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MEDICAL INSTRUMENTATION
Application and Design
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MEDICAL INSTRUMENTATION
Application and Design

FOURTH EDITION

John G. Webster, Editor

Contributing Authors
John W. Clark, Jr.
Rice University
Michael R. Neuman
Michigan Technological University
Walter H. Olson
Medtronic, Inc.
Robert A. Peura
Worcester Polytechnic Institute
Frank P. Primiano, Jr.
Consultant
Melvin P. Siedband
University of Wisconsin-Madison
John G. Webster
University of Wisconsin-Madison
Lawrence A. Wheeler
Nutritional Computing Concepts

JOHN WILEY & SONS, INC.


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Library of Congress Cataloging-in-Publication Data


Medical instrumentation : application and design / John G. Webster, editor ; contributing
authors, John W. Clark Jr. . . . [et al.]. — 4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-471-67600-3 (cloth)
1. Medical instruments and apparatus. 2. Physiological apparatus. I. Webster, John G.,
1932— II. Clark, John W. (John William), 1936–
[DNLM: 1. Equipment and Supplies. 2. Biomedical Engineering—instrumentation.
3. Equipment Design. W 26 M4898 2009]
R856.M376 2009
610.28–dc22
2008042917

ISBN-13 978-0471-67600-3

Printed in the United States of America

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PREFACE

Medical Instrumentation: Application and Design, Fourth Edition, is written


for a senior to graduate-level course in biomedical engineering. It describes the
principles, applications, and design of the medical instruments most commonly
used in hospitals. Because equipment changes with time, we have stressed
fundamental principles of operation and general types of equipment, avoiding
detailed descriptions and photographs of specific models. Furthermore, be-
cause biomedical engineering is an interdisciplinary field requiring good
communication with health-care personnel, we have provided some applica-
tions for each type of instrument. However, to keep the book to a reasonable
length, we have omitted much of the physiology.
Most of those who use this text have had an introductory course in
chemistry, are familiar with mathematics through differential equations,
have a strong background in physics, and have taken courses in electric circuits
and electronics. However, readers without this background will gain much
from the descriptive material and should find this text a valuable reference. In
addition, we recommend reading background material from an inexpensive
physiology text, such as W. F. Ganong’s Review of Medical Physiology, 22nd
edition (New York: McGraw-Hill, 2005).

EMPHASIS ON DESIGN
Throughout the book, we emphasize design. A scientist or engineer who has
some background in electronics and instrumentation will glean enough infor-
mation, in many of the areas we address, to be able to design medical
instruments. This ability should be especially valuable in those situations—
so frequently encountered—where special instruments that are not commer-
cially available are required.

PEDAGOGY
The book provides 300 homework problems, located at the end of each
chapter, plus 64 in-text worked examples. Problems are designed to cover a

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vi PREFACE

wide variety of applications ranging from analysis of the waves of the electro-
cardiogram to circuit design of biopotential amplifiers and identification of
electric safety hazards.

REFERENCES
Rather than giving an exhaustive list of references, we have provided a list of
review articles and books that can serve as a point of departure for further
study on any given topic.

ORGANIZATION
Each chapter has been carefully reviewed and updated for the fourth edition,
and many new examples and references are included.
Chapter 1 covers general concepts that are applicable to all instrumen-
tation systems, including on the commercial development of medical instru-
ments, on biostatistics, and on the regulation of medical devices. Chapter 2
describes basic sensors, and Chapter 3 presents the design of amplifiers for
them. Chapters 4 through 6 deal with biopotentials, tracing the topic from
the origin of biopotentials, through electrodes, to the special amplifier
design required.
Chapters 7 and 8 cover the measurement of cardiovascular dynamics—
pressure, sound, flow, and volume of blood. Chapter 9 presents the measure-
ment of respiratory dynamics—pressure, flow, and concentration of gases.
Chapter 10 describes the developing field of biosensors: sensors that
measure chemical concentrations within the body via catheters or implants.
Chapter 11 describes that area in the hospital where the greatest number of
measurements is made, the clinical laboratory. Chapter 12 starts with general
concepts of medical imaging and shows their applications to x-ray techniques,
magnetic resonance imaging, positron emission tomography, and Doppler
ultrasonic images.
Chapter 13 deals with devices used in therapy, such as the pacemaker,
defibrillator, cochlear prosthesis, transcutaneous electrical nerve stimulation,
implantable automatic defibrillators, the total artificial heart, lithotripsy, infant
radiant warmers, drug infusion pumps, and anesthesia machines. Chapter 14
presents a guide both to electric safety in the hospital and to minimization of
hazards.
We have used the recommended International System of Units (SI)
throughout this book. In the case of units of pressure, we have presented
both the commonly used millimeters of mercury and its SI unit, the pascal. To
help the reader follow the trend toward employing SI units, the Appendix
provides the most common conversion factors. The Appendix also provides a
number of physical constants used in the book and a list of abbreviations.
A Solutions Manual containing complete solutions to all problems is
available free to adopters of this text.
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PREFACE vii

ACKNOWLEDGMENTS
We would like to thank the reviewers of previous editions.
First Edition Reviewers
David Arnett, Pennsylvania State University
Robert B. Northrup, University of Connecticut (Starrs)
Kenneth C. Mylrea, University of Arizona
Curran S. Swift, Iowa State University
Second Edition Reviewers
Jonathan Newell, Rensselaer Polytechnic Institute
Robert B. Northrup, University of Connecticut (Storrs)
Third Edition Reviewers
Noel Thompson, Stanford University
W. Ed Hammond, Duke University
Robert B. Northrup, University of Connecticut
Richard Jendrucko, University of Tennessee, Knoxville
Fourth Edition Reviewers
Paul J. Benkeser, Georgia Institute of Technology
Lawrence V. Hmurcik, University of Bridgeport
Art Koblasz, Georgia Institute of Technology
Anant Madabhushi, Rutgers University
Andrew Mason, Michigan State University
Ken Meissner, Texas A&M University
Peter Molnar, Clemson University
Homer Nazeran, The University of Texas at El Paso
John A. Pearce, The University of Texas at Austin
Nadine Barrie Smith, The Pennsylvania State University

The authors welcome your suggestions for improvement of subsequent print-


ings and editions.
John G. Webster
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LIST OF SYMBOLS

This list gives single-letter symbols for quantities, without subscripts or


modifiers. Symbols for physical constants are given in Appendix A.1, multi-
letter symbols in Appendix A.4, and chemical symbols in Appendix A.5.

Symbol Quantity Introduced in Section

a Absorptivity 10.3
a Activity 5.2
a Coefficient 1.10
a Lead vector 6.2
A Absorbance 10.3
A Area 2.2
A Coefficient 1.9
A Gain 3.1
A Percent 1.7
b Coefficient 1.9
b Intercept 1.9
B Coefficient 1.10
B Percent 1.9
B Viscous friction 1.10
B Magnetic flux density 8.3
c Coefficient 7.13
c Specific heat 8.1
c Velocity of sound 8.4
C Capacitance 1.10
C Compliance 7.3
C Concentration 10.3
C Contrast 12.1
d Derivative 1.10
d Diameter 1.10
d Distance 4.1
D Density 12.4
D Detector responsivity 2.17

(Continued )

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x LIST OF SYMBOLS

Symbol Quantity Introduced in Section

D d/dt 1.10
D Diameter 5.8
D Diffusing capacity 9.8
D Distance 4.4
E emf 2.7
E Energy 2.13
E Exposure 12.4
E Irradiance 2.17
E Modulus of elasticity 7.3
f Force 2.6
f Frequency 1.10
f Function 4.2
F Filter transmission 2.17
F Flow 7.3
F Force 2.2
F Fraction 12.1
F Molar fraction 9.3
g Conductance/area 4.1
G Conductance 2.9
G Form factor 2.4
G Gage factor 2.2
G Gain 1.7
h Height 7.13
H Feedback gain 1.7
i Current 2.6
I Current 3.7
I Intensity 10.3
j +(–1)1/2 1.10
J Number of standard deviations 12.1
k Constant 6.7
k Piezoelectric constant 2.6
K Constant 1.10
K Number 12.1
K Sensitivity 1.10
K Solubility product 5.3
K Spring constant 1.10
L Inductance 2.4
L Inertance 7.3
L Length 2.2
L Line-source response 12.10
m Average number 12.1
m Mass 7.3
m Slope 1.9
M Mass 1.10
M Measured values 12.2
M Modulation 12.1
M Cardiac vector 6.2
n Number 1.8
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LIST OF SYMBOLS xi

Symbol Quantity Introduced in Section

n Refractive index 2.14


N Noise equivalent bandwidth 12.3
N Number 5.3
N Turns ratio 3.13
p Change in pressure 9.1
p Probability 12.1
P Power 1.9
P Pressure 7.3
P Projection 12.8
q Charge 2.6
q Rate of heat 8.1
q Change in volume flow 9.1
Q Heat content 8.2
Q Volume flow 9.1
r Correlation coefficient 1.8
r Radius 7.3
r Resistance/length 4.2
R Range 8.4
R Ratio 10.3
R Resistance 1.10
S Standard deviation 1.8
S Modulation transfer function 12.2
S Saturation 10.1
S Slew rate 3.11
S Source output 2.17
t Thickness 5.8
t Time 1.10
T Interval 1.10
T Temperature 2.8
T Transmittance 11.1
u Velocity 4.2
u Work function 12.6
U Molar uptake 9.1
v Voltage 1.10
v Change in volume 9.1
V Voltage 1.10
V Volume 2.2
W Power 2.10
W Weight 10.3
W Weighting factor 12.8
x Constant 10.3
x Distance 2.4
x Input 1.7
X Chemical species 9.1
X Effort variable 1.9
X Value 1.8
y Constant 10.3
(Continued )
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xii LIST OF SYMBOLS

Symbol Quantity Introduced in Section

y Output 1.7
Y Admittance 1.9
Y Flow variable 1.9
Y Value 1.8
z Distance 4.1
Z Atomic number 12.6
Z Impedance 1.9

Greek Letters

Symbol Quantity Introduced in Section

a Polytropic constant 9.5


a Thermistor coefficient 2.9
a Thermoelectric sensitivity 2.8
b Thermistor constant 2.9
D Deviation 10.3
e Emissivity 2.10
e Dielectric constant 2.5
z Damping ratio 1.10
h Viscosity 7.3
u Angle 2.14
L Logarithmic decrement 1.10
l Wavelength 2.10
m Attenuation coefficient 12.8
m Mobility 5.2
m Permeability 2.4
m Poisson’s ratio 2.2
r Density 7.3
r Mole density 9.1
r Resistivity 2.2
s Conductance 13.4
s Conductivity/distance 4.7
s2 Variance 12.1
t Time constant 1.10
f Number of photons 12.6
f Phase shift 1.10
f Divergence 8.4
F Potential 4.6
v Frequency 1.10
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CONTENTS

Preface v
List of Symbols ix

1 BASIC CONCEPTS OF
MEDICAL INSTRUMENTATION 1

Walter H. Olson

1.1 Terminology of Medicine and Medical Devices 4


1.2 Generalized Medical Instrumentation System 5
1.3 Alternative Operational Modes 7
1.4 Medical Measurement Constraints 9
1.5 Classifications of Biomedical Instruments 12
1.6 Interfering and Modifying Inputs 12
1.7 Compensation Techniques 13
1.8 Biostatistics 16
1.9 Generalized Static Characteristics 19
1.10 Generalized Dynamic Characteristics 25
1.11 Design Criteria 35
1.12 Commercial Medical Instrumentation Development Process 37
1.13 Regulation of Medical Devices 39
Problems 42
References 43

2 BASIC SENSORS AND PRINCIPLES 45

Robert A. Peura and John G. Webster

2.1 Displacement Measurements 45


2.2 Resistive Sensors 46
2.3 Bridge Circuits 53
2.4 Inductive Sensors 53
2.5 Capacitive Sensors 56
2.6 Piezoelectric Sensors 58
2.7 Temperature Measurements 62
2.8 Thermocouples 63

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2.9 Thermistors 66
2.10 Radiation Thermometry 69
2.11 Fiber-Optic Temperature Sensors 74
2.12 Optical Measurements 74
2.13 Radiation Sources 75
2.14 Geometrical and Fiber Optics 79
2.15 Optical Filters 82
2.16 Radiation Sensors 83
2.17 Optical Combinations 86
Problems 87
References 88

3 AMPLIFIERS AND SIGNAL PROCESSING 91

John G. Webster

3.1 Ideal Op Amps 91


3.2 Inverting Amplifiers 93
3.3 Noninverting Amplifiers 96
3.4 Differential Amplifiers 97
3.5 Comparators 100
3.6 Rectifiers 102
3.7 Logarithmic Amplifiers 103
3.8 Integrators 104
3.9 Differentiators 107
3.10 Active Filters 108
3.11 Frequency Response 110
3.12 Offset Voltage 112
3.13 Bias Current 114
3.14 Input and Output Resistance 115
3.15 Phase-Sensitive Demodulators 117
3.16 Timers 120
3.17 Microcomputers in Medical Instrumentation 122
Problems 123
References 125

4 THE ORIGIN OF BIOPOTENTIALS 126

John W. Clark, Jr.

4.1 Electrical Activity of Excitable Cells 126


4.2 Volume-Conductor Fields 135
4.3 Functional Organization of the Peripheral
Nervous System 138
4.4 The Electroneurogram 140
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CONTENTS xv

4.5 The Electromyogram 144


4.6 The Electrocardiogram 147
4.7 The Electroretinogram 158
4.8 The Electroencephalogram 163
4.9 The Magnetoencephalogram 181
Problems 182
References 186

5 BIOPOTENTIAL ELECTRODES 189

Michael R. Neuman

5.1 The Electrode–Electrolyte Interface 189


5.2 Polarization 192
5.3 Polarizable and Nonpolarizable Electrodes 196
5.4 Electrode Behavior and Circuit Models 202
5.5 The Electrode—Skin Interface and Motion Artifact 205
5.6 Body-Surface Recording Electrodes 209
5.7 Internal Electrodes 215
5.8 Electrode Arrays 220
5.9 Microelectrodes 222
5.10 Electrodes for Electric Stimulation of Tissue 231
5.11 Practical Hints in Using Electrodes 233
Problems 235
References 239

6 BIOPOTENTIAL AMPLIFIERS 241

Michael R. Neuman

6.1 Basic Requirements 241


6.2 The Electrocardiograph 243
6.3 Problems Frequently Encountered 254
6.4 Transient Protection 264
6.5 Common-Mode and Other Interference-Reduction
Circuits 266
6.6 Amplifiers for Other Biopotential Signals 269
6.7 Example of a Biopotential Preamplifier 274
6.8 Other Biopotential Signal Processors 275
6.9 Cardiac Monitors 282
6.10 Biotelemetry 287
Problems 288
References 291
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7 BLOOD PRESSURE AND SOUND 293

Robert A. Peura

7.1 Direct Measurements 295


7.2 Harmonic Analysis of Blood-Pressure
Waveforms 300
7.3 Dynamic Properties of Pressure-Measurement
Systems 301
7.4 Measurement of System Response 308
7.5 Effects of System Parameters on Response 310
7.6 Bandwidth Requirements for Measuring
Blood Pressure 311
7.7 Typical Pressure-Waveform Distortion 311
7.8 Systems for Measuring Venous Pressure 313
7.9 Heart Sounds 314
7.10 Phonocardiography 318
7.11 Cardiac Catheterization 318
7.12 Effects of Potential and Kinetic Energy on
Pressure Measurements 323
7.13 Indirect Measurements of Blood Pressure 325
7.14 Tonometry 330
Problems 335
References 336

8 MEASUREMENT OF FLOW AND VOLUME


OF BLOOD 338

John G. Webster

8.1 Indicator-Dilution Method That Uses


Continuous Infusion 338
8.2 Indicator-Dilution Method That Uses
Rapid Injection 341
8.3 Electromagnetic Flowmeters 344
8.4 Ultrasonic Flowmeters 350
8.5 Thermal-Convection Velocity Sensors 361
8.6 Chamber Plethysmography 364
8.7 Electrical-Impedance Plethysmography 366
8.8 Photoplethysmography 372
Problems 374
References 375
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CONTENTS xvii

9 MEASUREMENTS OF THE
RESPIRATORY SYSTEM 377

Frank P. Primiano, Jr.

9.1 Modeling the Respiratory System 378


9.2 Measurement of Pressure 385
9.3 Measurement of Gas-Flow 388
9.4 Lung Volume 396
9.5 Respiratory Plethysmography 404
9.6 Some Tests of Respiratory Mechanics 411
9.7 Measurement of Gas Concentration 425
9.8 Some Tests of Gas Transport 436
Problems 443
References 446

10 CHEMICAL BIOSENSORS 449

Robert A. Peura

10.1 Blood-Gas and Acid-Base Physiology 451


10.2 Electrochemical Sensors 453
10.3 Chemical Fibrosensors 461
10.4 Ion-Selective Field-Effect Transistor 475
10.5 Immunologically Sensitive Field-Effect
Transistor 478
10.6 Noninvasive Blood-Gas Monitoring 479
10.7 Blood-Glucose Sensors 486
10.8 Electronic Noses 492
10.9 Lab-on-a-Chip 493
10.10 Summary 494
Problems 495
References 495

11 CLINICAL LABORATORY
INSTRUMENTATION 498

Lawrence A. Wheeler

11.1 Spectrophotometry 499


11.2 Automated Chemical Analyzers 508
11.3 Chromatology 512
11.4 Electrophoresis 515
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11.5 Hematology 517


Problems 526
References 527

12 MEDICAL IMAGING SYSTEMS 528

Melvin P. Siedband

12.1 Information Content of an Image 528


12.2 Modulation Transfer Function 535
12.3 Noise-Equivalent Bandwidth 536
12.4 Television Systems 537
12.5 Radiography 540
12.6 Computed Radiography 549
12.7 Computed Tomography 553
12.8 Magnetic Resonance Imaging 561
12.9 Nuclear Medicine 566
12.10 Single-Photon Emission Computed
Tomography 572
12.11 Positron Emission Tomography 573
12.12 Ultrasonography 576
12.13 Contrast Agents 585
Problems 587
References 589

13 THERAPEUTIC AND PROSTHETIC DEVICES 590

Michael R. Neuman

13.1 Cardiac Pacemakers and Other Electric


Stimulators 590
13.2 Defibrillators and Cardioverters 606
13.3 Mechanical Cardiovascular Orthotic
and Prosthetic Devices 611
13.4 Hemodialysis 615
13.5 Lithotripsy 618
13.6 Ventilators 619
13.7 Infant Incubators 622
13.8 Drug Delivery Devices 624
13.9 Surgical Instruments 629
13.10 Therapeutic Applications of the Laser 632
Problems 633
References 635
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CONTENTS xix

14 ELECTRICAL SAFETY 638

Walter H. Olson

14.1 Physiological Effects of Electricity 639


14.2 Important Susceptibility Parameters 641
14.3 Distribution of Electric Power 646
14.4 Macroshock Hazards 650
14.5 Microshock Hazards 653
14.6 Electrical-Safety Codes and Standards 658
14.7 Basic Approaches to Protection Against Shock 659
14.8 Protection: Power Distribution 660
14.9 Protection: Equipment Design 663
14.10 Electrical-Safety Analyzers 667
14.11 Testing the Electric System 667
14.12 Tests of Electric Appliances 669
Conclusion 673
Problems 673
References 674

APPENDIX 676

A.1 Physical Constants 676


A.2 International System of Units (SI) Prefixes
(Thompson and Taylor, 2008) 676
A.3 International System of Units
(Thompson and Taylor, 2008) 677
A.4 Abbreviations 678
A.5 Chemical Elements 681

INDEX 683
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