'
Inthermistors,therelationshipbet'"lreenresistancechangeand
temperature change is non-linear. To overcome this, the instrumentation
oftenincorporatesspeciallinearizingcircuits'Itmaybeapairofmatched

ate
errors
thermistors as part o f ltnearizatron circuit. Thermistors also have
duetoself-heating,hysteresis,aging,therefore,suitablemeasuresareto
be taken to minimrze error. Most thermistors thermometers
use a wheat s

stone bridge or similar circuit to obtain a voltage output


proportional to (

,1
temperatu-re variations. The bridge is balanced at some reference
temperatureandcalibratedtoread'variationsaboVeandbelowthat I
refeience. Either ac or dc excitation can be used for the bridge.
i.
(

4 (
Lg.|.7.2. Skin Temperature Measurements t
Skin temperature can vary several degrees from one point to another'
1-
: C
yM
Therangeisformabout30to35"C(85to95"F).Exposuretoancient 1.
tt temperJures, the covering of fact over capillary areas' and the local r.
the
blood circulation pattern are some of the factors which influence t.
distribution of temperatures over the surface of the body.inSkin the
)
temperatur" -"."rr.-ents can be used to defect or locate defects C

circulatory system by showing differencesin the pattern from one side l


of the bodY to the other. \\
Flat thermistor probes taped to the skin are used for measurements Z
from specific locations of the body. The simultaneous readings from f(
several probes provid'e a means of measuring changes in the
special g
5
characteristics of the circulatory pattern over a time interval or with a a
ud

given stimulus. a
Another method is based. on infrared radiation trrrd temperature S

measuring device based on this principle are called infrared thermometer r1

and recording is known as thermograph' :I


Another device known as thermovision, has a scanner that operates S]

at a rate sufficiently high to permit the image to be shown in real time a.

on an oscilloscop"' n tfr.t-ovision system has a camera and displal :r


withbr:ightnessenhancementfacility;andaisohashighresolution'
St

13.2. REPRODUCTION SYSTEM


The multiple d.ifferences between males ancl females depend
primarily o:
a single .hro*o"o-e i.e.' Y-chromosomes and a single pair of endocrir:=
structures, the testes in the male and the ovaries in the female' Th:
Page No. 221 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 223

differetiation of the primitive gonads into testes and ovaries in utero is


genetically determined in humans, but the formation of male genitalia
depends upon the preserve of a functionai secreting testes; in the absence
of testicular tissue, development is female. Harmones secreted by the

l
gonads at the time of birth cause the appearance of features typical of

ria
the adult male or female and onset of the sexual cycle in the female. The
ovarian function regresses after a number of years, in femaies and
sexual cycles cease, i.e., menopause occurs. In males, there is a slow
declinein gonadal function with advancing age, but ability to father a
child persists.
The gonads have a dual functionality in both the sexes-the secretion
of sex hormones and the production of germ cells.

ate
13.2.1. Sex Differentiation and Development
Chromosomes determine the sex. The sex Genetic determination of
sex is done by two chromosomes called the sex chromosomes to
distinguish them from the somatic chromosomes. The sex chromosomes
are called X and Y chromosomes. The Y chromosome is necessary for the
production of testes. The tastes determining gene product is called SRY
(Sex-determining region of the Y-chromosome). SRY is a DNA
(beoxyribanualicacid) i.e., a giant molecule binding regulatory protein. It
bends the DNA and acts as a transcription factor. It initials transcription
of a cascade of genes necessary for testicular differentiation. It also
yM
includes the gene for MIS (Mullerian lnhibiting Substance). With deploid
number of chromosomes, male cells contain an X and Y chromosome
i.e., XY pattern, whereas female cells contain two X chromosomes i.e.,
-XX pattern. During gametigonesis, due to meiosis, each normal ovum
contains a single X chromosome. But half the normal sperms contain an
X chromosome and half contain a Y chromosome XY pattern results
rvhen a sperm containing a Y-chromosomes fertilizers an or,,r-rm. And
zvgote develops into a genetic male. XX pattern and a genetic female
:esults when fertilization occurs with an X containing sperm. A primitive
gonad arises from the genital ridge a condensation of tissue near the
adrenal gland on each side of the embryo. The gonad develops a cortex
ud

.nd a medulla. These structures are identical in both the sexes until the
=rxth week of development. The medulla develops into the testes during
.re seventh and eight week. And the cortex regresses. Testosterone and
=-iller ion inhibiting substance are secreted and leydig and Sertoli cells
.:art appearing. The cortex, in the case of genetic females develops into
n:-r. ovary and the medulla regresses. The embryonic differentiation of

=-a-le
and female internal genetical ducts is shown in figure 13.2.
St

Page No. 222 of 328.


Fundamentals of Biomedical Instrumentation
224 Fundamentals of Biomedical lnstrumentation

Fo
pa
of
C1I

l
Mesonephros

ria
Gonadal ligament

Wolffian duct
Mlillerian ligament Sym

Uterovaginal
canal Ur

Bladder

ate
Epididymis

Urogenital sinus

Vas
deferens
Uterine tube
INDIFFERENT I
Ovarian ligament ji ::eCt
Gubernaculum
: iocl
_:.teg
yM
Seminal
t vesicle --:1pu
::eCt:
:f 1na
-:eth
-:eth
Gartner's ducl -_-_at
l
:_--l-ert
Er
j.i:lTIe
:- JSCI
MALE FEMALE :- :he
ud

:tr::leti
Fig. 13.2. Embryonic differentiation of male and female internal genitalia (genital i. aal
ducts) from male and female primordia. ir_: 1o.
'I:'.'ef
13.2.2. Male Reproductive System t

? i t-.'e s

The loops of convoluted seminiferous tubules is what the rtestis is :h(


made up of. Spermatora are formed from primitive germ ce[! on the 'E I se(
walls of convoluted seminiferous tubules. Both ends of each lodp drair-
St

into a network of ducts in the head of the epididymis. From there.


spermatora pass through the tail of the epididymis into the vas deferens =:al
-. I I

The yenter through the ejaculatory ducts into the urethra in the bod_, ,r, ni
of the prostrate at the time of ejaculation, see of figure 13.3. There arr :=
nests of cells between the tubules in the testis containing lipid granules - '-'t /
the interstitial cells of leydig, which secrete testesterone into bloodstrear::- - --at
Page No. 223 of 328.
Fundamentals of Biomedical Instrumentation
Some General Topics 225

Fortons are spermatic arteries to the testes, and blood in them runs
parallel but in the opposite direction to blood in the pampiniferm plexus
of spermatic veins. This anatomic arrangement may permit counter
current exchange of heat and testosterone.

l
Bladder Ureter

ria
Vas deferens
Head of epididymis
\
Symphysis
Prostate

Urethra *
Seminiferous
tubules

Ejaculatory duct

ate
Epididymis
./'
Cowper's ',/
- (bulbourethral) gland Tunica albuginea
I
Scrotum Tail of epididymis
(a) (b)
Fig. 13.3(a) Male reproductive system. (b) Duct system of the testis F
Dilation of the arterioles of the penis results in an erection. As the
::ectile tissue of the penis fills with blood, the veins are compressed,
-locking outflow and adding to the turgor of the organ. Activation of the
,ltegrating centres in the lumbar segments of the spinal cord is done by
yM
-npulses in afferents from the genitalia and descending tracts that mediate (,
:rection in response to erotic psychic stimuli. Ejaculation is a two-part
spinal reflex involves emission, the movement of the semen into the
-rrethra; and ejaculation proper, the propulsion of the semen out of the
rrethra at the time of orgasm. The touch receptors in the glans penis
:hat reach the spinal cord through the internal pudendal nerves, are
lifferent pathways which are mostly fibres.
Enumission is a sympathetic response, integrated in the upper lumbar
segments of the spinal cord and effected by contraction of the smooth
ruscle of the vasa differential and seminal vesicles in response to stimuli
:r the hypogastric nerves. Contraction of the bulb cavernous muscle, a
ud

.<eletal muscle results in the propulsion of semen from the urethra. The
.rinal reflex centres for this part of the reflex are in the upper saral
..rd lowest lumbar segments of the spinal cord, and the motor pathways
':averse the first to third seral roots and the internal pudendal
-:rves.
The semen which is ejaculated at tire time of orgasm contains sperms
..:d secretions of the seminal vesicles, prostate lowper's glands, and the
-.ethral glands. An average volume for ejaculate is 2.5-3.5 ml after
St

'.,,'eral days of continence. With repeated ejaculation, the volume of


::rrrerr and the sperm count decreases. There are normally about
- 0 million sperms per millimeter of semen ion through it takes only
E ::rm to fertilisne the ovum. Movement of human sperms is traced at
nm/min through the female genital tract. after 30-60 minutes of
: :ulation, sperms reach the uterjne tubes.
Page No. 224 of 328.
Fundamentals of Biomedical Instrumentation

226 Fundamentals of Biomedical lnstrumentation

13.2.3. Female Reproduction SYstem


Me
Figure 13.4 shows the reprod.uctive system of women. Unlike the.r an(
cJunter- part, the Iigure shows regular cyclic changes that teleologically isr
may be regard.ed as periodic preparations for fertilization and pregnancy'

l
OCC'
periodic vaginal bleeding, the most conspicuous feature of the menstrual lron

ria
cycle, o""ri" with the shedding of the uterine mucosa (menstruation).
The average figure of the length of the cycle is 28 days from the start Whr
of one menstrual period to the start of the next, but it varies notoriously' wall
The days of the cycle are identihed by number, starting with the first day glan
of menstruation. to st
Uterine tube Ligament of the ovary Ovarian artery Ovary Uterine tube
sexu
, the I
\y;i', \..,, .,/' F'nd's Bectum Uterus
built

ate
/
autot
and ;
:rans
.---- lot d
Ovary Uterine cavity In
,han5
-'i'ome
Broad ligament

Cervix l
z' Urethra =Id a
Vagina uttoc
_
yM
,]

=rd rr
I
Fig. 13.4' The female reproductive system --at-to;
I

13.2.3. 1. Ovarian CYcle I3.2.3


There are many primordial follicles under the ovarian capsule fro= Fer
the time of birth. Each contains an immature ovum. Several of thesc ;: the r
follicles enlarge and a cavity forms around the ouum, at the start of eacb r- the I

-iiL::lefe.
i:-: OVt
.ctior
:he r
it that is needed for final maturation, is selected to be the domtn ETIn I
flollicle. Many follicles develop simultaneously when women are g1\'(
ud

::rCOt
hiehly purified human pituitary gonadotropin preparations by injectio - 100
Distended follicle raptures at the 14th day of the cycle, and the ovum .--rcid,
extruded into the abdominal cavity. This process is called evolutic iusi
Fimbriated ends of the uterine tubes picks up the ovum, and -:lin
transported to the uterus. And unless fertilization occurs, it passes : '.-iral
through the vagina. :..-:des
The corpus luteum persists and periods doesn't occur, if prel -ctio
St

occurs. If there is no pregnancy, the corpus luteum degenerates ' -iDert


4 days, before the next menses, i'e., 24th day of the cycle' It is eventu ' ::ent
replaced by scar tissue, forming a corpus albicans' i -:ida
Menstrual blood is predominantly arterial. Only 25uk of the bas
belongs to venous origin. It contains prostaglandins, debris. It :
contains a large amounts of fibrinolysin from endometrial tiss
Page No. 225 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 221

Menstrual flow takes about 3-5 days. But it can flow as


short as 1 day
and as long as 8 days in normal women blood ross
of more than go ml
is normal' on the omet of menopause when the evolution does
occur, bleeding is variable which Lsually occurs in less not

l
from the last menstrual period.
than 2g days

ria
The blood loss flow is arso variable from scanty to reratively
profuse.
when a woman is sexually excited, fluid is onto the vaginal
"""r"t"d
walls due to release of vasoactive intesti,al polypeptiae
vestibular
glards secrete lubricating mucus. The upper part oithe 1vre1.
vagina is sensitive
to stretch. Tactile stimulation from labia minora and ditiis
adds to the
sexual excitement- These stimuli are reinforced by tactile
stimuri from
the breasts and, as in men, by auditory and visual stimuli,
which may
:uilt up to erescendo known as orgasm. During orgasm, there

ate
are no
autonomically mediated rhythrnic contraction o1 the buluocavernosus
and ischiocavernosus muscres. The vaginal contraction
may aid sperm
:ransport but are not essential for it, since fertilization of
the ovum is
::ot dependent on orgasm.
In addition to enlargement of breasts, uterus, and vagina, the body
.:hanges
that develop in- girrs at puberty are due to feminining hormones.
''q'omen
have narrow shoulders and broad hips, thighs that converge,
:nd arms that diverge. The female distribution of fatln
the breasts and
:uttocks, is also seen in eastrate males and women have ress
body hair
i:rd more scalp hair, and the pubic hair generally has a
yM
characteristic
-at-topped pattern.
L3.2.3.2, Fertilization and Implantation
ud

Fusion of the sperm to the ovum membrane is mediated


ilin is a protein on the surface of the sperm head that by fertilin.
resembles
viral fusion proteins which permits viruses to.attack celrs. Fusion
-.-ides a signal that
initiates development. The fusion also sets off
rction in the membrane potential of the ovum that prevents
St

'.spermy, the fertilization of the ovum by more than one sperm. This
--sient potential change is folrowed
by structurar change in the zona
:cida that provides protecting against polyspermy on"a more long-
:. basis.
3lastocyst the developing embryo moves down the tube
into the
-rs, in about 3 days, during which blastocyst reaches the 1g
or
:ll stage.
Page No. Thg226 blastocyst
of 328. becomes surrounded by an outer layer of
Fundamentals of Biomedical Instrumentation

228 Fundamentals of Biomedical lnstrumentation

synchtiotrophoblast a multinucleate mass with no discernible cell


boundaries, and an inner layer of cytotrophoblast mode up of individual b
cel1s, once it comes in contact with the endometrium. The blastocyst ir
burrows into the endometrium as synctiotrophobast erodes it. The dorsal

l
C
wall of the uterus is the implantation sit. A placenta then develops, and Str

ria
the tropoblast remains associated with it' in
The fetus and,the mother are two genetically distinct individuals' its
The fetus is in effect a transplant of foreign tissue in the mother. However'
the transplant is toleraled, and. the rejection reaction that is 13
characteristically produced when other foreign tissues are transplantei
fails to occur. em
abs
potr

ate
excl
lt stin
U incl
'.1'er(
\
l
AS S]
sttm
Egg cytoplasm
'he1
Egg cell membrane .his
yM
1'aVe

133.I LASER APPLICATIONS IN MEDICAL FIELD


13.3.1. The Laser Thr
The full term of word LASER is "Light Amplification by Stimula
ud

.-,e:-:ctir
Emission of Radiation". The laser beam has spatial and temp: m - rrpl
coherence and is monochromatic. The beam is highly directiona'l ; r las
exhibits high density energr which can be timely focussed' -:ted
The use of lasers in the medical field is suitable where the:: _ratt
favourable interaction between the laser radiation and the human tiss- .:n t
The merlical use of laser is dependent on radiation wavelength ner
ability of the tissue to absorb this wavelength, delivered po\rel shur
treatment area, total eners/ incident on tissue and the area trea
St

:_ las
Lasers have been especially successfi.rl in the following areas of
mej
.f 1ng
treatment:
(i) Treatment of detached retina. J3. I
(iz') Coagulation of eye in dielectric retinopatthy' : rr,-ef
(iii) Treatment of tissues in the skull and spine (neuro-surgen- -.-ndi
(iu)Treatmentbycoagulationofthelowergastrointestinaltrac:
Page No. 227 of 328. r ltV
Fundamentals of Biomedical Instrumentation

Some General Topics 2Zg

Demotrologr for removal of skin defects by laser


-beam has becom :^: -*"-^ radiation.
'*** The laser
information cont
non pplications' The
can be detected
ted d bY structures

l
spread
stic The most wide
medical application of laser technologz in medicine

ria
in opthalmologr. This is due to the easy accessibility has occurred
of the human eye,
its transparency and the absorptio r properties of its
internal tissues.
13.3.2. Principle of Operation of Laser
The laser action depends upon the
emission. In the normal state most atoms
absorption is generally for more likely
population inversion could be obtained (

ate
oton of the correct frequency could trigger
an avalanche of coherent photons. The
to grow so long as the scattering processes
inversion could be maintained.
For generation of raser beam, it is necessary
to have arr active medium
as shown in figure 13'6 in which atoms
are kept in an excited state and
stimulated by an outsid.e photon to emit right
in a particular direction.
rhe process by means of which a medium is
activated is ca,ed pumping.
lhis inflates enta,s- erectromagnetic energy into the medium
at a
yM
;avelength different from the stimulating wavelength.
l Total
l refractive
I mtrror

Resonator
Fig. 13.6. Main element of laser
The active medium is usuary enclosed in a resonator box with highly
ud

rereas ed by the s ti.,,,raie J ._i"


:. i::,1*-:i:,:*
m:ltiple T: and
reflections ll?r:n_s
resurts in a coherent *rrr. of g.o*rrrg
und ergo
"io,strength.
lF-: laser output is obtained if the
resonator box is transparent to the
-:rted laser beam. For reflecting
the high beam a double mirrored
-' rnating chamber is used to collect
high energ, pnotor, ,""umulated
.:'rin the system. The high ener$/
stored within resonating chamber
the- partially refl ective mirror by releasing
: shutter
:*.1:_.,:b:"T_"_1,,hrough
in a precisely controlled manner.
St

\ laser's properties are determined by the gain of the medium,


:ring mechanism, the
and the resonatioi design.
.3. Types of Lasers
of lasers are e classi{ied according to the
modes of op , the pulsed operation such
Page No. 228 the ruby an
of 328. minum gtass and the continuous
Fundamentals of Biomedical Instrumentation

230 Fundamentals of Biomedical lnstrumentation


krypton' carbon dioxide Ir
wave operation (CW) such as helium-neon argon'
lasers.Eachofthesetwoclasseshasspecificareasofapplicationin of
medical field. th

l
are as
The types of lesser usually employed in the medical field he

ria
follows: StI
13.3.3.1. Pulsed RubY Laser SCi
or pulses because
The ruby laser is usually operated in a short bursts
in upsetting
in continuor. *.rr" operation it gets heated up and resultsphysical damage
wa
cause
the distribution of atoms quantum states. This may cor
to the crystal. of,
can
13.3.3.2. Nd Yag Laser con

ate
NdYagLaseraSVeryusefulinmedicalfectionoloSz,alightguideisat prer
.,...."".ry-*hich transmits the laser energr rk The
the same time, is sufficiently flexible to per savl
in various helds like endoscopy, uroloS' neu
g.'
,a.:
dermatologr, dental surgery and general surgery'
13.3.3.3' Helium Neon Laser lhe
AHe_Nelasercanbeused.forthemeasurementofvisualactivityanc -93
is very helPful to the oPhthalmolog \eC
,) perfoiming cataract surgery on the T
yM
i ifris appti-ation is in the range of tntr
can also be used as a scannlng o -:mO
and its supporting structure inclu = r:CtII
underlying layers. This layer beam c
in case of correction of eye cracks developed in the retina'
I

_:on
13.3.3.4. Argon Laser :3.3.1
Thislaserisnotusedformedicalapplicationasthecathodeemiss::m
is severe at high currents. It limits iire life which must be
replac*di Th

occasionally and replacement cost is very high' i -:nI


l Ces
'=Tul
ud

' . etit

_ NIF
. : -eS,
St

.Di
with operating microscope' _Di
Argon ion photo-coagulator is m9re. suitable
"t Pn*:.:?1i1iil-l
theretinasincetheoutp"utformtheRubylaserisnoteffectivelyabsc:
! 1. I

Uibfooa-"essels. The Argon iron laser. can be focrlsea 1,i^:i1T:. -: tl


producing less damaE:
.ii- ]..i mm with lo*i enerS' requirement sensors' :e as
"i 328. than with xener arc light
229 oftissue
No. healthy
Page the
Fundamentals of Biomedical Instrumentation

Some General Topics 23'l


13.3.3.6. CO, Laser
The co, laser is used for bloodless surgery. It provides a thin rayer
of^ .heat coagulated tissue immediately around the treatment site while
the cells beyond this site remain untouched, undisturbed and begin the

l
healing process promptry. post operative odema is minimal in laser

ria
surgery. The healing is faster with minimum of tissue swelling and
scarring and with less post operative pain and discomfort.
The co, laser is high power continuously operating raser and its
wavelength is in the infrared region of 10.5 mm. This wavelength is
completely absorbed by most biological tissues. The most common use
of co, laser are in microsurgery. The coherent monochromatic beam
can be exactly focused on arr area approximately 1 mm diameter and is
controlled through the optical system connected to microscope. A very

ate
precise micro-manipulator directs the laser light to the treatment area.
The laser is now used in selected areas of larynx, pharynx and oral
cavity.
13.3.3.7. Excimer Laser
The excimer laser operate primarily in the urtraviolet spectral region.
L
lhe most common excimer lasers are argon-fluoride (ArF) operated at
i -93 mm, krypton-fluoride. (Kr F) operated at 24g mm, Xenon-chloride
Xecl) operated at 308 mm and Xenon-fluoride XeF operated at 351 mm.
:f
E The most important use of excimer laser is improving vision by
yM
1l rontrolled ablation of the cornea with A, F (193 mm) excimer laser and
tmoval of anthrochorositic plaque from arteries with Xecl (30g mm) /
::r 'rcimer laser one of the area of great clinical interest is laser angioplasty
e , to open authenosclerotic arteriar narrowings in peripheral
and
rronary artery.
:3.3.3.8. Semiconductor Laser
The semiconductor lasers are smafl in size and are highly efficient.
-1ey are mainly constrrrcted
using gallium arsenide/aluminium gallium
':senide indium phosphide/indium, gallium arsenide phosphide. Laser
--odes made of Al Gra As and can be convenientry used in photo
!d :agulation. These semriconductor lasers can be used for the treatment
ud

iil : retinal vascular decr.eases.


udl
TE
&
rd --
e high frequency elec tric current is used to produce heat in the body
':-dl' :sues. The diathermy in medical applications are used in the following
ilr : :\_s:
rd
St

1. Diathermy in physriotherapy
l. Diathermy in surg;ery.
r 4.1. Diathermy in Physiotherapy
In the diathermy fi:r physiotherapy the siize of the electrodes are
':. as compared to cliathermy for surgical aLpplications.
Page No. 230 of 328.
Fundamentals of Biomedical Instrumentation

232 Fundamentals of Biomedical lnstrumentation

It is possible to pass higher frequency currents in the range of wit.


1OO K Hz through the body and at this frequency neither nerves nor anc
muscles are stimulated, but the current of high frequency produce heat
by ohmic dissipation in the tissue (diathermy). The diathermy in the

l
OD
early years used a spark-gap and induction coil giving pulses of 1 MHz ape
oscillation. Nowaday the diathermy machines uses much higher

ria
,S tV
frequencies. Since the wavelengths are much higher than the bod-t .: th
dimensions, the mechanism of heating is attributable to the movemen: : rdS
of ions in the tissue. The clinical objective of diathermy is to heat the _:twr
internal tissues without unduly raising the skin temperature and the ,ns i
heating depends upon the less angle of the tissues and the heat removed :^sto
by body circulations. If a greater localized heating of the subcrrtaneous
Ir
fatty layer is needed, microwave diathermy of 10 cm rvavelength is used lnn(

ate
The following type of diathermy equiprment for physiotherapy are ::OUI
used :
:t. v
1. Short-wave diathermy :ld i
2. Microwave diathermY _:ep
3. Ultrasonic therapy unit. -:atir
, :na
13.4.2. Short Wave Diathermy ..:thc
In diathermy for physiotherapy the patient body become a part of tht
electrical circuit and the heat is produced within the bod5r and tralsferenct
through the skin. It does not produce discomfort to the body as in cas:
yM
of externally applied source of hr:at like not towels, infrared lamps anc
electric heating pads.
Power
source

Fig. 13.7. Block diagrerm of a short wave diathermy machine


Another advantage of diathr:,rmy is that the trear.ment can be controlle:
ud

precisely. The placement of el,ectrodes permits localization of the heat :---


'heat can be regulate:
the region to be treated. The intersect of the
precisely by the control of nnode voltage/control of filament therrn-
heating current/adjusting the grid bias by change of grid leak resistanct
The timing that is the duration of treatment is adjusted by providi;-;
an independent timing circuit in the machine which rviil contrc-rl the oi--
off time of the machine.
The most common use of short wave diathermy is to operate =
St

capacitor plate method an<l intluctive method ar; shown in figure 13 :


In the capacitor plate rnethod the short-wavt: diathermy machine :-"
connected to metal electrocles which are positiont:d on the body over tl-re
region to be treated. These electrodes are called 'P7\DS'in the terminoiog
of d.iathermy. The PADS o.r electrodes do not dire'ctly come into conta:
Page No. 231 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 233


with the skin. Usually layers of towels are used between the electrodes
and the skin.
The PADS on electrodes are praced so that the portion of the body
to be treated is sandwiched between them. The ariangement is called

l
capacitor method as shown in figure 13.s (a) where the metal part act

ria
as two electrodes and body tissues to be treated by heat act as dielectric
of the capacitor. when the reduce frequency output is applied to the
pads, the dielectric loses of the capacitor produce heat in the tissues
cetween the electrodes. The dielectric losses may be due to vibration of
:ons and rotation of diodes in the tissue fluids (electrolytes) and molecular
listortion in tissues.
In another method the output of the diathermy machine may be
:onnected to a flexible cable in stead of pADS. This cable is coiled

ate
around the effected portion in this case the arm as shown in figure 13.g
e). when RF current is passed through such a cable, an electrostatic
:leld is set up between its ends and a magnetic field around the centre.
)eep heating in the tissues result from electrostatic action whereas the
,:eating of the superficial tissues is obtained by eddy currents set up by
- magnetic effect. The technique is known as inductothermy linducuvl
rethod).
Electrode
yM
I
I
I I
I I
I I
I I tttttt
I I ltttrl
I I tttttL ttt! I I
I ttlttz I tltt I I I I I ll
I I I t t, It I I tttt I I I I I ll
I I I ltll I I I ll
I tttt I ll

Layer of towel
between electrode Electrode
and skin Joints to be
treated
ud

(a) Capacitor method


St

(b) lnductive method.


Fig. 13.8. Methods of applying electrodes in short-wave diathermy treatment.

Page No. 232 of 328.


Fundamentals of Biomedical Instrumentation

234 Fundamentals of Biomedical lnstrumentation

The other types of diathermy machines are : T


1. Microwave diathermY or

2. Ultrasonic theraPY unit.


pi

l
13.4.3. Microwave DiathermY

ria
The microwave range for diathermy purpose is between 3OO-3O,OO0
MHz in frequency and wavelength varying from 10 mm to 1 m' The most
commonly used microwave frequency for heating is 2450 MHz. Microwave
diathermy provides one of the most valuable sources of therapeutic heat
available to physician. In some of the cases the results of microwave
diathermy are same as of short wave diathermy but in some cases the
results of microwave diathermy are better. The technique of application
of microwave diathermy is very simple. In microwave diathermy no PADS

ate
are required as in case of short wave diathermy. In microwave diatherml-
the microwaves are transmitted. from an emitter and are directed towards
the portion of the body to be treated the waves pass through the
intervening one space and one absorbed by the surface of the bodl-
producing the heating effect.
A special type of device called magnetron is used for the production fixt
of higtr frequency current of high power. The output enerSr is derived
from the resonant or system by means of a coupling loop. The energ; 13.4
packed up by the coupling loop is carried out of the magnet|on in the
tentral conduction of a coaxial output tube through a glass seal to a -.)
yM
-
director. The director consists of a relaviting element of antenna and a ::gul
reflector which direct the enerSr for application to the patient' ::S ST
:-eCt
13.4.4. Ultrasonic TheraPY Unit
In ultrasonic therapy unit the heating is produced due to th:
absorption of ultrasonic enerSr by the tissues. The effect of ultrasor::
ener$/ into tissue is high speed mechanical vibration which is nothi::5
but micro massage of soft tissues. As all of us know the massage is useC
to treat tissues the same principle is employed in ultrasonic therapl
The electrical power required in most of the applications is usually less
than 3 W lcrnd of the transducer are that is in contact with the pan d
ud

the body to be treated.


The transducer through which the ultrasonic enerSz is appliec
the patient is made of piezoelectric crystal.
A high frequency alternating current of 0.75 to 3.4 MHz is app: -1

to a crystal where acoustic vibration causes the mechanical vibratio:- C

a transducer lead, which itself is located directly in front of the cr-t-s :T

These mechanical vibration then pass through a metal cap and into -n
holes tissues though a coupling medium. The therapeutic ultrasc. . ---n(
St

power varies from 0.5 to 3 W/cm2. Applicator (transducer) range : r::n


iO to 130 cm in d.iameter. The larger is the diameter of the applica ::(
the smaller would be the angle of convergence of the beam artc Sol
lesser is the degree of penetration. _ jel
The electronic current of the ultrasonic therapy equipment is r0
simple frgure 13.9 shows the block diagram of a ultrasonic therapl'
Page No. 233 of 328.
Fundamentals of Biomedical Instrumentation
Some General Topics 235

The heart of the system is a tuned oscillator which produces the electrical
oscillation of the required frequency.
The oscillator output is given to the power amplifier which drives the
liezoelectric crystal to generate ultrasonic waves.

l
ria
ate
Ultrasonic Transducer

Fig. 13.9. Block diagram of ultrasonic therapy unit


The patient is given the ultrasonic energz lbr a predetermined period
f-rxed time) by providing a timer circuit in the ultrasound therapy unit.

13.4.5. Diathermy in Surgery


In surgical diathermy the frequency of the current is in the range of
-3 MHz. The basic principle of surgical diathermy machine is shown in
yM
:rgure 13.1O. Due to difference in current density between two electrodes
i<1/
issues below passive electrode heat up slightly. The tissues below active
.lectrode is heated to destroy the cell by heating the cell fluid.

Active
Electrode
RF
Generator Body

Passive
Electrode
ud

Fig. 13.10. Basic principle of surgical diathermy machine


Catherization of tissues is caused by the high free current following
rrough the tissue and heating is localiy so that it coagulate from inside.
he capillary and other vessels are sealed inductiously preventing
rntamination of bacteria"
In the initial stage the electrosurgery machine used a spark gap
:chnolog, operating in cut and coagulation mode. In cut mode a
St

rntinuous sine wave is used whereas in coagulation made a damped


i ave or chopped sine wave is used
Solid state diathermy machines available commercially provide high
..equencies
in the range of 250 KHzto I MHz. In cut mode they deliver
- 10-500 W to 500 Q load at a voltage of 2000 V whereas in coagulation
-ode around 150 is delivered. In coagulation mode the duration of pulse
Page No. 234 of 328.
Fundamentals of Biomedical Instrumentation

236 Fundamentals of Biomedical lnstrumentation

of 15 Khz is to a period of 10 ps. The block diagram of a solid state


diatherrny machine is given in figure 13. 1 1 .

l
ria
Fig. 13.11. Block diagram of solid state diathermy machine
The RF generator provides high frequency carrier signal which is 13.
modulated by a tone generator giving waveforms for coagulation and
cutting. The RF power is turned onloff with a control circuit connected
to switch which is operated by surgeon. The output circuit couples the :nt

ate
modulated RF output to active electrode. ,4.:

13.5. CLINICAL LABORATORY INSTRUMENTS :XCl


'1'aV(
Patient specimens analysis is done in the clinical laboratory. It provides , rbir
rnformation to aid in the diagnosis of disease ald evaluate the effectiveness
1
of therapy. The clinical laboratory is also known as clinical patholory _i- ni
department. Chemistry, hematologr, and microbiologz are the sections -ee
of the clinical laboratory. 1

tlsin
yM
I
Blood, urine, cerebrospinal fluid and other fluids are analysed in the :t th
chemistry section to find the content of various clinically important
substances. 13.5
The determination of numbers and characteristics of the formed V
elements in the blood i.e.,red blood cells, white blood cells, and platelets: - ave,

atrd aiso functions of physiological systems in the blood i.e., blood clotting. ave
etc. are done in the hematologr section. The microbiologz section helps : ISOI
in studies on various body tissues and fluids to determine whether :3.5.
pathological microorganisrns are existing.
In a1l above electronic automation arc quite common. Mainframes A
:I]SS
and minicomputers keep track of salient parameters. The fast response.
ihe accuracy and precision are essential requirements. an
ud

It
13.5.1. Spectrophotometry
'3.5.2
It is based on the fact that substances of clinical interest selectiveh-
absorb or emit electromagnetic enerry at different wavelengths i.e.. It
ultraviolet (200 to 400 nm), r,isible (400-700 nm) or near the infrarec -:lts.
(700 to 800 nm). Most of the instruments operate in the visible range. -:h
'-r-le
Figure 13.12 shows the block diagram of a spectrophotometer. It includes
'i -ch
St

photometer and calorimeters.

,*M : _-I1e f

Injr
Car

Selector (holds) Detector and read out


Fig. 13.12. Block diagrarn of a spectrophotometer
Page No. 235 of 328.
Fundamentals of Biomedical Instrumentation
Some General Topics 237

The subsystem details are:


Power source = Hydrogen discharge lamp for 200 to 36 nm
range and tungsten filament lamp for 360 to
800 nm range.

l
Wavelength selector = Glass filter and interference filters and

ria
monochromators using prisms and diffraction
gratings.
Cuvette = Holds the substance being antalyzed.
Detector = Photometric system.
13.5. 1.1. Flame Photometers
In this, case the power source and the sample holder are combined
:n the flame. It can determine only the concentrations of pure metals.

ate
13.5. 1.2. Atomic Emission
The flame photometer, produce about loh of the atoms are raised to
:xcited stage. Only a few elements produce enough power at single
,i-avelength when they move from higher ener$/ orbit to lower-energr
-,rbit. In view of this, its growth has been for only limited usage.
The sample combined with a solvent is drawn into the flame. Propane
-,r natural gas is mixed with compressed air. The solvent evaporates in
:re flame, Microscopic particles of the sample are left. These particles
:isintegrate giving atoms in very small proportion. When the atoms fall
yM
:r the ground state, it release power at their characteristic wavelength.
f 3.5.1.3. Atomic Absorption
Vast majority of atoms in flame absorb ener5/ at characteristic
-,r-avelength. A special power source is used
to emit power at characteristic
:r-aveiength. A photomultiplier is used as detector. The amount of
ibsorption is proportional to the amount of the atom present.
13.5.1.4. Fluorometry
A number of molecules emit light in a characteristic spectrum the
.nission spectrum-soon after absorbing radiant eners/ and being raised
:r an exited state.
ud

It has advantage of better sensitivity.


13.5.2. Chromatology
It is based on separating a mixture of substances into component
:arts. These methods are used for the detection of complex substance
.:ch as drugs and hormones. Gas-liquid chromotographs (GLC) and
--rin-layer chromatographs (TLC) help in determjning which drough or
thich drugs have been taken in overdoes. Its components are injector,
St

::rrier gas, column, recorder etc. as shown in figure 13.13.


Injector : Patient sample alongwith solvent is injected.
Carrier gas : It is inert gas carrier say N, which sweeps the
' evaporated sample and solvent gas down the column.

Page No. 236 of 328.


Fundamentals of Biomedical Instrumentation
238 Fundamentals of Biomedical lnstrun,entation

Column : It is packed with solid material in 1 m long and


about 6 mm diameter size. It helps in analysis of the
sample. m
Tem perature controlled
in

l
CO

ria
elt
I
13

bl(
col

13

ate
Fig. 13.13. Gas-liquid chromatograph (GLC) block diagram IrIL
dn
A sample GLC recording is shown in figure 13.74.
13.

sta
GS
Detector
output nel
yM
cur
t, mei
als<

Time
13J
Fig. 13.14. GLC record of analysis of blood
\t
13.5.3. Electrophoresis rehi
It means proteins in plasma and urine etc., to identity antiboides,
Electrophoresis is the movement of a solid phase with respect to a liquic :epl
i.e., buffer solution. ^lvir.
Magnitude of charge: The mobility of particle is directly related tc
ud

the net magnitude of the particle's charge. f lor


Ionic strength buffer of sample and solvent. ned
-ater
oiol<
rrga
ratt
:r1ps
Membrane
St

density ::om
I
:oml
lhe r

:Sa
Migration distance
rth
Fig. 13.15. Pattern of serum protein electrophoresis
Page No. 237 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 239

Temperature: Mobility is directly related to temperature' It causes


medium temperature to increase which decreases its resistance which
increases rate of migration. The evaporation helps in increase of

l
concentration of particles.
Time: The distance of migration is directly related to the time of

ria
electrophoresis.
13.5.4. Hematology
These are devices which measure characteristics formed element-red
blood cells, white blood cells and platelets. Electronic devices are quite
common.
13.5.5. Kymogrpah

ate
Kymograph is an instrument for continuous recording of heart beats,
muscle contraction and respiratory, events. It is comprised of a metal
drum, rotating spinals, electric motor, etc.
13.5.6. Galvanic Skin Resistance (GSR)
It is the change in skin resistance due to sweating. The emotional
state such as fear, panic or alertness indication can be achieved through
GSR. An active electrode is fixed on the palm of the hand and a second
neutral electrode is placed on the wrist or back of the hand. Constant
current of about 10 mA is passed through the electrodes and GSR is
yM
measured. GSR is in the range of 10 to 500 kw. GSR measurement is
also used in lie detection test.

.L biocompatible material is used to construct artificial organs,


rehabilitation devices, or prostheses and replace natural body tissues.
In surgery, a biomaterial is a synthetic or natural material used to
replace part of a living system or to functions in intimate contact with
living tissues.
In the first conserves conference of the European society for
ud

biomaterials a biomaterial was defined as "a nonviable material used in


medical devices, intended to interact with biological systems" but was
Iater in second round defined as a "material intended to interface with
biological systems to evaluate, tract, augment or replace any tissue,
organ or function of the body." A biomaterial is different from a biological
material such as bone that is produced by a biological system' Artificial
hips, vascular stands, artificial pacemakers, and catheters are all made
from different biomaterials and comprise different medical devices.
St

Biomimetic materials are not made by living organism, but have


compositions and properties similar to those made by living organisms.
The calcium hydro>ryapatite coating found on many artificial hipe is used
as a bone replacement that allows for easier attachment of the implant
to the living system.
Page No. 238 of 328.
Fundamentals of Biomedical Instrumentation
240 Fundamentals of Biomedical lnstrumentation

Surface functionalization rnay provide a way to transform a bio_inert


material into biomirnetic or even bio-acti..,e material by coupling of protein
layers on the surface, or coating th.e surface with seli-assernbling peptide
scaftolds to lend bioactivity and/cr cell attachment 3-D matrix different

l
approaches to functionalizator, of biomaterials exist. plasma processing
has been successfuily applied to chemically inert materials like polymerJ

ria
or silicon to graft various function groups to the surface of the implant
inside living system materials for biological use are classified according
to their base stnrcture as ceramics composites, metals and players.
These are per Table 13.3.
13
Table 13.3. Classification and Biomaterials
TT
S.No. Classification Material example Application ]Ir.

ate
1 Ceramics Aluminium oxide Dental and orthopaedic Th
2 Composites Carbon-carbon hbres Heart valves and joint Th
implants. pa
c Metals Aluminium, gold Joint replacements, an
titanium, iron. pacemaker sti
and electrodes nel
4 Polymers Nylon, synthetic rubber Replacement of soft ani
tissues like skin, blood extr
vessels, cartilage.
yM
Synthetic polymers constitute the vast majority of biomaterials usei
in humans. A polymer is characterized, by repeating submit (rnonomer
covalently connected to form a macro_molecule.
Synthetic polymers are made by two processes:
(f Addition polyrnerrzation e. g., poryethylen e, polymethyr methacryrate.
poly vinyl chloride and polyethylene_terephtalai.
(ii) Condensation polymerization e.g., polyesters, polyamicles anc
pol5rurethanes. 13.7
The detailed, most commonly used porymers and their applicatior-
are: :he
(i) Polyethylene: Low density - Bags, tubing Jaln
ud

High density - Catheter. :ont


Ultra high molecular - orthopedic and facial imprants weight :urr
(iif Polymethy-methacrylate : Intraocular lens, dentures. spec
(iii) Pollruinyl chloride (pVC) : Blood bags, catheters. :frm
lefVr
(iu) Polyethylene terephthalate (pET) : Heart valves.
terc(
(u) Polyesters : Bioresporable sutures, surgical products.
N
(uff Polyamides (Nylon) : Catheter. .--avlr
St

Polyurethanes (pU) : Film, coat implants. - Iz


Properties of Biomaterial are as follows: : lua.
(rj Biomaterials for implants should be nontoxic, non-allergen:: -.-:dtt
functional for its life time and biocompatible. : ltpr
(il) Polymers may loose some of their properties with time, process :.:Ctf
called degradation. -,:le
Page No. 239 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 241

(iirJ Pol5mers exhibit reasonable cost and cal be malufactured in various


shapes and sizes having desired mechanical and physical properties.
Biocompatability details are as follows:
(tJ Biocompatibiiity is the acceptance of an artificial device by the

l
surrounding tissues and the body as a whole.

ria
(ii) Bulk and surface properties of polymer biomaterial which are
functiom of their molecular structure and organisation, determine
their interaction with living organisms.

STIMULATORS
The various type of stimulators are used for pain relief. The electrical
impulses are used to block the pathways of the transmission of pain.

ate
The electrical impulses are produced in a battery powered pulse generator.
The pulses are passed on to the effected portion of the body through a
pair of electrodes. The electrical impulses are applied to the skin overlying
any painful area of the body. The electrodes provide mild electrical
stimulation. These signals abstract the pain signals travelling along the
nerye pathways before they can reach the brain. The result is like taking
analgesic, often for hours after stimulation ends. The pain control is
explained by the following methods:
1. The gate control theory which suggest that by electrically stimulating
sensory nerve receptors, a gate mechanism is closed in a segment
yM
of the spinal cord, preventing pain carrying messages from reaching
the brain and blocking the perception of pain.
2. The endorspin release theory suggests that electrical impulses
stimulate the production of endorspin and enkaphalins in the brain,
in a similar fashion to conventional drug therapy, but without the
danger of dependance on drug or any other side effects.
13.7.1. Transcutaneous Electrical Nerve Stimulator (TENS)
TENS provide electrical impulses required for electrotherapy to tract
the pain. The sqr:are wave or spike wave are equally effective relieving
pain. In most of the stimulators the adjustable settings are provided for
ud

controlling amplitude (intensity) of stimulation by the control of voltage,


current and the width (duration) of each pulse. Electrodes are placed at
specific sites on the body for treatment of pain. The current in pulsating
lorm travels through the electrodes and into the skin stimulating specific
nerve path ways to produce a massaging sensation that reduces the
cerception of pain.
Normally the stimulation is based around a 500 ms spike pulse,
having an adjustable amplitude of 0 to 75 mA and an adjustable frequency
St

of 12 to 100 pulses per second. The other type of instrument having


square waveform, have a pulse frequency range of 2O-2OO Hz, pr-rlse
ividth from 0.1 to 1.0 ms and pulse amplitude of 0- 120 V with maximum
cutput current of 25 mA. Transcutaneous or skin surface application of
:lectrical stimulus is achieved by application of pads to various trigger
zone areas or peripheral nerves. Skin irritation at the site of electrode
Page No. 240 of 328.
Fundamentals of Biomedical Instrumentation

242 Fundamentals of Biomedical lnstrumentation

application is minimized by the use of carbonized rubber electrodes


applied with a tincture of Benzoin interface.
In TENS the electrodes are commonly moulded from silicon rubber,
loaded with carbon particles to provide proper conductance. The

l
electrodes
are made thin to achieve conformability. Useful carbon_loaded silicon
rubbers have a minimum resistivity of 1O e cm.

ria
13.7.2. Muscle Stimulators
These stimulators are used for physicar therapy for exercising the
muscle to regain function of pararyzed muscles, to gain ability to grasp
in case of paralytic hand, gaining control of rowei extremities i.2., to
stand, walk. The different types of currents are used for different
applications.

ate
(a) Galvanic Current
A steady flow of direct current (dc) is passed through the skin (tissue)
producing a chemical effect used in treatment of paralysis and disturbance
of blood flow.
(b) Faradic Current
A sequence of triangurar pulses with pulse duration of about 1 ms
to 20 ms is used for treatment of muscle weakness. (

(c) Faradic Surging Current ?


yM
Her peak current intensity appried to patient increases or decreases
rhythmically at a slow rate. Such currents are used in the treatment of 13.7.,
functional paralysis in spasm and parn.
S,
(d) Exponentially progressive Current -t:e s.
Sequence of triangular pulses with pulse duration of .01 to looo ms :flna
and interval from 1 to 1o,o0o ms. This is used in treatment of severe - =r,elC
:
paralysis by providing selective stimulation.
-=OOli
phl
constant current type of stimulation is advantageous over the constar:
voltage t5rpe, because the charge transferred per stimulus pulse is constan: Th
regardless of electrode load impedance. The block diagram of a versatile -:que
muscle stimulation is shown in figure l3.z.l. It givis output curren: -: an(
ud

waveforms to cover the whole rr.rg1 of applicationl -lto


: ::ien
The Galvanic current is obtained from a dc supply via a variablt
.-:atm
potentiometer. A variable rate murtiprier gives basic siimulus frequenc-.
::nui
which triggers a monostable multi-vibrator which provides interruptec i*lr,'ee
Galvanic output. A triangular pulse generator provides triangular prl"..
.::dir
with width set by ttre monostable multi-vibrator. Faradic currents rr :: j--Sm
obtained after modulating surged Faradic currents at frequency set L--, _- - -L1
St

main free running multi-vibrator in a mlxer.


The waveforms generated are serected with the help of a selecr:,-- -he
::lpl
switch and feel to the muscles through a high impedance (more tha:
i00 1(o) constant current stage which is calibrated in mA Isolation of Lar lhe
: .:r j
stimulus is provided through the opto-coupler.
-:ati
Page No. 241 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 243

l
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Monostable Higher
multi-vibrator tmp.
(Pulse width) Const Current
source

(1) Galvanic ate


(2) Galvanoic Interrupt (3) Triangular
(4) Surged Faradic (S) Faradic.
Fig. 13.16. Block diagram of a constant current mascle stimurator
I
yM
13.7.3. Spinal Cord Stimutator
Spinal cord stimulation is provided by placing the electrodes crose to
::e spinal cord for the relief of pain. The Llectrodes are placed close to
'ainal cord by surgery through skin. The appried erectricar impulses
:evelop an electrical field in and around. spinai cord, which
then causes
:epolarization or activation of a portio, o1 th" neural system resulting
--- physiological changes.
The stimulus implant is a RF coupled type and the stimulus purse
=equencies ranging from 10 to 15oo Hz, pulse widths from 1oo to 600
,rs and controllable amplitude form 1 to 15 mA delivered
into a load of
ud

l'-'0 to 15oo o. Spinal cord stimulation has been of great


benefit to some
:.:tient with multiple selerosis and other neurol"ogical disease. For
::atment of this disease the transmitter is designed io generate pulses
[:: muscle contraction lasting 1.6 seconds with a-rest p..i-oa of 9 seconds
i'::ween contractions. The actual stimulation is burst of pulses
consisting
crr :ndividual pulses of 22o ms wide,
repeated 33 times per second. For
rr:rsmission through the skew the pulses busts ...
ier frequency of 460 kHz. -odrlated with a
St

The receiver demodulates the signal and pass them into the
:ropriate muscles to produce stimulation.
The receiver and transmitter are shown in figure 1&12. The
receiver
- -rit is embedded in an epoxy disc coated with siticon
rubber for,tissue
n':-patibility.

Page No. 242 of 328.


Fundamentals of Biomedical Instrumentation

244 Fundamentals of Biomedical lnstrumentation

wic
ger

l
131

ria
1.

ate
s

T
lmplantable Transrnitting lv
antenna antenna
(b)
t
(a)
r
Fig. 13.17. (a) lmplantable radio receiver with leads, p
(b) External transmitting unit with an antenna T
The receiver with three leads of platinum-iridium are placed ove: St

ofspinalmusclesduringSurgery.Thereceiverisplacec h
ous pocket on the converse side of the curve' Tht
yM
F,
ennaisaflatdiscwhichistapedontheskinoverth: c'<

subcutaneous receiver by disposable adhesive' fe


OI
'13.7.4. Bladder Stimulators te
The bladder stimulators are useful when emtying of bladder is nc: rh
TT
on
en
fer
Th
e-set pulse with 0.2 ms, a pulse to 25 V r:: Th
ud

ate of 10 to 50 Hz' T]rre electrod he insulate: rvh


wires, 2.5 mm in length, with conical tis-." Rel
2.5 rnm on an epoxy strip. Th are flexib"- LAi
silastic coated and are made of stainless steel and are connected tc e Tht
receiver with a circumference of 3 cm. The receiver is placed in '-u"
abi
subcutaneous tissue on the left or right side of patient's waist.

13.7.5. Cerebellar Stimulators


,f
St

e
The cerebellar stimulation is useful in the treatment of epilepsr : )1I
Stimulation to cerebellum is provided by transcutaneous induc--: -:ac
coupling through an antenna fixed subcutaneously on the chest. I: Diar
deliverJ through from pairs of platinum discs fixed on a plate of sil:l :ry
coated mesh. The electrode bearing plate is placed on both the ante: : f1t
and posterior cerebellar cortex. Normally the rectangular pulses of I --:e(
Page No. 243 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 245

width, with a rate of 7-2oo Hz and an intensity of 0.5 to 14 v are


generally used.

l
ria
1 The body temperature is determined by the delicate balance between
heat production and heat loss. The traditional noimal value for the
oral temperature is 37'c (98.6"F). chronic elevation of 0.5"c occurs
when the metabolic rate is high and lowered when metabolic rate is
low. Few normal adults chemically have a temperature above the
normal range. The reflex and semi-reflex thermoregulatory responses
in humans are mechanisms activated by hot and cold. The mechanism
activated by cold which increase heat production, are hunger,

ate
shivering, increased voluntary activity, increased secretion of
morepinephrine and curling up, horropilation and cutaneous
vasoconstriction decrease the heat. The mechanism's activated by
heat such as increased heart loss due to sweating, increased
respiration and cutaneous vasodilation; and also decreased heat
production due to anorexia, apathy and inertia.
The hypothalamus integrates body temperature information from
I sensory receptors in the skin, deep tissues of spinal cord, extra
I hyperthermic portions of the brain, and hypothalamus itself.
I Fever is most universally known hall mark of disease. Body temperate
yM
r can be measured by the mercury thermometer, but recording is not
feasible. In view of this, electronic thermometers are available based
on the principle of the thermocouple and the thermistor. Skin
temperature measurement is done using flat thermistor probe
thermometer or infrared radiation thermometer.
The multiple differences between males and females depend primarity
on a single chromosome, i.e. Y-chromosome and single pair of
endocrine structures, the testes in the male and the ovaries in the
female. Male cells contain an X and y chromosorne, i.e. Xy pattern.
The female cells contain two X chromosomes, i.e. Xy pattern.
The semen ejaculated by male at the time of orgasm contains sperms
ud

rvhich move to ovum in the female to fertlhze. This leads to


Reproduction of the human race.
LASER is Light Amplification by simulated Emission of Radiation.
The medical use of laser is dependent on radiation wavelength, the
ability of the tissue to absorb this wavelength, delivered power on
treatment area, total ener$/ incident on the tissue and the area
"reated. It has been in use for treatment of detached retina, coagulation
of eye in dielectric retinopathy, treatment of tissues in the skull and
St

spine and treatment by coagulation of the lower gastrointestinal


:ract.
Diathermy for physiotherapy: The diathermy for physiotherapy is
'.-ery useful and advantageous for the patient. The heat by means
of
','arious methods is applied to the joint or where the heat is required
:irectly without discomforting the skin. This means the heat is directly
Page No. 244 of 328.
Fundamentals of Biomedical Instrumentation

246 Fundamentals of Biomedical lnstrumentation

given to the joint or their tissues without lecting the skin, unlike
the
application of heat by hot pads and towels, etc'
The following main types of diathermy equipments are ln use:

l
(i) Short wave diathermY

ria
(ii) Microwave diathermY
('
(iii) Ultrasonic theraPY unit' (t,

Intheshortwavediathermyunitthetissuebecomesthepartofthe
circuit while in microwave diathermy and ultrasonic therapy unit'
1C
IJ.
1a
thetissuetobeheated'areappliedmicrowaveorultrasonicenergi- 1J.
1C
through aPPlication. 1J-
precisell-
In surgery the diathermy unit is used to cut the tissues very
blood in case
as well as for coagulation purpose' There is no loss of
13..

ate
]? I
of surgery by way of surgical diathermy'
department
5. The clinical laboratory is also known as clinical pathologr of the
13. (

Chemistry, hematoloS', and microbiolo5/ are the sections


fluid, etc. are analyzec
clinical laboratory. Bl;d, urine, cerebrospinal
in chemistry section to find the content of various clinically importan:
substances.
Electronic automation in clinical laboratory is quite commor:
Mainframes and minicomputers keep track of salient parameters
The fast response, the accuracy and precision are essentia-
yM
requirements.
!, Spectrophotometryisbasedonthefactthatsubstancesofclinicar]
interestselectivelyabsorboremitelectromagneticenerSratdifferem
emisstc=
wavelengths. It is comprised of flame ptrotometer' atomic
atomic absorption and fluorometry' ChromatoloSr instruments a-=

based on separating a mixture of substances into component pz

Injector, .r..i.. gas column, Electrophoresis,facilitate ll^"^J:'


Electro phoresis is the movement of a solid phase with respect
tc

liquid, i.e., buffer solution. Hematologz hnd out the characteristics


beats, mur
urfoa.'Kymograph helps in continuous recording of heart
contraciion,-and respiratory events' Galvanic skin resistance (G
to sweating, which helps to find
helps to find skin resistance due
ud

emotional state such as fear, panic or alertness indication'


6 Biomaterial:Biomaterialisdef,rnedasamaterialusedinmec
devices,intendedtointerfacewithbiologicalsystemstoevalu
tract, augment or replace any tissue, organ or functions. lf
the b
Some of the biomaierials are aluminium oxide used in denr:
carbon-carbon fibers for heart valves and joint implants, alumii--
gold., titanium and iron for joint replacement pacemaker
Electrodes, polymers such as oxylion and synthetic rubbe;
St

."pt.""t".t t of soft tissues like skin blood vessels and cartilaS"


7. Stimulation:
(r) Electronic stimulators are used for the relief of pain
in the mu
spinal cord., etc' The normal stimulators consists of an el

which is placed on the skin as subcutaneciusly'


Page No. 245 of 328.
Fundamentals of Biomedical Instrumentation

Some General Topics 241


(a) The stimulatorsnormary generate puises in various shapes and
various time period and ampiitude (intensity).
(iifl The stimulators also find use in emptying of the
braclder. The
stimulators are also used to contror ancr correct the epitepsy
in

l
the patient.

ria
txercidea
3. 1.Write short notes or-r bocly temperature.
l-
o.z. Write short notes on reproduction system.
)) Describe micro'qzave diathermy machine. Discuss
electro-diagnostic
therapeutic apparatus.
3.4. Erplain the working of a modern surgical diatherrn}. machine.

ate
35 trxplain the use of diathermy in physiotherapy and surgery.
3.6. Explain diathermy and defibrillator. Also explain defibrillator analyzers.
(UPTU 2006)
7. Write short notes on diathermy. ppTU 2OC:S)
8. trxplain the application of laser in medicine. (U7TU 2OO4)
9. Discuss with a block diagram the working of a laser system.
10. Discuss laser inieraction with tissue.
1 1. Differentiate between use of laser in surgery and coagulation.

12. Explain laser beam focussing.


13. What are biomaterials? trxp1ain.
yM
Up,fU 2006)
14. What are biomaterials? (U7TU 2OO4) ia/
15. Describe various kinds of currents used in muscle stimulators.
i6. Write short notes on stimulators. (U7TU 20OS)
i7. Explain stimulators. ppTU 2006)

AJJ
ud
St

Page No. 246 of 328.


Fundamentals of Biomedical Instrumentation

l
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Monitors and Recorders

> Inside this chapter


14.1.
14.2.
14.3.
14.4.
Biopotential Amplifiers
Monitors
Recorders
Summary
ate
yM
14.1. I BIOPOTENTIAL AMPLIFIERS
Biopotentials are picked up by an electrode or available at the outp:
stage of a transducer. Normally the value of such potential is of the lc
order. In recorder the biopotential developed in ECG, EEG, EMG, etc. a--
to be interacted with 50 Hz AC supply. Use of a differential amplt
r.rrinirnize the interference of capacitively coupled current. To achi
this, the differential amplifiers must have higher Common Mode Rejecl
ud

Ratio (CMMR) . The simple system to measure bioelectric potential u-


differential amplifier is shown in figure 14.1.

H gh freq
filter

EI
St

Grouno -
Fig. 14.1. Bioelectric potential with differential amplifier

248

Page No. 247 of 328.


Fundamentals of Biomedical Instrumentation

Monitors and Recorders 249

Apart from normal requirement of instrumentation amplifiers the


:opotential amplifiers have the following requirements:
(a) Input impedance should be high in the order of 10 MW so
that negligible loading is provided to the biorogical system being

l
measured.

ria
1b) Amplifier should have high gain of the order of looo or more so
that weak biological signals of the order of mv or mv are amplified.
1c) These amplifiers should have high CMMR.
d) voltage appearing at the amplifier input due to changes in magnetic
fields should be minimised.
e) Amplifiers should have isolation ciruitry for the safety of the patient
being studied.
Earlier transistorized amplifrers were being used to amplify and operate

ate
-: writing device. Now at the input stage the operation amplihers (oA)
.sed on IC technolos/ are being used. The commonly used lC is 741.
- --:
IC contains 2o transistors and other passive components. The circuit
i :graJrr and pin diagram of this IC may be seen in the data books on

In normal practice the operational amplifiers are used as an


':trumentation amplifrer. The hrst stage comprise 2 input amplifiers
i' and A, connected in non-inverting followers configuration. This
. :s high input impedance. The second stage is a basic differential
, ',:liher giving high gain. The circuit diagram is shown in figure 14.2.
yM
ud

Fig. 14.2. lnstrumentation Amplitude


.n this circuit overall voltage gain can be controlled by ad.justment
St

t.
.n the circuit:
R"=
TJOI
R.=R,=R-
m
+ e, is input to amplifier A,
m
+ e, is input to amplifier A,
Page No. 248 of 328.
Fundamentals of Biomedical Instrumentation

250 Fundamentals of Biomedical lnstrumentation

If R2 = R, output voltage is given as: 1,

"- {,-'+}
"s= x @r- e1t M
I R,J sy

l
The input ampliliers A, and A, act as input buffers with unity gain th

ria
cir
e" with a gain of
I zn^l
for the differe- thr
for common mode signal and.
tt.T, I ar(
rec
ntial gain. These amplifiers work as biomedical amplifrer due to very of
high input impedance, high gain and good common mode rejection ratio'
mo
The isolation in bioelectric amplifies are provided by the incorporation
of an opto coupler. In the opto coupler there is an LED at the input stage
war
and a photo-transistors is provided at the output stage.

ate
the
Normally a transistorized circuit is provided at the output stage to dev
supply current to the pen coil of the galvanometer. The pen motor is disl
driven by a dc driven stage feeding a four transistor output stage operating Warv
the galvanometer. Due to low power efficiency of push pull amplifier a on,
bridge arrangement is preferred. A circuit diagram may be seen in
hgure 14.3.
mor
disp
(

bes
yM
14.2,

\
lare
:il0nl
T
ll :lr w
-lr a
imoo
.76
=rd h
ud

.: ter
anb
TT
_: ho
Fig. 14.3. Output stage using bridge amplifier for driving galvanometer coil in recorom : lwer
The current in I, and ?o increases and T, and T. decreases' Tl-- :ack r
when T, and ?o approximates to short circuits, ?, and Ta are nearly c :: pov
off and almost all the circuit current passes through the galvano In
St

coil. t and 71. function as emitter loads, I. and To operate as amplifica: - _trsln
having I, and ?. as collector loads. Resistors R, to Ro provide coc =:-t be
biasing to T, and To. - ton(
--splay
:-the
Page No. 249 of 328.
Fundamentals of Biomedical Instrumentation
Monitors and Recorders 251

l.lonitors have become essential part of any biomedical instrumentation


.r'stem. This is basically similar to the conventional oscilloscope used for

l
:ie display of waveforms in electronic laboratories. They have the usual
ircuit blocks like vertical and horizontal amplifiers the time base a,nd

ria
ne EHT (Extra High Tension) for the cathode ray tube. These monitors
,-re of slow speed and long persistence type of screen. The slow speed
. equire a long persistence screen so as to enable a conveniept observation

f waveforms. Without a long persistence screen one can only see a


:-roving dot of light instead of a continuous trace.
The conventional oscilloscope can not be used to display low frequency
,i'aveforms which are generated by various physiological parameters. For

ate
hese purposes non fade monitors using digital memories have been
leveloped to overcome the problem of the fading of slow scanning CRT
lisplays. By using this technique it is possible to generate a rolling
'.r'aveform display. The display is thus continuous, bright and flicker free
ln a normal non-storage CRT.
This means that normal oscilloscopes are not suitable to work as
nonitors. A special type of digital storage scope with non-fade type of
lisplay may be a suitable choice.
Some of the details of non-fade displays and cardiac monitors may
je seen in the chapter on Patient care and Monitoring.
yM
14.2.'1. Video Monitors "t
Video monitors are used in intensive care unit and intensive cardiac
:are unit. Video monitors are provided as bed side monitors and video
lonitors for central monitoring.
The monitor (display) part has two subsections-raster type display
rcr waveforms and a conventional 300 x 260 picture-element but map
rcr aplphanumeric display and graphics. To make the waveforms look
smooth, a l2OO line vertical raster is used. The display section also uses
a 16 KB word memory, which is used as temporary storage for waveform
and hard copy data. ECG waveform for each patient is continually stored
ud

,n temporary locations for delayed waveform output for recording. This


:an be used to send the waveform of abnormal ECG to a recorder.
The microprocessor based video monitors can hold patient data for
14 hour. It contains 6 K words of CMOS RAM which requires very little
rower in the stand by mode and therefore can be connected to a battery
rack up power supply. Thus the potent data may be secure even in case
rf power failure.
In the bedside video monitors and video monitors in the central
St

:rursing room a video and audio alarms are provided. The audio alarm
,-an be distinguished by varying its pitch, volume, duration and sequence
rf tones. Visual alarms can be indicated by varying the colour of the
lisplay on the monitor screen. The bed side monitor data can be monitored
rn the central nursing station.

Page No. 250 of 328.


Fundamentals of Biomedical Instrumentation
252 Fundamentals of Biomedical lnstrumentation

The various types of display are now available like CRT display,
plasma display, liquid. crystal display (LCD), surface conduction electron
emitter display (sED).

l
ria
In any instrumentation system one of the important consideration is the
method by which the data acquired is recorded. The recording method
should be consistent with the typical system. If the signal is analogue
and the analogue output is available for recording then we need an
analogue recorder to record the event. On the other hand, if the system
has a digital output then digital recor:ding system to needed.
/Thus there are two types of recorders are used:

ate
(a) Analogue Recorders.
(b) Digital Recorders.
Analogue Recorders are of various types. They can be broadly classified
as under: PaI
(z) Graphic Recorders.
(irJ Osicllographic Recorders. elec
(ifiJ Magnetic Tape Recorders. ISL
The Graphic Recorders are devices which display and store a pen *.:
and ink record of some physical event. The basic element of a recorder
include a chart for displaying and storing the recorded information, a
yM
papr
chart drive for driving paper with known speed and a suitable coupling
for connecting the source of information. The graphic recorders can be Mar
further classified as follows:
(a) Strip Chart Recorders: :hat
A strip chart recorder records one or more variables with respect to lapll
-,r'hic
time. Normally it is X verses time (t) recorder.
(b) X-Y Recorders: 1orn
An X-Y recorder records one or more dependent variables with respect lsed
to an independent variable. :teth
ipee(
14.3.1. Strip Chart Recorder -he
ud

<

A basic strip chart recorder may be seen in figure 14.4. A strip charr :atcl
recorder consists of: -l op
(r') A long roll of graph paper which moves vertically. Mark
(irJ A drive system for driving the paper at some selected speed. -{ Sr
speed selector switch is provided for chart speeds of 1 mm/sec tc . his
lOO mm/sec. .:vius
(iirJ A stylus for making marks on the moving graph paper. The stylus ,iack
St

moves horizontally in proportion to the quantity to be recorded. .up


(iu) A styles drive system to move proportional to the quantity to bt -:qUlI
recorded. Th
A range selector switch is used so that the recorder drive system i: .: the
within the acceptable level. : USer
. don
Page No. 251 of 328.
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 253

Stylus drive
system

Stylus

l
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Analogne
ntermation
'- be recorded

ate
Poper drive
mechanism
Fig. 14.4. Basic Strip Chart Recorder
. aper Drive System
- he paper drive system moves the paper at a uniform
speed. An
.:-onic stepper motor, synchronous motor or spring wound mechanism
..ed for driving the paper.
llirking Mechanism
- here are many types of mechanisms used for making marks on the
yM
r :r. The most commonly used ones are as follows:
f,arking with Ink filled Stylus
ud

arking with Heated Stylus


Some recorders ,se a heated stylus which writes on a speciar paper.
s method overcomes the difhculties encountered in the ink hlled
St

Page No. 252 of 328.


Fundamentals of Biomedical Instrumentation
254 Fundamentals of Biomedical lnstrumentation

stylus marking in this method the paper with special coating which is
sensitive to a current. When the current is passed from the stylus to the
paper a trace appears on the paper. In electrostatic stylus method the
stylus produces a high voltage discharge which produces a permanent

l
trace on an electro-sensitive paper. The other method is optical marking
method. This method uses a beam of light to write on a photosensitive

ria
paper. This method allows higher frequencies to be recorded and permits
a relatively large chart speed with a good resolution. The disadvantage
is the cost of paper which is very high and this is a photographic method
and in this case the paper must be developed before a record is available.
This method is not very suitable, where instantaneous monitoring is
required.
Tracing Systems

ate
There are two types of tracing systems used for producing graphic
representations. In the curvilinear system the stylus is mounted on a
central pivot and moves through an arc. In this system the time base
is curved. lines. The other system is rectiiinear system of tracing. In the
system a line of constant time is perpendicular tc the time axis and
therefore the system produces a straight line across the width of the
chart.
In the biomedical recorders the electrode picks up the bioelectrica-
potentials and transducer is used to convert the physiological signal to
be measured into a usable electrical output. The signal conditione:
yM
converts the output of the electrode/transducer into an electrical quantiq'
suitable for operating the writing system. The writing system provides a
visible graphic representation of the input signal.
14.3.2. Galvanometric Recorders
The mechanism of Galvanometric recorder is a modifred form c:
DArsonval meter movement. A cut-away view of the moving coil elemer-:
is shown in figure 14.5. As the current flows through the coil it deflec:=
The deflection of the coil is proportional to the input quantity. Th"t
instrument requires an appreciable torque. For this a large moving cc:l
in a stroilg magnetic field is needed. The instrumcnt lnust be criticaf
damped so there is no overshoot. But this results in slow respons:-
ud

which is being of the order of 0.75 to 1.5 sec. This type of recorder 5
not r-rseful for recording fast variations in either current or voltage. T1--:r
is suitable for recording average values.
A galvanometer type recorder is shown in figure 14.6.It is a modited
version of PMMC (Permanent Magnet Moving Coil) instrument. the ch
may be driven at a constant speed by a clock',riork movement, an electr-
motor or stepper motor. The recorder shown in fig. 14'6 uses a rectil
St

system of tracing. The galvanometric recorders can work on range f


a few mA to several mA or from a few mV to several mV it can worti
a low frequency bandwidth of o to lo Hz.It has a sensitivity of 0.4 r:-i"
mm. For measurement of smaller voltages iinear amplifier are used
these recorder the bearing rnust be substantially larger than those u
in indicator instrurrnents because of the large mass of cool and sn--
Page No. 253 of 328.
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 255

l
Steel ring

ria
Moving coil

ate
Spirols
Steel core

Fig. 14.5. Cut-away view of moving coil element

lnk reservoir
Moving coil
movement
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Rollers

Drive-motor

Curvi-linear chort

Rollers

Fig. 14.6. Galvanometer Recorder System


The ink recording method is very widely used. The trace should be
ud

thin, well defined and uninterrupted to allow best resolution of


measurements. To achieve this a pressurised ink system is developed.
The system uses high pressure, high viscosity ink to overcome inertial
effects within the pen tube and give continuous flow of ink even at high
pen velocities. Ink is supplied by a ce,ttral ink reservoir that produces
Dressure of 15 to 20 psi and forces viscous ink into the microscopic
rores on the chart paper surface. The other method of heated stylus
-.rriting system in which pointed stylus make a mark on the moving wax
St

?aper.
The usual paper drive is by a synchronous motor with a gear box for
;chieving different chart speeds. The other method of achieving variable
=peed by the use of different crystal frequency is also employed.
Normally
= time.marker is produced before taking the ECG or other recording.
As already studied by the students in the course on measurement
254 ofthe
=:rd Instruments
Page No. 328.PMMC instrument using galvanometric principle
Fundamentals of Biomedical Instrumentation

256 Fundamentals of Biomedical lnstrumentation

has three forces which act upon the moving system namely (4 the d
deflecting force (ir) the controlling force and (lir) the damping force. The p
deflection force results from the current which flows in the coil and is a)
supplied to it from the driving ampliher. This force cause the pen to hi

l
move from its zero position. A controlling force applied by the spring et

ria
action will limit the otherwise indefinite movement of the pen and ensure w.
that same movement of pen is always achieve by a given value quantity 1n
to be recorded. The damping force is necessary in order to bring the wl
position of pen to rest quickly. In the absence of damping, owing to the mi
inertia of the moving parts, the pen would oscillate about the final ap
deflecting position for some time before coming to rest. The main function ap
of damping is to absorb energz from the oscillating system and to bring an
it quickly in its equilibrium position. The amount of overshoot of pen sh

ate
depends upon the value of the damping factor. This is taken as unity no
when the galvanometer is critically damped. Under these conditions, the
coil r'rill deflect smoothly and take up its final position in the shortest
possible time.
T Potentiometric Recorders
Potentiometric recorders are used for recording of low frequencv
phenomena. The basic disadvantage of a galvanometer type of recorder
is that it has a low input impedance and a limited sensitivity. The
operating principle of a potentiometer recorder is shown in figare 14.7
A resistive slide wire AB is supplied with a constant current from a
yM
Li
voll
battery S. The slide wire is constructed trom a resistance wire of high F
stability and uniform cross section so that resistance per unit length is
constant. The unknown dc voltage is fed between the moving contact C
and one end A of the slide wire. The moving contact C is adjusted so tha:
the current flowing through the detector is zero. At that moment the
unknown input voltage is proportional to the length of the wire AC. k-
practice the slide wire is calibrated in terms of span voltage being 100.
10 or 1 mV. The moving contact of the slide wire is attached with a per:
which writes on a caliberated chart. ..:TIC
The balancing of the unknown input voltage with reference to the --:ne
reference voltage is achieved by using a servo motor. The voltage difference ..:lp
ud

between the sliding contact C and the input dc signal is given to a -mj
chopper type dc amplifier (in place of a galvanometer coil). The coppe: :tl

is driven at the mains frequency and convert this voltage difference intc I
a square wave signal. This signal is amplified by the amplifier and the:- ,':le
applied to the control winding of the servo motor. The servo moto: : -:aI
is a two phase motor whose second winding is supplied with a 50 H_- 'ra
mains supply which works as a reference phase winding. The motor -= -. iln
mechanically coupled to the sliding contact of the potentiometer wher= ::.S
St

pen is attached. When signal input or the voltage to be recorded is give:_ :m


to the input point, the motor moves the pen and simultaneously varie= : '::l
the voltage of the sliding contact such that the potential differenc: :r.:eI]
between the input voltage and reference voltage is zero. The circu-: Pr
operates in such a way that the motor revolves in one direction if ti.: :- .ll

voltage increases and operates in the reverse direction if the volta.:


Page No. 255 of 328.
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 257

decreases. The servo motor is shaft-coupled to a techo-generator to


provide the damping to the servo motor. The response slows down as it
approaches balance position. The servo motor used in this arrangement
has two separate stator windings, which are physically perpendicular to

l
each other. The out of phase alternative currents irr the two stator

ria
windings produce a rotating magnetic field. The rotating magnetic held
induces a voltage in the rotor and resulting current in the armature
which makes the rotor to rotate in the same direction as the rotating
magnetic fields. For producing a rotating magnetic-field the ac voltage
applied to one stator winding should be 9o' out of phase with the volta[e
applied to the other winding. This can be done either in the po*E,
amplifier, which supplies the voltage to control winding or in a prrr""
shift network for the line winding. For zero input signai the rotor does

ate
not turn.

o
.0)
o=
.Nj
aa
+a)
v)-
o
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o.

AC servometer
Fig. 14.7. Schematic diagram of a self-balancing potentiometric recorder
The paper chart is driven by a constant speed motor to provide a
:-re axis. In this type of recorder the input signal is plotted against
i :re. In the current generation of record.ers the chart is moved with the
F ,ip of a stepper motor. The advantage of using a stepper motor
in
ud

nparison to a synchronous motor is that the speed of chart movement


-:-r be varied.
In the earlier recorders the electromechanical contact between slider

liability and
, has two hxed
-s and one coil on which the pen is htted. The distance is measured
St

propagat he detail of circuit diagram may be


udy by St titled ultrasonic feedback recording
, Measure 1980, 131.
?otentiometric recorders are very useful for the record of slowly
- -ng physiological signals over a period of 24 hours.
Page No. 256 of 328.
Fundamentals of Biomedical Instrumentation

258 Fundamentals of Biomedical lnstrumentation

1 Itraviolet Recorders
4.3.3. U re
The galvanometric and potentiometric recorders due to the inertia of el
writing system are not suitabte to work when the signal is of higher utr
frequency. Ultra-violet (UV) recorders record the events with frequencies pa

l
from zero to several kHz. The writing system of an ultra-violet recorder 25

ria
consists of an ultra-violet light source and a photosensitive paper. The dis
trace becomes variable in 30 sec after the exposure. If the recordings are res
required for permanent storage then after the exposure paper should be of,
chemically treated.
The recorder consists of a number of galvanometer (moving coil) anc
elements mounted in a single magnet block as shown in figure 14.8. A wirr
surface silvered mirror is attached to the galvanometer coil. A paper barr
sensitive to r.ltraviolet light is used for producing a trace for the purpose volt

ate
of recording. The ultra-violet light is projected on the paper with the help app
JOSl
or mirror's attached to the galvanometer coil.
char
UV :rak
light
source
:oatr
::om
Poper drive mechanism T
:i dr
.25
-:ree
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UV light
-sed.
Sensitive paper :'a lel
Recorded trace + -:ctrr
._-cxll'l
Timing line Galvanomes
coils i : turi
.ir_ lUfi
Fig. 14.8. Ultraviolet (u.v.) recorder
]:fUe
The moving (galvanometer) coil is deflected if any current is passed
i4.3.5.
through its coil, because the coils are under the influence of magnetrc
freld. The ultra violet light falling on it is deflected and is projected co Tht
the u.v. light sensitive paper through a lens and mirror system. ::em
paper is clriven past the moving light spot and thus a trace of variau
ud

in proportion to the current with respect to time is traced- Tn manv u


recorders arrangement are provided to select a suitable paper drir :,1:pe
speed out of as many as 12 difference speeds. Some u.v. recorders h :IA
an arrangement for controlling the speed of paper by applying exte:
voltage
Ultra-violet recorders may be single channel or multichannel' ::cII
dynamic performance of a ultraviolet recorder is determined by chart =jllr
St

characteristic, its overall frequency response depends on galvanom.


performance and its maximum writing speed. The u.v. recorders
frequency response upto 2OO0 Hz are commercially available.
'l4.3.4. Electrostatic Recorder
The frequency response of pen type recorders are limited to fer
257 of 328.in UV recorders take sometime
before the pe
No.the recording
Pageand
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 2Sg

record o
electro ;i
upto s T
paper for recording and gives

l
250 mm per sec. The electro

ria
iisadvantage of stylus inertia, effects such as
overshoot or low-frequency
'esponse limits, rinkage effects such as non-rinearity,
:,f clogging of ink, etc.
hysteresis effects
The electrostatic recording co
,nd vacuum knife. The imaging
,,'ire elements, spaced
4 per mm.
ars called shoes. As the paper mo
rltage is applied to the selected

ate
:plied to the closest shoes. The pape
,sitively charged ink particles aaheie to where
the paper had a
'arge' A vacuum knife removes arl excess toner and
other
--king the image with charged particles. when erposed to
air the
ated particles permanentry
- in the machine completely bond dry.
to the paper and the record emerges
The paper is moved at a speed of 0.25
cord is made
dots. At the top speed of 2SO mm/
_ r mm. In defining frequency
t spacing of
- :e response atic recorder
capture, bandwidth and waveform response are
yM
, .d. defined as the shortest ar.atio"
- :ep frlse which can
value of recorder. The peak capture rating of the
' ':rostatic recorder is 40 microsecond. ganawiatn
': ''imum sine wave frequency which can be recordedis defined as the
with a specified
' 'racy. The bandwidth of the recording system is sooo Hz with an
' ''racy of 2ok or 15 kHz with an accuracy of 2ook No waveform
'' .,-ency analysis will be possible. or

'{ 35. lnkjet Recorder


-re advantage of inkjet recorder is
the frequency response of the
'n which extend to several hundred cycles. The technfrue consists
ud

light beam

"lt'"Jll,'l
l} ",k:
u p to t o o o Hz. rh e arra.g.-" r,":"::H
: between the poles of an electromagnet. Theh"r,ff
:i :.,-::i"
- - nagnet coils of this
to the output amplifrer and are driven by
piified cylindricai permanent magnet is attached
St

. capilla ns of .r...rrt corresponding to the signal


rn in the electromagnet coil produce a varying magnetic
field
-rteracts with the frerd of the permanent magnet wrricrrls
attached
.ra.ction deflect
., rm of a nozzle
essllre from the
Page No. paper and the
258 of 328.
Fundamentals of Biomedical Instrumentation

260 Fundamentals of Biomedical lnstrumentation

The filtered ink is frlled in the reservoir. The high pressure for jet InIr
recording in produced by a pump and is adjustable between 20-50
atmospheric pressure. The inkjet recorders are suitable for recording at mal
high frequency due to the absence of any moving assembly. The mass

l
in this case is comparable to that of UV recorder. In this case the Prir
amplitude of 60 mm peak to peak can be traced with the inkjet recorder'

ria
It different colour ink is used then the inkjet recorder can work as :art
multichannel recorder. Since, the inkjet recorder can write on the trr1n
recording paper without friction, linear tracing is ensured even with ven- _1av(

small amplitudes. The inkjet recorder use the normal untreated paper rr fe
which is much cheaper as compared to heat sensitive, photographic
paper. This type of recorder is suitable for phonocardiography and :t1Ovr

.1""t.o-yography when require recording of signals which is much higher -:na

ate
as compared to Pen tYPe recorder. ::1e tr
leCOr
14.3.6. Colour Printer -.estr
Inkjet printers were introduce in the market in 1980. An inkje:
printer places extremely small droplets of ink onto paper to create or-
i*u.g.. The dots are extremely small usually between 50 and 60 microns
in diameter. The dots are thinner than the diameter of human ha-::
(70 microns). The dots are positioned on the paper very precisely, wir-
resolution of upto I44O x 720 dots per inch (dpi).
There are several major printer technologies available. Thest
yM
technologies can be broken down into two main categories with severa
types in each.
A. Impact
These printers have a mechanism that touches the paper in order ::
create an image. There are two main technologies-
. Dot matrix printers use a series of small pins to strike a ribbc-
coated with ink, causing the ink to transfer to the paper at Lt
point of impact. Thr
. Character printers are basically computerised t5rpewriters' Thgt :-:thor
have a ball or series of bars with actual characters (letters cr - -: III
numbers) embossed on the surface. The appropriate character s :
ud

:his
struck against the ink ribbon, transferring the character's image :n' : -:ble
the paper. ::ott
':'---s n
B. Non-Impact - crir
These printers do not touch the paper when creating an image, inl'-ra clet
printers are part of this group and includes. {p
. Inkjet printers which use a series of nozzles to spray drops of : IIO
directly on the PaPer.
St

r Crj
. Laser printers use dry ink (toner), static electricity and hea: -:n tl
place and bond the ink onto the paper. : 1OZ2
-:pla
Print Head AssemblY
Print head is the core of an inkjet printer. The print head cont
a series of nozzles that are used to spray drops of ink.
Page No. 259 of 328.
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 261

Ink Cartridge
In colour printer the cartridge has three primary colours cyan,
=agenta, yellow and black (CMYK).

l
Print Head Stepper Motor

ria
A stepper motor moves the print head assembly (print head and ink
,rartridges) back and forth across the paper. A belt is used to attach the
of the inkjet printers
paper in from the tray
ead assembly is ready

=--ovethe paper in the exact increment need.o ,.1'"::1"" fH',"ffiJ:


I::lage is printed. A smallbut sophisticated amount of circuit is built into

ate
:e printers to control all the mechanical aspect of operation, as well as
tcode the information sent to the printer from the microprocessor based
.strument.
Heating

\
\1+

lnk
reservors
yM

Fig. 14.9. A thermal bubble print head


There are various methods of ink to be put on the paper. The important
:thods are heating or vibration. A thermal bubble method is used by
: manuthcturer canon and Hewlett Packard as shown in figure 14.9.
this tiny resistor create heat, and this heat vaporizes ink to create a
ud

cble. As the bubble expands, some of the ink is pushed out of a nozzle
:o the paper. when the bubble collapses, a vacuum is created. This
-ls more ink into the print head from the cartridge. A typical bubble
print head has 300 on 600 tiny nozzres and all of then can fire a
, plet simultaneously.

A piezoelectric print head is patented by Epson as shown in figure


I0. A crystal is located at the back of the ink reservoir of each nozzle.
:: crystal receivers a tiny electric charge that causes it to vibrate.
St

:-en the crystal vibrates inward, it forces a tiny amount of ink out of
nozzle. when it vibrates out, it pulls some more ink into the reservoir
:eplace the ink sprayed out.

Page No. 260 of 328.


Fundamentals of Biomedical Instrumentation

262 Fundamentals of Biomedical lnstrumentation

l
C
(;A

ria
ate
Nozzle

Fig. 14.10. Piezoelectric inkjet print head


D
Colour Laser Printers
colour laser printers works the same way as monochrome printers-
except they go through the entire printing process four times, one pasD
each for cyan (blue), magenta (red), yellow and black' By combtru-o;
these four colours of toner in varying proportions one can generate th
yM
full spectrum of colour.
There are several different ways of doing this. Some printers
four toner and developer units on a rotating wheel' The' printer
down the electrostatic image of one colour and puts that toner unit i
position, it then applies this colour to the paper and goes through
p.o"."" again for the next colour. Some printers add all the four colo
to a plate before placing the image on the paper'
Some expensive printers actually have a complete printer unit
as a laser assembly, a drum and a toner system, for each colour.
paper simply moves past the different drum heads, collecting all
colours similar to an assembly line.
ud

14.4, I SUMMARY
1. Biopotential Amplifier: The preamplifier and power amplifier is
to drive the pen motors of the recorder.
2. Monitor: The monitor is a display devices to display the im
physiological parameters such as ECG, heart rate, etc' There
u"iior" types of CRT"s such as non fade, bouncing ball etc', u-
St

are used in the monitors.


3. Recorders: The recorders are used to make a hard copy of the
like ECG, EMG, EEG etc. There are various types of recorders
as Galvanometric, Potentiometric, Ultra-violet, Electrostatic and
The different types of recorders are suitable for different fu
A Galvanometric recorder is simple cheapest and is useful '-
Page No. 261 of 328.
Fundamentals of Biomedical Instrumentation

Monitors and Recorders 263

frequency applications. If the frequenc}, is high, the other type of


recorders such as Ultra-violet, Electrostatic or inkjet are more suitable.

l
OE elcided

ria
1. Discuss requirement of an ideal biopotential amplifrer.
2. With a block diagram discuss the various stages in an operational
ampliher OA.
3. Explain any two types of recorders with the help of suitable diagrams.
(UPTU 2OOs)
1.4. Explain ultra-violet (UV) recorders. (UPTU 2006)
-1.5. Discuss inkjet and potentiometric recorders. (UPTU 2006)
-.6. Explain monitors and printers.

ate
(UPTU 2006)
:.7. Discuss different types of displays in a monitor.

JAA
\
r ,1t
t;
yM
7
ud
St

Page No. 262 of 328.


Fundamentals of Biomedical Instrumentation

l
ria
Shock Hazards and Prevention

>. fnside this chaPter

ate
r5.1. Physiological Effects of Electrical Current
t5.2. Shock Hazards from Electrical Equipment
15.3. Methods of Accident Prevention
t5.4. Isolated Power Distribution Si,'stem
\
Kno\
yM
15.5. Summary :o tt
:lSSL
:he 1

Awareness for safety from shock hazards from medical equipmen:-" :ISSU
is of prime importance. During seventies sensational reports we- .lmit,
published on microshock hazards which was the cause of large numb'r .s hi1
of deaths of patients in intensive-care units. Consequently numero--:s :he d
regulations and standards came into existence to improve electrical safe-- :arts
in the hospital. Although some of the requirements have increased ''= :r Fil
cost of health care, but this development has dehnitely contributed ln
improved design of electrical and electronic equipments in medical use
ud

15I. I PHYSIOLOGICAL EFFECTS OF ELECTRICAL CURRENT -"r(


The interaction of electrical current with the tissues of the body ca
electrical accidents. If the current of sufficient magnitude flows thro
the body in such a way that it impairs the functioning of vital or
it is the electrical accident. If three conditions are met simultaneou
the electrical accident occurs: ^l
AN
St

Two contacts must exist with the bodv and simultaneously voi: - ,h{
source to drive current through the two contacts should also exist. :, -en$
damaging effects of the current depend on the magnitude and alsc ,,.::Sat
the current path way through the body, which in turn depends or: - ,:- Il IU
Iocation of the hrst and second contacts, see hgure 15.1. ' ::-tra
:- COI
264
Page No. 263 of 328. .-: Of[
Fundamentals of Biomedical Instrumentation

Shock Hazards and Prevention 265

Heart

l
Body surface Second contact

ria
Voltage source

First contact

ate
Fig. 15.1. Three necessary conditions of electrical accidents,
i.e , voltage source, first contact and second contact
When both contacts are applied to the surface of the body, it is
inown as macroshock. In the case when one contact is applied directly
\
r'j,
yM
o the heart, it is known as microshock. The electric current effects the
:issue in two different ways. When the electric ener5/ is dissipated in
:he tissue it causes temperature rise. A high temperature can damage
:issue i.e., burn. In household cases, electrical burns are normally
-imited to localized damage near contact points i.e. density of the current
-s highest. In the cases of lightening accidents and industrial accidents,
:he dissipated electrical energz may be suff,rcient enough to burn larger
:arts of the body. A generalized model of an electrical accident is shown
.n Figure 15.2, which will be useful in several ways.
Rcz Rt

R, = fault resistance
ud

R", = first contact re