Biomedical Engineering Module III S5-ECE, 2017

Types of Electrodes
Essentially, five types of electrodes are typically used:
1. Scalp: silver pads, discs, or cups; stainless steel rods; and chlorided silver wires.
2. Sphenoidal: Alternating insulated silver and bare wire and chlorided tip inserted through
muscle tissue by a needle.
3. Nasopharyngeal: silver rod with silver ball at the tip inserted through the nostrils.
4. Electrocorticographic: cotton wicks soaked in saline solution that rests on the brain
surface (removes artifacts generated in the cerebrum by each heartbeat).
5. Intracerebral: sheaves of Teflon-coated gold or platinum wires cut at various distances
from the sheaf tip and used to electrically stimulate the brain.

Reusable disks
 These electrodes can be placed close to the scalp, even in a region with hair because they are
small. A small amount of conducting gel needs to be used under each disk. The electrodes are
held in place by a washable elastic head band. Disks made of tin, silver, and gold are
available. They can be cleaned with soap and water or Cidex.
 The cost of each disk and lead is dependent on the type of metal used as a conductor, the
gauge of wire used as a lead, and the type of insulation on the wire lead.

EEG Cups with disks


I N
Different styles of caps are available with different numbers and types of electrodes. Some

S .
OTE
caps are available for use with replaceable disks and leads. Gel is injected under each disk


K T U N
through a hole in the back of the disk.
Since the disks on a region of the scalp covered with hair cannot be placed as close to the
scalp as individual disc electrodes, a greater amount of conducting gel needs to be injected
under each. After its use, more time is required to clean the cap and its electrodes, as well as
the hair of the subject. Depending on the style and longevity of the cap and the electrodes,
their expense can be moderate to high.

Adhesive Gel Electrodes

 These are the same disposable silver/silver chloride electrodes used to record ECGs and
EMGs, and they can be used with the same snap leads used for recording those signals.
 These electrodes are an inexpensive solution for recording from regions of the scalp without
hair. They cannot be placed close to the scalp in regions with hair, since the adhesive pad
around the electrode would attach to hair and not the scalp.
Subdermal Needles
These are sterilized, single-use needles that are placed under the skin. Needles are available
with permanently attached wire leads, where the whole assembly is discarded, or sockets that
are attached to lead wires with matching plugs. Since they are a sterile single-use item, the
expense of needle electrodes is moderate to high.

Placement of electrodes

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 An internationally recognized method that allows EEG electrode placement to be
standardized.
 Ensures inter-electrode spacing is equal
 Electrode placements proportional to skull size & shape
 Covers all brain regions
F = Frontal P = Parietal
T = Temporal O= Occipital

 Numbering system

Odd=Left Side Even=Right Side Z=Midline

Four Skull Landmarks

•Nasion
•Inion
•Left Pre‐auricular point
•Right Pre‐auricular point

S . I N

N OTE
Lead FP1 for example, is in the frontal area and lies on

T U

K
a circle with other leads. Nineteen electrodes, plus one
for grounding the subject, are used.
Electrodes are placed (using a flexible tape measure)
by measuring the nasion-inion distance and marking points on the (shaved) head 10%, 20%,
20%, 20%. and 10% of this length.
 The vertex. C2 electrode is the midpoint. Figure given below shows the complete 10- 20
electrode placement system. Here, 19 electrodes are used on the scalp, plus one for grounding
the subject.

 Electrode arrangements may be either unipolar or bipolar. A unipolar arrangement is

composed of a number of scalp leads connected to a common indifference point such as an
earlobe.
 Hence, one electrode is common to all channels. For example, FP2 may be measured with
respect to two ear electrodes connected together or summation of scalp electrodes.
 A bipolar arrangement is achieved by the interconnection of scalp electrodes. The difference
of voltage between and Fpg may also be measured. Montages are patterns of connections
between electrodes and recording channels. All of these combinations have inputs to a three-
lead differential amplifier and use a third connection for the reference (two ears, forehead, or
nose).

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Biomedical Engineering Module III S5-ECE, 2017

Measurement of Cz
• Measure the distance from pre‐auricular point to pre‐ auricular
point
•Mark the midpoint (50%) with a vertical line • This cross
represents Cz which has been correctly aligned in the horizontal
& vertical planes

Measurements - T3, C3, Cz, C4, T4

Mark 10%, 20%, 20%, 20%, 20%, 10% =T3,C3, Cz, C4, T4

Measurements - Fpz, Fz, Cz, Pz, Oz

Reapply the tape along the midline from nasion to inion

Mark 10%, 20%, 20%, 20%, 20%, 10% =FpzFz, Cz, Pz, Oz

Measurements - Fp1, F7, T3, T5, O1, Oz

S . I N
Measure the distance between Fpz & Oz by applying the tape
around the head via T3.

T U N OTE
Mark at 10%, 20%, 20%, 20%, 20%, 10% =Fp1F7, T3, T5, O1,
Oz,
K
Measurement - F3

Measure Fp1 to C3 and mark midpoint

Measure Fz to F7 and mark midpoint
Mark 50% = F3
(Repeat the process using Fp2 to C4 & Fz to F8 to mark
F4)

Measurements M1 & M2
M1 & M2 are the reference electrodes (formally known as A1 & A2)
M1 & M2 are placed on the mastoid (M) process.
These are the bony prominences behind the ears.

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EVOKED POTENTIAL

 A special form of electroencephalography is the recording of evoked potentials from

various parts of the nervous system. In this technique the EEG response to some form
of sensory stimulus, such as a flash of a light or an audible click, is measured.
 To distinguish the response to the stimulus from ongoing EEG activity, the EEG
signals are time-locked to the stimulus pulses and averaged, so that the evoked
response is reinforced with each presentation of the stimulus, while any activity not
synchronized to the stimulus is averaged out.
 Figure given below shows a raw EEG record containing an evoked response from a
single presentation of the stimulus and the effect of averaging 8 and 64 presentations,
respectively.

S . I N
T U N OTE
K

Averaging of EEG evoked potentials:

(a) raw EEG of single response; (b) average of 8 responses; (c) average of 64 responses.

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 Biomedical Engineering Module III S5-ECE, 2017

Body Plethysmographs

 Body plethysmography is a well-established technique of lung function determination.

 plethysmographs are commonly used to measure the functional residual capacity (FRC) of
the lungs—the volume in the lungs when the muscles of respiration are relaxed—and total
lung capacity.

Principles of body plethysmography

Apparatus

S . I N
T U N OTE
K

B, body plethysmograph;
S, shutter which occludes airway;
L, lung;
C, capacitance manometer to record pressure changes in the plethysmograph (which are
proportional to the change in body volume);
P, capacitance manometer to record pressure changes in the mouth (which are equal to
alveolar pressure when there is no airflow);
O, cathode ray oscillograph with x and y axes.

The volume-constant whole-body plethysmograph is a chamber resembling a glass-walled

telephone box in shape and volume (about 700–1000 L). During measurement the box is
closed with an airtight seal, except for a small controlled leak that is used to stabilize the
internal pressure by allowing for equilibration of slow pressure changes, e.g. due to warming-

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 up. One pressure transducer serves to measure the pressure inside the box relative to ambient
pressure, another one is placed close to the mouth for recording mouth pressure during a
shutter maneuver. The shutter mechanism can be used to deliberately block the airflow by
transient occlusion. Moreover, respiratory flow rate is recorded by conventional equipment,
such as pneumotachograph, anemometer, or ultrasound measurement, all of which is
calibrated via syringes delivering a defined volume.

Principle of measurement

The principle of measurement of the commonly used plethysmographs relies on detecting

changes in box pressure in combination with either changes of mouth pressure or with flow
rate under defined breathing conditions. These signals are evaluated in order to determine
static lung volumes and airflow resistance.

The basic physical principle exploited by body plethysmography is the law of Boyle-
Mariotte.

Based on Boyle’s law PV = k

 Assumes temperature remains constant

 When subject breathes in and out against a shutter, changes in pressure and volume occur

S . I N
T U N OTE
K

For the present purpose this law can be concisely expressed as the statement that for a fixed
amount of gas in a closed compartment the relative changes in the compartment’s volume are
always equal in magnitude but opposite in sign to the relative changes in pressure. Thus one
can infer relative volume changes from pressure changes and, even more, absolute volumes if
the absolute volume changes are known.

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 Biomedical Engineering Module III S5-ECE, 2017

Gas Exchange and Distribution

Once air is in the lungs, oxygen and carbon dioxide must be exchanged between the air and
the blood in the lungs and between the blood and the cells in the body tissues. In addition, the
gases must be transported between the lungs and the tissue by the blood. A number of tests
have been devised to determine the effectiveness with which these processes are carried out.

Measurements of Gaseous Exchange and Diffusion

 The mixing of gases within the lungs, the ventilation of the alveoli, and the exchange of
oxygen and carbon dioxide between the air and blood in the lungs all take place through a
process called diffusion.
 Diffusion is the movement of gas molecules from a point of higher pressure to a point of
lower pressure to equalize the pressure difference. This process can occur when the gas is
unequally distributed in a chamber or wherever a pressure difference exists in the gas on two
sides of a membrane permeable to that gas.
 Measurements required for determining the amount of diffusion involve the partial pressures
of oxygen and carbon dioxide, Pq2 and Pc02» respectively. There are many methods by
which these measurements can be obtained, including some chemical analysis methods and
measurements of diffusing capacity.

S . I N
1. Chemical analysis methods. In the original gas analyzers devices, a gas sample of

OTE
approximately 0.5 ml is introduced into a reaction chamber by use of a transfer pipet at the
upper end of the reaction chamber capillary. An indicator droplet in this capillary allows the

T U N
sample to be balanced against a trapped volume of air in the thermobarometer. Absorbing
K
fluids for C02 and 02 can be transferred in from side arms without causing any change in the
total volume of the system. The micrometer is adjusted so as to put mercury into the system
in place of the gases being absorbed. The volume of the absorbed gases is read from the
micrometer barrel calibration.
2. Diffusing capacity using CO infrared analyzer. To determine the efficiency of perfusion of
the lungs by blood and the diffusion of gases, the most important tests are those that measure
02, C02, pH, and bicarbonate in arterial blood. In trying to measure the diffusion rate of
oxygen from the alveoli into the blood, it is usually assumed that all alveoli have an equal
concentration of oxygen. Actually, this condition does not exist because of the unequal
distribution of ventilation in the lung; hence, the terms diffusing capacity or transfer factor
(rather than diffusion) arc used to describe the transfer of oxygen from the alveoli into the
pulmonary capillary blood.

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 Gas chromatograph. The quantities of various gases in the expired air can also be
determined by means of a gas chromatograph, an instrument in which the gases are separated
as the air passes through a column containing various substances that interact with the gases.
The reactions cause different gases to pass through the column at different rates so that they
leave the column at different times. The quantity of each gas is measured as it emerges. To
identify the gases in the expired air other than oxygen, nitrogen, or COj, a mass spectrometer
is used in conjunction with the gas chromatograph. The mass spectrometer identifies the ions
according to their mass/charge ratio.

Measurements of Gas Distribution

The distribution of oxygen from the lungs to the tissues and carbon dioxide from the tissues
to the lungs takes place in the blood. The process, by which each gas is transported, however,
is quite different. As mentioned earlier, oxygen is carried by the hemoglobin of the red blood
cells. On the other hand, carbon dioxide is carried through chemical processes in which C02
and water combine to produce carbonic acid, which is dissolved in the blood. The amount of
carbonic acid in the blood, in turn, affects the pH of the blood. In assessing the performance
of the blood in its ability to transport respiratory gases, then, measurements of the partial
pressures of oxygen (Pq}) and carbon dioxide (Pco2) ]n the blood, the percent of oxygenation
of the hemoglobin, and the pH of the blood are most useful.

INSTRUMENTS USED FOR CLINICAL LABORATORY

S . I N
OTE
1. SPECTROPHOTOMETERS


K T U N
A spectrophotometer is an instrument which isolates monochromatic radiation in a more
efficient and versatile manner than colour filters used in filter photometers.
 In these instruments, light from the source is made into a parallel beam and passed to a prism
or diffraction grating, where light of different wavelengths is dispersed at different angles.
 The amount of light reaching the detector of a spectrophotometer is generally much smaller
than that available for a colorimeter, because of the small spectral band width.
 Therefore, a more sensitive detector is required. A photomultiplier or vacuum photocell is
generally employed.

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 Biomedical Engineering Module III S5-ECE, 2017

 In this device the simple selection filter of the colorimeter is replaced by a monochromator.
 A monochromator uses a diffraction grating G (or a prism) to disperse light from a lamp that
falls through an entrance slit S, into its spectral components.
 An exit slit S2 selects a narrow band of the spectrum, which is used to measure the absorption
of a sample in cuvette C.
 The narrower the exit slit, the narrower the bandwidth of the light, but also the smaller its
intensity.
 A sensitive photodetector D (often a photomultiplier) is therefore required, together with an
amplifier and a meter, which is calibrated in units of transmittance or absorbance. The
wavelength of the light can be changed by rotating the grating.
 The spectrophotometer allows the determination of the absorption of samples at various
wavelengths. The light output of the lamp, however, as well as the sensitivity of the
photodetector and the light absorption of the cuvette and solvent, varies when the wavelength
is changed.
 This situation requires that, for each wavelength setting, the density reading be set to zero,
with the sample being replaced by a blank cuvette, usually filled with the same solvent as
used for the sample. In double-beam spectrophotometers this procedure is done automatically
by switching the beam between a sample light path and a reference light path, generally with
a mechanical shutter or rotating mirror. By using a computing circuit, the readings from both
paths are compared and only the ratio of the absorbances (or the difference of the densities) is
indicated.

S . I N
T U N OTE
K

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 Biomedical Engineering Module III S5-ECE, 2017

OXIMETRY

 Oximetry refers to the determination of the percentage of oxygen saturation of the circulating
arterial blood. By definition:


Where [Hb02] is the concentration of oxygenated haemoglobin |Hb | is the concentration of
deoxygenated haemoglobin.

 In clinical practice, percentage of oxygen saturation in the blood is of great importance. This
saturation being a bio-constant, is an indications of the performance of the most important
cardio-respiratory functions. It is maintained at a fairly constant value to within a few percent
in an healthy organism.
 The main application areas of oximetry arc the diagnosis of cardiac and vascular anomalies:
the treatment of post-operative anoxia and the treatment of anoxia resulting from pulmonary
affections.
 Oximetry is now considered a standard of care in anaesthesiology and has significantly
reduced anaesthesia-related cardiac deaths.

In Vitro Oximetry

. I N
When blood is withdrawn from the subject under anaerobic conditions and measurement for
S
OTE
oxygen saturation is made at a later time in the laboratory, the procedure is referred to as in


vino oximetry.

K
Transmission Oximetry:
T U N
Measurement of the degree of oxygen saturation of the blood can be made by
spectrophotometric method.
 In spcctrophotometry the concentration of substances held in solution are measured by
determining the relative light attenuations that the light absorbing substances cause at each of
several wavelengths.

In Vivo Oximetry
In vivo oximetry measures the oxygen saturation of blood while the blood is flowing through
the vascu lar system or it may be flowing through a cuvette directly connected with the
circulatory system by means of a catheter. The blood in this case is unhaemolyzed. Both
techniques, reflection and transmission,are utilized for in vivo oximetry.

EAR OXIMETER
In this case, the pinna of the ear acts as a cuvette. Blood in the ear must be made similar to
arterial blood in composition. This is done by increasing the flow through the ear without
appreciably increasing the metabolism. Maximum vasodilatation is achieved by keeping the
ear warm. It takes about 5 or 10 min for the ear to become fully dilated after the ear unit has
been put up in place and the lamp turned on.

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 Figure above explains the basic operation of the instrument. The light source isa tungsten-
iodine lamp that has a high output in the spectrum of interest. A lens system collimates the
light beam and directs it through thin-film interference filters that provide wavelength
selection.
S . I N
OTE
 These filters are mounted in the periphery of a wheel rotating at 1300 rpm and thus cut the


to the ear.
K U N
light beam sequentially. The filtered light beam then enters a fibre optic bundle that carries it
T
Another fibre optic bundle carries the light passing through the car back to a detector in the
instrument. A second light path is developed with a beam splitter in the path of the collimated
light beam near the source. This path also passes through the filter wheel and then through a
fibre optic bundle directly to the photodetector. So, the detector receives two light pulses for
each wavelength.
 The processor takes the ratio of two pulses as the measured value; so readings are
compensated for any changes in the spectral characteristics of the light source and optical
system.
 The current developed at the photodetector is only 0.5 nA or less during a light puIse. This is
amplified in a high gain amplifier and then converted to a 16-bit digital form by an A-D
converter synchronized with the wheel rotation. The 16-bit words are given to a digital signal
averager that performs two fu net ions. First, it averages out the noise content of the signal w
ith a time constant of 1.6sand secondly it servesasa buffer to hold information till it is
required for computation.
 Computation of percent oxygen saturation is accomplished by a 24-bit algorithmic-state
machine. It uses serial processing with the program stored in ROM and the necessary
coefficients of the equations stored on a field programmable ROM. The computation circu its
also derive the quantity of total haemoglobin seen within the field of view of the earpiece. If
this quantity is low, the instrumentdisplaysan ‘Off Ear’ indication. From the computational

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 Biomedical Engineering Module III S5-ECE, 2017

section,data is transferred in pulse-decimal form to the output circuit board where it is

converted to BCD for the front panel digital display.
 The patient related part consists of arterializing blood flow in the pinna by a brisk 15 s rub.
Application of the probe to the ear results in a suitable display in about 30s. A built-in heater
regulated to 41°C maintainsartcrialization. Restandardization is not required when the
instrument is to be used on other patients.
 Measurements at eight wavelengths provide a great deal of information, which makes it
possible to account for eight unknowns. This is sufficient to take into consideration the
patient to patient variables and account for the various forms of haemoglobin.
 The procedure is simple, requiring only the storage of initial light intensities at each of the
eight wavelengths. However, it is still necessary to arterialize blood flow by warming the ear,
and a large ear probe incorporating fibre optics is necessary to make the system work.

S . I N
T U N OTE
K

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 Biomedical Engineering Module III S5-ECE, 2017

Types of Electrodes
Essentially, five types of electrodes are typically used:
1. Scalp: silver pads, discs, or cups; stainless steel rods; and chlorided silver wires.
2. Sphenoidal: Alternating insulated silver and bare wire and chlorided tip inserted through
muscle tissue by a needle.
3. Nasopharyngeal: silver rod with silver ball at the tip inserted through the nostrils.
4. Electrocorticographic: cotton wicks soaked in saline solution that rests on the brain
surface (removes artifacts generated in the cerebrum by each heartbeat).
5. Intracerebral: sheaves of Teflon-coated gold or platinum wires cut at various distances
from the sheaf tip and used to electrically stimulate the brain.

Reusable disks
 These electrodes can be placed close to the scalp, even in a region with hair because they are
small. A small amount of conducting gel needs to be used under each disk. The electrodes are
held in place by a washable elastic head band. Disks made of tin, silver, and gold are
available. They can be cleaned with soap and water or Cidex.
 The cost of each disk and lead is dependent on the type of metal used as a conductor, the
gauge of wire used as a lead, and the type of insulation on the wire lead.

EEG Cups with disks

 Different styles of caps are available with different numbers and types of electrodes. Some
caps are available for use with replaceable disks and leads. Gel is injected under each disk

 KTU NOTES
through a hole in the back of the disk.
Since the disks on a region of the scalp covered with hair cannot be placed as close to the
scalp as individual disc electrodes, a greater amount of conducting gel needs to be injected
under each. After its use, more time is required to clean the cap and its electrodes, as well as
the hair of the subject. Depending on the style and longevity of the cap and the electrodes,
their expense can be moderate to high.

Adhesive Gel Electrodes

 These are the same disposable silver/silver chloride electrodes used to record ECGs and
EMGs, and they can be used with the same snap leads used for recording those signals.
 These electrodes are an inexpensive solution for recording from regions of the scalp without
hair. They cannot be placed close to the scalp in regions with hair, since the adhesive pad
around the electrode would attach to hair and not the scalp.
Subdermal Needles
These are sterilized, single-use needles that are placed under the skin. Needles are available
with permanently attached wire leads, where the whole assembly is discarded, or sockets that
are attached to lead wires with matching plugs. Since they are a sterile single-use item, the
expense of needle electrodes is moderate to high.

Placement of electrodes

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 An internationally recognized method that allows EEG electrode placement to be
standardized.
 Ensures inter-electrode spacing is equal
 Electrode placements proportional to skull size & shape
 Covers all brain regions
F = Frontal P = Parietal
T = Temporal O= Occipital

 Numbering system

Odd=Left Side Even=Right Side Z=Midline

Four Skull Landmarks

•Nasion
•Inion
•Left Pre‐auricular point
•Right Pre‐auricular point


KTU NOTES
Lead FP1 for example, is in the frontal area and lies on
a circle with other leads. Nineteen electrodes, plus one
for grounding the subject, are used.
 Electrodes are placed (using a flexible tape measure)
by measuring the nasion-inion distance and marking points on the (shaved) head 10%, 20%,
20%, 20%. and 10% of this length.
 The vertex. C2 electrode is the midpoint. Figure given below shows the complete 10- 20
electrode placement system. Here, 19 electrodes are used on the scalp, plus one for grounding
the subject.

 Electrode arrangements may be either unipolar or bipolar. A unipolar arrangement is

composed of a number of scalp leads connected to a common indifference point such as an
earlobe.
 Hence, one electrode is common to all channels. For example, FP2 may be measured with
respect to two ear electrodes connected together or summation of scalp electrodes.
 A bipolar arrangement is achieved by the interconnection of scalp electrodes. The difference
of voltage between and Fpg may also be measured. Montages are patterns of connections
between electrodes and recording channels. All of these combinations have inputs to a three-
lead differential amplifier and use a third connection for the reference (two ears, forehead, or
nose).

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Biomedical Engineering Module III S5-ECE, 2017

Measurement of Cz
• Measure the distance from pre‐auricular point to pre‐ auricular
point
•Mark the midpoint (50%) with a vertical line • This cross
represents Cz which has been correctly aligned in the horizontal
& vertical planes

Measurements - T3, C3, Cz, C4, T4

Mark 10%, 20%, 20%, 20%, 20%, 10% =T3,C3, Cz, C4, T4

Measurements - Fpz, Fz, Cz, Pz, Oz

Reapply the tape along the midline from nasion to inion

Mark 10%, 20%, 20%, 20%, 20%, 10% =FpzFz, Cz, Pz, Oz

Measurements - Fp1, F7, T3, T5, O1, Oz

Measure the distance between Fpz & Oz by applying the tape

KTU NOTES
around the head via T3.
Mark at 10%, 20%, 20%, 20%, 20%, 10% =Fp1F7, T3, T5, O1,
Oz,

Measurement - F3

Measure Fp1 to C3 and mark midpoint

Measure Fz to F7 and mark midpoint
Mark 50% = F3
(Repeat the process using Fp2 to C4 & Fz to F8 to mark
F4)

Measurements M1 & M2
M1 & M2 are the reference electrodes (formally known as A1 & A2)
M1 & M2 are placed on the mastoid (M) process.
These are the bony prominences behind the ears.

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EVOKED POTENTIAL

 A special form of electroencephalography is the recording of evoked potentials from

various parts of the nervous system. In this technique the EEG response to some form
of sensory stimulus, such as a flash of a light or an audible click, is measured.
 To distinguish the response to the stimulus from ongoing EEG activity, the EEG
signals are time-locked to the stimulus pulses and averaged, so that the evoked
response is reinforced with each presentation of the stimulus, while any activity not
synchronized to the stimulus is averaged out.
 Figure given below shows a raw EEG record containing an evoked response from a
single presentation of the stimulus and the effect of averaging 8 and 64 presentations,
respectively.

KTU NOTES

Averaging of EEG evoked potentials:

(a) raw EEG of single response; (b) average of 8 responses; (c) average of 64 responses.

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