Bab9 Tekanandarahvolumedarah PDF

Anatomy of The Heart
Blood Pressure, Blood Flow

and Volume of Blood
Achmad Rizal
BioSPIN
Basic structure of the heart. RA is the right atrium, RV is the right ventricle; LA is
the left atrium, andARL
LV- EL4703 - Isntrumentasi
is the left ventricle.Biomedis 2
Deoxygenated Oxygenated
blood blood
Upper body
Lung
Right Left
atrium atrium
Right Left
venticle venticle
Lower body
The simplified circulatory system. The blood is delivered from the right ventricle to the
lung. The oxygenated blood from the lung is then returned to the left atrium before being In the top figure, the electrocardiogram (ECG) initiates the cardiac cycle. The cardiac
sent throughout the body from the left ventricle. Deoxygenated blood from the body flows sounds are also shown. The bottom figure shows that ejection occurs when the pressure in
ARL - EL4703 - Isntrumentasi Biomedis 3 ARL - EL4703
the left ventricle exceeds - Isntrumentasi
that in the arteries. Biomedis 4
back to the right atrium and the cycle repeats.
Blood Pressure Measurement (1)

Duration at 75 bpm
Event Characteristics
(0.8 second cycle)
Atrial diastole
AV valves opened. • Ave = 0,5 (Syst + Dias)
Semilunar valves close. 0.4 seconds
Ventricular diastole
Ventricular filling. • Mean = 1/3 (Syst- Dias) + Dias
AV valves open.
Atrial systole
Semilunar valves closed. 0.1 seconds
Ventricular diastole
Ventricular filling.
AV valves closed.
• Syst 115 to 140mmHg
Atrial diastole
Ventricular systole
Semilunar valves open.
0.3 seconds • Dias 60 to 90 mmHg
Blood pumped into aorta
and pulmonary artery. • Mean 80 to 105 mmHg
Duration and characteristics of each major event in the cardiac cycle.

ARL - EL4703 - Isntrumentasi Biomedis 5 ARL - EL4703 - Isntrumentasi Biomedis 6
1
Blood Pressure Measurement (1) Blood Pressure Measurement
Blood Pressure Measurement (2) General Facts

Indirect Blood Pressure Measurement Indirect measurement = non-invasive measurement
- Pressure Cuff Methods Brachial artery is the most common measurement site
Riva-Rocci Method Close to heart
Oscillometry Convenient measurement
Continuous Vascular Unloading Other sites are e.g.:
- Tonometry forearm / radial artery

wrist (tends to give much higher SP)
The most common indirect methods are auscultation

and oscillometry
Riva-Rocci Method
Korotkoff Method (1)
The occlusive cuff is inflated until the pressure above systolic pressure,
And then is slowly bled off (2-3 mmHg/s). When the systolic peaks are higher
than the occlusive pressure, the blood spurt under th cuff and causes a Korotkoff’s method
palpable pulse In the
ARLwrist
- EL4703 - Isntrumentasi Biomedis 11 ARL - EL4703 - Isntrumentasi Biomedis 12
2
Korotkoff Method (2) Korotkoff Method (3)
• Cuff is inflated until cuff pressure exceeds systolic
pressure. Brachial artery is occluded below the cuff and
Korotkoff sounds undergo 5 phases:
no blood passes through it. • Phase I: initial ‘tapping” sounds (cuff
• Cuff pressure is slowly reduced at 2-3 mm Hg/s. pressure =systolic pressure)
When cuff pressure = systolic pressure, blood begins
passing through artery under cuff. Stethoscope picks up
• Phase II: sounds increase in intensity
korotkoff sounds. • Phase III: sounds at maximum intensity
• As cuff pressure drops below diastolic pressure • Phase IV: sounds become muffled (cuff
Korotkoff sounds disappear.
cuff
pressure = diastolic pressure)
occluded
blood vessel • Phase V: sounds disappear
Korotkoff Method (4) Korotkoff Method (5)

• Origin of Korotkoff Sounds
-several theories exist:
- Turbulence
- Vibration of vessel walls
• Accuracy of korotkoff method :

- underestimates systolic pressure by 5-20 mm Hg
- overestimates diastolic pressure by 12-20 mm Hg.
- errors are compounded in hypotensive, & elderly.
- in some subjects sounds disappear during phase III,
then reappear: auscultatory gap, get erroneous
diastolic reading,
Korotkoff Method (6) Oscillometry (1)

Cuff Size and Dynamics • Similar to Korotkoff method, looks at cuff
• Too small a cuff length will not occlude artery properly.
• Cuff width should be about 0.4 limb circumference.
pressure rather than Korotkoff sounds.
• Different cuff sizes are available for different limb/patient • Used in automated blood pressure
sizes.
monitors.
• Cuff volume is not linearly related to cuff pressure. This
suggests that some of the cuff pressure is used to
deform the cuff rather than occlude the artery. Introduces
nonlinear distortion, particularly at low pressures (< 50
mm Hg).
3
Oscillometry (2)
External Internal Cuff pressure
Pressure
Auto-zero sensor
valve Multiplexer
Cuff pressure and analog
BP cuff oscillations to digital
converter
Inflation
system
Deflate valve
Microcomputer
Dump with memory
valve and I/O
Over-
Pressure
switch
MAP SYS
HR DYS
Top: Cuff pressure with superimposed Korotkoff sounds, which appear between systolic Block diagram of the major components and subsystems of an
and diastolic pressures. Bottom: the oscillometric method detects when the amplified cuff oscillometric blood-pressure monitoring device, based on the Dinamap
pressure pulsations exceed about 30% of maximal pulsations. unit, I/O = input/output; MAP = mean arterial pressure; HR = heart rate;
SYS= systolic pressure; DYS = diastolic pressure. From Ramsey M III.
From Geddes, L. A. Cardiovascular devices and their applications. New York: Wiley. 1984.8.9.219
ARL - EL4703 - Isntrumentasi Biomedis Blood pressureARL monitoring: automated
- EL4703 - Isntrumentasi oscillometric devices, J. Clin. 20
Biomedis
Direct measurement
Monit. 1911, 7, 56-67.
Tonometry Tonometry
Linear array of pressure sensors is pressed
• A tonometry test measures the pressure inside against a superficial artery, which is
your eye, which is called intraocular pressure supported from below by a bone (radial artery).
(IOP). This test is used to check for glaucoma, A sensor array is used here, because at
least one of the pressure sensors must lay
an eye disease that can cause blindness by directly above the artery
damaging the nerve in the back of the eye (optic
When the blood vessel is partly collapsed,
nerve). the surrounding pressure equals the artery
pressure.
• Arterial tonometry Æ using linear of pressure
array sensor Æ pressed against radial artery so The pressure is increased continuously and
the measurements are made when the
that at least one sensor is directly over the artery is half collapsed
lumen. The hold-down pressure varies between
individuals and therefore a ’calibration’ must
ARL - EL4703 - Isntrumentasi Biomedis 21 be done ARL - EL4703 - Isntrumentasi Biomedis 22
Tonometry (2) Tonometry (cont.)

ADVANTAGES
+) Can be used for non-invasive, non-painful, continuous measurement
DISADVANTAGES
-) Relatively high cost
-) The wrist movement and tendons result
in measurement inaccuracies
4
Blood Pressure Direct Blood Pressure Direct
Measurement Measurement
• Arterial & venous blood pressure can be • Sterile saline filled catheter is inserted into blood
measured by inserting a catheter into the blood stream
vessel and maneuvering it until the end is at the • The pressure at the tip of catheter is transmitted
site at which the blood pressure is to be to an external pressure transducer
measured • Some blood vessel :
• Catheter can be inserted into the artery inside a Artery: carotid, brachial, femoral
needle Veins : femoral, brachial, subcalian, internal
• The alternative method Æ catheter tip sensor jugulas,
CVP Æ central venous pressure
• Very invasive procedure
RAP Æ right atrium pressure
Blood Pressure Blood Pressure Direct

Direct Measurement
Flush solution under pressure Measurement
Fluid resitance Æ how fluid flows in a
Sensing
catheter, flow Æ f
port
Sample and transducer Roller clamp p = R Cf Æ p = p1 – p2
zero stopcock
p = pressure (N/m ), 2
p1, p2 = gauge pressure at two specific

Electrical connector point
Disposable pressure transducer with an integral flush device
Figure 7.3 Extravascular pressure-sensor system A catheter couples a flush

RC = resitance of the tube (Ns/m5)
solution (heparinized saline) through a disposable pressure sensor with an integral flush
device to the sensing port. The three-way stopcock is used to take blood samples and f = flow (Kg/s)
zero the pressure sensor.
Blood Pressure Direct

Blood Flow (2)
Measurement
• Gauge pressure Æ pressure relative to
atmospheric pressure
• If f = 0 , p1 = p2 , in other word, when the
flow in a closed tube is zero, pressure at
the input equal the pressure at the output
• Tube resistance
RC = 8ηl/(πr4)
η = viscosity, l = tube length, r = radius
ARL - EL4703 - Isntrumentasi Biomedis 29

Normal blood flow velocity 0,5 m/s – 1 m/s (Systolic, large vessel)
5
Indicator Dilution with Continuous
Blood Flow Measurement
Injection
• Measures flow / cardiac output averaged over several heart beats
How to make blood flow / volume
measurements? Standard flow meters, Change in [] due to dm dt
continuously added ΔC =
such as turbine flow meters, obviously indicator m to volume V dV dt
cannot be used!
– Indicator-dilution method: cont./rapid injection, • Fick’s technique: the amount of a substance (O2) taken up by an
dye dilution, thermodilution organ / whole body per unit time is equal to the arterial level of O2
minus the venous level of O2 times the blood flow Î
– Electromagnetic flowmeters
dV dm dt
– Ultrasonic flowmeters / Doppler flowmeters F= =
– Plethysmography: Chamber / electric dt ΔC
Blood flow, liters/min Consumption of O2 (mL/min)
impedance / photoplethysmography dm dt
(cardiac output)
=
ARL - EL4703 - Isntrumentasi Biomedis 31 Ca −Biomedis
ARL - EL4703 - Isntrumentasi Cv Arterial and venous 32
concentration of O2 (mL/L of blood)
Indicator Dilution with

Fick’s technique
Rapid Injection
O 2 consumption(mL/ min) • A known amount of a substance, such as a dye or radioactive
Cardiac Output = isotope, is injected into the venous blood and the arterial
[O 2 ]a − [O 2 ]v concentration of the indicator is measured through a serious
250 mL/ min of measurements until the indicator has completely passed
= = 5 L/ min through given volume.
190mL / L − 140mL/L
• The cardiac output (blood flow) is amount of indicator injected,
divided by average concentration in arterial blood.
m
• How is dm/dt (O2 consumption) measured? F= t
• Where and how would we measure Ca and Cv? (Exercise) ∫ C (t )dt
0
Indicator – Dilution Curve An Example
After the bolus is injected at time A, there is a transportation delay before the
concentration begins rising at time B. After the peak is passed, the curve enters an
exponential decay region between C and D, which would continue decaying alone the dotted
curve to t1 if there were no recirculation. However, recirculation causes a second peak at E
before the indicator becomes thoroughly mixed in the blood at F. The dashed curve indicates
the rapid recirculationARL
that- EL4703
occurs -when there is Biomedis
Isntrumentasi a hole between the left and right sides of 35
the ARL - EL4703 - Isntrumentasi Biomedis 36
heart.
6
Dye Dilution Thermodilution
• In dye-dilution, a commonly used dye is indocyanine green
(cardiogreen), which satisfies the following • The indicator is cold – saline, injected into
– Inert
– Safe
the right atrium using a catheter
– Measurable though spectrometry • Temperature change in the blood is
– Economical
– Absorption peak is 805 nm, a wavelength at which absorption of
measured in the pulmonary artery using a
blood is independent of oxygenation thermistor
– 50%of the dye is excreted by the kidneys in 10 minutes, so
repeat measurements is possible • The temperature change is inversely
proportional to the amount of blood flowing
through the pulmonary artery
Electromagnetic
Measuring Cardiac Output
Flowmeters
• Based on Faraday’s law of induction that a conductor that
moves through a uniform magnetic field, or a stationary
conductor placed in a varying magnetic field generates emf on
the conductor:
When blood flows in the vessel with
velocity u and passes through the
magnetic field B, the induced emf e
measured at the electrodes is.
L
e = ∫ u × B ⋅ dL
0
Several methods of measuring cardiac output In the Fick method, the indicator is O2; consumption is
For uniform B and uniform velocity profile u,
measured by a spirometer. The arterial-venous concentration difference is measure by drawing simples
the induced emf is e=BLu. Flow can be obtained
through catheters placed in an artery and in the pulmonary artery. In the dye-dilution method, dye is
by multiplying the blood velocity u with the
injected into the pulmonary artery and samples are taken from an artery. In the thermodilution method,
ARL - EL4703 - Isntrumentasi Biomedis 39 vessel cross section A.
cold saline is injected into the right atrium and temperature is measured in the pulmonary artery.
Electromagnetic
Flowmeter Probes
+ • Comes in 1 mm increments for
1 ~ 24 mm diameter blood vessels
• Individual probes cost $500 each
B • Made to fit snuggly to the vessel
B
l during diastole
N S
e • Only used with arteries, not veins,
as collapsed veins during diastole
lose contact with the electrodes
−
u • Needless to say, this is an
e = Blu INVASIVE measurement!!!
• A major advantage is that it can
measure instantaneous blood
flow, not just average flow
Figure 8.16 Principle of an electromagnetic flowmeter.
7
Ultrasonic Flowmeters Near / Far Fields
• Due to finite diameters, UT transducers produce diffraction
• Based on the principle of measuring the time it takes for an patterns, just like an aperture does in optics.
acoustic wave launched from a transducer to bounce off red • This creates near and far fields of the UT transducer, in which
blood cells and reflect back to the receiver. the acoustic wave exhibit different properties
• All UT transducers, whether used for flowmeter or other – The near field extends about dnf=D2/4λ, where D is the
applications, invariably consists of a piezoelectric material, transducer diameter and λ is the wavelength. During this region,
which generates an acoustic (mechanical) wave when excited the beam is mostly cylindrical (with little spreading), however
with nonuniform intensity.
by an electrical force (the converse is also true)
– In the far field, the beam diverges with an angle sinθ=1.2 λ/D,
• UT transducers are typically used with a gel that fills the air but the intensity uniformly attenuates proportional to the square
gaps between the transducer and the object examined of the distance from the transducer
Higher frequencies and larger

transducers should be used for near
field operation. Typical operating
frequency is 2 ~ 10 MHz.
Oscillator
Scan head
UT Flowmeters
Image plane Skin surface
Zero-crossing
detector / LPF
Blood vessel
Doppler
angle
Computer Determine
direction
RF AF F/V
Detector amplifier
amplifier converter
Figure 8.17 Ultrasonic flowmeter. The sensor at the scan head transmits the signal from the
oscillator and receives the reflected wave from the blood cells. The RF (radio frequency)
amplifier amplifies the received signal and the carrier frequency, then AF (audio frequency) High acoustic
impedance material
signal is produced by a detector.
Adapted from Picot, P.ARL - EL4703
A. and - Isntrumentasi
Fenster, Biomedisblood volume flow rate meter. US Patent,
A. 1996. Ultrasonic 45 ARL - EL4703 - Isntrumentasi Biomedis 46
5,505,204.
Transit Time
Transit time flowmeters
Flowmeters
Effective velocity of sound in blood: velocity of sound (c) +
velocity of flow of blood averaged along the path of the ultrasound (û)
û=1.33ū for laminar flow, û=1.07ū for turbulent flow

ū: velocity of blood averaged over the cross sectional area, this is different
than û because the UT path is along a single line not over an averaged of
cross sectional area
Transit time in up/down stream direction:

distance D
t= =
conduction velocity c ± uˆ cosθ
The quantity ∆T is typically very small
Difference between upstream and downstream directions and very difficult to measure,
particularly in the presence of noise.
2 Duˆ cos θ 2 Duˆ cos θ Therefore phase detection techniques
Δt = ≅
( c 2 − uˆ 2 cos2 θ ) c2 are usually employed rather then
ARL - EL4703 - Isntrumentasi Biomedis 47 measuring actual timing.
8
Doppler Measurements (3) Doppler
Ultrasound Doppler Flowmeters
The ultrasound Doppler device can be either a continuous wave or a pulsed • The Doppler effect describes the change in the frequency of a
Doppler
received signal , with respect to that of the transmitted signal,
when it is bounced off of a moving object.
CW DOPPLER PULSED DOPPLER
– Doppler frequency shift
No minimum range Accuracy Source signal Speed of blood flow
frequency (~150 cm/s)
No minimum flow Angle between UT beam

Simpler hardware
and flow of blood
2 f u cosθ
fd = o
Range ambiguity Minimum range c
Low flow cannot be (Maximum flow) x (range) Speed of sound in blood

detected = limited (~1500 m/s)
Doppler Problems Associated with

Flowmeters Doppler Flowmeters
• There are two major issues with Doppler flowmeters
– Unlike what the equations may suggest, obtaining direction
information is not easy due to very small changes in frequency shift
that when not in baseband, removing the carrier signal without
affecting the shift frequency becomes very difficult
– Also unlike what the equation may suggest, the Doppler shift is not a
single frequency, but rather a band of frequencies because
• Not all cells are moving at the same velocity (velocity profile is not
uniform)
u • A cell remains within the UT beam for a very short period of time;
ΔF = ± f s (cosθ + cos φ ) the obtained signal needs to be gated, creating side lobes in the
c frequency shift
• Acoustic energy traveling within the beam, but at an angle from
the bam axis create an effective ∆θ, causing variations in Doppler
shift
• Tumbling ARL
and- EL4703 - Isntrumentasi Biomedis
collision of cells cause various Doppler shifts 52
Directional Doppler
• Directional Doppler borrows the quadrature phase detector
technique from radar in determining the speed and direction
of an aircraft.
• Two carrier signals at 90º phase shift are used instead of a
single carrier. The +/- phase difference between these
carriers after the signal is bounced off of the blood cells
indicate the direction, whereas the change in frequency
indicate the flowrate
Figure 8.10 Doppler ultrasonic blood flowmeter. In the

simplest instrument, ultrasound is beamed through the
vessel walls, back-scattered by the red blood cells, and
ARL - EL4703 - Isntrumentasi Biomedis 53 received
ARL - EL4703 -by a piezoelectric
Isntrumentasi Biomedis crystal. 54
9
Directional Doppler
Plethysmography
in
Blood Flow Measurements
(a) Quadrature-phase detector. Sine and cosine signals at the carrier frequency are summed with the RF
output before detection. The output C from the cosine channel then leads (or lags) the output S from the sine
channel if the flow is away from (or toward) the transducer. (b) Logic circuits route one-shot pulses through
the top (or bottom) ANDARL gate-when the- flow
EL4703 is away from
Isntrumentasi (or toward) the transducer. The differential
Biomedis 55
amplifier provides bi-directional output pulses that are then filtered.
Plethysmography (1) Plethysmography (2)

Strain Gage Method Chamber Method
Plethysmography means the methods for recording volume changes of an As the volume of the leg increases, the leg
organ or a body part (e.g. a leg) squeezes some kind of bladder and decreases
its volume
Strain gage is made of silicone rubber
Volume transducer can be e.g. water filled tube
tubes, which are filled with conductive
(level) or air (pressure)
liquid (e.g. mercury) whose impedance
changes with volume.
Venous occlusion cuff is inflated to 40

– 50 mmHg. In this way there will be The speed of the return of the
the arterial inflow into the limb but no venous blood is measured
venous outflow.
If only a segment of limb is measured, there is a need for arterial occlusion Chamber plethysmograph is the only accurate non-invasive way to
cuff also. ARL - EL4703 - Isntrumentasi Biomedis 57
measure changes in the blood volume
Plethysmography (3) Plethysmography (4)

Electric-Impedance Method Photoelectric Method
Different tissues in a body have a different resistivity. Blood is one of the best A beam of IR-light is directed to the
conductors in a body ( ρ = 1,5 Ωm) part of the tissue which is to be
measured for blood flow (e.g. a finger
A constant current is applied via or ear lobe)
skin electrodes
I = 0,5 – 4 mA rms (SNR)
f = 50 – 100 kHz
(Zskin-electrode+shock) The blood flow modulates the attenuated
/ reflected light which is recorded.
The change in the impedance is
measured
The light that is transmitted / reflected is
collected with a photodetector
2
L
ΔVol =ρ ΔZ
Z 02
Method is simple Poor measure for changes in volume
ARL - EL4703 - Isntrumentasi Biomedis
The accuracy is often poor or unknown 59 Heart rate is clearly seen - Isntrumentasi Biomedis
ARL - EL4703 Very sensitive to motion artefacts 60
10
Radioisotopes
A rapidly diffusing, inert radioisotope of lipid-soluble gas (133 Xe or 85 Kr) is
injected into the tissue or passively diffused
Other Methods
in
Blood Flow Measurements
The elimination of the radioisotope from microcirculatory bed is related to
the blood flow:
C (t ) = C 0 exp(− kt )
k = ln 2 / t1 / 2
Thermal Convection Probe Summary (1)

This is one of the earliest techniques for blood flow measurements
The rate of heat removal from the tissue under probe is measured
BLOOD PRESSURE
The concentric rings are
isolated thermally & electrically Describes the physiology and pathology of cardiocvascular system
from each other
”Normal” values are 120 / 80 mmHg
The central disk is heated High values may lead to heart attack and strokes
1 – 2 o C over the temperature Low values may lead to low oxygen perfusion
of tissue
Almost all indirect methods rely on an occlusive
A temperature difference of cuff which is placed on the bracial artery. The actual
2- 3 oC is established between measurement is done when the cuff is deflated
the disks
All direct methods require skin punctuation and a use

of catheter. Methods are used only when continuous and
The method is not ARL
very- EL4703
common due extreme nonlinear properties and difficulties
- Isntrumentasi Biomedis 63 ARLaccurate measurements
- EL4703 - Isntrumentasi Biomedisare needed. 64
in practical use (e.g. variable thermal characteristics of skin)
Summary (2)
BLOOD FLOW
Usually more invasive methods are used than with blood
pressure measurements
Used for understanding physiological processes (e.g. medicine
dissolution). Also used for locating clots in arteries
Normal velocity is 0,5 - 1 m/s
Indirect measurements are done by using ultrasound or

plethysmographic method
Direct measurements are done by dilution methods (dye / thermal)
11

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Anatomy of The Heart

Blood Pressure, Blood Flow

Blood Pressure Measurement (1)

Duration and characteristics of each major event in the cardiac cycle.

ARL - EL4703 - Isntrumentasi Biomedis 7 ARL - EL4703 - Isntrumentasi Biomedis 8

Blood Pressure Measurement (2) General Facts

Riva-Rocci Method Close to heart

Oscillometry Convenient measurement

Continuous Vascular Unloading Other sites are e.g.:

- Tonometry forearm / radial artery

The most common indirect methods are auscultation

ARL - EL4703 - Isntrumentasi Biomedis 9 ARL - EL4703 - Isntrumentasi Biomedis 10

ARL - EL4703 - Isntrumentasi Biomedis 13 ARL - EL4703 - Isntrumentasi Biomedis 14

Korotkoff Method (4) Korotkoff Method (5)

• Accuracy of korotkoff method :

ARL - EL4703 - Isntrumentasi Biomedis 15 ARL - EL4703 - Isntrumentasi Biomedis 16

Korotkoff Method (6) Oscillometry (1)

ARL - EL4703 - Isntrumentasi Biomedis 17 ARL - EL4703 - Isntrumentasi Biomedis 18

Tonometry (2) Tonometry (cont.)

+) Can be used for non-invasive, non-painful, continuous measurement

ARL - EL4703 - Isntrumentasi Biomedis 23 ARL - EL4703 - Isntrumentasi Biomedis 24

Blood Pressure Blood Pressure Direct

p1, p2 = gauge pressure at two specific

Figure 7.3 Extravascular pressure-sensor system A catheter couples a flush

Blood Pressure Direct

ARL - EL4703 - Isntrumentasi Biomedis 29

Indicator Dilution with

ARL - EL4703 - Isntrumentasi Biomedis 33 ARL - EL4703 - Isntrumentasi Biomedis 34

Indicator – Dilution Curve An Example

Higher frequencies and larger

û=1.33ū for laminar flow, û=1.07ū for turbulent flow

Transit time in up/down stream direction:

No minimum flow Angle between UT beam

Low flow cannot be (Maximum flow) x (range) Speed of sound in blood

Doppler Problems Associated with

Figure 8.10 Doppler ultrasonic blood flowmeter. In the

Plethysmography (1) Plethysmography (2)

Venous occlusion cuff is inflated to 40

Plethysmography (3) Plethysmography (4)

Thermal Convection Probe Summary (1)

All direct methods require skin punctuation and a use

Normal velocity is 0,5 - 1 m/s

Indirect measurements are done by using ultrasound or

Direct measurements are done by dilution methods (dye / thermal)

ARL - EL4703 - Isntrumentasi Biomedis 65

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