4-Full Notes For BMI 7TH

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com
UNI
TI
PHYSI
OLOGYANDTRANSDUCERS:Cel
landi
tsst
ruct
ure–Rest
ingandAct
ionPot
ent
ial–
Ner
voussyst
em:Funct
ionalor
gani
zat
ionoft
hener
voussyst
em – St
ruct
ureofner
vous
syst
em,neur
ons-synapse– t
ransmi
tt
ersandneur
alcommuni
cat
ion– Car
diovascul
ar
syst
em –r
espi
rat
orysyst
em –Basi
ccomponent
sofabi
omedi
calsyst
em -Tr
ansducer
s–
sel
ect
ioncr
it
eri
a–Pi
ezoel
ect
ri
c,ul
tr
asoni
ctr
ansducer
s-Temper
atur
emeasur
ement
s-
Fi
beropt
ict
emper
atur
esensor
s.
Cel
landi
tsst
ruct
ure
 Cel
list
hebasi
cuni
tofl
if
e.Cel
lsar
ethebasi
cbui
ldi
ngbl
ockofal
lani
mal
sincl
udi
ng
humanbei
ngs.
 Cel
ls ar
e ofdi
ff
erentsi
ze,shape,or
ganel
le composi
ti
on and physi
ologi
calr
oles.
Howevert
her
ear
eanumberofst
ruct
urescommont
omostoft
heani
malcel
ls.
 Thecont
ent
soft
hecel
lar
esepar
atedf
rom t
heext
ernalsur
roundi
ngsbyt
hepl
asma
membr
aneorcel
lmembr
ane.I
tissemiper
meabl
einnat
ure.I
thel
psi
nregul
ati
ngt
he
passageofmat
eri
alsbet
weent
hecel
landi
tssur
roundi
ngs.
 Ther
ear
epr
oject
ionsatsomepor
ti
onsoft
hecel
lmembr
anecal
ledast
hemi
crovi
ll
i.
Thesemi
crovi
ll
ihel
pini
ncr
easi
ngt
hesur
facear
eaoft
hecel
lsoast
oincr
easet
he
amountofmat
eri
alpassi
ngt
hrought
hecel
lmembr
aneaccor
dingt
oneed.
 Cyt
opl
asm i
stheconst
it
uentoft
hecel
lencl
osedbyt
hecel
lmembr
ane.
 Ther
ear
enet
wor
ksofbr
anchi
ngmembr
anouschannel
swi
thi
nthecyt
opl
asm cal
led
t
heendopl
asmi
cret
icul
um.
 Ther
ear
eal
soanumberofsmal
lpar
ti
clesi
nthecyt
opl
asm cal
ledt
her
ibosomes.
 Endopl
asmi
cret
icul
ums wi
th associ
ated r
ibosomes ar
e cal
led r
ough endopl
asmi
c
r
eti
cul
um and endopl
asmi
c r
eti
cul
ums wi
thout r
ibosomes ar
e cal
led smoot
h
endopl
asmi
cret
icul
um.
www.vidyarthiplus.com
 Avesi
cul
aror
ganel
lepr
esenti
nthecyt
opl
asm i
scal
ledt
hemi
tochondr
ia.
 Themi
tochondr
iaar
ecover
edbyt
womembr
anes,
theout
ersmoot
hmembr
aneandt
he
i
nnermembr
anewhi
chgoi
nforf
oldi
ngcal
ledcr
ist
ae.
 The space bet

ween t
he cr
ist
ae ort
he f
oldi
ng oft
he i
nnermembr
ane oft
he
mi
tochondr
iai
sthemi
tochondr
ialmat
ri
x.
 Met
abol
ic act
ivi
ti
es oft
he cel
l(i
ncl
udi
ng ATP synt
hesi
s)ar
etaken car
e by t
he
mi
tochondr
iahencei
tiscal
ledt
hepowerhouseoft
hecel
l.
Cel
lSt
ruct
ure
 TheGol
giappar
atusi
sanot
hervesi
clewhi
chconsi
stsofasetofsmoot
h,f
lat
tened
ci
ster
naear
rangedi
npar
all
elr
ows.
 Thegol
giappar
atusi
sal
socal
ledt
hedi
ctyosome.
 Thegol
giappar
atushel
psi
npr
ocessi
ng,
picki
nganddi
spl
acementofpr
otei
ns.
 Lysosomesar
esmal
lervesi
cul
arst
ruct
urescapabl
eofdi
gest
ingpr
otei
n,nucl
eicaci
d,
pol
ysacchar
ideandot
hermat
eri
als.
 Lysosomesar
einvol
vedi
nthei
ntr
acel
lul
ardi
gest
ionandi
ntr
acel
lul
arscavengi
ngof
wor
nandpoor
lyf
unct
ioni
ngor
ganel
les.
Di
ff
erentTypesofHumanCel
ls
 Ther
e ar
e ot
hersmal
leror
ganel
les pr
esenti
nthe cel
lcal
led per
oxi
somes and
gl
yoxysomeswhi
char
einvol
vedi
nthedi
gest
ionofhydr
ogenper
oxi
deandgl
yoxl
icaci
d
i
nthecel
l.
 Thenucl
eusi
sal
argerst
ruct
ureoft
hecel
llocat
edati
tscent
re.
 Thenucl
eusi
scover
edbyt
henucl
earenvel
opewhi
chi
smadeofi
nnerandout
er
membr
ane.
 The out
ermembr
ane may cont
ainr
ibosomes at
tached t
oitand hence f
orms
cont
inui
ti
eswi
tht
heendopl
asmi
cret
icul
um.
 Thei
nnerandout
ermembr
anef
usesatcer
tai
npoi
ntst
ofor
m por
est
hroughwhi
ch
gr
anul
armat
eri
alf
rom t
hecyt
osoli
nter
actwi
thnucl
eopl
asm.(
cont
ent
sofnucl
eus)
 Thenucl
euscont
ainschr
omosomalDNA andchr
omosomalpr
otei
nswhi
char
ethe
genet
icmachi
ner
yoft
hecel
l.
 I
tal
socont
ainsdensegr
anul
arst
ruct
urescal
lednucl
eol
us.
 Cel
lsar
eofdi
ff
erentsi
zesr
angi
ngf
rom 200nm t
osever
alcent
imet
ersi
nlengt
h.
 Thehumanbodycont
ainsupt
oabout75t
ri
ll
ioncel
lsofwhi
chabout25t
ri
ll
ioncel
lsar
e
r
edbl
oodcel
ls.
 Al
lcel
lsr
etai
n cer
tai
n char
act
eri
sti
cs,such as or
gani
zat
ion,r
esponse t
o ext
ernal
st
imul
i,
nut
ri
ti
on,
met
abol
ism,
respi
rat
ion,
excr
eti
on,
repr
oduct
ionet
c.
 Thecel
lsunder
godi
visi
oncal
l
edmi
tosi
sinwhi
cht
her
eisanappr
oxi
mat
edquant
it
ati
ve
di
visi
onofcyt
opl
asm andaccur
atequal
it
ati
vedi
visi
oni
nthenucl
eusmat
eri
al.
 Dependi
ngont
hef
unct
ionsandst
ruct
uralor
gani
zat
iont
her
ear
edi
ff
erentf
ormsof
cel
lsi
nhumanbodyi
ncl
udi
ngskel
etalcel
ls,muscl
ecel
ls,epi
thel
ialcel
ls,neur
alcel
ls,
whi
tebl
oodcel
ls,
redbl
oodcel
ls,
mucussecr
eti
ngcel
lset
c.
keNa+,
K+,
Ca+,
Mg+, -
 TheI
ntr
acel
lul
arf
lui
dandext
ra-
cel
lul
arf
lui
dcont
aini
onsl
i Cl,HCo3
-
So4+et
, c.
 Cor
rectbal
anceoft
hesei
onsi
nandoutoft
hecel
lisver
ymuchnecessar
yfort
he
pr
operf
unct
ioni
ngoft
hecel
l.
Rest
ingPot
ent
ialandAct
ionPot
ent
ial
Rest
ingpot
ent
ialorr
est
ingmembr
anepot
ent
iali
sdef
inedast
hepot
ent
ialt
hatexi
sts
acr
osst
hecel
lmembr
aneduet
othedi
ff
erent
ialdi
str
ibut
ionofi
onsi
nandar
oundt
hecel
l.
Di
ff
erent
ialdi
str
ibut
ionofi
onsi
smai
ntai
nedbyt
hesemiorsel
ect
ivel
yper
meabl
enat
ure
oft
hecel
lmembr
ane.
- +
I
nhumancel
ls,
most
lyCl
,K, andNa+i
onscont
ri
but
etor
est
ingmembr
anepot
ent
ial
.
I
nnor
malcondi
ti
onatpol
ari
zat
iont
hepor
esi
nthesemi
-per
meabl
emembr
aneoft
hecel
l
ow Na+ i ow K+ andCl
-
ar
enotbi
genought
oal
l onst
opasst
hroughbutcanal
l topass
t
hrough.
eK+andCl
-
Ther
efor ionscont
ri
but
etot
hemembr
anepot
ent
ial
.
Ther
efor
eatpol
ari
zedst
ateNa+i
onsi
nsi
det
hecel
lbecomesmuchl
owert
hani
ntheext
ra
cel
lul
arf
lui
dout
side.
Si
ncesodi
um i
onsar
eposi
ti
ve,
out
sideoft
hecel
lisposi
ti
vecompar
edt
othei
nsi
de.
Equi
li
bri
um i
nionconcent
rat
ioni
sthusr
eachedwi
thapot
ent
ialdi
ff
erenceacr
osst
he
membr
ane,negat
iveoni
nsi
deorposi
ti
veont
heout
sideandt
hismembr
anepot
ent
iali
s
knownasr
est
ingpot
ent
ial
.
Thi
spot
ent
iali
smai
ntai
nedunt
ilsomedi
stur
bance(
exci
tat
ion)i
sgi
ven.Rest
ingpot
ent
ial
r
angesnor
mal
lyf
rom -
60mVt
o-100mV.
Duet
oconcent
rat
iondi
ff
erenceofK+ i
onsi
nthei
nsi
deandout
sideoft
hecel
l,cr
eat
esa
di
ff
usi
ongr
adi
entwhi
chi
sdi
rect
edout
war
dacr
osst
hemembr
anewhi
chcausest
he
i
nsi
deoft
hecel
ltobecomemor
enegat
ivet
hant
heout
side.
-
Whi
chmeanst
hatmor
eClpasst
hrought
othei
nsi
deoft
hecel eK+ i
landmor onspass
t
hrought
hecel
lmembr
anet
otheout
sideoft
hecel
l.
Att
hiscondi
ti
on,
thecel
lresembl
esal
eakycapaci
torwher
etheassoci
atedel
ect
ri
cfi
eldi
s
di
rect
edi
nwar
ds(
posi
ti
veandnegat
ive)t
othecel
l.Thi
sst
opst
hei
nwar
dfl
owofnegat
ive
-
(
Cl)ionsandout
war
dfl
owofposi
ti
vei K+)
ons( .
Si
ncet
heel
ect
ri
candt
hedi
ff
usi
onf
orceact
sopposi
tet
oeachot
her
,ast
eadyst
ate
(
equi
li
bri
um st
ate)i
sreached.Atst
eadyst
ate,
thepot
ent
ialusi
ngNer
nstequat
ioni
sgi
ven
by,
Eeq,
K+=RT/
zFl
n[K+]
o/K+]
[ i
Eeq,
K+ i
stheequi
li
bri
um pot
ent
ialf
orpot
assi
um,
measur
edi
nvol
ts.
k-1. -
1
Ri
stheuni
ver
salgascont
ant
,equalt
o8.
314j
oul
es. mol
Ti
stheabsol
utet
emper
atur
e,measur
edi
nKel
vins
zi
sthenumberofel
ement
arychar
gesoft
hei
on
-
1
Fi
stheFar
adayconst
ant
,equalt
o96,
485coul
ombs.
mol
K+]
[ oist
heext
racel
lul
arconcent
rat
ionofpot
assi
um,
measur
edi
nmol
.m-3
K+]
[ ii
sthei
ntr
acel
lul
arconcent
rat
ionofpot
assi
um,
measur
edi
nmol
.m-3
Pol
ari
zedSt
ateofcel
lwi
thr
est
ingpot
ent
ial
Ther
est
ingpot
ent
ialcanbecal
cul
atedwi
tht
heGol
dman–Hodgki
n–Kat
zorGol
dman
Equat
ionvol
tageequat
ionusi
ngt
heconcent
rat
ionsofi
onsal
soi
ncl
udi
ngt
her
elat
ive
per
meabi
l
ityofeachi
oni
cspeci
es.
Undernor
malcondi
ti
ons,onl
ypot
assi
um (
K+)
,sodi
um (
Na+)andchl
ori
de(
Cl-
)ionspl
ay
l
arger
olesf
ort
her
est
ingpot
ent
ialcal
cul
ati
on.
PNa+[
Na+] + + - -
PNa+[
Na+] + + - -
Em =RT/
Fln(
( o+PK [
K]o+PCl[
Cl]
)
i/( i+PK [
K]i+PCl[
Cl]
o)
)
Thi
sequat
ionr
esembl
est
heNer
nstequat
ion,
buthasat
ermf
oreachper
meanti
on.
Themembr
anepot
ent
iali
sal
wayschangi
ngi
ncer
tai
ncel
lsl
iket
hecar
diacpacemaker
cel
ls.
Ther
est
ingmembr
anepot
ent
ialcanbemeasur
edbyi
nser
ti
nganel
ect
rodei
ntot
hecel
l
wi
thar
efer
enceel
ect
rodeatt
heout
sideoft
hecel
l.
Thesepot
ent
ial
scanal
sobemeasur
edwi
tht
heusageofdyest
hatchanget
hei
ropt
ical
pr
oper
ti
esaccor
dingt
othemembr
anepot
ent
ial
.
Soast
omai
ntai
nst
eadyst
atei
oni
cimbal
ance,cont
inuoust
ranspor
tofi
onsi
srequi
red.
Theact
ivet
ranspor
tofi
onsi
srequi
red.
Theact
ivet
ranspor
tmechani
sm oft
hecel
liscal
ledsodi
um –pot
assi
um pump.
Thi
spumpact
ivel
ytr
anspor
tsK+ i
onsi
ntot landNa+ i
hecel onsoutoft
hecel
lint
her
ati
o
3Na+:
2K+.Ener
gyoft
hepumpi
spr
ovi
dedbycel
lul
arener
gy(
ATP)
.
Fact
orsi
nfl
uenci
ngt
hef
lowofi
onsacr
osst
hemembr
anear
e,
1.Di
ff
usi
ongr
adi
entacr
osst
hemembr
ane
2.El
ect
ri
cfi
elddi
rect
edi
ntot
hecel
l
3.Membr
anenat
ure(
Semiper
meabl
e)
4.Act
ivet
ranspor
tofi
onsagai
nstt
heel
ect
rochemi
calgr
adi
ent
.
Thi
smovementofsodi
um i
onsi
ntot
hecel
lconst
it
utesani
oni
ccur
rentf
low t
hatf
urt
her
r
educest
hebal
anceoft
hemembr
ane.Thenetr
esul
tisanaval
ancheef
fectwhi
cht
ri
est
o
bal
ancewi
tht
hei
onsout
side.Att
hesamet
i K+i
me, ons,
whi
char
ehi
gheri
nconcent
rat
ion
i
nsi
det
hecel
ldur
ingr
est
ingpot
ent
ialst
atet
ryt
oleavet
hecel
l,
butar
eunabl
etomoveas
astasNa+ i
f ons.Thust
hecel
lat
tai
nsasmal
lposi
ti
vepot
ent
ialont
hei
nsi
deduet
o
i anceofK+i
mbal onsknownasact
ionpot
ent
ialwhi
chi
snear
ly+20mV.Thecel
lisnowi
n
t
hedepol
ari
zedcondi
ti
on.Thepr
ocessofchangi
ngt
hecel
lfr
om r
est
ingpot
ent
ialst
atet
o
act
ionpot
ent
ialst
atei
scal
leddepol
ari
zat
ion.
Depol
ari
zedSt
ateofcel
lwi
thact
ionpot
ent
ial
Now equi
li
bri
um st
atei
s achi
eved,once t
he r
ush ofsodi
um i
ons t
hrough t
he cel
l
membr
anehasst
opped.I
oni
ccur
rent
s,whi
chl
ower
edt
hebar
ri
ersodi
um i
onsar
eno
l
ongerpr
esentandt
hemembr
aner
ever
tsbackt
oit
sor
igi
nalsemi
/sel
ect
ivel
yper
meabl
e
condi
ton.ThuspassageofNa+i
i onsf
rom out
sidet
oinsi
dei
sagai
nbl
ocked.
Ti
met
akenf
ort
hecel
ltocomebackt
orest
ingpot
ent
ialf
rom act
ionpot
ent
ialwi
llbemor
e
butbyt
heact
ivepr
ocess(
sodi ,Na+ ar
um pump) etr
anspor
tedout
sidet
hecel
landhence
t
he cel
lbecomes pol
ari
zed at
tai
ns r
est
ing pot
ent
ialst
ate.Thi
s pr
ocess i
s cal
led
r
epol
ari
zat
ion.Ther
ateofpumpi
ngi
sdi
rect
lypr
opor
ti
onalt
othesodi
um concent
rat
ioni
n
t
hecel
l.
The nethei
ghtofact
ion pot
ent
iali
s def
ined as di
ff
erence bet
ween t
he pot
ent
ialof
depol
ari
zedmembr
aneatpeakofact
ionpot
ent
ialandr
est
ingpot
ent
ial
.
Af
teranact
ionpot
ent
ial
,ther
eexi
stsabr
iefper
iodoft
imedur
ingwhi
cht
hecel
lcannot
r
espondt
oanynew st
imul
us.Thi
sper
iodi
sabsol
uter
efr
act
oryper
iod.Fol
lowi
ngt
he
absol
uter
efr
act
oryper
iod,t
her
eoccur
sar
elat
iver
efr
act
oryper
iod,dur
ingwhi
chanot
her
act
ionpot
ent
ialcanbet
ri
gger
ed,
byast
rongerst
imul
ati
on.
Act
ionPot
ent
ial–Cycl
e
Anact
ionpot
ent
iali
sthusar
api
dchangeoft
hepol
ari
tyoft
hevol
tagef
rom negat
ivet
o
posi
ti
veandt
henvi
cever
sa,
theent
ir
ecycl
elast
ingnt
heor
derofmi
ll
iseconds.Eachcycl
e
andt
her
efor
eeachact
ionpot
ent
ialhasar
isi
ngphase,andf
inal
lyanover
shootphase.I
n
car
diacpacemakercel
ls,apl
ateauphas4ofi
nter
medi
atevol
tagemaypr
ecedet
hef
all
ing
phase,
ext
endi
ngt
heact
ionpot
ent
ialdur
ati
oni
ntohundr
edofmi
ll
iseconds.
Ner
vousSyst
em
Thener
voussyst
em i
sthebody’
scont
rolcent
er.
Funct
ionsoft
hener
voussyst
em i
ncl
ude
1.I
tsenseschangeswi
thi
nthebodyandout
sideenvi
ronment
.
2.I
tint
erpr
etst
hechanges.
3.I
thel
psi
ntheco-
ordi
nat
ionoft
hevar
iouspar
tsoft
hebody.
Funct
ionalOr
gani
zat
ionalofNer
vousSyst
em
Cent
ralner
voussyst
em:
Thecent
ralnervoussyst
em f
ormst
hecont
rolcent
reofent
ir
esyst
em andi
tcompr
isest
he
brai
nandspinalcord.
Br
ain:
 Thehumanbr
ai esabout1500cm3i
nmeasur nvol
umeandwei
ghs1.
36Kgs.
 I
tispl
acedi
nsi
det
hecr
ani
um whi
chgi
vesi
tcompl
etepr
otect
ion.
 Thebr
aini
scover
edbyt
hreemembr
anesnamel
ypi
amat
er,
arachnoi
danddur
amat
er.
 Thespacebet
weent
hepi
amet
erandar
achnoi
disf
il
ledwi
tht
hecer
ebr
ospi
nalf
lui
d.
 Thebr
aini
sdi
videdi
ntot
hreepar
tsnamel
y,
1)For
eBr
ain(
Prosencephal
on)
2)Mi
dBr
ain(
Mesencephal
on)
3)Hi
ndBr
ain(
Rhombencephal
on)
1)For
ebr
ain:
 Thef
orebr
ainconsi
stsoft
hecer
ebr
um,
olf
act
oryl
obesandt
hedi
encephal
ons.
 Cer
ebr
um:Thecer
ebr
um occupi
es2/
3por
ti
onoft
hebr
ain.Ther
ear
etwol
obesof
cer
ebr
um cal
ledcer
ebr
alhemi
spher
esandt
heset
woar
econnect
edbyat
issuecal
led
cor
puscal
losum.
 Thehemi
spher
esoft
hecer
ebr
um ar
edi
videdi
ntof
ourl
obesvi
sibl
efr
om t
heout
side.
 Theyar
ea)Fr
ont
alb)Par
iet
alc)Occi
pit
ald)Tempor
al.
 Theout
err
egi
onoft
hecer
ebr
um i
sgr
eyi
ncol
orandhenceknownasgr
eymat
ter
(
cer
ebr
alcor
tex)
.
 Thi
sconsi
stsoft
hecyt
onsoft
heneur
ons.
 Thei
nnerpor
ti
onwhi
chi
swhi
tei
ncol
ori
sknownast
hewhi
temat
terandi
scomposed
ofbundl
esofner
vef
iber
s.
 Thegr
eymat
teri
sfol
dedandt
hrowni
ntoanumberofconvol
uti
onsconsi
sti
ngof
r
idgesandf
urr
owst
obeaccumul
atedwi
thi
nthel
imi
tedspaceoft
hecr
ani
um.
 Ther
idgesar
eknownasgyr
i(si
ngul
argyr
us)andt
hef
urr
owssul
ci(
Singul
arSul
eus)
 Thecapi
ll
ari
esf
oundal
lovert
hecer
ebr
alcor
texsuppl
yoxygent
othebr
ain.
 Thecer
ebr
um i
stheseatofconsci
ousness,i
ntel
li
gence,i
magi
nat
ion,memor
y,and
r
easoni
ng,
thi
nki
ngandpl
anni
ng.
 Speci
fi
car
easar
eassi
gnedont
hecor
texf
orspeci
fi
cfunct
ion.Thust
her
eisacent
re
f
orvi
sion,
forper
cept
ionofsound,
tast
e,smel
l,
touchet
c.
 Di
encephal
on:They ar
e a gr
oup ofunpai
red st
ruct
ures l
ocat
ed deep wi
thi
nthe
cer
ebr
um.
 Thi
sisconsi
der
edast
hei
nter
brai
nthatl
iesal
mosthi
ddenbyt
hecer
ebr
um.
 I
tconsi
stsoft
het
hal
amus,
hypot
hal
amus,
lat
eralgeni
cul
atenucl
eus,
pit
uit
arygl
and.
 Si
gnal
sfr
om t
hecer
ebel
lum passt
hrought
het
hal
amusont
hewayt
othemot
orar
eas
oft
hecer
ebr
um.
 Al
lsi
gnal
sent
eri
ngt
hebr
ainf
rom t
heopt
icner
vesent
ert
heLGN(
Lat
eralGeni
cul
ate
Nucl
eus)andunder
gosomepr
ocessi
ngbef
oremovi
ngont
hevar
iousar
easoft
he
cer
ebr
um.
 Thehypot
hal
amusi
stheseatofaut
onomi
cner
voussyst
em andi
sthesour
ceofabout
8hor
mones.Damaget
othi
spar
tisver
yfat
al.
 Pi
tui
tar
ygl
andr
ecei
vest
heant
i-
diur
eti
chor
mone(
ADH)andt
heoxyt
oci
nfr
om t
he
hypot
hal
amusandr
eleasesi
ntot
hebl
oodst
ream.
 Ol
fact
oryl
obes:Thi
sisr
esponsi
blef
ort
hesenseofol
fact
ion(
smel
l)
 Theyr
ecei
vei
nputf
rom t
heol
fact
oryepi
thel
i
a.
HumanBr
ain
2)Mi
dBr
ain:
 Themi
dbr
ainoccupi
esonl
yasmal
lregi
oni
nhumanwhent
hewhol
eoft
hebr
aini
s
concer
ned.
 Ther
ear
efourhemi
spher
icalbodi
escal
ledcor
por
aquadei
gemi
na.
 Thesear
eresponsi
blef
ort
hemovementoft
heeyes,t
heheadandt
her
efl
exesofbot
h
si
desoft
hebody.
 Thesubst
ant
iani
grai
nthemi
dbr
ainhel
psi
nsmoot
hmovementoft
hebody.
 Damaget
othi
ssubst
ant
iani
gracausesPar
kinson’
sdi
sease.
3)Hi
ndBr
ain:
 Thehi
ndbr
ainconsi
stsoft
hecer
ebel
lum,
ponscer
ebel
liandt
hemedul
laobl
ongat
a.
 Cer
ebel
lum:Thi
sis si
tuat
ed bel
ow t
he cer
ebr
um and i
tconsi
sts oft
wo deepl
y
convol
uted,
hemi
spher
es.
 I
trepr
esent
sonl
y10%oft
hewei
ghtoft
hebr
ainand50%oft
heneur
onspr
esenti
nthe
br
ain.
 I
tregul
atesandco-
ordi
nat
est
hegr
oupmovement
sofskel
etalmuscl
es.(
ie)i
tcont
rol
s
act
ionsl
ikewal
king,
runni
nget
c.
 PonsCer
ebel
li
:Thesear
eabr
idgeofner
vef
iber
sconnect
ingt
het
wol
obesoft
he
cer
ebel
lum.
 I
tact
sast
her
elaycent
reandi
sresponsi
blef
ormuscul
armovement
s.
 Medul
laObl
ongat
a:Themedul
laObl
ongat
ali
espost
eri
orl
ytot
hebr
ainandi
tcont
inues
ast
hespi
nalcor
d.
 Ner
vei
mpul
sesar
isi
ngf
rom her
e,
i
) St
imul
atest
hei
nter
coast
almuscl
esanddi
aphr
agm maki
ngbr
eat
hingpossi
ble.
i
i)Regul
ateshear
tbeat
i
ii
)Regul
atest
hedi
amet
erofar
ter
iol
est
husadj
ust
ingbl
oodf
low.
 Spi
nalcor
d:Spi
nalcor
dist
hecont
inuat
ionoft
hemedul
laobl
ongat
a
 I
tist
ubul
ari
nst
ruct
ureandi
sencl
osedwi
thi
ntheneur
alcanaloft
hever
tebr
alcol
umn.
 Thepost
eri
orpor
ti
onoft
hespi
nalcor
disf
il
ament
ousandi
sknownasf
il
um t
ermi
nal
e.
 Ther
eisacent
ral
canal
runni
ngt
hrought
hecent
reoft
hespi
nalcor
d.
 Thi
scanali
sfi
ll
edwi
thnut
ri
ti
vef
lui
dcal
ledcer
ebr
ospi
nalf
lui
d.
 Funct
ionsofspi
nalcor
d:
i
)Itconnect
sal
argepar
toft
heper
ipher
alner
voussyst
em.
i
i)Ner
vei
mpul
sesf
rom t
hesensor
yneur
onsar
etr
ansmi
tt
edt
othebr
ainbyt
his.
i
ii
)Si
gnal
s(cont
rol
)ar
isi
ngf
rom t
hebr
ainar
eal
sodel
iver
edt
othemot
orneur
ons.
i
v)Thespi nalcor
dalsoact
sasami norcoor
dinat
ingcent
rer
esponsi
blef
orsome
ref
lexesli
kethewi
thdr
awref
lex.
Per
ipher
alNer
voussyst
em:
a.Cr
ani
alNer
ves:
 Ner
vest
hatemer
gef
rom t
hebr
ainar
ecal
ledcr
ani
alner
ves.Ther
ear
etwel
vepai
rsof
cr
ani
alner
vesi
nhumanbei
ngs.
 Thesener
vesmaybeoneoft
heset
ypes,
a)Sensor
y:Car
ryi
ngr
ecept
orst
othebr
ain
b)Mot
or:Car
ryi
ngi
mpul
sesf
rom t
heCNSt
oamuscl
eoragl
and.
c)Mi
xed:Bot
hsensor
yandmot
ori
nfunct
ion.
b.Spi
nalNer
ves:
 31pai
rsofner
vear
isef
rom t
hespi
nalcor
d.
 Thesepai
rsofner
vesar
ecal
ledt
hespi
nalner
ves.
 Eachner
veor
igi
nat
esf
rom t
wor
oot
sador
salr
ootandavent
ralr
oot
,thesej
oint
ofor
m
t
hespi
nalner
ve.
 Thesensor
yner
vesr
ecei
vei
mpul
sest
hrought
hedor
salr
ootandmot
orner
vesr
ecei
ve
t
hrought
hevent
ralr
oot
.
Aut
onomousNer
voussyst
em:
 Thi
sli
esout
sidet
hecent
ralner
voussyst
em (
ie)out
sidebr
ainandspi
nalcor
d.
 I
thel
psi
nfunct
ioni
ngofor
gansl
ikehear
t,st
omachandi
ntest
ines.
 I
tconsi
stsoft
woner
vesnamel
ysympat
het
icandpar
asympat
het
icner
ves.
 Theset
woner
vespossessant
agoni
sti
cfunct
ions.
S.
No Par
aSympat
het
icNer
ves Sympat
het
icNer
ves
.
1 Const
ri
ctst
hepupi
l Di
lat
est
hepupi
l
.
2 Ret
ardshear
tbeat Accel
erat
eshear
tbeat
.
3 I
nfl
uencessal
ivar
ysecr
eti
ons I
nhi
bit
ssal
ivar
ysecr
eti
ons
.
4 Lowers bl
ood pressur
e and causes Raisesbloodpressur
eandcauses
. di
lat
ionofsmoot
hmuscl es contract
ionofsmoothmuscl
es
5 Nerve endings rel

ease a subst
ance Nerveendi
ngsrel
easeasubst
ance
. cal
ledacetyl
chol
ine cal
ledsympat
hin
Ner
vecel
l(Neur
on)andSynapse–Tr
ansmi
tt
ersandneur
alCommuni
cat
ion
 Ner
vecel
list
hebasi
cuni
toft
hener
voussyst
em.
TheNer
veCel
l(Neur
on)
 Thener
vecel
lbodyi
scal
ledast
hesoma.
 Thesomai
ssur
roundedbyt
woki
ndsofpr
otopl
asmi
cpr
ocesses.
 Theyar
e,
o Br
anchedst
ruct
ureknownasdendr
it
es
o Si
ngl
eun-
branchedst
ruct
urecal
ledt
heaxon
 Thedendr
it
esr
ecei
vei
mpul
seswher
easaxonsconducti
mpul
ses.
 Some ner
ve f
iber
s ar
e cover
ed by an i
nsul
ti
ng l
ayercal
led myel
in sheat
h wi
th
const
ri
cti
onsatr
egul
ari
nter
val
s.
 Theseconst
ri
cti
onsar
ecal
lednodesofRanvi
er.
 ThenodeofRanvi
erser
vesaspoi
ntsal
ongt
heneur
onf
orgener
ati
ngasi
gnal
.
 Ner
vef
iber
swi
thmyel
insheat
har
ecal
ledmyel
inat
edner
vef
iber
sandner
vef
iber
s
wi
thoutmyel
insheat
har
ecal
lednon-
myel
inat
edner
vef
iber
.
 Thener
vei
mpul
sest
ravelf
rom oneneur
ont
oanot
herbypassi
ngf
rom axonofone
neur
ont
othedendr
it
eoft
heot
her
.
 Thef
unct
ionbet
weent
heaxonanddendr
it
eiscal
ledt
hesynapse.
 I
tist
hrought
hesynapset
hener
vei
mpul
sespasst
othedendr
it
eoft
hef
oll
owi
ng
neur
on.
 Messagest
ravelwi
thi
ntheneur
onasanel
ect
ri
calact
ionpot
ent
ial
.
Neur
o–Muscul
arJunct
ion
 Thespacebet
weent
wocel
lsi
sknownast
hesynapt
iccl
eft
.
 To cr
oss t
he synapt
ic cl
eftt
he el
ect
ri
c i
mpul
ses r
equi
res t
he act
ions of
neur
otr
ansmi
tt
ers.
 Neur
otr
ansmi
tt
ersar
est
oredi
nsmal
lsynapt
icvesi
clest
omovet
otheendoft
heaxon
anddi
schar
get
hei
rcont
ent
sint
othesynapt
iccl
eft
.
 Ar
ri
valoft
heact
ionpot
ent
ialcausessomeoft
hevesi
clest
omovet
otheendoft
he
axonanddi
schar
get
hei
rcont
ent
sint
othesynapt
iccl
eft
.
 Rel
easedneur
otr
ansmi
tt
ersdi
ff
useacr
osst
hecl
eft
,andbi
ndt
orecept
orsont
heot
her
cel
l’
smembr
ane,
causi
ngi
onchannel
sont
hatcel
ltoopen.
 Thi
spr
ompt
str
ansmi
ssi
onoft
hemessageal
ongt
hatcel
l’
smembr
ane.
 Acet
ylchol
ine,dopami
ne and Nor
epi
nephei
ne ar
e exampl
es ofneur
otr
ansmi
tt
ers,
al
thougheachact
sindi
ff
erentr
esponses.
 Theseneur
otr
ansmi
tt
ersr
emai
nint
hecl
eftonl
yforsomet
ime.
 Enzymesi
nthecl
efti
nact
ivat
etheneur
otr
ansmi
tt
ers.
 I
nact
ivat
edneur
otr
ansmi
tt
ersar
etakenbacki
ntot
heaxonandr
ecycl
ed.
 Neur
otr
ansmi
tt
er,
”dopami
ne”def
ici
encycausesPar
kinson’
sdi
sease.
Car
diovascul
arSyst
em
Cardiovascul
arsyst
em rel
atestot
hepumpingmechani
sm ofhear
t,t
hest
ruct
ureofr
elat
ed
organsandor i
ginandconducti
onofhear
tbeat
.
Anat
omyofhumanhear
t:
 Humanhear
tisl
ocat
edi
ntheupperpor
ti
onoft
hechest
.
 Al
thought
hesi
zeandwei
ghtoft
hehear
tvar
yfr
om onei
ndi
vidualt
oanot
heri
nmost
cases,t
hesi
zeoft
hehear
tisappr
oxi
mat
elyt
hesi
zeoft
heper
son’
scl
enchedf
istand
t
heaver
agewei
ghtoft
hehear
tisabout300gm.
 Thehear
tisachambercover
ed bymuscl
est
hati
sencased i
n asaccal
led t
he
per
icar
dium.
 Thi
sper
icar
dium cr
eat
esal
ubr
icat
ingf
lui
doni
tsi
nsi
desur
facesot
hatt
hef
ri
cti
on
bet
weeni
tandt
hehear
twal
lisr
educed,al
lowi
ngt
hehear
ttobeatf
reel
ywi
thi
nthe
wal
lsoft
hesac.
 Thehear
tist
hecent
reoft
heci
rcul
ator
ysyst
em,
iti
smadeofmuscl
esandi
tact
sasa
pump.
 Thehear
tismadeoff
ourchamber
snamel
yther
ightat
ri
um,l
eftat
ri
um,r
ightvent
ri
cle
andl
eftvent
ri
cle.
 The pumpi
ng act
ion ofhear
tis per
for
med by cont
ract
ion oft
he hear
tmuscl
es
sur
roundi
ngeachchamber
soft
hehear
t.
 Thesemuscl
esr
ecei
vebl
oodf
rom t
hecor
onar
yar
ter
ieswhi
chcovert
hehear
tli
kea
cr
own(
cor
ona)
.
 Ther
ear
ethr
eet
ypesofhear
torcar
diacmuscl
esnamel
y,
i
) At
ri
almuscl
e
i
i) Vent
ri
cul
armuscl
e
i
ii
) Speci
ali
zedexci
tat
oryandconduct
ivemuscl
e.
 Car
diacmuscl
esar
est
ri
atedandi
nvol
unt
aryi
nnat
ure.St
ri
atedmuscl
esar
ethosewi
th
st
ri
ati
ons ort
ransver
se l
ines atr
egul
ari
nter
val
s.I
nvol
unt
ary muscl
es ar
ethose
muscl
eswhi
chcannotbecont
rol
ledatwi
ll
.
 Thet
woat
ri
aar
esepar
atedbyacont
inuouspar
ti
ti
oncal
ledt
hei
nter
-at
ri
alsept
um and
t
hevent
ri
clesar
esepar
atedbyt
hei
nter
-vent
ri
cul
arsept
um.
 Theat
ri
aar
esepar
atedf
rom t
hevent
ri
clesbyt
heaur
icul
ovent
ri
cul
arsept
um.
 Thust
her
eisacompl
etesepar
ati
onofoxygenat
edbl
oodanddeoxygenat
edbl
ood.
 Deoxygenat
edbl
oodf
rom al
lpar
tsoft
hebodyi
sbr
oughtt
other
ightat
ri
um t
hrought
he
super
iorandt
hei
nfer
iorvenacavae.
 Thepul
monar
yar
ter
ydi
videsmanyt
imes,
int
osmal
lerar
ter
ies(
art
eri
oles)
.
 Thear
ter
iol
essuppl
ybl
oodt
otheal
veol
arcapi
ll
ari
esoft
hel
ungswher
eredbl
oodcel
ls
ar
erechar
gedwi
thoxygenandt
heygi
veoutCO2.
 Ont
heot
herl
ung,
thet
inycapi
ll
ari
esf
eedi
ntot
inyvei
nsandvenul
eswhi
chcombi
net
o
f
ormt
hepul
monar
yvei
n.
 Thi
svei
nret
urnst
heoxygenat
edbl
oodt
othehear
t.
 Thebl
oodent
erst
hrought
hel
eftat
ri
um f
rom wher
eiti
spumpedt
hrought
hemi
tr
alor
t
hebi
cuspi
dval
vei
ntot
hel
eftvent
ri
cle.
 Thel
eftvent
ri
cul
armuscl
econt
ract
sandt
hepr
essur
edevel
opedcl
osest
hebi
cuspi
d
val
ve.
 Abui
lt
-uppr
essur
eint
hevent
ri
clef
orcest
heaor
ti
cval
vet
oopencausi
ngt
hebl
ood
f
lowi
ntheaor
ta.
 Thebl
oodr
eachesvi
talor
ganssuchasbr
ainandt
otheext
remi
ti
esbyt
hebi
fur
cat
ion
ordi
visi
onofar
ter
ies.
 Thehear
tpumpsabout5l
it
ersofbl
oodpermi
nut
e.
 Thehear
tbeat
s72t
imespermi
nut
e.
 I
nanor
mal
adul
tthesyst
oli
cbl
oodpr
essur
erangesi
n95mm t
o140mm ofHg.
 Theaver
agepr
essur
eisar
ound120mm ofHg.
 Thedi
ast
oli
cormi
nimum bl
oodpr
essur
erangei
s60mm t
o90mm ofHg.
 Theaver
agepr
essur
eisar
ound80mm ofHg.
Anat
omyofHumanHear
t
Or
igi
n,conduct
ionandr
egul
ati
onofhear
tbeat
:
 Outoft
het
hreecar
diacmuscl
esnamel
ytheat
ri
almuscl
e,t
hevent
ri
cul
armuscl
eand
t
hespeci
ali
zedexci
tat
ory&conduct
ivemuscl
est
heexci
tat
oryandconduct
ivemuscl
es
ar
eresponsi
blef
ort
heconduct
ionofhear
tbeat
.
 Thehear
tbeator
igi
nat
esatt
heSA(
SinoAt
ri
al)nodewhi
chi
slocat
edneart
hej
unct
ion
oft
hesuper
iorvenacavaandt
her
ightat
ri
um.
 Thehear
tbeatst
art
supwi
thar
hyt
hmi
cali
mpul
segener
atedatt
heSAnode.
 TheSAnodeact
sasapacemakerf
ort
hehear
t.
 Thei
mpul
set
hati
sgener
ated att
heSA nodei
sconduct
ed orpassed on t
othe
at
ri
ovent
ri
cul
arnodeort
heAVnodel
ocat
edont
her
ightsi
deoft
hei
nter
-at
ri
alsept
um,
neart
het
ri
cuspi
dval
vebyt
hei
nter
-nodalt
ract
s.
 Thei
nter
-nodalpat
hwaysar
ecompr
ised oft
hreepai
rofspeci
ali
zed cel
lsnamel
y
ant
eri
or,mi
ddl
e and post
eri
orand t
hese ar
e speci
ali
zed conduct
ing f
iber
s whi
ch
conduct
simpul
sesf
rom SAnodet
otheAVnode.
 Thei
nter
-nodalpat
hwaysdel
ayt
hei
mpul
sesf
rom t
heat
ri
abef
orepassi
ngi
tont
othe
vent
ri
cles.
 Theconduct
ionofpul
sef
rom SAnodet
oAVnodet
akes0.
03sec.
 Thi
sdel
ayi
stoenabl
ethecont
ract
ionoft
heat
ri
aandhencet
hedr
aini
ngofbl
oodi
nto
t
hevent
ri
cles.
 Fr
om t
heAVnodet
hei
mpul
sest
raveldownt
othevent
ri
clest
hrought
heAVbundl
e.
 TheAVbundl
eisl
ocat
edatt
heaur
icul
arvent
ri
cul
arsept
um.
 TheAV bundl
eisnot
hingbutmuscl
efasci
clespassi
ngt
hrought
hef
ibr
oust
issue
separ
ati
ngt
heat
ri
aandvent
ri
cles.
 Thei
mpul
sest
oreacht
heAVbundl
efr
om t
heAVnode,
takes0.
09sec.
 The muscl
es i
nthe AV bundl
e ar
elar
gert
han t
he vent
ri
cul
armuscl
es and t
he
conduct
ionvel
oci
tyofi
mpul
sesar
esl
ower
.
 Thust
her
eisaf
urt
herdel
ayi
nconduct
ionofpul
sesatt
heAVbundl
eforaanot
her0.
04
sec.
 Thepul
sesar
ethenconduct
edt
hroughoutt
hevent
ri
clet
oenabl
eit
scont
ract
ionby
f
iber
swhi
chbr
anchoutf
rom t
heAVbundl
east
her
ightbr
anchandt
hel
eftbr
anch
cal
ledt
hepur
kinj
efi
ber
s.
 Thepur
kinj
efi
ber
scauset
hedepol
ari
zat
ionoft
hevent
ri
cles.
 Theconduct
ionofi
mpul
sei
nPur
kinj
efi
berr
angeatar
ateof1.
5m/
sect
o4.
0m/
sec.
 Thi
srat
eis 160 t
imes mor
e when compar
ed t
othe conduct
ion vel
oci
ty oft
he
vent
ri
cul
armuscl
es.
 Ast
heexci
tat
ionpul
sest
raveldownf
rom t
heSAt
othepur
kinj
efi
ber
sorr
atherf
rom
t
heat
ri
atot
hevent
ri
clest
hecont
ract
ionoft
heat
ri
ast
art
supandpassesdownt
othe
vent
ri
cles.
 Thensl
owr
epol
ari
zat
ionoft
hevent
ri
clest
akespl
acet
oini
ti
atet
henexthear
tbeat
.
 Soahear
tbeatcompr
isesofbot
hcont
ract
ionandr
elaxat
ion.
 Ther
efor
e,acompl
etecar
diaccycl
eisdi
videdi
nto,
 Syst
ole– Cont
ract
ionofhear
t,bl
oodbei
ngpumpedi
ntot
heaor
taf
orci
rcul
ati
on
t
hroughoutt
hebody.
 Di
ast
ole– Rel
axat
ionordi
lat
ionofhear
t,Hear
tcavi
ti
esbei
ngf
il
ledwi
thbl
ood
t
hrought
hesuper
iorandi
nfer
iorvenacavae.
 So,
thedi
ast
oleandt
hesyst
olecompr
iseacompl
etecar
diaccycl
e.
Respi
rat
orySyst
em
I
ntr
oduct
ion:
 Thehumanbodyt
akesi
noxygen,whi
chcombi
neswi
thhydr
ogen,car
bonandvar
ious
ot
hernut
ri
ent
stopr
oduceheatandener
gyt
oper
for
m wor
k.
 Theent
ir
epr
ocessoft
aki
ngi
noxygenf
rom t
heenvi
ronment
,tr
anspor
ti
ngt
heoxygen
cel
ls,
removi
ngcar
bon–di–oxi
def
rom t
hecel
lsandexhaust
ingi
ttot
heat
mospher
e
i
scal
ledasr
espi
rat
ion.
 Respi
rat
ioncansi
mpl
ybecal
ledasexchangeofgases.
 Respi
rat
ionar
eoft
wot
ypesnamel
y,1)Ext
ernalRespi
rat
ion2)I
nter
nalRespi
rat
ion.
 Ext
ernalRespi
rat
ion:Theexchangeofgasesbet
ween t
hebl
ood and t
heext
ernal
envi
ronmentt
akespl
acei
nthel
ungsandi
ster
medasext
ernalr
espi
rat
ion.
 I
nter
nalRespi
rat
ion:I
nter
nalRespi
rat
ioni
sther
espi
rat
ionoft
hecel
lsori
tist
he
i
ntr
acel
lul
aruseofO2t
omakeAdenosi
net
riphosphat
e(ATP)
.
 Lungi
stheor
ganr
esponsi
blef
orr
espi
rat
ion.
St
ruct
ureofRespi
rat
orySyst
em:
 Thel
ungi
sthechi
efr
espi
rat
oryor
gan.i
tisencl
osedi
nthet
hor
aci
ccagewhi
chi
s
composedoft
hest
ernum i
nfr
ont
,thever
tebr
alcol
umni
ntheback,t
her
ibsenci
rcl
ing
t
hechestandt
hedi
aphr
agm bel
ow.
 Ai
rent
erst
hel
ungst
hrought
heai
rpassageswhi
chi
ncl
udet
henasalcavi
ti
es,
phar
ynx,
l
arynx,
trachea,
bronchiandt
hebr
onchi
oles(
ter
minalandr
espi
rat
ory)
 Thel
ungi
sinapai
rnamel
yri
ghtandl
eft
.
HumanRespi
rat
orySyst
em
 Ther
ightl
ungconsi
stsoft
hreel
obes(
upper
,mi
ddl
eandl
ower
)andt
hel
eftl
unghas
t
wol
obes(
upperandl
ower
).
 Thel
arynxort
hevoi
ceboxwhi
chcont
ainst
hevocalchor
dsi
sconnect
edt
othebr
onchi
t
hrought
het
rachea(
thewi
ndpi
pe)
.
 Abovet
hel
arynxi
stheepi
glot
ti
s,aval
vet
hatcl
oseswheneveraper
sonswal
lows,so
ast
oavoi
dfoodorl
iqui
dtoent
ert
hel
arynxandt
rachea.
 Thet
racheai
sabout1.
5to2.
5cm i
ndi
amet
erandappr
oxi
mat
ely11cm l
ongext
endi
ng
f
rom l
arynxt
otheupperboundar
yoft
hechest
.
 Ther
eitdi
videsi
ntor
ightandl
eftbr
onchi
.
 Eachbr
onchusent
eri
ntot
hecor
respondi
ngl
unganddi
videsi
ntosmal
lbr
anches.
 Thesebr
anchesar
eofunequall
engt
handar
eatdi
ff
erentangl
es.
 Thedi
amet
ersoft
hesebr
anchesar
ereducedf
rom 1.
5or2.
5to0.
1.
 Thesesmal
ltubeswhi
char
ehel
pfuli
nai
rconduct
ionar
ecal
ledt
hebr
onchi
oles.
 Thedi
amet
eroft
hesebr
onchi
olesf
urt
herr
educet
heset
inyt
ubesar
ecal
led t
he
t
ermi
nalbr
onchi
oles.
 These t
ermi
nalbr
onchi
oles agai
n br
anches i
nto smal
lerbr
onchi
oles cal
led t
he
r
espi
rat
orybr
onchi
oles.
 Al
veol
iar
eat
tachedt
othewal
lsoft
hel
ungs.
 Theyactast
heai
rsacs.
 Theexchangeofgasest
akespl
aceatt
heal
veol
us.
 Thel
ungsar
ecover
edbyat
hinmembr
anecal
ledt
hepl
eur
a.
 Thepl
eur
aisdoubl
elayer
ed,
thel
ayert
hatencl
osest
hel
ungsi
dei
scal
ledt
hevi
scer
al
pl
eur
a.
 Themembr
anet
hatl
iest
owar
dst
het
hor
aci
cwal
lsi
scal
ledpar
iet
alpl
eur
a.
 Aspeci
alf
lui
dissecr
etedbet
weent
heset
womembr
anesandt
hisi
scal
ledt
hei
nter
pl
eur
alf
lui
d.
 Thedi
aphr
agm i
saspeci
aldomeorbel
lshapedmuscl
esl
ocat
edatt
hebot
tom oft
he
t
hor
aci
ccavi
ty.
Mechani
csandVent
il
ati
onoft
hel
ung:
 Ast
hedi
aphr
agm cont
ract
s,t
hel
ungsexpands.
 Thi
sexpansi
onoft
hel
ungscausest
hepr
essur
eint
hel
ungsandt
heal
veol
inegat
ive
r
elat
ivet
oat
mospher
icpr
essur
e.
 Asar
esul
t,ai
rmovesf
rom ar
egi
onofhi
gherpr
essur
e(at
mospher
e)t
oar
egi
onofl
ow
pr
essur
e(l
ungsandal
veol
i)
.
 Af
terexchangeofgasessuchasO2 andCO2 t
akespl
ace,asetofabdomi
nalmuscl
es
pul
lst
hedi
aphr
agm upwar
ds.
 Thi
scausespr
essur
eint
hel
ungs,posi
ti
ver
elat
ivet
oat
mospher
icpr
essur
e,t
hust
he
i
mpur
eorexhaust
edai
r,l
eavest
hel
ungs.
Respi
rat
ionMechani
sm
 Thi
sai
r(oxygen)t
hatent
erst
hel
ungsdi
ff
usesf
rom t
her
etobl
oodandt
husdi
str
ibut
ed
t
ovar
iousor
gansoft
hebody.
 Di
ff
usi
onofgast
oal
veol
i:
 Thet
idalvol
umeofl
ungexpi
redf
rom at
mospher
eissuf
fi
cientenought
oreacht
he
br
onchi
.
 The ai
rtor
each t
he al
veol
arsacs vi
athe t
ermi
nalbr
onchi
oles,t
he r
espi
rat
ory
br
onchi
oles,
alveol
arsacs,
alveol
arduct
sdependsuponapr
ocesscal
leddi
ff
usi
on.
 Di
ff
usi
oni
snot
hingbutmovementofgasmol
ecul
esathi
ghvel
oci
tyei
thert
owar
dst
he
at
mospher
eort
owar
dst
heal
veol
i.
 Ener
gyf
ordi
ff
usi
oni
sobt
ainedf
rom t
heki
net
icener
gyoft
hemol
ecul
est
hemsel
ves.
Gasexchangei
nthel
ungs:
 Dur
ingi
nspi
rat
iont
heal
veol
isaci
sfi
ll
edwi
thoxygenr
ichai
rfr
om at
mospher
e.
ExchangeofGases
 Thepul
monar
ycapi
l
lar
iesdi
videdf
rom pul
monar
yar
ter
y,whi
chcar
ryi
mpur
ebl
ood
f
rom hear
tisi
nthepr
oxi
mit
yoft
heal
veol
isac.
 TheO2absor
bedf
rom at
mospher
edi
ff
usest
otheal
veol
isacandi
nter
changeofO2gas
wi
tht
heCO2f
rom t
hepul
monar
ycapi
ll
ari
es(
Pul
monar
ybl
ood)t
akespl
ace.
Pr
essur
eter
msr
elat
edt
orespi
rat
ion:
Al
veol
arPr
essur
e:
 Pr
essur
eofai
rinsi
del
ung(
alveol
i)i
scal
ledal
veol
arpr
essur
e.
 Whennoai
risf
lowi
ngi
noroutoft
hel
ungs,
thepr
essur
eofai
rinsi
det
hel
ungsi
smor
e
orl
essequal
tot
hatoft
heat
mospher
e.
 Thi
sissai
dtobe0cm ofH2Oi
nther
efer
encescal
e.
 Butt
odr
aw i
nai
ral
veol
arpr
essur
eshoul
dbenegat
ivei
nrel
ati
ont
oat
mospher
ic
pr
essur
e,sopr
essur
edr
opsdownt
o-1cm ofH2O.
 Thi
spr
essur
eissuf
fi
cientenought
odr
aw0.
5li
ter
sofai
rint
othel
ungs.
 Dur
ingexpi
rat
iont
her
ever
sehappens,t
hepr
essur
ebui
ldsupt
o1cm ofH2Owhi
chi
s
enought
oexpel0.
5ofai
r.
Pl
eur
alPr
essur
e:
 Hydr
ost
ati
cpr
essur
eofi
nter
-pl
eur
alf
lui
discal
ledpl
eur
alpr
essur
e.
 Nor
malpl
eur
alpr
essur
eatt
hebegi
nni
ngofi
nspi
rat
ioni
s-5cm ofH2Obutwhenl
ungs
expandt
hepr
essur
ebecomesst
il
lmor
enegat
ivet
oabout-
7.5cm ofH2O.
 Dur
ingexpi
rat
iont
her
ever
sehappens.
Tr
ans-
pleur
alpr
essur
e:
 Pr
essur
edi
ff
erencebet
weenal
veol
arpr
essur
eandpl
eur
alpr
essur
eiscal
ledt
rans-
pl
eur
alpr
essur
e.
 I
not
herwor
ds,t
hepr
essur
edi
ff
erencebet
weent
heal
veol
iint
hel
ungsandout
er
sur
faceoft
hel
ungsi
scal
ledast
rans-
pleur
alpr
essur
e.
 I
tisameasur
eofel
ast
icf
orcesoft
hel
ungst
hatt
endt
ocol
lapset
hel
ungsateach
i
nst
antofr
espi
rat
ion.
Changes i
n Lung Vol
ume,Al
veol
arPr
essur
e,Pl
eur
alPr
essur
e and Tr
ans-
pleur
al
Pr
essur
e
Basi
cBi
o-Medi
calI
nst
rument
ati
onSyst
em
Thequant
it
y,pr
oper
tyorcondi
ti
ont
hati
smeasur
edbyani
nst
rument
ati
onsyst
em i
scal
led
t
hemeasur
and.I
namedi
cali
nst
rument
ati
onsyst
em,t
hemeasur
andcanbeabi
oel
ect
ri
c
si
gnal
,suchast
hosegener
atedbymuscl
esort
hebr
ain,ort
hehear
torachemi
calor
mechani
calsi
gnal
thati
sconver
tedt
oanel
ect
ri
calsi
gnal
.
Sensor
s:
Conver
sionofphysi
calmeasur
andsi
ntoel
ect
ri
cout
put
sisdonebySensor
s(Bi
osensor
s).
Theout
put
sfr
om t
hesebi
osensor
sar
eanal
ogsi
gnal
s,i
.e.
,cont
inuoussi
gnal
sthatar
e
sentt
otheanal
ogpr
ocessi
nganddi
git
alconver
sionbl
ock.
Anal
ogPr
ocessi
ngandDi
git
alConver
sion:
Her
ethesi
gnal
sar
eampl
if
ied,
fil
ter
ed,
condi
ti
oned,
andconver
tedt
odi
git
alf
orm.
Bi
o-si
gnalPr
ocessi
ng:
Thent
hesi
gnal
sar
esubj
ect
edt
oBi
o-si
gnalpr
ocessi
ng(
Signalcondi
ti
oni
ng)whi
chi
sused
t
ohel
pincompensat
ionf
orundesi
rabl
esensorchar
act
eri
sti
cs.Oncet
heanal
ogsi
gnal
s
havebeendi
git
izedandconver
tedt
oaf
ormt
hatcanbest
oredandpr
ocessedbydi
git
al
comput
ers,
manymor
emet
hodsofsi
gnalcondi
ti
oni
ngcanbeappl
ied.
Basi
cBi
o-Medi
calI
nst
rument
ati
onSyst
em
Out
putDi
spl
ay:
Basi
cinst
rument
ati
onsyst
emsal
soi
ncl
udeout
putdi
spl
aydevi
cest
hatenabl
ehuman
oper
ator
stovi
ewt
hesi
gnali
naf
ormatt
hati
seasyt
ounder
stand.Thesedi
spl
aysmaybe
numer
icalorgr
aphi
cal
,di
scr
eteorcont
inuous,andper
manentort
empor
ary.Mostout
put
di
spl
aydevi
cesar
eint
endedt
otheobser
vedvi
sual
ly,
butsomeal
sopr
ovi
deaudi
bleout
put
,
e.
g.,
abeepi
ngsoundwi
theachhear
tbeat
.
Dat
aSt
orage:
I
naddi
ti
ont
odi
spl
ayi
ngdat
a,manyi
nst
rument
ati
onsyst
emshavet
hecapabi
li
tyofst
ori
ng
dat
a.I
nsomedevi
ces,
thesi
gnali
sst
oredbr
ief
lysot
hatf
urt
herpr
ocessi
ngcant
akepl
ace
orsot
hatt
heoper
atorcanexami
net
hedat
a.I
not
hercases,t
hesi
gnal
sar
est
ored
per
manent
lysot
hatdi
ff
erentsi
gnalpr
ocessi
ngcanbeappl
iedatal
atert
ime.Hol
ter
moni
tor
s,f
orexampl
e,acqui
re24hofECGdat
athatar
epr
ocessedt
odet
ermi
near
rhyt
hmi
c
act
ivi
tyandot
heri
mpor
tantdi
agnost
icchar
act
eri
sti
cs.
Dat
aTr
ansmi
ssi
on:
Wi
tht
heusageofi
nter
netandt
elephone,si
gnal
scanbeacqui
redwi
thadevi
cei
none
l
ocat
ion,per
hapsi
n a pat
ient
’shome,and can bet
ransmi
tt
ed t
o anot
herdevi
cef
or
pr
ocessi
ngand/
orst
orage.Thi
shasmadei
tpossi
ble,f
orexampl
e,t
opr
ovi
dequi
ck
di
agnost
icf
eedbacki
fapat
ienthasanunusualhear
trhyt
hm whi
leathome.I
tisal
lowed
medi
calf
aci
l
iti
esi
nrur
alar
east
otr
ansmi
tdi
agnost
ici
magest
oter
ti
arycar
ehospi
tal
sso
t
hatspeci
ali
zedphysi
cianscanhel
pgener
alpr
act
it
ioner
smakemor
eaccur
atedi
agnoses.
Cal
i
brat
ion:
Two ot
hercomponent
spl
ayi
mpor
tantr
olesi
ninst
rument
ati
on syst
ems.Thef
ir
sti
s
cal
ibr
ati
onsi
gnal
.Asi
gnalwi
thknownampl
it
udeandf
requencycont
enti
sappl
iedt
othe
i
nst
rument
ati
on syst
em at t
he sensor
’si
nput
.The cal
ibr
ati
on si
gnalal
lows t
he
component
soft
hesyst
em t
obeadj
ust
edsot
hatt
heout
putandi
nputhaveaknown,
measur
edr
elat
ionshi
p.Wi
thoutt
hisi
nfor
mat
ion,
iti
simpossi
blet
oconver
ttheout
putofan
i
nst
rumentsyst
em i
ntoameani
ngf
ulr
epr
esent
ati
onoft
hemeasur
and.
FeedbackCont
rol
:
Anot
heri
mpor
tantcomponenti
saf
eedback el
ementwhi
ch i
s nota par
tofal
l
i
nst
rument
ati
on syst
ems.These devi
ces i
ncl
ude pacemaker
s and vent
il
ator
sthat
st
imul
atet
hehear
tort
hel
ungs.Somef
eedbackdevi
cescol
lectphysi
ologi
caldat
aand
st
imul
atear
esponse(
e.g.
,ahear
tbeatorbr
eat
h)whenneededorar
epar
tofbi
ofeedback
syst
emsi
nwhi
cht
hepat
ienti
smadeawar
eofaphysi
ologi
calmeasur
ement(
e.g.
,bl
ood
pr
essur
e)andusesconsci
ouscont
rolt
ochanget
hephysi
ologi
calr
esponse.
Concl
usi
on:
Thebasi
ccomponent
sofa bi
omedi
cali
nst
rument
ati
on syst
em cont
ain sensor
sthat
conver
tthemeasur
and,e.
g.,car
diacel
ect
ri
calact
ivi
ty,i
ntoanel
ect
ri
calsi
gnal
,si
gnal
pr
ocessi
ngcomponent
sthatcondi
ti
on(
i.
e.,f
il
ter
,ampl
if
yandi
nsomecasesdi
git
ize)t
he
anal
ogsi
gnal
,andcomponent
sthatar
eusedt
ost
oreanddi
spl
ayt
heanal
ogand/
ordi
git
al
dat
a.I
nsomecases,dat
amaybet
ransmi
tt
edt
oanot
hersi
tef
ori
nter
pret
ati
onormaybe
usedaspar
tofacont
rolci
rcui
tthatf
eedsbackt
othepat
ient
.Al
lthesecomponent
sar
e
cont
rol
ledusi
ngpr
operi
nst
rumentcont
rol
.
sof
tti
ssues:
Whatdowemeanbysof
tti
ssues?Apr
imar
ygr
oupoft
issuewhi
chbi
nds,suppor
tsandpr
otect
s
ourhumanbodyandst
ruct
uressuchasor
gansi
ssof
tconnect
ivet
issue.I
ncont
rar
ytoot
her
t
issues,i
tisawi
de-
rangi
ngbi
ologi
calmat
eri
ali
nwhi
cht
hecel
lsar
esepar
atedbyext
racel
lul
ar
mat
eri
al.1Connect
ivet
issuesmaybedi
sti
ngui
shedf
rom har
d(mi
ner
ali
zed)t
issuessuchasbones
f
ort
hei
rhi
ghf
lexi
bil
it
yandt
hei
rsof
tmechani
calpr
oper
ti
es.I
nthi
sar
ti
clewear
emai
nlyconcer
ned
t
osaysomet
hingabouti
tfr
om t
hepoi
ntsofvi
ewofmat
eri
alsci
ence,
biomechani
csandst
ruct
ural
engi
neer
ing(
formor
edet
ail
ssee,f
orexampl
e,[
6],Chapt
er7)
.Exampl
esf
orsof
tti
ssuesar
e
t
endons,l
igament
s,bl
oodvessel
s,ski
nsorar
ti
cul
arcar
ti
lagesamongmanyot
her
s.Tendonsar
e
muscl
e-t
o-bonel
inkagest
ost
abi
li
zet
hebonyskel
eton(
ort
opr
oducemot
ion)
,whi
lel
igament
sar
e
bone-
to-
bonel
inkagest
orest
ri
ctr
elat
ivemot
ion.
Bl
oodvessel
sar
epr
omi
nentor
ganscomposedofsof
tti
ssueswhi
chhavet
odi
stendi
nresponse
t
opul
sewaves.Theski
nist
hel
argestsi
ngl
eor
gan(
16%oft
hehumanadul
twei
ght
).I
tsuppor
ts
i
nter
nalor
gansandpr
otect
sourbody.Ar
ti
cul
arcar
ti
lagesf
ormt
hesur
faceofbodyj
oint
s(whi
chi
s
al
ayerofconnect
ivet
issuewi
that
hicknessof1-
5mm)anddi
str
ibut
eloadsacr
ossj
oint
sand
mi
nimi
zecont
actst
ressesandf
ri
cti
on.Sof
tconnect
ivet
issuesofourbodyar
ecompl
exf
iber
-
r
einf
orced composi
te st
ruct
ures.Thei
rmechani
calbehavi
ori
s st
rongl
yinf
luenced by t
he
concent
rat
ion and st
ruct
uralar
rangementofconst
it
uent
s such as col
lagen and el
ast
in,t
he
hydr
ated mat
ri
xofpr
oteogl
ycans,and t
he t
opogr
aphi
calsi
te and r
espect
ive f
unct
ion i
nthe
or
gani
sm.
Col
lagen.Col
lagen i
s a pr
otei
n whi
ch i
s a maj
orconst
it
uentoft
he ext
racel
lul
armat
ri
x of
connect
ivet
issue.I
tist
hemai
nloadcar
ryi
ngel
ementi
nawi
devar
iet
yofsof
tti
ssuesandi
sver
y
i
mpor
tantt
ohumanphysi
ology(
forexampl
e,t
hecol
lagencont
entof(
human)achi
ll
est
endoni
s
about20t
imest
hatofel
ast
in)
.Col
lageni
samacr
omol
ecul
ewi
thl
engt
hofabout280nm.Col
lagen
mol
ecul
esar
eli
nkedt
oeachot
herbycoval
entbondsbui
ldi
ngcol
lagenf
ibr
il
s.Dependi
ngont
he
pr
imar
yfunct
ionandt
her
equi
rementofst
rengt
hoft
het
issuet
hedi
amet
erofcol
l
agenf
ibr
il
s
var
ies(
theor
derofmagni
tudei
s1.
5nm [
17]
).I
nthest
ruct
ureoft
endonsandl
igament
s,f
or
exampl
e,col
l
agenappear
saspar
all
elor
ient
edf
iber
s[1]
,whi
lemanyot
hert
issueshaveani
ntr
icat
e
di
sor
der
ednet
wor
kofcol
lagenf
iber
sembeddedi
nagel
ati
nousmat
ri
xofpr
oteogl
ycans.
Gener
almechani
calchar
act
eri
sti
cofsof
tti
ssues:
Bef
oredescr
ibi
ngamodelf
orsof
tti
ssuesi
tisbenef
ici
alandi
nst
ruct
ivet
ogi
vesomei
nsi
ghti
n
t
hei
rgener
almechani
calchar
act
eri
sti
c.Sof
tti
ssuesbehaveani
sot
ropi
cal
lybecauseoft
hei
rfi
ber
s
whi
ch t
end t
o havepr
efer
red di
rect
ions.I
n ami
croscopi
csenset
heyar
enon-
homogeneous
mat
eri
alsbecauseoft
hei
rcomposi
ti
on.
Thet
ensi
ler
esponseofsof
tti
ssuei
snonl
inearst
if
feni
ngandt
ensi
lest
rengt
hdependsont
he
st
rai
nrat
e.I
ncont
rastt
ohar
dti
ssues,sof
tti
ssuesmayunder
gol
argedef
ormat
ions.Somesof
t
t
issuesshowvi
scoel
ast
icbehavi
or(
rel
axat
ionand/
orcr
eep)
,whi
chhasbeenassoci
atedwi
tht
he
sheari
nter
act
ionofcol
lagenwi
tht
hemat
ri
xofpr
oteogl
ycans[
16](
themat
ri
xpr
ovi
desavi
scous
l
ubr
icat
ionbet
weencol
lagenf
ibr
il
s).I
nasi
mpl
if
iedwayweexpl
ainher
ethet
ensi
lest
ress-
str
ain
behavi
orf
orski
n,anor
ganconsi
sti
ngmai
nlyofconnect
ivet
issues,whi
chi
srepr
esent
ati
veoft
he
mechani
calbehavi
orofmany(
col
lagenous)sof
tconnect
ivet
issues.Fort
heconnect
ivet
issue
par
tsoft
heski
nthet
hree-
dimensi
onalnet
wor
koff
iber
sappear
stohavepr
efer
reddi
rect
ions
par
all
elt
othesur
face.However
,inor
dert
opr
eventout
-of
-pl
aneshear
ing,somef
iberor
ient
ati
ons
al
sohavecomponent
sout
-of
-pl
ane.
Fi
gur
e1showsaschemat
icdi
agr
am ofat
ypi
calJ-
shaped(
tensi
le)st
ress-
str
aincur
vef
orski
n.3
St
rai
nSt
ressII
III
IFi
gur
e1:Schemat
icdi
agr
am ofat
ypi
cal(
tensi
le)st
ress-
str
aincur
vef
orski
n
showi
ngt
heassoci
atedcol
lagenf
ibermor
phol
ogy.Thi
sfor
m,r
epr
esent
ati
vef
ormanysof
tti
ssues,
di
ff
erssi
gni
fi
cant
lyf
rom st
ress-
str
aincur
vesofhar
dti
ssuesorf
rom ot
hert
ypesof(
engi
neer
ing)
mat
eri
als.I
naddi
ti
on,Fi
gur
e1showshow t
hecol
lagenf
iber
sst
rai
ght
enwi
thi
ncr
easi
ngst
ress.
Thedef
ormat
ionbehavi
orf
orski
nmaybest
udi
edi
nthr
eephasesI
,IIandI
II
:PhaseI
.Int
he
absenceofl
oadt
hecol
lagenf
iber
s,whi
char
ewoveni
ntor
hombi
c-shapedpat
ter
n,ar
einr
elaxed
condi
ti
onsandappearwavyandcr
imped.Unst
ret
chedski
nbehavesappr
oxi
mat
elyi
sot
ropi
cal
ly.
I
nit
ial
lyl
ow st
ressi
srequi
redt
oachi
evel
argedef
ormat
ionsoft
hei
ndi
vidualcol
lagenf
iber
s
wi
thoutr
equi
ri
ngst
ret
choft
hef
iber
s.I
nphaseIt
het
issuebehavesl
ikeaver
ysof
t(i
sot
ropi
c)
r
ubbersheet
,andt
heel
ast
inf
iber
s(whi
chkeept
heski
nsmoot
h)ar
emai
nlyr
esponsi
blef
ort
he
st
ret
chi
ngmechani
sm.Thest
ress-
str
ainr
elat
ioni
sappr
oxi
mat
elyl
inear
,theel
ast
icmodul
usof
ski
ninphaseIi
slow(
0.1-
2MPa)
.PhaseI
I.I
nphaseI
I,ast
hel
oadi
sincr
eased,
thecol
lagenf
iber
s
t
endt
oli
neupwi
tht
hel
oaddi
rect
ionandbearl
oads.Thecr
impedcol
lagenf
iber
sgr
adual
ly
el
ongat
eandt
heyi
nter
actwi
tht
hehydr
atedmat
ri
x.Wi
thdef
ormat
iont
hecr
impangl
eincol
lagen
f
ibr
il
sleadst
oasequent
ialuncr
impi
ngoff
ibr
il
s.Not
e,t
hatt
heski
nisnor
mal
lyundert
ensi
oni
n
vi
vo.PhaseI
II
.InphaseI
II
,athi
ght
ensi
lest
resses,t
hecr
imppat
ter
nsdi
sappearandt
hecol
lagen
f
iber
sbecomest
rai
ght
er.Theyar
epr
imar
il
yal
ignedwi
thoneanot
heri
nthedi
rect
ioni
nwhi
cht
he
l
oadi
sappl
ied.
Thest
rai
ght
enedcol
lagenf
iber
sresi
stt
hel
oadst
rongl
yandt
het
issuebecomesst
if
fathi
gher
st
resses.Thest
ress-
str
ainr
elat
ionbecomesl
inearagai
n.Beyondt
het
hir
dphaset
heul
ti
mat
e
t
ensi
lest
rengt
hisr
eachedandf
iber
sbegi
ntobr
eak.Themechani
calpr
oper
ti
esofsof
tti
ssues
dependst
rongl
yont
het
opogr
aphy,
riskf
act
ors,
age,
speci
es,
physi
calandchemi
calenvi
ronment
al
f
act
orssuchast
emper
atur
e,osmot
icpr
essur
e,pH,andont
hest
rai
nrat
e.Themat
eri
alpr
oper
ti
es
ar
est
rongl
yrel
atedt
othequal
it
yandcompl
etenessofexper
iment
aldat
a,whi
chcomef
rom i
nvi
vo
ori
nvi
tr
otest
shavi
ngt
heai
m ofmi
micki
ngr
eal4l
oadi
ngcondi
ti
ons.Ther
efor
e,t
opr
esent
speci
fi
cval
uesf
ort
heul
ti
mat
etensi
lest
rengt
handst
rai
nofaspeci
fi
cti
ssuei
sadi
ff
icul
ttask.
Never
thel
ess,Tabl
e 1 at
tempt
sto pr
esentr
anges ofval
ues ofmechani
calpr
oper
ti
es and
col
lagen/
elast
incont
ent
s(%dr
ywei
ght
)insomer
epr
esent
ati
veor
gansmai
nlyconsi
sti
ngofsof
t
connect
ivet
issues.
Basi
cmechani
csofspi
nalcol
umnandl
imbs:
Thespi
nalcol
umn,
mor
ecommonl
ycal
l
edt
hebackbone,
ismadeuppr
imar
il
yofver
tebr
ae,
discs,
andt
hespi
nalcor
d.Act
ingas
acommuni
cat
ioncondui
tfort
hebr
ain,
signal
sar
etr
ansmi
tt
edandr
ecei
vedt
hrought
hespi
nalcor
d.
Whenani
njur
ytot
hespi
nal
cor
doccur
sthef
lowofi
nfor
mat
ionf
rom t
hatpoi
ntdowni
sst
opped.Thi
sbr
eaki
ninst
ruct
ionst
o
t
hear
ms,
legs,
andot
herpar
tsoft
hebodywi
llpr
eventt
hei
ndi
vidualf
rom movi
ng,
somet
imesbr
eat
hing,
andobst
ruct
sorst
ops
anysenseoff
eel
i
ngort
ouch.
Gener
alOver
view
Spi
nalCor
d&Col
umn
Thespi
nalcol
umni
ssepar
atedi
nto5speci
fi
cfunct
ional
areas.
 Cer
vical/C1-
7
 Thor
aci
c/T1-12
 Lumbar/L1-5
 Sacr
al
 Coccyx
Thespi
nalcor
disabundl
eofner
vecel
lsandf
iber
swr
appedt
oget
herext
endi
ngdownf
rom t
hebr
ainst
em t
othel
owerback.
Thecor
dispr
otect
edbyaki
ndofbonet
unnel
madeupofver
tebr
aewhi
char
esepar
atedbymembr
anescal
leddi
scs.Thebr
ain
sendsel
ect
ri
calsi
gnal
sthr
ought
hespi
nal
cor
d,gi
vingi
nst
ruct
ionst
othel
egs,
arms,
andot
herar
easoft
hebody.
Ver
tebr
ae
Ther
ear
e33ver
tebr
aet
hatmakeupt
hebonest
ruct
ureoft
hespi
nalcol
umn,
wit
hthel
astf
ourbei
ngf
usedt
oget
hert
omaket
he
t
ail
bone.
Di
scs
Eachver
tebr
aei
ssepar
atedbyasof
tbonesubst
ance,
cal
ledadi
sc,
whi
chact
sasacushi
onandaseal
att
hesamet
ime.
Compl
ete&I
ncompl
eteSCI
AnSCIi
scat
egor
izedasei
ther"
compl
ete"or"
incompl
ete"
.A"
compl
ete"SCImeansat
otal
lossoff
unct
ionandsensat
ionbel
ow
t
heaf
fect
edver
tebr
ae,
andan"
incompl
ete"SCImeansonl
ypar
ti
all
ossoff
unct
ionorsensat
ion.
BONYANATOMY
Cer
vical
Spi
ne
Ther
ear
esevencer
vicalbonesorver
tebr
ae.Thecer
vical
bonesar
edesi
gnedt
oal
lowf
lexi
on,
ext
ensi
on,
bendi
ng,
andt
urni
ngof
t
hehead.Theyar
esmal
lert
hant
heot
herver
tebr
ae,
whi
chal
lowsagr
eat
eramountofmovement
.
Eachcer
vical
ver
tebr
aconsi
stsoft
wopar
ts,
abodyandapr
otect
ivear
chf
ort
hespi
nal
cor
dcal
ledt
heneur
alar
ch.Fr
act
uresor
i
njur
iescanoccurt
othebody,
li
m pedi
cles,
orpr
ocesses.Eachver
tebr
aar
ti
cul
ateswi
tht
heoneabovei
tandt
heonebel
owi
t.
Thor
aci
cSpi
ne
I
nthechestr
egi
ont
het
hor
aci
cspi
neat
tachest
other
ibs.Ther
ear
e12ver
tebr
aei
nthet
hor
aci
cregi
on.
Thespi
nalcanal
int
het
hor
aci
cregi
oni
srel
ati
vel
ysmal
lert
hant
hecer
vicalorl
umbarar
eas.Thi
smakest
het
hor
aci
cspi
nalcor
d
atgr
eat
err
iski
fther
eisaf
ract
ure.
Themot
iont
hatoccur
sint
het
hor
aci
cspi
nei
smost
lyr
otat
ion.Ther
ibspr
eventbendi
ngt
othesi
de.Asmal
lamountof
movementoccur
sinbendi
ngf
orwar
dandbackwar
d.
Lumbosacr
alSpi
ne
Thel
umbarver
tebr
aear
elar
ge,
wide,
andt
hick.Ther
ear
efi
vever
tebr
aei
nthel
umbarspi
ne.Thel
owestl
umbarver
tebr
a,L5,
ar
ti
cul
ateswi
tht
hesacr
um.Thesacr
um at
tachest
othepel
vis.
Themai
nmot
ionsoft
hel
umbarar
eaar
ebendi
ngf
orwar
dandext
endi
ngbackwar
ds.Bendi
ngt
othesi
deal
sooccur
s.
NEUROANATOMY
Justl
iket
hespi
nalcol
umni
sdi
videdi
ntocer
vical
,thor
aci
c,andl
umbarr
egi
ons,
soi
sthespi
nalcor
d.Eachpor
ti
onoft
hespi
nal
cor
disdi
videdi
ntospeci
fi
cneur
ologi
cal
segment
s.
Thecer
vical
spi
nal
cor
disdi
videdi
ntoei
ghtl
evel
s.Eachl
evel
cont
ri
but
est
odi
ff
erentf
unct
ionsi
ntheneckandt
hear
ms.
Sensat
ionsf
rom t
hebodyar
esi
mil
arl
ytr
anspor
tedf
rom t
heski
nandot
herar
easoft
hebodyf
rom t
heneck,
shoul
der
s,andar
ms
upt
othebr
ain.
I
nthet
hor
aci
cregi
ont
hener
vesoft
hespi
nal
cor
dsuppl
ymuscl
esoft
hechestt
hathel
pinbr
eat
hingandcoughi
ng.Thi
sregi
on
al
socont
ainsner
vesi
nthesympat
het
icner
voussyst
em.
Thel
umbosacr
alspi
nalcor
dandner
vesuppl
ylegs,
pel
vis,
andbowelandbl
adder
.Sensat
ionsf
rom t
hef
eet
,legs,
pel
vis,
and
l
owerabdomenar
etr
ansmi
tt
edt
hrought
hel
umbosacr
alner
vesandspi
nalcor
dtohi
ghersegment
sandevent
ual
lyt
hebr
ain.
Ner
vePat
hways
Ther
ear
emanyner
vepat
hwayst
hatt
ransmi
tsi
gnal
supanddownt
hespi
nalcor
d.Somesuppl
ysensat
ionf
rom t
heski
nand
out
erpor
ti
onsoft
hebody.Ot
her
ssuppl
ysensat
ionf
rom deeperst
ruct
uressuchast
heor
gansi
nthebel
ly,
thepel
vis,
orot
her
ar
eas.Ot
herner
vest
ransmi
tsi
gnal
sfr
om t
hebr
aint
othebody.St
il
lot
her
swor
katt
hel
eveloft
hespi
nalcor
dandactas"
go
bet
weens"i
nthesi
gnal
transmi
ssi
onpr
ocess.
TheMot
orNeur
on
Theuppermot
orneur
onr
efer
stoi
njur
iest
hatar
eabovet
hel
evel
oft
heant
eri
orhor
ncel
l.Thi
sresul
tsi
naspast
ict
ypeof
par
alysi
s.Conver
sel
y,t
hel
owermot
orneur
oni
njur
yref
erst
oani
njur
yatorbel
owt
heant
eri
orhor
ncel
lthatr
esul
tsi
nthef
lacci
d
t
ypepar
alysi
s.Thet
ermsneur
ogeni
cbowel
andneur
ogeni
cbl
adderar
eusedt
odescr
ibeabnor
malbowel
andbl
adderf
unct
ion
andcanbecl
assi
fi
edasei
theranuppermot
orneur
onorl
owermot
orneur
ont
ypeofpr
obl
em.I
ngener
al,
thosepat
ient
swi
than
uppermot
orneur
onpar
alysi
swi
llhaveanuppermot
orneur
onbowelandbl
adder
,andt
hosewi
thl
owermot
orneur
oni
njur
ies
wi
llhaveal
owermot
orneur
onpi
ctur
eoft
hebowel
andbl
adder
.Adequat
ebowelandbl
addermanagementi
scr
it
icalf
or
adequat
erei
ntegr
ati
onoft
hepat
ient
/cl
ienti
ntot
hecommuni
tyandhopef
ull
yint
othewor
kpl
ace.
Sensor
yPat
hways
Feel
ingsf
rom t
hebodysuchashot
,col
d,pai
n,andt
ouch,
aret
ransmi
tt
edt
otheski
nandot
herpar
tsoft
hebodyt
othebr
ain
wher
esensat
ionsar
e"f
elt
".Thesepat
hwaysar
ecal
ledt
hesensor
ypat
hways.
Oncesi
gnal
sent
ert
hespi
nalcor
d,t
heyar
esentupt
othebr
ain.Di
ff
erentt
ypesofsensat
ionar
esenti
ndi
ff
erentpat
hways,
cal
led"
tr
act
s".Thet
ract
sthatcar
rysensat
ionsofpai
nandt
emper
atur
etot
hebr
ainar
eint
hemi
ddl
epar
toft
hespi
nalcor
d.
Theset
ract
sar
ecal
ledt
he"
spi
not
hal
ami
c".Ot
hert
ract
scar
rysensat
ionofposi
ti
onandl
ightt
ouch.Thesener
vei
mpul
sesar
e
car
ri
edal
ongt
hebackpar
toft
hespi
nal
cor
dinwhatar
ecal
led"
dor
salcol
umns"oft
hespi
nalcor
d.
Aut
onomi
cNer
vePat
hways
Anot
hert
ypeofspeci
alner
vesar
etheaut
onomi
cner
ves.I
nspi
nal
cor
dinj
uri
es,
theyar
ever
yimpor
tant
.Theaut
onomi
cner
ves
ar
edi
videdi
ntot
wot
ypes:t
hesympat
het
icandpar
asympat
het
icner
ves.
Theaut
onomi
cner
voussyst
em i
nfl
uencest
heact
ivi
ti
esofi
nvol
unt
ary(
alsoknownassmoot
h)muscl
es,
thehear
tmuscl
e,and
gl
andst
hatr
eleasecer
tai
nhor
mones.I
tcont
rol
scar
diovascul
ar,
digest
ive,
andr
espi
rat
orysyst
ems.Thesesyst
emswor
kina
gener
all
y"i
nvol
unt
ary"f
ashi
on.Thepr
imar
yrol
eoft
heaut
onomi
cner
voussyst
em i
stomai
ntai
nast
abl
eint
ernalenvi
ronment
wi
thi
nthebody.Thehear
tandbl
oodvessel
sar
econt
rol
l
edbyt
heaut
onomi
cner
voussyst
em.Thesympat
het
icner
veshel
pto
cont
rolbl
oodpr
essur
ebasedont
hephysi
cal
demandspl
acedont
hebody.I
tal
sohel
pst
ocont
rolhear
trat
e.Thesympat
het
ic
ner
ves,
whenst
imul
ated,
causet
hehear
ttobeatf
ast
er.
Sympat
het
icNer
ves
Thesympat
het
icner
vesal
socauseconst
ri
cti
onoft
hebl
oodvessel
sthr
oughoutt
hebody.Whent
hishappens,
theamountof
bl
oodt
hati
sret
urnedt
othehear
tincr
eases.Theseef
fect
swi
lli
ncr
easebl
oodpr
essur
e.Ot
heref
fect
sincl
udeani
ncr
easei
n
sweat
ingandi
ncr
easedi
rr
it
abi
li
tyorasensat
ionofanxi
ety.
Whenspi
nalcor
dinj
uryi
satorabovet
heT6l
evel
thesympat
het
icner
vesbel
owt
hei
njur
ybecomedi
sconnect
edf
rom t
he
ner
vesabove.Theycont
inuet
ooper
ateaut
omat
ical
lyoncet
heper
iodofspi
nalshocki
sover
.Anyt
hingt
hatsi
mul
atest
he
sympat
het
icner
vescancauset
hem t
obecomeover
act
ive.Thi
sover
-act
ivi
tyoft
hesympat
het
icner
vesi
swhati
scal
led
aut
onomi
cdysr
efl
exi
a.
Par
asympat
het
icNer
ves
Thepar
asympat
het
icner
vesacti
nanopposi
temannert
othesympat
het
icner
ves.Thesener
vest
endt
odi
lat
ebl
oodvessel
sand
sl
owdownt
hehear
t.Themosti
mpor
tantner
vet
hatcar
ri
espar
asympat
het
icf
iber
sist
hevagusner
ve.Thi
sner
vecar
ri
es
par
asympat
het
icsi
gnal
stot
hehear
ttodecr
easehear
trat
e.Ot
herner
vessuppl
ythebl
oodvessel
stot
heor
gansoft
heabdomen
andski
n.
Thepar
asympat
het
icner
vesar
isef
rom t
woar
eas.Thef
iber
sthatsuppl
ytheor
gansoft
heabdomen,
hear
t,l
ungs,
andski
n
abovet
hewai
stbegi
natt
hel
eveloft
hebr
ainandver
yhi
ghspi
nal
cor
d.Thener
vest
hatsuppl
yther
epr
oduct
iveor
gans,
pel
vis,
andl
egbegi
natt
hesacr
all
evel
,orl
owestpar
toft
hespi
nal
cor
d.Af
teraspi
nalcor
dinj
ury,
thepar
asympat
het
icner
vest
hat
begi
natt
hebr
aincont
inuet
owor
k,evendur
ingt
hephaseofspi
nal
shock.Whendysr
efl
exi
aoccur
s,t
hepar
asympat
het
icner
ves
at
temptt
ocont
rolr
api
dlyi
ncr
easi
ngbl
oodpr
essur
ebysl
owi
ngdownt
hehear
t.
Opt
ical–Fi
berTemper
atur
esensor
s
 Temper
atur
e sensor
s, such as t
her
mist
or or t
her
mocoupl
es r
equi
re met
all
ic
component
sandconnect
ingwi
res,whi
chdi
stur
bst
hei
nci
dentel
ect
romagnet
icf
iel
ds
andmayevencausel
ocal
izedheat
ingspot
sandt
het
emper
atur
ereadi
ngsmayevenbe
er
rat
icduet
oint
erf
erence.
 Thi
spr
obl
em i
sover
comebyusi
ngt
emper
atur
esensor
s,basedonf
iber
-opt
ics.
 These f
iber opt
ic devi
ces ut
il
ize ext
ernal
lyi
nduced changes i
n t
ransmi
ssi
on
char
act
eri
sti
csoft
heopt
icalf
iber
sandof
fert
ypi
caladvant
agesofopt
icalf
iber
ssuch
as,
flexi
bil
it
y,smal
ldi
mensi
onsandi
mmuni
tyf
rom el
ect
ro-
magnet
ici
nter
fer
ence.
 Si
mpl
estt
ypeoft
emper
atur
esensor
sconsi
stsofal
ayerofl
iqui
dcr
yst
alatt
heendof
opt
icalf
iber
s,gi
vingavar
iat
ioni
nli
ghtscat
ter
ingwi
tht
emper
atur
eatapar
ti
cul
ar
wavel
engt
h.
 Fi
gur
ebel
ow showsr
ay-
pat
hconf
igur
ati
onoft
emper
atur
esensor
,whi
chut
il
izesa
si
li
ca-
cor
e,si
li
concl
adf
iber
,wi
thanuncl
adt
ermi
nalpor
ti
oni
mmer
sedi
nal
iqui
dwhi
ch
r
epl
acet
hecl
ad.
 Temper
atur
eri
secauseser
educt
ioni
nref
ract
ivei
ndexi
nli
qui
d,cl
adf
ibersect
ion.
 Ther
efor
e,l
ightt
ravel
li
ngf
rom t
hesi
li
concl
adf
ibert
oli
qui
dcl
adf
iberunder
goesan
at
tenuat
ion,
whi
chdecr
easesbyi
ncr
easedt
emper
atur
e.
 Thel
ightf
rom an860mm LEDi
scoupl
edi
ntot
hef
iber
.
 The l
ightr
efl
ect
ed backwar
ds i
s sental
ong t
he same f
iber
s and l
ightampl
it
ude
modul
ati
on,i
nducedbyt
her
mosensi
ti
vecl
addi
ngappl
iedont
hedi
stalendoff
iber
,is
det
ect
edandpr
ocessed.
 A mi
niat
uret
emper
atur
epr
obef
ormedi
calusewi
th0.
8mm ext
ernaldi
amet
erand
0.
5mm i
nter
naldi
amet
erachi
evedasensi
ti
vit
yof+/
-0.
1°Ci
ntemper
atur
eint
erval
,20-
50°
C.
 Onemor
etypeoft
emper
atur
esensori
sbasedont
het
emper
atur
edependenceofband
edgeabsor
pti
onofi
nfr
aredl
ighti
nGaAscr
yst
al.
 I
nthet
emper
atur
emeasur
ingsyst
em asshowni
nfi
gur
eabovebasedont
hepr
inci
ple,
l
ighti
semi
tt
edbyaLED,t
ransmi
tt
edt
oandf
rom t
hecr
yst
alvi
aopt
icalf
iberand
measur
edbyaphot
odet
ect
or.
 Nomet
alpar
tsar
eusedi
nthet
emper
atur
epr
obedesi
gn,r
esul
ti
ngi
ntr
anspar
encyof
t
hepr
obet
oel
ect
romagnet
icf
iel
ds.
Si
ngl
esensorpr
obewit
hanouterdiamet
erof0.
6mm and4poi
ntt
emper
atur
esensor
pr
obeof1.
2mm di
amet
erar
eavai
labl
e.
UNI
T I
I:
NON ELECTRI
CAL PARAMETERS MEASUREMENT AND DI
AGNOSTI
C
PROCEDURES
Measur ementofbloodpressure-Car
diacoutput-Heartrat
e-Heartsound-Pulmonar y
funct
ionmeasurements–spi romet
er–PhotoPlethysmogr
aphy,
BodyPl et
hysmography–
BloodGasanalyser
s,pHofbl ood–measurementofbloodpCO2,pO2,
finger-
ti
poxymeter-
ESR,GSRmeasur ements.
Measur
ementofbl
oodpr
essur
e
I
ntr
oduct
ion:
 Bl
oodi
spumpedbyl
eftsi
deoft
hehear
tint
otheaor
ta,
whi
chsuppl
iesi
ttot
hear
ter
ies.
 Duet
othel
oadr
esi
stanceatt
hear
ter
iesbl
oodl
osesmostofi
tspr
essur
eandr
etur
ns
t
othehear
tatal
owpr
essur
eandr
etur
nsatal
owpr
essur
evi
athevei
ns.
 Ri
ghtsi
deoft
hehear
tpumpsi
ttot
hepul
monar
yvei
n,whi
choper
atesatal
ower
pr
essur
e.
 Themaxi
mum pr
essur
ereacheddur
ingcar
diacout
puti
scal
ledsyst
oli
cpr
essur
e.
 Themi
nimum pr
essur
eoccur
ri
ngatt
heendofvent
ri
cul
arr
elaxat
ioni
ster
medas
di
ast
oli
cpr
essur
e.
 Pul
sepr
essur
e=Di
ff
erencebet
weent
hesyst
oli
canddi
ast
oli
cval
ues.
 Haemodynami
cpr
essur
eval
uesar
e:
o Ar
ter
ialsyst
em =30–300mm ofHg.
o Venoussyst
em =5–15mm ofHg.
o Pul
monar
ysyst
em =6–25mm ofHg.
 Themostf
requent
lymoni
tor
edpr
essur
ear
e,
o Ar
ter
ialpr
essur
e
o Venouspr
essur
e
Bl
oodPr
essur
eMeasur
ement
:
1)Di
rectMeasur
ement
2)I
ndi
rectMeasur
ement
1)Di
rectMeasur
ementusi
ngCat
het
ers:
Acat
het
eroraneedl
etypepr
obei
sinser
tedt
hroughavei
norar
ter
ytot
hear
eaofi
nter
est
.
Twot
ypesofpr
obescanbeused.Onet
ypei
sthecat
het
ert
ippr
obei
nwhi
cht
hesensori
s
mount
edont
het
ipoft
hepr
obeandt
hepr
essur
esexer
tedont
hesensor
sar
econver
tedt
o
t
hepr
opor
ti
onalsi
gnal
s.
Di
rectMeasur
ementusi
ngCat
het
ers
Theot
heri
sthef
lui
dfi
ll
edcat
het
ert
ypewhi
cht
ransmi
tst
hepr
essur
eexer
tedoni
tsf
lui
d
f
il
ledcol
umnt
oanext
ernalt
ransducer
.Thi
str
ansducerconver
tst
heexer
tedpr
essur
eto
el
ect
ri
calsi
gnal
s.Theel
ect
ri
calsi
gnal
scanbeampl
if
iedanddi
spl
ayedorr
ecor
ded.
Cat
het
ert
ippr
obespr
ovi
det
hemaxi
mum dynami
cresponseandavoi
daccel
erat
ion
ar
tef
act
swher
east
hef
lui
dfi
ll
edcat
het
ert
ypesyst
emsr
equi
rescar
efuladj
ust
mentoft
he
cat
het
erdi
mensi
onst
oobt
ainanopt
imum dynami
cresponse.
2)I
ndi
rectMet
hod:
Thei
ndi
rectmet
hodr
out
inel
yusedbyphysi
cianr
equi
resadevi
cecal
ledas
sphygmomanomet
erconsi
sti
ngofani
nfl
atabl
erubberbl
addercal
ledt
hecuf
f,ar
ubber
squeeze,
bal
lpumpandval
veassembl
yandamanomet
er.Thecuf
fiswr
appedar
oundt
he
pat
ient
’supperar
m atapoi
ntaboutmi
dwaybet
weent
heel
bowandshoul
der
.The
st
ethoscopei
spl
acedoveranar
ter
ytot
hecuf
f.Thecuf
fisi
nfl
atedsot
hatt
hepr
essur
e
i
nsi
det
hei
nfl
atedbl
adderi
sincr
easedt
oapoi
ntgr
eat
ert
hant
heant
ici
pat
edsyst
oli
c
pr
essur
e.Thi
spr
essur
ecompr
essest
hear
ter
yagai
nstt
heunder
lyi
ngbone,
causi
ngan
occl
usi
ont
hatshut
sof
fthef
lowofbl
oodi
nthevessel
.Theoper
atort
hensl
owl
yrel
eases
t
hepr
essur
eint
hecuf
f(=3mm Hg/
s)andwat
chest
hepr
essur
egaugeormer
cur
ycol
umn.
whent
hesyst
oli
cpr
essur
efi
rstexceedst
hecuf
fpr
essur
e,t
heoper
atorbegi
nst
ohear
somecr
ashi
ng,
snappi
ngsoundsi
nthest
ethoscopet
hatar
ecausedbyt
hef
ir
stj
etsof
bl
oodpushi
ngt
hrought
heKor
otkof
f,soundscont
inueast
hecuf
fpr
essur
edi
mensi
on,
becomi
ngl
essl
oudast
hebl
oodf
lowt
hrought
heoccl
usi
onbecomessmoot
her
.
I
ndi
rectMet
hod
Kor
otkof
fsoundsdi
sappearwhent
hecuf
fpr
essur
edr
opsbel
owt
hepat
ient
’sdi
ast
oli
c
pr
essur
e.t
oreadt
hebl
oodpr
essur
e,t
heoper
atornot
esbot
hthegaugepr
essur
eatt
he
onsetofKor
otkof
fsounds,
syst
oli
candwhent
hesoundsdi
sappeardi
ast
oli
c.These
pr
essur
esar
eusual
lyr
ecor
dedi
nther
ati
oofsyst
oli
coverdi
ast
oli
c(i
.e.
,120/
80mm Hg)
.
TheuseofKor
otkof
fsoundsast
hei
ndi
recti
ndi
cat
ionofbl
oodpr
essur
eisal
socal
led
auscul
tat
ion(
useofhear
ing)
.
3)Aut
omat
icbl
oodpr
essur
emeasur
ementkor
otkof
f’
smet
hod(
Aut
omat
ic
Sphygmomanomet
er)
:
Themet
hodconsi
stsi
nput
ti
ngacuf
far
oundt
heupperpar
toft
hepat
ient
’sar
m and
pl
aci
ngami
crophoneovert
hear
ter
y.Thecompr
essedai
rrequi
redf
ori
nfl
ati
ngt
hecuf
fis
pr
ovi
dedbyapumpi
ngsyst
em i
ncor
por
atedi
ntheappar
atus.Usual
lyt
hei
nfl
ati
ngi
sdone
t
oapr
esetpr
essur
elevel
,wel
lbeyondt
hesyst
oli
cval
veatt
her
ateof30mm Hg/
s.t
he
pr
essur
eint
hecuf
fist
hendecr
easedatar
elat
ivel
ysl
owpaceatt
her
ateof3–5mm
Hg/
s.t
hecuf
fist
obeappl
iedi
nsuchawayt
hatvei
nsar
enotoccl
uded.Whenai
ris
al
lowedt
oleakf
rom t
hecuf
f,t
heKor
otkof
fsoundsar
epi
ckedupbyaspeci
alpi
ezoel
ect
ri
c
mi
crophone.Thecor
respondi
ngel
ect
ri
calsi
gnal
sar
efedt
oapr
eampl
if
ier
.theampl
if
ied
si
gnal
sar
ethenpassedont
oabandpassf
il
terhavi
ngabandwi
dthof25t
o125Hz.wi
th
t
hispassband,
agoodsi
gnalt
onoi
ser
ati
oisachi
eved.Thesyst
em i
ssodesi
gnedt
hatt
he
appear
anceoft
hef
ir
stKor
otkof
fsoundswi
tchesi
nthesyst
oli
cmanomet
erandl
ockst
he
r
eadi
ngont
hei
ndi
cat
ingmet
er.I
nasi
mil
arway,
thedi
ast
oli
cval
uei
sfi
xedbyt
hel
ast
Kor
otkof
fsound.Thecuf
fiscompl
etel
ydef
lat
edaut
omat
ical
lyaf
terani
nter
valof2–5
secondsaf
tert
hedet
ermi
nat
ionofdi
ast
oli
cval
ue.
4)TheRheogr
aphi
cmet
hod:
Af
ull
yaut
omat
icappar
atusf
ormeasur
ingsyst
oli
canddi
ast
oli
cbl
oodpr
essur
eshasbeen
devel
oped.Her
e,t
hechangei
nimpedanceat2poi
ntsundert
heoccl
udi
ngcuf
fsf
ormst
he
basi
sofdet
ect
ionofdi
ast
oli
cpr
essur
e.I
nthi
smet
hod,
asetoft
hreeel
ect
rodesA,
BandC
whi
char
eat
tachedt
othecuf
far
epl
acedi
ncont
actwi
tht
heski
n.Agoodcont
acti
s
essent
ialt
oreducet
heski
nel
ect
rodecont
acti
mpedance.El
ect
rodeBwhi
chact
sasa
commonel
ect
rodei
sposi
ti
onedsl
ight
lyawayf
rom t
hemi
dli
neoft
hecuf
f.El
ect
rodesA
andCar
epl
acedatacer
tai
ndi
stancef
rom t
heel
ect
rodeB,
oneaboveandt
heot
herbel
ow.
Ahi
ghf
requencycur
rentsour
ceoper
ati
ngat100KHzi
sconnect
edt
oel
ect
rodesAandC.
Whent
hecuf
fisi
nfl
atedabovet
hesyst
oli
cval
ue,
nopul
sei
sdet
ect
edbyt
heel
ect
rodeA.
Thepul
seappear
swhent
hecuf
fpr
essur
eisj
ustbel
owt
hesyst
oli
clevel
.Asl
ongast
he
pr
essur
eint
hecuf
fisbet
weent
hesyst
oli
canddi
ast
oli
cval
ues,
dif
fer
ent
ialsi
gnalexi
sts
bet
weent
heel
ect
rodesAandC.Whent
hecuf
fpr
essur
ereachesdi
ast
oli
cpr
essur
ethe
ar
ter
ialbl
oodi
snol
ongeri
mpededanddi
ff
erent
ialsi
gnaldi
sappear
s.Acommandsi
gnali
s
t
heni
nit
iat
edandt
hedi
ast
oli
cpr
essur
eisi
ndi
cat
edont
hemanomet
er.
Car
diacout
putMeasur
ement
Ther
ear
ethr
eemet
hodsf
ormeasur
ingCar
diacOut
put
.Theyar
e,
1)I
ndi
cat
ordi
lut
ionMet
hod
2)Dyedi
lut
ionMet
hod
3)Ther
mal
dil
uti
onMet
hod
1)I
ndi
cat
ordi
lut
ionMet
hod:
Thevol
umef
lowoft
hef
lui
d(bl
ood)f
rom t
hehear
tcanbeest
imat
edbyi
ntr
oduci
nga
knownamountofi
ndi
cat
orandmeasur
ingt
heconcent
rat
ionupst
ream anddownst
ream of
i
nject
ion.Thei
ndi
cat
orcanbei
nject
edataconst
antr
ateorasabol
us.Buti
findi
cat
orsat
aconst
antr
atemostofi
twi
llr
e-ci
rcul
ateandt
hispr
event
sest
imat
ionofconcent
rat
ion
ef
fi
cient
ly.I
nthebol
ust
ypeofi
nject
ionasmal
lquant
it
yofi
ndi
cat
ori
sinj
ect
edi
ntot
he
r
ighthear
tit
sel
f.Af
terpassi
ngt
hrought
her
ighthear
t,l
ungsandt
hel
efthear
tthei
ndi
cat
or
appear
sint
hear
ter
ial
cir
cul
ati
on.Thepr
esenceoft
hei
ndi
cat
ori
ntheper
ipher
alar
ter
yis
det
ect
edbyaphot
oel
ect
ri
ctr
ansducersi
ncet
hei
ndi
cat
ori
sar
adi
oisot
opeandt
he
concent
rat
ioni
sdi
spl
ayedonachar
trecor
der
.Thecur
veobt
ainedi
scal
ledt
hedi
lut
ion
cur
ve.
I
ndi
cat
ordi
lut
ionMet
hod–Di
lut
ionCur
ve
Dur
ingt
hef
ir
stci
rcul
ati
onper
iod,
thei
ndi
cat
orwoul
dmi
xupwi
tht
hebl
oodandwi
lldi
lut
e
j
ustabi
t.Att
het
ransducert
hechangei
nconcent
rat
ioni
sdet
ect
ed.Thi
sisshownbyt
he
r
isi
ngpor
ti
onoft
hedi
lut
ioncur
ve.Si
ncet
heci
rcul
ati
oni
sacl
osedone,
fract
ionofi
nject
ed
i
ndi
cat
oronceagai
npassest
hrought
hehear
tandent
erst
hear
ter
ial
cir
cul
ati
on.Thusa
secondpeakappear
sint
hecur
ve.Whent
hei
ndi
cat
orcompl
etel
ymi
xesupwi
thbl
ood,
the
cur
vebecomespar
all
elt
othet
imeaxi
s.Theampl
it
udeoft
hecur
vebecomespar
all
elt
othe
t
imeaxi
s.Theampl
it
udeoft
hecur
vedependsont
hequant
it
yofi
nject
edi
ndi
cat
orandon
t
het
otalquant
it
yofci
rcul
ati
ngbl
ood.Thecar
diacout
putcanbecal
cul
atedf
rom t
he
di
lut
ioncur
ve,
Q=(
(M *60)
/ar
eaundert
hecur
ve)i
nl/
min
Q–Car
diacOut
put
M –Amountofi
ndi
cat
or
Forexampl
e,i
f10mgofi
ndi
cat
orwasi
nject
edandaver
ageconcent
rat
ionf
rom cur
vei
s5
mg/
lforcur
vedur
ati
onof20seconds,
then,
Q=(
10*60)
/(5*
20)l
/mi
n=6l
/mi
n
2)Dyedi
lut
ionmet
hod:
Her
eint
hismet
hod,
thei
ndi
cat
orusedi
sadye.I
ndocyani
negr
eenorCar
diogr
eendyei
s
commonl
yused.Thi
sdyei
susedt
orecor
dthedi
lut
ioncur
ve.Theconcent
rat
ionoft
hedye
i
smeasur
edwi
tht
hehel
pofi
nfr
aredphot
ocel
l.
Dyedi
lut
ionmet
hod
Thedyei
sneededi
nver
ysmal
lquant
it
iesofupt
o5mg.t
hedyei
sinj
ect
edandt
hedye
passt
hroughci
rcul
ati
on.Thebl
oodi
sdr
awnf
rom t
her
adi
alorf
emor
alar
ter
ybyamot
or
dr
ivensyr
inget
hroughacuvet
te.Ar
adi
ati
onsour
cei
ll
umi
nat
est
hecuvet
tef
rom onesi
de
andt
hedet
ect
orphot
ocel
lrecei
vest
hescat
ter
edl
aser
.Thecur
vei
smadeofdi
sposabl
e
pol
yet
hyl
enet
ube.Ther
eisani
nter
fer
encef
il
terwi
thapeakt
ransmi
ssi
onof805nm whi
ch
per
mitonl
yinf
rar
edr
adi
ati
ont
obet
ransmi
tt
ed.Thesyr
ingewhi
chdr
awsbl
oodhasa
vol
umeof50ml
/mi
n.t
heout
putoft
hephot
ocel
lisconnect
edt
oal
owdr
if
tampl
if
ier
.Ithas
hi
ghi
nputi
mpedanceandl
owout
puti
mpedance.Apot
ent
iomet
ri
crecor
derr
ecor
dst
he
ampl
if
ierout
putsi
gnalonar
ecor
dingpaperataspeedof10mm/
s.af
terr
ecor
dingt
he
di
lut
ioncur
ve,
sal
inei
sinj
ect
edt
ofl
usht
hedyeoutoft
heci
rcul
ati
ngbl
ood.
3)Ther
mal
dil
uti
onmet
hod:
I
nthi
smet
hod,
ather
mali
ndi
cat
orofknownvol
umei
sint
roducedi
ntoei
thert
her
ightor
l
eftat
ri
um andt
hiswi
llpr
oducear
esul
tantt
emper
atur
echangei
nthepul
monar
yar
ter
yor
t
heaor
tar
espect
ivel
y.Thet
emper
atur
echangehel
psi
nest
imat
ingcar
diacout
put
.
Car
diacOut
put=
(
aconst
ant*[
Bloodt
emper
atur
e–i
nject
atet
emper
atur
e])
/(ar
eaundert
hedi
lut
ioncur
ve)
Asol
uti
onof5%dext
rosei
nwat
eratr
oom t
emper
atur
eisi
nject
edi
ntot
her
ightat
ri
um.
Thi
sist
het
her
mali
ndi
cat
or.I
tmi
xesi
nther
ightvent
ri
cleandi
sdet
ect
edi
nthepul
monar
y
ar
ter
ybymeansofat
her
mist
or.Thet
her
mist
ori
smount
edt
oacat
het
erpr
obe.The
i
nject
atet
emper
atur
eisal
sosensedbyat
her
mist
orandt
hedi
ff
erencei
ntemper
atur
e
bet
weent
hei
nject
ateandbl
oodci
rcul
ati
ngi
nthepul
monar
yar
ter
ymeasur
ed.Reduct
ion
i
ntemper
atur
eint
emper
atur
eint
hepul
monar
yar
ter
yduet
othepassageofdext
rosei
s
i
ntegr
atedwi
thr
espectt
oti
meandt
hebl
oodf
lowi
nthepul
monar
yar
ter
yist
hen
comput
edel
ect
roni
cal
ly.Anext
ernaldevi
cepr
ovi
desdi
rectr
eadi
ngofcar
diacout
put
.10
mlofi
nject
atei
susedf
ordi
lut
ioncur
ve.Dext
rosesol
uti
onatat
emper
atur
eof18°
C-28°
C
i
sused.Bl
oodt
emper
atur
eismeasur
edoverar
angeof30°
Cto40°
C.
Hear
trat
eMeasur
ement
Hear
trat
e:
Thenumberofhear
tbeat
speruni
tti
mei
smeasur
edast
hehear
trat
e.The
hear
trat
eisbasedont
henumberofcont
ract
ionsoft
he
vent
ri
cles
(t
hel
owerchamber
sof
t
hehear
t).Thehear
trat
emaybet
oof
ast(
tachycar
dia)ort
oosl
ow(
bradycar
dia)
.
Hear
trat
ecanbemeasur
edf
rom t
heECGsi
gnalei
therbyt
heaver
ageori
nst
ant
aneous
t
imei
nter
val
sbet
weent
wosuccessi
veRpeaks.
Techni
quesusedt
ocal
cul
atehear
trat
eincl
ude,
1)Aver
ageCal
cul
ati
on:Anaver
ager
atei
nbeat
s/mi
niscal
cul
atedbycount
ingt
henumber
ofpul
sesi
nagi
vent
ime.
2)Beatt
oBeatCal
cul
ati
on:Thi
sisdonebymeasur
ingt
het
ime(
sayT)i
nseconds,
bet
weent
woconsecut
ivepul
ses,
andconver
ti
ngt
hist
imei
ntobeat
s/mi
n(60/
T).
3)Combi
nat
ionofbeat
-t
o-beatcal
cul
ati
onwi
tht
heaver
agi
ngt
echni
que:Thi
sisdone
basedonaf
ourorsi
xbeat
saver
age.
1)Aver
agehear
trat
emet
ers:
Theywor
kont
hebasi
sofconver
ti
ngeachRwaveoft
heECGpul
seoff
ixedampl
i
tudeand
dur
ati
onandt
hendet
ermi
ningt
heaver
agecur
rentf
rom t
hesepul
ses.Theyhavef
requency
t
ovol
tageconver
torci
rcui
tincor
por
atedi
nthem t
odi
spl
ayt
heaver
agehear
trat
eint
erms
ofbeat
spermi
nut
e.
2)I
nst
ant
aneoushear
trat
emet
ers:
Measur
ementofhear
trat
eisdependentont
her
eli
abl
edet
ect
ionoft
heQRScompl
exi
n
t
heECGwave.TheECGi
ssampl
edever
y2ms.Twoadj
acent2mssampl
esar
eaver
aged
andt
her
esul
tisat
rai
nof4mssampl
es.I
nor
dert
oremoveunnecessar
yhi
ghf
requency
component
soft
hesi
gnal
,a30Hz,
inf
ini
te–i
mpul
ser
esponse,
But
ter
wor
thf
il
teri
sused.
QRS
Sl
ewRate 30Hzlow– 1.
25Hzhigh Matched
ECG2
l
imit passf
il
ter –passf
il
ter fi
lt
er
ms
Aver
age
Low
HeartRat
e Al
arm
BeatDet
ect
or
Detect
or
Hi
gh
Bl
ockDi
agr
am –Hear
tRat
eMet
er
Thi
spr
oduces8mssampl
esi
nthepr
ocess.Anydcof
fsetwi
tht
hesi
gnali
sremovedbya
1.
25Hzhi
ghpassf
il
ter
.Thecl
ampedandf
il
ter
edECGwavef
ormi
sfi
nal
lypassedt
hrough
aQRSmat
chedf
il
ter
.Thi
sbeatdet
ect
orr
ecogni
zesQRScompl
exesi
nthepr
ocessed
(
fi
lt
ered)ECGwavef
orm val
uet
hathasoccur
redsi
ncet
hel
asthear
tbeat
.Ift
hisval
ue
exceedsat
hreshol
dval
ue,
ahear
tbeati
scount
ed.Thebeati
nter
valaver
agedoversever
al
beat
sisusedt
ocal
cul
atet
hehear
trat
efordi
spl
ay,
alar
mli
mitcompar
isont
rendi
ngand
r
ecor
derannot
ati
on.Thet
hreshol
dint
hisar
rangementget
saut
omat
ical
lyadj
ust
ed
dependi
ngupont
heval
ueoft
heQRSwaveampl
it
udeandt
hei
nter
valbet
weent
heQRS
compl
exes.Fol
lowi
ngeachbeat
,ani
nhi
bit
oryper
iodof200msi
sint
roduceddur
ingwhi
ch
nohear
tbeati
ndet
ect
ed.Thi
sreducest
hepossi
bil
it
yoft
heTwavef
rom get
ti
ngcount
ed.
Thei
nhi
bit
oryper
iodi
sal
sokeptvar
iedasani
nver
sef
unct
ionoft
hehi
ghr
atel
imi
t,wi
th
l
owerhi
ghr
atel
imi
tsgi
vingl
ongeri
nhi
bit
oryper
iods.
Hear
tSoundMeasur
ement
Hear
tsoundsar
edi
agnost
ical
lyusef
ul.Soundspr
oducedbyheal
thyhear
tsar
ever
ymuch
i
dent
ical
.Wher
easabnor
malsoundsal
wayscor
rel
atet
ospeci
fi
cphysi
calabnor
mal
it
ies.
Thehear
tsoundsmaybeduet
omovementofhear
twal
l,
closur
eofwal
ls,
flowofbl
ood,
l
eakageofbl
oodet
c.Thepr
inci
pali
nst
rumentusedf
ort
hecl
ini
caldet
ect
ionofhear
t
soundsi
stheacoust
icalst
ethoscope.Ani
mpr
ovementovert
heacoust
icalst
ethoscopei
s
t
heel
ect
roni
cst
ethoscopeconsi
sti
ngofami
crophone,
anampl
if
ierandaheadset
.
El
ect
roni
cst
ethoscopescandet
ecthear
tsoundswhi
char
etool
owi
nint
ensi
tyort
oohi
gh
i
nfr
equencyt
obehear
dinapur
elyacoust
icali
nst
rument
.
Thephonocar
diogr
aphi
sani
nst
rumentusedf
ordet
ect
ingandr
ecor
dingt
hesounds
connect
edwi
tht
hepumpi
ngact
ion(
mechani
calact
ion)oft
hehear
t.Thi
shel
psi
n
i
ndi
cat
inghear
trat
eandr
hyt
hmi
cit
yofhear
tbeat
,ef
fi
ciencyofpumpi
ngofbl
ood,
val
ve
act
ionet
c.t
hephonocar
diogr
aphconsi
stsofami
crophone,
anampl
if
ierandt
her
ecor
der
.
Ther
ear
etwot
ypes’
micr
ophonest
hatar
eusedf
orr
ecor
dingphonocar
diogr
am,
1)Cr
yst
al
and2)Dynami
c.Thecr
yst
almi
crophoneconsi
stsofapi
ezoel
ect
ri
cmat
eri
alwhi
ch
gener
atespot
ent
ial
swhensubj
ect
edt
omechani
calst
ressesduet
ohear
tsounds.The
dynami
ctypemi
crophoneconsi
stsofamovi
ngcoi
lhavi
ngaf
ixedmagnet
iccor
einsi
dei
t.
Thecoi
lmoveswi
tht
hehear
tsoundsandpr
oducesavol
tagebecauseofi
tsi
nter
act
ion
wi
tht
hemagnet
icf
lux.Theampl
if
ierusedf
oraphonocar
diogr
aphhaswi
debandwi
dth
wi
thaf
requencyofr
angeabout20t
o2000Hz.Fi
lt
ersper
mitsel
ect
ionofsui
tabl
e
f
requencybands,
sot
hatpar
ti
cul
arhear
tsoundf
requenci
escanber
ecor
ded.The
phonocar
diogr
am r
equi
resar
ecor
dingsyst
em capabl
eofr
espondi
ngt
o2000Hz.
Gal
vanomet
err
ecor
der
s,di
rectwr
it
ingr
ecor
der
s,i
nkj
etr
ecor
der
s,el
ect
rost
ati
crecor
der
s
ort
her
malr
ecor
der
scanbeusedt
orecor
dPCG(
PhonoCar
dioGr
am)waves.
Typi
calPhonocar
diogr
am
Thef
ir
stsoundi
sduet
othecl
osur
eofmi
tr
alandt
ri
cuspi
dval
ves.Thi
ssound
cor
respondst
otheRwaveoft
heECG.Anyabnor
mal
it
yint
hef
ir
stsoundt
husr
elat
est
o
r
elaxat
ionofat
ri
aorcont
ract
ionofvent
ri
cles.Thenor
malsoundsar
elongeri
ndur
ati
on,
l
oweri
nfr
equencyandgr
eat
eri
nint
ensi
tyt
hant
hesecondsound.Thef
requenci
esof
t
hesesoundsr
angebet
ween30t
o100Hzanddur
ati
onr
angef
rom 50t
o100ms.The
secondsoundi
shi
gheri
npi
tchwi
thdur
ati
on25t
o50msandf
requency100Hz.t
his
soundi
spr
oducedduet
othecl
osur
eofaor
ti
candpul
monar
yval
ves.Thet
hir
dsoundi
s
pr
oducedbyt
hei
nfl
owofbl
oodt
othevent
ri
cles.Thef
our
thsoundi
spr
oducedduet
othe
cont
ract
ionoft
heat
ri
a.
Pul
monar
yfunct
ionmeasur
ement
s
Measur
ementofPul
monar
yfunct
ionsi
simpor
tantasf
arasdi
agnosi
ngpr
obl
emsr
elat
ed
t
orespi
rat
orysyst
em t
hatar
iseei
therduet
oor
gani
corenvi
ronment
ali
ssues.Pul
monar
y
f
unct
ionmeasur
ement
sincl
ude
1)Maxi
mum Vol
unt
aryMeasur
ement(
MVV)–Thi
sisdonebymaki
ngdeepandr
api
d
br
eat
hingonaspi
romet
er.
2)For
cedExpi
rat
oryVol
umei
n1Second(
FEV1)–Thi
sisdonebymaki
ngr
api
d
i
nhal
ati
on-
exhal
ati
ononaspi
romet
er.
3)Maxi
mum Expi
rat
oryFl
owRat
e(MEFR)–Thi
sisdonebyf
orci
blei
nhal
ati
on-
exhal
ati
onmeasur
edonapneumot
achomet
er.
4)I
ntr
a-al
veol
arPr
essur
e–Thi
smeasur
espr
essur
eint
heal
veol
arsacbyabody
pl
ethysmogr
aph.
5)Bl
oodGasMeasur
ement–Thi
smeasur
espar
ti
alpr
essur
eofbl
oodO2andbl
ood
CO2usi
ngbl
oodgasanal
yzer
.
Spi
romet
er
I
ntr
oduct
ion:
Thepr
ocessofmeasur
ementoft
heamount(
vol
ume)ofai
rthatcanbei
nhal
edand
exhal
edi
scal
ledspi
romet
ry.Spi
romet
ryi
sani
mpor
tantt
oolusedf
orassessi
ngcondi
ti
ons
suchasast
hma,
pul
monar
yfi
brosi
sandchr
oni
cobst
ruct
ivepul
monar
ydi
sease.
Spi
romet
eri
saspeci
aldevi
cet
hatr
egi
ster
stheamountofai
rasubj
ecti
nhal
esorexhal
es
i
ntooroutoft
hel
ungs.Theout
putpr
oducedbyaspi
romet
eri
scal
ledakymogr
apht
race
orspi
rogr
am.Spi
rogr
amsar
etr
aci
ngsorr
ecor
dingsoft
hei
nfor
mat
ionobt
ainedf
rom t
he
spi
romet
ri
ctest
.Ther
ear
etwot
ypesofspi
romet
ers,
1)Vol
umeSpi
romet
er:Thoset
hatr
ecor
dtheamountofai
rexhal
edori
nhal
edwi
thi
na
cer
tai
nti
me(
vol
ume)
.
2)Fl
owSpi
romet
er:Thoset
hatmeasur
ehowf
astt
heai
rfl
owsi
noroutast
hevol
umeof
ai
rinhal
edorexhal
edi
ncr
eases(
fl
ow)
.
Basi
cSpi
romet
er:
Thebasi
cspi
romet
erconsi
stsofawat
ert
ankwi
thani
nver
tedcover
ingf
loat
ingbel
lmade
ofl
ightwei
ghtmat
eri
al.Ther
eisapr
ovi
sionf
ort
ubi
ngatt
hebot
tom oft
het
ank.The
subj
ectorpat
ient
,whosel
ungcapaci
tyhast
obemeasur
ed,
ismadet
oexhal
eai
rint
othe
t
ubi
ng,
whi
chf
il
lsupt
het
ankandt
husvol
umei
nthet
anki
ncr
eases.Thi
svol
umeofai
r
pushesupwar
dst
hef
loat
ingbel
lwhi
chi
sbal
ancedbyacount
erwei
ght
.Awi
rei
s
suspendedt
othef
loat
ingbel
lsucht
hatwhenvol
umechanget
akespl
acet
hewi
removes
i
naccor
dancet
othef
loat
ingbel
l.Ast
hewi
removesver
ti
cal
lyupanddownr
ecor
derpen
at
tachedt
oitmovesoverachar
t,si
mul
taneousl
yrecor
dingt
hevol
umechangei
nthe
wat
ert
ankwhi
chi
spr
opor
ti
onalt
othel
ungcapaci
ty.Thedi
sadvant
ageoft
hissetupi
s
t
hatt
heosci
ll
ati
onscausedbecauseofwat
eri
nthet
ankshowi
ngi
naccur
ateunst
eady
vol
umemeasur
e.Toover
comet
hisef
fectacent
ralcor
eofchamberf
orexpi
redai
rcanbe
madewher
ethear
eaofwat
eroccupi
edbecomesl
ess.Thi
sspi
romet
erwor
ksef
fect
ivel
y
onl
yift
hesubj
ectof
fer
sful
lcooper
ati
onandt
hatt
heyar
etr
ainedf
ort
hispur
pose.
Spi
romet
er
Thevol
umechangei
nfor
mat
ioni
nthechamberorwat
ert
anki
npr
opor
ti
ont
othel
ung
capaci
tycanbeconver
tedt
ocor
respondi
ngel
ect
ri
calsi
gnal
sbyt
heusageofappr
opr
iat
e
t
ransducer
sli
kebel
lowsel
ementorpi
stonoper
ateddevi
ces.
Typi
calVol
ume–Ti
meCur
veofSpi
romet
er
Phot
oPl
ethysmogr
aphy
I
ngener
alPl
ethysmogr
aphyi
sthedet
ermi
nat
ionofbl
oodf
lowi
napar
toft
hebodyby
measur
ementofvol
umechangesi
nthepar
t.Thephot
opl
ethysmogr
aphywhi
chi
sal
so
cal
ledt
hepseudopl
ethysmogr
aphyi
sconst
ruct
edusi
ngaphot
odet
ect
orandal
ightsour
ce.
Thel
ightsour
cei
sa(
LED)l
ightemi
tt
ingdi
odeandt
hephot
odet
ect
ori
saphot
oresi
stor
t
ypewhi
chi
sexci
tedbyaconst
antcur
rentsour
ce(
CCS)
.Changesi
nli
ghti
ntensi
tycause
pr
opor
ti
onalchangesi
nther
esi
stanceoft
hephot
odet
ect
or.Si
ncet
hecur
rentt
hrought
he
phot
oresi
stori
sconst
antt
her
esi
stancechangespr
oducevol
tagechanges(
Eo)att
he
out
putoft
heext
ernal
cir
cui
tr
y.
Asbl
oodf
lowst
hrought
het
humbdur
ingeachcont
ract
ionoft
heat
ri
um bl
oodvol
umeal
so
changes,
aidi
ngachangei
nopt
icaldensi
tyoft
hebl
ood.Thei
ntensi
tyoft
hel
ighti
s
changedi
naccor
dancet
otheat
ri
alcont
ract
ion.Li
ghtf
rom t
heLEDi
sref
lect
edi
ntot
he
phot
odet
ect
orbyscat
ter
ingandbydi
rectr
efl
ect
ionf
rom t
heunder
lyi
ngbonest
ruct
uresof
t
het
humb.Thechangei
nint
ensi
tyofl
ightduet
obl
oodf
lowi
nandoutoft
het
humbi
s
det
ect
edbyt
hephot
odet
ect
or.Thi
schangei
nint
ensi
tyi
scal
ibr
atedi
nter
msofbl
oodf
low.
Thevol
tagechangeatt
hephot
oresi
stori
sampl
i
fied,
sampl
ed,
fil
ter
edanddi
spl
ayedi
n
t
ermsofbl
oodf
low.
BodyPl
ethysmogr
aphy
Pl
ethysmogr
aphyi
sbasi
cal
lyusedt
omeasur
ethevol
umechangesi
nanypar
toft
hebody
t
hatr
esul
tfr
om t
hepul
sat
ionsofbl
oodoccur
ri
ngwi
theachhear
tbeat
.These
measur
ement
sar
eusef
uli
nthedi
agnosi
sofar
ter
ialobst
ruct
ionsandpul
sewavevel
oci
ty
measur
ement
swhi
chmayl
eadt
odet
ermi
net
hehear
trat
e.
Tomeasur
etheTot
alLungCapaci
ty(
TLC)abodypl
ethysmogr
aphyi
sused.i
tconsi
stsof
ar
igi
dai
rti
ghtchamberi
nwhi
cht
hepat
ienti
smadet
osi
t.Changesi
nvol
umer
efl
ectas
pr
essur
echangesofai
rinsi
det
hechamber
.Thusbymeasur
ingpr
essur
echangeat
const
antvol
umecondi
ti
onormeasur
ingvol
umechangeatconst
antpr
essur
econdi
ti
on
onecani
nter
pretval
uesf
orTot
alLungCapaci
ty.Sensor
ssuchasst
rai
ngauge,
phot
o
el
ect
ri
csensor
s,capaci
ti
veori
mpedancesensor
scanbeused.
Dependi
ngupont
henat
ureoft
hesensor
,itcanbecal
ledcapaci
tancepl
ethysmogr
aph,
st
rai
ngaugepl
ethysmogr
aph,
phot
oel
ect
ri
cpl
ethysmogr
aphandi
mpedance
pl
ethysmogr
aph.
Thepr
inci
pleofoper
ati
onoft
hebodypl
ethysmogr
aphdependsont
heBoyl
e’
slawwhi
ch
st
atest
hatatagi
venKel
vint
emper
atur
e,t
hepr
essur
eofagi
venmassofgasi
sinver
sel
y
pr
opor
ti
onalt
oit
svol
ume.
Thati
s,P*V=K.
T………….(
1)
wher
e,Ki
saconst
ant
.
Si
ncef
orTLCmeasur
ementt
hepat
ientsi
tsi
nsi
deanai
rti
ghtchamberwhoset
emper
atur
e
r
emai
nsconst
ant
,equat
ionbecomes,
P*V=Const
ant
………….(
2).
Par
ti
all
ydi
ff
erent
iat
ingequat
ion(
2)weget
,
d(
P*V)=(
∂(P*
V)/∂P)dP+(
∂(P*
V)/∂V)dV=0……………(
3)
(
or)
V.
dP+P.
dV=0………….(
4)
d.
P/d.
V=-P/
V…………….
.(5)
Nowt
hedooroft
heai
rti
ghtchamberi
sseal
edwi
tht
hepat
ienti
nsi
deandt
heval
veont
he
mout
hpi
ecei
scl
osed.Si
ncet
hepat
ientcannotbr
eat
hewi
tht
heval
vecl
osed,
theai
r
pr
essur
eint
hemout
hpi
ecei
sequalt
othel
ungpr
essur
ePT.
I
nthebody,
d.
TLC/
d.PT=-TLC/
PT……………….(
6)
wher
e,TLC=t
hor
axVol
ume
PT=t
hor
axpr
essur
e.
I
ntheChamber
,
d.
VC/
d.PC=-VC/
PC……………….(
7)
wher
e,VC=ChamberVol
ume
PC=Chamberpr
essur
e.
Si
ncet
hechamberi
scl
osed,
anyi
ncr
easei
nthet
hor
aci
cvol
umecausesadecr
easei
nthe
chambervol
umeofai
r.
Thati
s,d(
VC)=-d(
TLC)…………………(
8)
TLC/
PT.d.
PT=-VC/
PC.d.
PC………………(
9)
Dur
ingt
hemeasur
ement
,PC=PTsi
ncet
hechangesi
npr
essur
einducedbybr
eat
hing
mot
ionsar
esmal
lwhent
hepat
ienti
ssi
tt
ingnor
mal
ly.
Ther
efor
e,TLC=-VC.d.
PC/
d.PT…………………(
10)
Measur
ementPr
ocedur
e:
Mout
hpi
eceval
vei
scl
osedwhent
hepat
ienti
ssi
tt
ingi
nsi
det
heseal
edchamber
.The
pat
ienti
saskedt
omakebr
eat
hingmot
ions.Changei
npr
essur
ereadi
ngi
nthepr
essur
e
gauge(
1)whi
chr
eadsoutd.
PTi
snot
eddown.Si
mil
arl
ychangei
npr
essur
ereadi
ngi
nthe
pr
essur
egauge(
2)whi
chr
eadsoutd.
PCi
sal
sonot
ed.Thusbyknowi
ngt
hechamber
vol
umeVCTot
alLungCapaci
ty(
TLC)i
scal
cul
atedusi
ngt
hef
oll
owi
ngequat
ionTLC=VC.
[
d.PC/
d.PT]
.
Measur
ementofpHofBl
ood
 pHofbl
oodandot
herbodyf
lui
dhel
psi
nident
if
yingchemi
calbal
anceoft
hebody.
 Thenor
mal
pHoft
heext
racel
lul
arf
lui
dli
esi
nther
angeof7.
35t
o7.
45,
indi
cat
ing
t
hatt
hebodyf
lui
dissl
ight
lyal
kal
ine.
 Whent
hepHexceeds7.
45,
thebodyi
sconsi
der
edt
obei
nast
ateofal
kal
osi
s.
 AbodypHbel
ow7.
35i
ndi
cat
esaci
dosi
s.
 Bot
haci
dosi
sandal
kal
osi
sar
edi
seasecondi
ti
onswi
del
yencount
eredi
ncl
ini
cal
medi
cine.
 Anychangei
nthepHofbl
oodmayr
esul
tint
hef
oll
owi
ngt
hreephysi
ologi
cal
mechani
sms:(
i)buf
fer
ingbychemi
cal
means,
(ii
)Respi
rat
ion,
(ii
i)Excr
eti
on,
int
othe
ur
inebyki
dneys.
 pHi
sameasur
eofhydr
ogeni
onconcent
rat
ioni
nasol
uti
on.
 pH=-l H+)
og(
 Whi
chmeanst
heaci
dit
yoral
kal
ini
tyofasol
uti
ondependsoni
tsconcent
rat
ionof
hydr
ogeni
ons.
 I
ncr
easi
ng t
he concent
rat
ion ofhydr
ogen i
ons makes a sol
uti
on mor
e aci
dic,
decr
easi
ngt
heconcent
rat
ionofhydr
ogeni
onsmakesi
tmor
eal
kal
ine.
 pHcanbemeasur
edusi
ngei
ther
pHi
ndi
cat
ors
(l
ikephenol
pht
hal
ein)-i
nthef
orm of
sol
uti
onor
pHst
rps
i -orusi
ng
pot
ent
iomet
ri hod.
cmet
 I
npot
ent
iomet
ri
cmet
hods,pot
ent
ialdi
ff
erencebet
weenknownr
efer
enceel
ect
rode
andt
hemeasur
ing
pHel
ect
rodei
sdet
ermi
ned.
 Pot
ent
ial
oft
hepHel
ect
rodedependsont
heact
ivi
ti
esofhydr
ogeni
ons.
 Thi
sdependencei
sdescr
ibedby
Ner
nstequat
ion,t
husoncet
hepot
ent
ialhasbeen
measur
edt
heact
ivi
tyi
scal
cul
ated.
 Theact
ivi
tyi
sident
icalt
othei
onsconcent
rat
ion.
 pH met
eri
snot
hingbutapr
eci
sevol
tmet
er,connect
edt
othepH el
ect
rode,and
scal
edi
nsuchawayt
hati
tdi
spl
aysnott
hemeasur
edpot
ent
ial
,butdi
rect
lyt
hepH
val
ue.
 Ner
nstequat
ioni
sgi
venby,
E=Eo+2.
3026RT/
FlogCH
Wher
e,
E=El
ect
rodePot
ent
ial
Eo=St
andar
dPot
ent
ial
R=Gasconst
ant
T=absol
utet
emper
atur
e
F=Far
adayConst
ant
CH =Concent
rat
ionofhydr
ogeni
ons.
 Twoel
ect
rodeswhi
char
einvol
vedi
nthemeasur
ementofpH,
are
1.The
glass el
ect
rode (
Indi
cat
ing El
ect
rode or Sensi
ng El
ect
rode or Measur
ing
El
ect
rode)
2.The
ref
erenceel
ect
rode(
Cal
omelEl
ect
rode)
 ForpH measur
ementsi
lver– si
lverchl
ori
deel
ect
rodei
susedast
hemeasur
ing
el
ect
rode.
 Measur
ingel
ect
rodei
smadeofaseal
edgl
assout
erbodywi
thaspeci
alpHsensi
ti
ve
gl
assbul
bjoi
nedatt
heendwhi
chdevel
opsan
el
ect
ri
cpot
ent
i
alcor
respondi
ngt
othe
pHoft
hesol
uti
on.
 Thebul
bisof0.
5cm i
ndi
amet
er.
 The bul
b pr
ovi
des a t
hin gl
ass membr
ane whi
ch per
mit
sthe passage ofonl
y
hydr
ogeni
onsi
nthef
orm ofH3O+.
 Thi
sgl
assbul
bhast
heAg/
AgClel
ect
rodei
mmer
sedi
nchl
ori
debuf
fersol
uti
on.
 Chl
ori
debuf
fersol
uti
oni
snot
hingbutKCli
n0.
1M HCl
.
 Acal
omelel
ect
rodei
susedast
he
ref
erenceel
ect
rode.
 Ther
efer
enceel
ect
rodei
sa
hal
fcel
l
compl
eti
ngt
hepHel
ect
rodepai
r(al
ongwi
tht
he
gl
assel
ect
rode)
.
 Thecal
omelel
ect
rodei
smadeofagl
assi
nnert
ubef
il
ledwi
thmer
cur
ouschl
ori
de
[
Hg2Cl
2]past
e.
 Thi
sgl
asst
ubehasapor
ouspl
ugatt
hebot
tom.
 Apl
ati
num wi
rei
sinser
tedt
hrought
hiswhi
chi
sthel
eadwi
re.
 Ont
opoft
heHg2Cl
2past
eanel
ement
almer
cur
ylayeri
sfor
med.
 Thi
swhol
einnergl
asssetupi
snow pl
acedi
nanout
erbi
ggergl
asst
ubewi
tht
he
por
ouspl
ugatt
hebot
tom.
 Theout
ergl
asst
ubei
sfi
ll
edwi
thKClandf
ormsahal
fcel
lpot
ent
ial
.
 Thepor
ouspl
ugatt
hebot
tom oft
heel
ect
rodeassembl
yisusedt
omakecont
act
bet
weent
hei
nter
nalKClel
ect
rol
yteandt
heunknownpHt
estsol
uti
oni
ntowhi
cht
he
el
ect
rodei
simmer
sed.
 Thepot
ent
ialbet
weent
hisel
ect
rodeandt
hegl
assmeasur
ementel
ect
rodegi
vest
he
pHoft
heunknownsol
uti
on.
 Si
nceasal
tbr
idgei
sfor
medbet
weent
heKCli
nmeasur
ingel
ect
rode–unknownt
est
sol
uti
on–KCli
nref
erenceel
ect
rode.
 I
twi
tht
hei
nter
nalel
ect
rol
ytesol
uti
on,(
KCl
),makescont
actwi
tht
hesampl
esol
uti
on
vi
aapor
ousgl
assf
ri
t.
 Ther
efer
enceel
ect
rodepr
ovi
desast
abl
e,known
ref
erencepot
ent
i ,agai
al nstwhi
ch
t
he
glass/
pHel
ect
rode
canbemeasur
ed.
 Ther
efer
enceel
ect
rodei
snowadaysi
ncor
por
atedi
ntot
hegl
ass/
pHel
ect
rodet
ofor
m
a
compoundorcombi
nat
ionel
ect
rode.
 Formaki
ngpHmeasur
ement
s,t
hesol
uti
oni
stakeni
nabeaker
.
 Apai
rofel
ect
rodes(
glassel
ect
rode&cal
omelel
ect
rode)i
simmer
sedi
nthesol
uti
on.
 Thevol
tagedevel
opedacr
osst
heel
ect
rodesi
sappl
iedt
oanel
ect
roni
campl
if
ier
,
whi
cht
ransmi
tst
heampl
if
iedsi
gnalt
othedi
spl
ay.
 ThepH met
eri
susual
lyequi
pped wi
th cont
rol
sforcal
ibr
ati
on and t
emper
atur
e
compensat
ion.
 ForpHmeasur
ementi
npar
ti
cul
ar,gl
assel
ect
rodeswi
thaccommodat
ionf
orasmal
l
quant
it
yofbl
oodandyi
eldi
ngaccur
ater
esul
tshavebeendevel
opedandputi
ntouse.
 Oneamongsuchel
ect
rodei
sthesyr
inget
ypei
nwhi
chsmal
lsampl
esofbl
oodi
s
t
akenanaer
obi
cal
lyandt
hesmal
l‘deadspace’bet
weent
heel
ect
rodebul
bandt
he
i
nnersur
faceoft
hesyr
ingebar
reli
sfi
ll
edwi
thdi
lut
ehepar
insol
uti
ont
opr
eventbl
ood
coagul
ati
on.
 Theot
heri
sthemi
crocapi
ll
arygl
assel
ect
rodeswhi
ch ar
epr
efer
red when i
tis
r
equi
redt
omoni
torpHcont
inuousl
y,f
orexampl
edur
ingsur
ger
y.
 Mi
crocapi
ll
aryel
ect
rodesf
orcl
ini
calappl
icat
ionsr
equi
reonl
y20–25mi
crol
it
erof
bl
oodf
ordet
ermi
nat
ionofpH.
 Theel
ect
rodei
sencl
osedi
nawat
erj
acketwi
thci
rcul
ati
ngwat
erataconst
ant
t
emper
atur
eof38°
C.
 Thewat
ercont
ains1%NaCl
forshi
eldi
ngagai
nstst
ati
cint
erf
erence.
 Thecapi
ll
aryi
spr
otect
edwi
thpol
yet
hyl
enet
ubi
ng.
 The pH measur
ing Si
lver
/Si
lverChl
ori
de and t
he r
efer
ence cal
omelel
ect
rode i
s
connect
edt
oasmal
lpoolofsat
urat
edKCl
,thr
oughapor
ouspi
n.
 Gl
assel
ect
rodesdet
eri
orat
eifal
lowedt
oremai
nincont
actwi
thbl
oodf
oral
ongt
ime,
whi
chmayr
esul
tini
naccur
atepHmeasur
ement
.
 Poi
soni
ngef
fectduet
opr
otei
ndeposi
ti
oni
nbl
oodcanber
educedbyput
ti
ngt
he
el
ect
rodei
npepsi
nand0.
1NHCl
,fol
lowedbycar
efulwi
pingwi
that
issuepaper
.
Measur
ementofBl
oodpCO2
Thebl
oodpCO2 i
sthepar
ti
alpr
essur
eofcar
bonofbl
oodt
akenanaer
obi
cal
ly.I
tis
expr
essedi
nmm ofHgandi
srel
atedt
otheper
cent
ageCO2asf
oll
ows:
pCO2=Bar
omet
ri
cpr
essur
e–Wat
ervaporpr
essur
e*(
%CO2/
100)
At37°C,
thewat
ervaporpr
essur
eis47mm ofHg,
soat750mm bar
omet
ri
cpr
essur
e,5.
7
%CO2cor
respondst
oapCO2of40mm.
pCO2Measur
ement
:
ThepCO2 el
ect
rodeconsi
stsoft
hest
andar
dgl
assel
ect
rodeusedaspHmeasur
ement
el
ect
rode.Theel
ect
rodei
sencl
osedbyaper
meabl
erubbermembr
ane.At
hinf
il
m of
wat
ersur
roundst
hegl
assel
ect
rodei
nbet
weent
her
ubbermembr
ane.
pCO2Measur
ement
Thewhol
esetupi
skepti
nthesol
uti
onwhoseCO2concent
rat
ioni
stobef
oundout
.CO2
f
rom t
hesol
uti
ondi
ff
usest
hrought
her
ubbermembr
aneandr
eachest
hewat
erf
il
m.The
pH oft
hewat
erf
il
m whi
ch i
smeasur
ed wi
tht
hehel
p oft
hesi
lver
/si
lverchl
ori
de
el
ect
rode(
pH measur
ementel
ect
rode)get
sdi
stur
bedandchangesdependi
ngont
he
di
ff
usedCO2.Thust
heconcent
rat
ionofCO2i
smeasur
ed.
pCO2El
ect
rode:
ThepCO2 el
ect
rodebasi
cal
lyconsi
stsofapHsensi
ti
vegl
assel
ect
rodehavi
ngar
ubber
membr
anest
ret
chedoveri
t,wi
that
hinl
ayerofwat
ersepar
ati
ngt
hemembr
anef
rom t
he
el
ect
rodesur
face.Thet
echni
quei
sbasedont
hef
actt
hatt
hedi
ssol
vedCO2changest
he
pHofanaqueoussol
uti
on.TheCO2 f
rom bl
oodsampl
edef
usest
hrought
hemembr
ane
t
ofor
m H2CO3,whi
chdi
ssoci
atesi
nt H+)and(
o( HCO3-)i
ons.Ther
esul
tantchangei
npH
i
sthusaf
unct
ionoft
heCO2concent
rat
ioni
nthesampl
e.TheEMFgener
atedwasf
ound
t
ogi
veal
inearr
elat
ionshi
pbet
weent
hepHandt
henegat
ivel
ogar
it
hm ofpCO2.
Anal
ter
nat
emodi
fi
edf
orm oft
heel
ect
rodeusedf
orpCO2 measur
ementi
ncl
udesat
hin
f
il
m ofanaqueoussodi
um bi
car
bonat
e(NaHCO3)sol
uti
oni
nst
eadoft
hewat
erl
ayer
.The
r
ubbermembr
anewasal
sor
epl
acedbyat
hinTef
lonmembr
ane,whi
chi
sper
meabl
eto
CO2butnott
oanyot
heri
ons,
whi
chmi
ghtal
tert
hepHoft
hebi
car
bonat
esol
uti
on.Ther
e
wi
llbeadr
opi
npHduet
oCO2r
eact
ingwi
thwat
erf
ormi
ngcar
boni
caci
d.ThepHf
all
sby
al
mostonepHuni
tforat
enf
oldi
ncr
easei
nCO2 t
ensi
onoft
hesampl
e.Hence,t
hepH
changei
sal
inearf
unct
ionoft
hel
ogar
it
hm oft
heCO2t
ensi
on.
I
nst
eadofSi
lver
/Si
lverchl
ori
deel
ect
rodeacal
omelel
ect
rodecanal
sobeused.
Measur
ementofBl
oodpO2
Thepar
ti
alpr
essur
eofoxygeni
nthebl
oodorpl
asmai
ndi
cat
est
heext
entofoxygen
exchangebet
weent
hel
ungsandt
hebl
ood,andnor
mal
ly,t
heabi
li
tyoft
hebl
oodt
o
adequat
elyper
fuset
hebodyt
issueswi
thoxygen.Thepar
ti
alpr
essur
eofoxygeni
s
usual
lymeasur
edwi
thaPol
arogr
aphi
cel
ect
rode.Underanappl
iedvol
tageof0.
6to0.
9V,
i
tisobser
vedt
hatt
hecur
rentf
lowi
ngi
ntheel
ect
rochemi
calcel
lispr
opor
ti
onalt
othe
oxygenconcent
rat
ioni
nthesol
uti
on.
Forbl
oodpO2 measur
ementt
heCl
arkoxygenel
ect
rodei
sused.Thi
stypeofel
ect
rode
consi
stsofapl
ati
num cat
hode,asi
lver
/si
lverchl
ori
deanodei
nanel
ect
rol
ytef
il
li
ng
sol
uti
onandapol
ypr
opyl
enemembr
ane.Theel
ect
rodei
sofasi
ngl
euni
tandi
tusual
ly
cont
ainst
her
efer
enceel
ect
rodeal
soi
nit
sassembl
y.Theent
ir
euni
tisi
nser
tedi
ntot
he
sol
uti
onundermeasur
ement
.Oxygendi
ff
usesacr
osst
hepol
ypr
opyl
enemembr
anei
nto
t
heel
ect
rol
ytef
il
li
ngsol
uti
onandi
sreducedatt
hecat
hode.Att
heanodesi
lveri
s
oxi
dizedandt
hemagni
tudeoft
her
esul
ti
ngcur
renti
ndi
cat
est
hepar
ti
alpr
essur
eof
oxygen.
Ther
eact
ionsoccur
ri
ngatt
heanodeandcat
hodear
e:
Cat
hodeReact
ion:
O2+2H2O+4e- 4OH-
AnodeReact
ion:
4Ag 4Ag++4e-
Advant
agesofCl
arkel
ect
rodei
npO2Measur
ement
:
 Sampl
esi
zer
equi
redf
ort
hemeasur
ementcanbeext
remel
ysmal
l.
 Thecur
rentpr
oducedduet
opO2 att
heel
ect
rodei
sli
near
lyr
elat
edt
othepar
ti
al
pr
essur
eofoxygen.
 Theel
ect
rodecanbemadesmal
lenought
omeasur
eoxygenconcent
rat
ioni
nhi
ghl
y
l
ocal
izedar
ea.
 Responset
imei
sver
ylow,
sot
hemeasur
ement
scanbemadei
nseconds.
I
fthemeasur
edcur
rentduet
ooxygenconcent
rat
ioni
slowi
tnecessar
yforampl
if
icat
ion
f
ordr
ivi
ngt
hedi
spl
aydevi
ce.Measur
ementofoxygenel
ect
rodecur
renti
smadeby
usi
nghi
ghi
nputi
mpedance,
lownoi
seandl
owcur
rentampl
if
ier
s.Fi
eldef
fectt
ransi
stor
s
usual
lyf
ormt
hei
nputst
ageoft
hepr
eampl
if
ier
s.Theoper
ati
onalampl
if
ieri
sconnect
ed
asat
ransr
esi
stanceconver
ter
,theout
putofwhi
chcanbedi
rect
lybyadi
git
alvol
tmet
er.
Thepol
ari
zingvol
tagei
ssuppl
iedbyt
hecel
lB(
1.3V)andvar
iabl
eresi
stance“
VR1”
.The
st
andi
ngcur
rentf
rom t
heel
ect
rochemi
calcel
liscancel
ledbymeansof“
VR2.Bat
ter
yB
andGΩ r
esi
stance.Capaci
torCi
sincl
udedt
oli
mitt
hebandwi
dthoft
heampl
if
iert
o
r
educenoi
seandt
oensur
egooddynami
cst
abi
li
ty.
ACompl
eteBl
oodGasAnal
yzer
Bl
oodgasanal
yzer
sar
edesi
gnedt
omeasur
epH,
pCO2,
andpO2f
rom asampl
eofbl
ood.
Thesi
zeoft
hesampl
emayvar
yfr
om 25mi
crol
it
erst
oaf
ewhundr
edmi
crol
it
ers.The
i
nst
rumentcanal
socomput
etot
alCO2,
HCO3andbaseexcess.
Thebl
ockdi
agr
am i
sshownabove.I
nthi
sinst
rumentsepar
atesensor
sar
eusedf
orpH,
pCO2,
and
pO2.
Thei
nst
rumentcont
ainst
hreesepar
atehi
ghi
nputi
mpedanceampl
if
ier
sdesi
gnedt
o
oper
atei
nthe speci
fi
crange ofeach measur
ing el
ect
rode.A separ
ate modul
e
t
her
most
ati
cal
lycont
rol
sthet
hreeel
ect
rodes.I
tal
sopr
ovi
dest
her
most
ati
ccont
rolf
or
t
hehumi
dif
icat
ionoft
hecal
ibr
ati
nggases.Cal
ibr
ati
nggasesar
esel
ect
edbyaspeci
al
pushbut
toncont
rolandpassedt
hrought
hesampl
echamberwhenr
equi
red.Twogases
ofaccur
atel
yknownO2 andCO2 per
cent
agesar
erequi
redf
orcal
ibr
ati
ngt
heanal
yzeri
n
t
hepCO2 andpO2 modes.Avacuum syst
em pr
ovi
desaspi
rat
ionandf
lushi
ngofsampl
e
i
nthet
hreeel
ect
rodes.
I
nputsi
gnalt
ot HCO3-)measur
he( ementbl
ockcomesf
rom t
heout
put
soft
hepH and
pCO2ampl
if
ier
s.Theout
putoft
hisci
rcui
tgoest
oanADCboar
dfordi
spl
ay.Thet
otalCO2
(
TCO2)i
smeasur
edbysummi
ngt
heout
putsi
gnal
soft HCO3-)andt
he( hepCO2ampl
if
ier
.
Anant
il
oggener
atori
susedatt
heout
putofpCO2 ampl
if
iert
ocal
cul
ateTCO2.Faci
li
ti
es
f
oradj
ust
ingt
hesl
opeandzer
oatt
heout
put
sar
eavai
labl
e.
Fi
ngert
ipOxi
met
er
I
ntr
oduct
ion:
 Oxi
met
ryi
sat
echni
quet
hathel
psi
nmeasur
ingt
heamountofoxygeni
napat
ient
’s
orsubj
ect
’sbl
ood.
 OxygenSat
urat
ion=[
HbO2]
/([
HbO2]
+[Hb]
)
Wher
e,
[
HbO2]=Concent
rat
ionofOxygenat
edhemogl
obi
n
[
Hb]=Concent
rat
ionofDe-
Oxygenat
edhemogl
obi
n
 I
tshoul
dbenot
edt
hatt
heamountofoxygencombi
ningwi
thhemogl
obi
ndepends
upont
hepar
ti
alpr
essur
eofoxygen.
TypesofOxi
met
ry:
Ther
ear
etwot
ypesofOxi
met
rynamel
y,
i
)Invi
voOxi
met
ry
i
i)I
nvi
tr
oOxi
met
ry
i
) I
nvi
tr
oOxi
met
ry:
I
nthi
stechni
queoxygensat
urat
ioni
nbl
oodi
smeasur
edbyt
aki
ngbl
oodoutoft
hebody
andmeasur
ementpr
ocessi
sdoneatal
atert
imei
nthel
abor
ator
yunderanaer
obi
c
condi
ti
ons.
i
i) I
nvi
voOxi
met
ry:
I
nthi
stechni
queoxygensat
urat
ioni
nbl
oodi
smeasur
edwhi
let
hebl
oodi
sst
il
lfl
owi
ngi
n
t
heci
rcul
ator
ysyst
em.
I
nvi
tr
oOxi
met
ry:
Ther
ear
etwot
ypesofmeasur
ementpr
inci
plesnamel
y,
a)Tr
ansmi
ssi
onMet
hod
b)Ref
lect
ionMet
hod
Bot
hthemet
hodsusespect
rophot
omet
erst
omeasur
econcent
rat
ionandhenceoxygen
sat
urat
ion.
a)Tr
ansmi
ssi
onOxi
met
ry:
I
ntr
ansmi
ssi
onOxi
met
rybl
oodi
stakeni
nat
ranspar
entcuvet
te.Li
ghtofi
ntensi
tyI
ois
t
ransmi
tt
edt
hrought
hebl
oodi
nthecuvet
te.Thet
ransmi
tt
edl
ighti
sofi
ntensi
tyI
.Thi
s
i
ntensi
tyi
sexponent
ial
lypr
opor
ti
onalt
otheconcent
rat
ionofconst
it
uent
sofbl
ood,
accor
dingt
oBeer-Lamber
t'
slaw.Accor
dingt
othel
aw,
whenabeam ofl
ightr
adi
ati
oni
s
passedt
hroughamedi
um t
her
ateofdecr
easeofi
ntensi
tyofr
adi
ati
onwi
tht
het
hickness
oft
hemedi
um i
spr
opor
ti
onalt
othei
ntensi
tyoft
hei
nci
dentr
adi
ati
onaswel
las
concent
rat
ionoft
hemedi
um.
-
kCb
I=I
o
Wher
e,
I
o=I
ntensi
tyofor
igi
nali
nci
dentl
ight
I=I
ntensi
tyoft
ransmi
tt
edl
ight
k=Absor
pti
oncoef
fi
cient
C=Concent
rat
ion
b=Thi
cknessoft
hemedi
um
Tr
ansmi
ssi
onOxi
met
ry-I
nvi
tr
o
Bl
oodi
stakeni
nacuvet
teandmeasur
ementf
ort
ransmi
tt
edl
ighti
sdonei
na
spect
rophot
omet
er.Thewavel
engt
hbestsui
tedf
ormeasur
ementofoxygensat
urat
ionof
bl
oodi
s600and700nm.I
nvi
tr
omeasur
ementi
smadeatawavel
engt
hof650nm (
red)
andal
soat805nm (
inf
rar
ed)
.Themeasur
ementatvi
sibl
eredwavel
engt
haccount
sfor
t
heamountofoxygeni
nbl
oodandt
heamountofbl
oodt
issuesi
ntheopt
icalpat
h.The
measur
ementati
nfr
aredwavel
engt
haccount
sforonl
ytheamountofbl
oodandt
issuesi
n
t
heopt
icalpat
h.Thi
senabl
est
oknowt
heamountofoxygenpr
esenti
naknownquant
it
y
ofbl
ood.
b)Ref
lect
ionOxi
met
ry:
I
nref
lect
ionOxi
met
rybl
oodi
stakeni
nat
ranspar
entcyl
indr
icalcuvet
teof15nm i
nter
nal
di
amet
er.
Ref
lect
ionOxi
met
ry-I
nvi
tr
o
Li
ghtf
rom at
ungst
enf
il
amentl
ampi
scondensedandf
ocusedont
othepl
anebot
tom of
t
hiscyl
inder
.
Thi
sinci
dentl
ighti
sscat
ter
edf
rom t
hebl
oodsampl
e.Theangl
eofr
efl
ect
ioni
sabout135°
.
Thi
sscat
ter
edl
ighti
scondensedont
otwomat
chedphot
oconduct
orsPD1andPD2.Two
f
il
ter
sCandC’
li
mitt
hel
ightr
eachi
ngeachphot
oconduct
oratλ1=650nm andλ2=805
nm.Ther
ati
oofr
esi
stanceoft
hephot
odi
odesPD1,
PD2i
smeasur
edbyaWheat
stone
br
idge.Thei
ncr
easeoft
her
ati
ogi
vest
hel
ighti
ntensi
tyscat
ter
edbyt
hebl
oodsampl
eat
t
hecuvet
te.Oxygensat
urat
iondependsoni
ntensi
tyofr
efl
ect
edl
ight
.Oxygensat
urat
ion=
(
I(
r805nm)
/I(
r650nm)
)*(
A–B)
,wher
eAandBar
econst
ant
s.
I
nvi
voOxi
met
ry:
 I
nthi
stypebl
oodsampl
eisnott
akenoutoft
hebodyf
ormeasur
ement
.
 Cat
het
ersar
eut
il
ized.
 EarOxi
met
erandf
ingert
ippul
seOxi
met
erar
ethet
wot
ypesunderi
nvi
vot
ypeof
oxygensat
urat
ionmeasur
ement
.
a)EarOxi
met
er:
I
nthi
stype,
pinnaoft
heearact
sast
hecuvet
tewher
eusual
lyt
hesampl
eisst
ored
t
empor
ari
lyf
oroxygensat
urat
ionmeasur
ement
.Thepi
nnaoft
heeari
srubbedbr
iskl
yin
or
dert
oenabl
evasodi
lat
ati
onandhencei
ncr
easedbl
oodf
low.A2.
5m l
ongf
lexi
bleear
pr
obeconnect
sthepat
ientt
othei
nst
rument
.Ahi
ghout
put
,tungst
eni
odi
del
ampi
s
ut
il
ized.Li
ghtf
rom t
hel
ampsour
cei
scol
li
mat
edbyal
enssyst
em.Thecol
li
mat
edl
ight
beam i
sdi
rect
edt
hrought
hinf
il
mint
erf
erencef
il
terar
rangedont
heper
ipher
yoft
hef
il
ter
wheel
.Thef
il
terwheelr
otat
esat1300r
pm andt
huscut
sthel
ightbeam sequent
ial
ly.The
f
iberopt
icbundl
ecar
ri
est
hisf
il
ter
edl
ightt
othepi
nnaoft
heearatonesi
deoft
hecat
het
er.
Att
heot
herendoft
hecat
het
eranot
herf
iberopt
iccabl
ecol
lect
sli
ghtscat
ter
ed/
t
ransmi
tt
edandpassesont
othedet
ect
orwhi
chgi
vesel
ect
ri
ccur
rentcor
respondi
ngt
o
i
ntensi
tyoft
ransmi
tt
edl
ight
.
EarOxi
met
er-I
nvi
vo
Thi
str
ansmi
tt
edl
ighti
sampl
if
iedbyahi
ghgai
nampl
if
ierandt
henconver
tedt
idi
git
al
f
orm byanADC.Thi
sADCandot
herpr
ocessi
ngci
rcui
tsar
esynchr
oni
zedwi
tht
her
otat
ing
f
il
terwheel
.Thet
ransmi
tt
edl
ighti
ntensi
tywhi
chi
sconver
tedt
odi
git
alf
ormi
spassed
ont
oadi
git
alaver
agi
ngci
rcui
twhi
chf
il
ter
sthenoi
seduet
oot
heri
nter
fer
ingl
ight
.
Acent
ralpr
ocessorcomput
esper
cent
ageofoxygensat
urat
ion.Thenecessar
y
coef
fi
cient
sfort
hecal
cul
ati
onar
est
oredonapr
ogr
ammabl
eROM.Af
tercomput
ati
ont
he
measur
eddat
aisdi
spl
ayeddi
git
all
yint
hef
rontpanel
.
b)
Pul
seOxi
met
er(
Fingert
ipoxi
met
er)
:
Thepul
seoxi
met
erconsi
stsoff
ingert
ippr
obe.Thepr
obehas2LEDs,
oneemi
tt
ing
i
nfr
aredl
ightat940nm andt
heot
hert
ransmi
tt
ingvi
sibl
e(r
ed)at660nm.Thepr
obehasa
phot
osensoront
heot
hersi
deoft
heLED.Thi
spr
obei
scl
ippedont
othef
ingert
ip.Li
ght
f
rom t
heLEDpassest
hrought
hef
ingert
ipandr
eachest
hephot
osensorwhi
chconver
tsi
t
i
ntor
espect
iveel
ect
ri
calcur
rent
.Theout
putoft
hephot
osensori
sar
awsi
gnalt
hat
r
epr
esent
sbot
htheabsor
pti
onofr
edl
ightandt
hei
nfr
aredl
ight
.Iti
smadeofbot
hacand
dccomponent
s.Theacsi
gnali
sduet
othepul
singofar
ter
ial
bloodwhi
let
hedcsi
gnali
s
duet
oal
lthenonpul
sat
ingabsor
ber
sint
het
issues.
Oxygensat
urat
ion,
R=(
ac660/
dc660)
/(ac940/
dc940)
.Thecur
rentsi
gnali
sfi
rst
ampl
if
ied,
conver
tedt
ovol
tagef
orm andt
henf
urt
herampl
if
iedatasecondampl
if
ierst
age.
I
tist
hensepar
atedi
ntor
edandi
nfr
aredcomponent
sbyade-
mul
ti
plexerci
rcui
t.Aband
passf
il
terci
rcui
tfur
thersepar
atesi
tint
oacanddccomponent
s.ThenanADCi
s
empl
oyedt
oconver
titt
odi
git
alf
orm.Thi
sisf
oll
owedbyami
cropr
ocessorwhi
chsuppor
ts
t
her
equi
reddi
git
alsi
gnalpr
ocessi
ng.
Advant
agesoff
ingert
ipoxi
met
eri
ncl
udes,
 Noneedofr
ubbi
ngofski
ntoi
ncr
easevasodi
lat
ati
ont
oincr
easebl
oodf
low.
 Si
mpl
if
iedoper
ati
onalpr
ocedur
esar
etobef
oll
owed.
 Subj
ectvar
iabi
li
tyl
ikeski
npi
gment
ati
on,
thi
cknessoft
issue,
sensorl
ocat
ionet
c
hasnosi
gni
fi
canti
nfl
uenceont
heoxygensat
urat
ionmeasur
ement
.
Di
sadvant
agesoff
ingert
ipoxi
met
eri
ncl
udes,
 I
nter
fer
enceduet
oambi
entl
ight
 Mot
ionar
ti
fact
s
GSRmeasur
ement
s:
Gal
vani
cSki
nResponse(
GSR)
,al
soknownasel
ect
roder
malr
esponse(
EDR)
,
psychogal
vani
cref
lexes(
PGR)
,orski
nconduct
ancer
esponse(
SCR)andi
tisamet
hodof
measur
ingt
heel
ect
ri
calr
esi
stanceoft
heski
n.
GSRi
sconduct
edbyat
tachi
ngt
wol
eadst
otheski
n,andacqui
ri
ngabasemeasur
e.Then
ast
heact
ivi
tybei
ngst
udi
edi
sper
for
med,
recor
dingsar
emadef
rom t
hel
eads.Ther
ear
e
t
wowayst
oper
for
m aGSR.
1)I
nact
iveGSR–Cur
renti
spassedt
hrought
hebody,
wit
hther
esi
stance
measur
ed.
2)I
npassi
veGSR–Cur
rentgener
atedbyt
hebodyi
tsel
fismeasur
ed.
GSRmeasur
ementi
sonecomponentofpol
ygr
aphdevi
ces.GSRmeasur
ementi
sal
so
becomi
ngacommonpl
acei
nhypnot
her
apyandpsychot
her
apypr
act
ice.GSRf
eedback
i
nst
rumentmeasur
esski
nconduct
ivi
tyf
rom t
hef
inger
sand/
orpal
ms.SuchGSRf
eedback
i
nst
rumenthasbeenusedi
nthet
reat
mentofexcessi
vesweat
ingandr
elat
ed
der
mat
ologi
calcondi
ti
ons.I
tmeasur
est
heaver
ageact
ivi
tyoft
hesweatgl
andsandi
sa
measur
eoft
hephasi
cact
ivi
tyoft
hesegl
ands.GSRi
smeasur
edatt
hepal
m,wher
ethe
bodyhast
hehi
ghestconcent
rat
ionofsweatgl
ands.Themeasur
ementi
smadeusi
nga
DCcur
rentsour
ce.Si
lver
/Si
lverChl
ori
deel
ect
rodesar
eusedt
omeasur
eGSR.
Ar
rangementf
ormeasur
ingGSRi
sshowni
nfi
gur
eabove.BSRgi
vest
hebasel
ineval
ueof
t
heski
nresi
stance.TheBSRout
puti
sconnect
edt
oanRCnet
wor
kwi
that
imeconst
antof
3t
o5secondswhi
chenabl
est
hemeasur
ementofGSRasachangeoft
heski
nresi
stance.
UNI T II
I: ELECTRI CAL PARAMETERS ACQUI SITI
ON AND ANALYSIS
Electr
odes– Li mbelectrodes–f l
oati
ngelectr
odes– pr egell
eddisposabl eelect
rodes-
Mi cr
o,needleandsur f
aceel ect
rodes– Ampl i
fi
ers,Pr
eampl if
ier
s,differ
entialampli
fi
ers,
chopperampl if
ier
s–Isol at
ionampl i
fi
er-ECG–EEG–EMG–ERG–Leadsyst emsand
recordi
ngmet hods–Typi calwaveforms-Elect
ri
calsaf
etyinmedi calenvironment,shock
hazards– l eakagecurrent-I
nst
rumentsforchecking safetyparamet er
sofbi omedical
equipments.
El
ect
rodes
 El
ect
rodeshel
pinpi
cki
ngupel
ect
ri
calsi
gnal
s.
 I
npar
ti
cul
ar,
Bio-
pot
ent
ialel
ect
rodesar
ethosewhi
chhel
pinpi
cki
ngupt
heel
ect
ri
cal
si
gnal
soft
hebody.
 Theseel
ect
ri
calsi
gnal
sar
eaconsequenceoft
hechemi
calact
ivi
tyi
nthebi
ologi
cal
syst
em.
 Chemi
cal
act
ivi
ti
esar
eduet
oionsandt
hischemi
calact
ivi
tyt
akespl
aceatcel
lul
ar
l
evel
.
keNa+, - +
 I
onsl
i Cl,K ar
epr
edomi
nant
lypr
esent
.
 Theconcent
rat
iongr
adi
entandi
tsunbal
ancedcondi
ti
oni
nsi
deandout
sidet
hecel
l
l
eadst
oel
ect
ri
calact
ivi
ty,
whi
chi
spi
ckedupbybi
o-pot
ent
ialel
ect
rodes.
 Typesofel
ect
rodes:
i
) Mi
croel
ect
rodes:Theseel
ect
rodesar
eusedt
omeasur
ebi
o-pot
ent
ialwi
thi
nasi
ngl
e
cel
l.
a)Met
almi
croel
ect
rode
b)Mi
cropi
pet
i
i)Dept
handneedl
e:Theseel
ect
rodesar
eusedt
omeasur
ebi
o-pot
ent
ialathi
ghl
y
l
ocal
izedext
racel
lul
arr
egi
on.
a)Dept
h
b)Needl
e
i
ii
)Sur
faceel
ect
rodes:Theseel
ect
rodesar
eusedi
nmeasur
ingpot
ent
ial
savai
labl
e
f
rom t
hesur
faceoft
heski
n.
a)Met
alPl
ate
b)Suct
ioncup
c)Adhesi
veTape
d)Mul
ti
poi
nt
e)Fl
oat
ing
i
v)Chemi
cal
elect
rodes:
a)Hydr
ogenel
ect
rode
b)Pr
act
icalr
efer
enceel
ect
rode
c)pHel
ect
rode
d)pCO2el
ect
rode
e)pO2el
ect
rode
Hal
fCel
lPot
ent
ial
:
 Vol
tagedevel
opedatel
ect
rode–el
ect
rol
ytei
nter
facei
scal
ledhal
fcel
lpot
ent
ial
.
 I
nmet
al–el
ect
rol
yteel
ect
rodes,
twopr
ocessest
akespl
ace,
 Thepassageofi
onsf
rom t
hemet
ali
ntot
hesol
uti
on
 Thef
ormat
ionofat
omsoft
hemet
albyt
hecombi
nat
ionofi
onsi
nthesol
uti
onandi
ons
i
nthemet
al.
 Becauseoft
hesepr
ocessest
her
eischar
gegr
adi
ent
,andanel
ect
ri
caldoubl
elayeri
s
f
ormed.
 El
ect
ri
caldoubl
elayeri
sthespat
ialar
rangementofmet
ali
ons.
 Ther
ear
eel
ect
rodeswher
ether
ear
enonett
ransf
erofchar
geacr
ossmet
al–
el
ect
rol
ytei
nter
facesuchel
ect
rodesar
ecal
ledper
fect
lypol
ari
zedel
ect
rodes.
 El
ect
rodeswher
ether
eisunhi
nder
edexchangeofchar
gecar
ri
ersacr
ossmet
al–
el
ect
rol
ytei
nter
facear
ecal
ledper
fect
lyun-
pol
ari
zedel
ect
rodes.
 Pr
act
icalel
ect
rodeswi
llbebet
weent
heset
wol
imi
ts.
 Pot
ent
ialduet
othi
schar
gegr
adi
enti
sobj
ect
ionabl
eifi
tkeepsonvar
ying,
butpr
act
ical
casest
hepot
ent
iali
snotst
abl
eandt
hisconst
it
utesnoi
sevol
tagecal
ledar
ti
fact
.
Mi
croEl
ect
rodes
 Mi
croel
ect
rodesar
eusedt
omeasur
epot
ent
ialnearorwi
thi
nasi
ngl
ecel
l.
 Theseel
ect
rodesar
eot
her
wisecal
ledi
ntr
acel
lul
arel
ect
rodes.
 Thesear
eofver
ysmal
ldi
amet
erssot
hatt
heydonotdamagecel
lsdur
ingi
nser
ti
on.
 Whenami
croel
ect
rodei
susedt
omeasur
ethepot
ent
ialoft
hecel
l,
iti
slocat
edwi
thi
n
t
hecel
lwhi
let
her
efer
enceel
ect
rodei
ssi
tuat
edout
sidet
hecel
l.
 Thedi
amet
eroft
het
ipoft
hemi
croel
ect
rodesr
angesf
rom 0.
5to5mi
crons.
 Ther
ear
etwot
ypesofmi
croel
ect
rodesnamel
y,
i
.Met
alMi
croel
ect
rode
i
i.Non–met
almi
croel
ect
rode(
or)Mi
cropi
pet
Met
alMi
croel
ect
rode:
 Theseel
ect
rodesar
emadeoff
inet
ungst
enorst
ainl
essst
eelwi
re.
 Theyar
efor
medbyel
ect
rol
yti
cal
lyet
chi
ngt
het
ipoft
het
ungst
enorst
ainl
essst
eelwi
re
t
oaf
inepoi
nt.Thi
stechni
quei
sknownasel
ect
ropoi
nti
ng.
 Thi
set
chedmet
alwi
rei
sthensuppor
tedbyal
argermet
all
icshaf
t.
St
ruct
ureofMet
alMi
croel
ect
rode
 Thi
smet
all
icshaf
tact
sasa
i
.St
urdymechani
cal
suppor
tfort
hemi
croel
ect
rode.
i
i.Meansofconnect
ingt
hemi
croel
ect
rodet
oit
sleadwi
re.
 Themi
croel
ect
rodeandt
hesuppor
ti
ngshaf
tisi
nsul
atedbyapol
ymermat
eri
alor
var
nish.
 Theext
remet
ipoft
hemi
croel
ect
rodei
slef
twi
thouti
nsul
ati
on.
 Thebi
oel
ect
ri
cpot
ent
ialmeasur
edi
sact
ual
lyt
hedi
ff
erencei
ninst
ant
aneouspot
ent
ial
oft
hemeasur
ingmi
croel
ect
rodeandr
efer
enceel
ect
rode.
Met
alMi
croel
ect
rode
Ci
rcui
t–Met
alMi
croel
ect
rode
 I
not
herwor
ds,
thebi
oel
ect
ri
cpot
ent
iali
sgi
venby,
E=EA+EB+EC
E–Bi
o-pot
ent
ial
EA–Met
alel
ect
rode-el
ect
rol
ytepot
ent
ialatt
hemi
croel
ect
rodet
ip
EB–Ref
erenceel
ect
rode-el
ect
rol
ytepot
ent
ial
EC–Var
iabl
ecel
lmembr
anepot
ent
ial
RA –Resi
stanceofconnect
ingwi
re
RB–Resi
stanceofmi
croel
ect
rodet
ip
RFA,
RWA,
WWA –I
mpedanceofmi
croel
ect
rodet
ip.
RIN –Resi
stanceofi
ntr
acel
lul
arf
lui
d.
RB–Resi
stanceofwi
reconnect
edt
oref
erenceel
ect
rode
RFB,
RWB,
CWB–I
mpedanceofel
ect
rode-ext
racel
lul
arf
lui
dint
erf
ace.
REX–Resi
stanceofext
racel
lul
arf
lui
d.
CD –Capaci
tancebet
weeni
nsul
atedshaf
tofmi
croel
ect
rodeandt
heext
racel
lul
arf
lui
d.
i
i)Mi
cropi
pet
:
 Mi
cropi
peti
stheot
hernameoft
henonmet
almi
croel
ect
rode.
Non–Met
al(
or)Mi
cropi
petEl
ect
rode
 I
tconsi
stsofagl
assMi
cropi
petwhoset
ip’
sdi
amet
eri
sabout1mi
cromet
er.
 At
hin,
flexi
blemet
alwi
remadeofsi
lver
,st
ainl
essst
eelort
ungst
eni
sinser
tedi
ntot
he
st
em oft
hemi
cropi
pet
.
 Oneendoft
hemet
alwi
rei
smount
edt
oar
igi
dsuppor
tandt
heot
herf
reeendt
hrough
t
hest
em oft
hemi
cropi
peti
srest
ingont
hecel
ltopi
ckupbi
o-el
ect
ri
cpot
ent
ial
.
 Her
ebi
o-el
ect
ri
cpot
ent
iali
sgi
venas
E=EA+EB+EC+ED
E–Bi
o-el
ect
ri
cPot
ent
ial
EA –Pot
ent
ialbet
weent
hemet
alwi
reandel
ect
rol
ytef
il
ledi
nthemi
cropi
pet
.
EB–Pot
ent
ialbet
weent
her
efer
enceel
ect
rodeandt
heext
racel
lul
arf
lui
d
EC–Var
iabl
ecel
lmembr
anepot
ent
ial
ED –Pot
ent
ialexi
sti
ngatt
het
ipduet
odi
ff
erentel
ect
rol
ytespr
esenti
nthepi
petandt
he
cel
l.
Equi
val
entCi
rcui
t
 Themi
cropi
peti
sfi
ll
edwi
thanel
ect
rol
yteusual
ly3MkCl
.
R–Resi
stanceofconnect
ingwi
re
RFA,
RWA,
WWA –I
mpedanceofel
ect
rodeel
ect
rol
ytei
nter
facei
nthest
em oft
hemi
cropi
pet
R¬T–Resi
stanceoft
heel
ect
rol
ytef
il
li
ngt
het
ipoft
hemi
cropi
pet
.
RIN,
REX–Resi
stanceofel
ect
rol
yte
RFB,
RWB,
CWB–Ref
erenceel
ect
rode-el
ect
rol
ytei
nter
facei
mpedance
RB–Resi
stanceoft
hewi
reconnect
edwi
thr
efer
enceel
ect
rode
CD –Capaci
tanceexi
sti
ngbet
weent
hef
lui
dint
hepi
petandt
heext
racel
lul
arf
lui
d.
Dept
handneedl
eel
ect
rode
 Theset
ypeofel
ect
rodesar
eusedt
omeasur
eandr
ecor
dbi
o-el
ect
ri
cevent
sfr
om
hi
ghl
ylocal
izedext
racel
lul
arr
egi
ons.
 Theyar
eoft
wot
ypesnamel
y,
i
.Dept
hel
ect
rode
i
i.Needl
eel
ect
rode
(
i)Dept
hEl
ect
rode:
 Usedt
ost
udyel
ect
ri
calact
ivi
tyofneur
onsi
nthesuper
fi
ciall
ayer
soft
hebr
ain.
 Thesear
emadeofabundl
eofTef
loni
nsul
atedpl
ati
num 90%-i
ri
dium 10%al
l
oywi
res.
 Thesewi
resactasi
ndi
vidualel
ect
rodesandsuppor
tedbyast
ainl
essst
eelwi
re.
Dept
hEl
ect
rode
 Thi
sst
ainl
essst
eelsuppor
ti
ngwi
rei
sroundedof
fatt
het
ipf
oreasyi
nser
ti
oni
ntot
he
t
opl
ayer
soft
hebr
ain.
 Theel
ect
roder
est
sont
hesub-
cor
ti
calner
vecel
ls.
 Theact
ivear
eaofdept
hel
ect
rodei 5mm2.
s0.
 Thust
hei
mpedanceofdept
hel
ect
rodesi
ssmal
lercompar
edt
omi
croel
ect
rodes.
 Thesuppor
ti
ngst
ainl
essst
eelwi
recani
tsel
factasanel
ect
rodei
fanappr
opr
iat
e
var
nishi
sused.
 Thesuppor
ti
ngwi
rei
fmadei
nthef
orm ofacapi
ll
aryt
ubecanbeusedt
oinj
ect
medi
cinesi
ntot
hebr
ain.
i
i)Needl
eel
ect
rode:
 Theneedl
eel
ect
rodei
susedt
omeasur
eact
ionpot
ent
ialsofper
ipher
alner
ves.
 Her
eaneedl
eisusedt
omakeal
ument
hroughwhi
chashor
tlengt
hmet
alwi
rei
s
i
nser
ted.
 Thi
sshor
tlengt
hmet
alwi
rei
sbentatoneendandi
nser
tedt
hrought
hel
umeni
ntot
he
muscl
es.
Needl
eEl
ect
rode
 Thi
swi
repi
cksupt
heel
ect
ri
calact
ivi
tyoft
hebi
ologi
calsyst
em.
 I
fonewi
rei
susedasameasur
ingel
ect
rodeandanot
hersepar
ater
efer
enceel
ect
rode
i
susedt
heni
tiscal
ledmono-
pol
arneedl
eel
ect
rode.
Bi
pol
arEl
ect
rode
 I
ftwoi
nsul
atedwi
resar
eusedoneasr
efer
enceandt
heot
herasmeasur
ingel
ect
rode
t
hrought
hel
umenoft
heneedl
ethensuchanel
ect
rodesyst
em i
scal
ledbi
pol
arneedl
e
el
ect
rode.
Un-
insul
atedWi
re(
Needl
eel
ect
rode)
Sur
faceel
ect
rode
 Sur
faceel
ect
rodesar
eusedt
orecor
dECG,
EMGandEEGsi
gnal
s.
 Lar
gersur
facear
ea,
sur
faceel
ect
rodesar
eusedf
orECGmeasur
ement
.
 Smal
lersur
facear
ea,
sur
faceel
ect
rodesar
eusedf
oeEEGandEMGmeasur
ement
.
Met
alpl
atesur
faceel
ect
rodes(
LimbEl
ect
rodes)
 Si
mpl
estofal
lsur
faceel
ect
rodes
 I
tconsi
stsofamet
all
icconduct
ori
ncont
actwi
tht
heski
n.
 I
tismost
lyusedasl
i
mbel
ect
rodesi
nECGmeasur
ement
.
 I
tismadeupofaf
latmet
alpl
atet
hati
sbenti
ntoacyl
indr
icalsegment
.
 Ther
eisat
ermi
nalont
hecyl
indr
icalsegmentoni
tsout
ersur
face,
toat
tacht
hel
ead
wi
ret
otheel
ect
rocar
diogr
aph.
 Ther
eisal
soapostpl
acedont
hesamesi
deoft
hesegmentneart
hecent
re.
 Thi
sposti
susedt
oconnectar
ubberst
rapt
otheel
ect
rodeandhol
diti
npl
aceont
he
ar
m orl
eg.
 Theel
ect
rodei
sgener
all
ymadeofger
mani
um si
lver
,ni
ckelpl
atedst
eel
,ni
ckelet
c.
 Ther
ear
ebasi
cal
lyt
wot
ypesofmet
alpl
atesur
faceel
ect
rodesnamel
y,
i
.Rect
angul
ar
i
i.Ci
rcul
ar
 Theact
ivesur
facear
eaofar
ect
angul
arsur
faceel
ect
rodei
snor
mal
ly3.
5cm *5cm.
 Theact
ivesur
facear
eaoft
heci
rcul
arsur
faceel
ect
rodei 6cm2(
s17. 4.75cm –
Di
amet
er)
 Thei
nnersur
faceoft
heel
ect
rodei
scover
edwi
thgeloranel
ect
rol
ytesoakedpadi
s
keptwhi
chwi
llmai
ntai
ntheel
ect
rodecont
actwi
tht
heski
n.
 I
nci
rcul
armet
aldi
skel
ect
rodest
hel
eadwi
rei
ssol
der
edt
othebacksur
face.
 Theconnect
ionbet
weenl
eadwi
reandel
ect
rodei
spr
otect
edbyal
ayerofi
nsul
ati
ng
mat
eri
alsuchasepoxyorpol
yvi
nylchl
ori
de.
 Theseel
ect
rodescanbeusedf
orECG,
EMG,
andEEGr
ecor
dings.
 Di
skel
ect
rodesusedf
orECGmeasur
ement
sar
emadeofsi
lverandhasan
el
ect
rol
yti
cal
lydeposi
tedl
ayerofAgCloni
tscont
act
ingsur
face.
 I
tisal
socoat
edwi
thel
ect
rol
ytegelandpl
acedont
hepat
ient
’schestwal
l.
 Di
skel
ect
rodesusedf
orEMGr
ecor
dingsar
emadeofst
ainl
essst
eel
,pl
ati
num orgol
d
pl
ateddi
sks.
 Di
skel
ect
rodesal
socomei
nthef
orm ofdi
sposabl
ethi
nmet
alf
oil
swhi
chcanconf
orm
t
otheshapeoft
hebodysur
face.
Suct
ionCupel
ect
rode:
 Suct
ioncupel
ect
rodescanbecal
ledasmodi
fi
edmet
alpl
ateel
ect
rodes.
 Theseel
ect
rodesdonotr
equi
rest
rapsoradhesi
vest
ohol
dthem t
oapar
ti
cul
ar
l
ocat
ion.
 Theseel
ect
rodesar
emost
lyusedaschestl
eadel
ect
rodesf
orECGmeasur
ement
.
Suct
ionCupel
ect
rode
 Theyconsi
stofahol
l
owmet
all
iccyl
indr
icalel
ect
rodet
hatmakescont
actwi
tht
heski
n
ati
tsbase.
 At
ermi
nali
sther
eont
hemet
alcyl
inderf
orl
eadwi
reat
tachment
.
 Ar
ubbersuct
ionbul
bisf
it
tedt
otheot
herbaseoft
hecyl
indermet
alel
ect
rode.
 Ther
ubberbul
bissqueezedandpl
acedont
hebody,
thebul
brel
easesandappl
ies
suct
ionagai
nstt
heski
n,t
hushol
dingt
heel
ect
rodet
othebody.
 Thi
sel
ect
rodecanbeusedf
oronl
yshor
tper
iodsoft
imebecauset
hesuct
ionand
pr
essur
ecancausei
rr
it
ati
ont
otheski
n.
 Event
hought
heel
ect
rodei
slar
ge,
thecont
actar
eai
ssmal
l,
ther
efor
e,t
hei
mpedance
i
slar
ge.
 Theseel
ect
rodesar
egener
all
yusedasECGl
imbel
ect
rodes.
 Theseel
ect
rodesar
ewel
lsui
tedf
orat
tachmentt
ofl
atsur
facesoft
hebody.
Adhesi
vet
apeel
ect
rode(
Pre-
gel
ledDi
posabl
eEl
ect
rode)
 Whensur
faceel
ect
rodesar
eused,
thepr
essur
eappl
iedoni
tacr
osst
hebodysqueezes
t
hegel
orel
ect
rodepast
eout
.
Adhesi
vet
apeel
ect
rode
 Suchapr
obl
em i
savoi
dedwi
tht
heuseofadhesi
vet
apeel
ect
rode.
 I
tconsi
stsofal
argedi
skofpl
ast
icf
oam mat
eri
alwi
thasi
lverpl
ateddi
skononesi
de
andsi
lverpl
atedsnapont
heot
hersi
de.
 Thesi
lverpl
ateddi
skser
vesast
heel
ect
rodeandmaybecoat
edwi
thsi
lverchl
ori
de
l
ayer
.
 Al
ayerofel
ect
rol
ytegelcover
sthedi
sk.
 Al
eadwi
rei
ssnappedont
otheel
ect
rodeandconnect
edt
otheECGappar
atus.
 Theel
ect
rodesi
deoft
hef
oam i
scover
edwi
thanadhesi
vemat
eri
al,
whi
chi
scover
ed
wi
thapr
otect
ivef
oilmat
eri
al.
 Toappl
ytheel
ect
rode,
theski
niscl
eaned,
thepr
otect
ivemat
eri
ali
sremovedand
pr
essedagai
nstt
hepat
ient
.
Mul
ti
poi
ntel
ect
rodes:
 Mul
ti
poi
ntel
ect
rodescont
ainsnear
ly1000f
ineact
ivecont
actpoi
nts.
 Si
ncet
heact
ivesur
facear
eai
sver
ysmal
l,
aver
ylowr
esi
stancecont
acti
sest
abl
ished
i
ntheset
ypeofsur
faceel
ect
rodes.
 Theset
ypeofel
ect
rodesar
eusedonsubj
ect
swher
ether
egi
onofi
nter
esti
scover
ed
wi
thhai
r.
 Theseel
ect
rodescanbeusedunderanyenvi
ronment
alcondi
ti
ons.
 Themul
ti
poi
ntel
ect
rodei
saver
ypr
act
icalel
ect
rodef
orECGmeasur
ement
.
Fl
oat
ingel
ect
rodes
 I
nfl
oat
ingel
ect
rodes,
themet
alel
ect
rodei
snoti
ncont
actwi
tht
hebody,
hencemot
ion
ar
ti
facti
savoi
ded.
 I
tisal
soknownast
op-
hatel
ect
rode.
Fl
oat
ingel
ect
rodes
 Her
e,t
heact
ualel
ect
rodeel
ementormet
aldi
ski
skepti
nacavi
tyofi
nsul
atedpackage.
 Thust
heel
ect
rodeel
ementdoesnotcomei
ncont
actwi
tht
heski
n.
I
nter
nalSt
ruct
ureofFl
oat
ingEl
ect
rodes
 Theel
ect
rodeel
ementi
ssur
roundedbyel
ect
rol
ytegeli
nsi
det
hecavi
ty.
 Thecavi
tydoesnotmovewi
thr
espectt
othemet
aldi
sk,
soi
tdoesnotpr
oduceany
mechani
calmovement
.
 Theel
ect
rode,
elect
rol
ytegelcavi
tyi
sat
tachedt
otheski
nsur
facebymeansofa
doubl
esi
dedadhesi
vet
aper
ing.
 Theel
ect
rodedi
ski
smadeofsi
lvermet
alandcoat
edwi
thsi
lverchl
ori
de.
Equi
val
entCi
rcui
tofSur
faceEl
ect
rode:
I
nst
rument
Ehc–Hal
fcel
lpot
ent
ialatel
ect
rode-el
ect
rol
ytei
nter
face.
Cd–El
ect
rodecapaci
tance
Rd–Leakager
esi
stance
Rs–El
ect
rol
yteandski
nresi
stance
Thei
mpedanceoft
hisequi
val
entci
rcui
tisgi
venby,
Z=Rs+(
Rd/
j2Πf
Cd)
/(Rd+(
1/(
j2Πf
Cd)
))
Z=Rs+Rd/1+j
2Πf
CdRd
Ampl
if
ier
s
 Ampl
if
ieri
sadevi
cewhi
champl
if
iesori
ncr
easesani
nputofcur
rentorvol
tage.
 Mostbi
o-el
ect
ri
csi
gnal
sar
eofver
ylowampl
it
udet
husr
equi
ri
ngampl
if
icat
ion.
 Ampl
if
ier
sar
eal
sousedf
ori
nter
faci
ngsensor
s/t
ransducer
sthatsensesbodymot
ions,
t
emper
atur
eandchemi
cal
concent
rat
ionst
osi
gnalcondi
ti
oner
s.
 Thusi
tcanbesai
dthatanampl
if
ierusedt
opr
ocessbi
o-pot
ent
ial
sar
ecal
ledbi
o-
el
ect
ri
campl
if
ier
s.
 Somebi
o-el
ect
ri
campl
if
ier
sar
eac-
coupl
edandsomear
edc-
coupl
ed.
 Li
neari
ntegr
atedci
rcui
tsar
ebei
ngusedi
nanumberofel
ect
roni
cappl
icat
ions
i
ncl
udi
ngmedi
calel
ect
roni
cinst
rument
s.
 Ani
mpor
tantl
ineari
ntegr
atedci
rcui
tisoper
ati
onalampl
if
ier
.
 Theoper
ati
onalampl
if
ier(
OP-
AMP)i
samul
ti
-t
ermi
nal
,hi
ghgai
ndi
ff
erent
ialampl
if
ier
.
 I
tisnor
mal
lyusedi
nci
rcui
tst
hathavechar
act
eri
sti
csdet
ermi
nedbyext
ernalnegat
ive
f
eedbacknet
wor
ks.
 Theci
rcui
tsymbolf
oranOP-
AMPi
sshowni
nfi
gur
ebel
ow.
 Thei
nver
ti
ngi
nputpr
oducesanout
putsi
gnalt
hati
s180degr
eesoutofphasewi
tht
he
i
nputsi
gnal
,whi
chi
ster
medasi
nver
sionoft
hesi
gnal
.
 Thenon-
inver
ti
ngi
nputpr
oducesanout
putsi
gnalt
hati
sinphasewi
tht
hei
nputsi
gnal
.
Oper
ati
onalAmpl
if
ierCi
rcui
tDi
agr
am
 Thepr
oper
ti
esofani
dealop-
ampi
ncl
ude,
i
.Inf
ini
teopenl
oopvol
tagegai
n.
i
i.Zer
oout
puti
mpedance
i
ii
.Inf
ini
tei
nputi
mpedance
i
v.I
nfi
nit
efr
equencyr
esponse
v.Zer
onoi
secont
ri
but
ion
vi
.Bot
hinputf
oll
oweachot
heri
nfeedbackci
rcui
ts.
 Ther
ear
ethr
eebasi
ccl
assesofvol
tageampl
if
ier
snamel
y,
 I
nver
ti
ngf
oll
ower
 Non-
inver
ti
ngf
oll
owerwi
thgai
n
 Uni
tygai
nnoni
nver
ti
ngf
oll
ower
.
 Ther
ear
etwobasi
crul
esori
nputt
ermi
nalr
est
ri
cti
onst
hatar
ever
yhel
pfuli
ndesi
gni
ng
op-
ampci
rcui
ts.
 Theyar
e,
 Whent
heop-
ampout
puti
sini
tsl
inearr
ange,
thet
woi
nputt
ermi
nal
sar
eatt
hesame
vol
tage.
 Nocur
rentf
lowsi
ntoei
theri
nputt
ermi
naloft
heop-
amp.
 I
nthebasi
cinver
ti
ngampl
if
ierci
rcui
ts,
apor
ti
onoft
heout
putvol
tageVoi
sfedbackvi
a
f
eedbackr
esi
storRft
onegat
ivei
nputt
ermi
nal
.
 Theposi
ti
vei
nputoft
heop-
ampi
sat0V.Thi
scondi
ti
oni
scal
ledasvi
rt
ualgr
ound.
 Si
ncet
hei
nputvol
tagei
sVit
hecur
rentt
hroughRii
si=Vi/
Ri
I
nver
ti
ngAmpl
if
ier
 Byr
ule(
2)nocur
rentcanent
ert
heop-
ampandt
husIf
lowst
hroughRf.
 Hencet
her
eisavol
tagedr
opiRfacr
ossRf.
 Ther
efor
e,Vo=-
i.
Rf
Vo=-
Vi.
Rf/
Ri
(
or)Vo/
Vi=-Rf/
Ri
I
nthebasi
cnoni
nver
ti
ngampl
i
fierci
rcui
tVii
sconnect
edt
oposi
ti
vei
nputt
ermi
nal
.
Non-
inver
ti
ngAmpl
if
ier
Byr
ule(
1),
Vial
soexi
stsatnegat
ivet
ermi
nal
.
Thi
scausescur
renti=Vi/
Rit
ofl
owt
ogr
oundt
hroughRf.
Vo=i
(Rf+Ri)
Vo/Vi=i
(Rf+Ri)/
i.Ri
Vo/Vi=(
Rf+Ri)/
Ri
Di
ff
erent
ialAmpl
if
ier
 I
nmedi
calel
ect
roni
cs,
thedi
ff
erent
ialampl
if
ieri
sempl
oyedwheni
tisnecessar
yto
measur
ethevol
tagedi
ff
erencebet
weent
wopoi
nts,
bot
hoft
hem var
yingi
nampl
it
ude
atdi
ff
erentr
atesandatdi
ff
erentpat
ter
ns.
 Exampl
e:Di
ff
erent
ialampl
if
icat
ionofhear
tgener
atedvol
tagespi
ckedupbymeansof
el
ect
rodesont
hear
msandl
egs.
 Adi
ff
erent
ialampl
if
ierpr
oducesanout
putvol
taget
hati
spr
opor
ti
onalt
othedi
ff
erence
bet
weent
hevol
tagesappl
iedt
othet
woi
nputt
ermi
nal
s.
Di
ff
erent
ialAmpl
if
ier
Si
nceanoper
ati
onal
ampl
if
ierhasapai
rofdi
ff
erent
iali
nputt
ermi
nal
s,i
tiseasi
ly
connect
edf
orusei
nadi
ff
erent
ialampl
if
ierconf
igur
ati
on.
Thedi
ff
erent
ialvol
tageatt
hei
nputt
ermi
nal
soft
heop-
ampi
szer
o,t
hati
snodesaandb
ar
eatt
hesamepot
ent
ialdesi
gnat
edasV3.
Thenodalequat
ionat‘
a’i
s
(
(V3–V2)
/R1)+(
(V3–V0)
/R2)=0……………(
1)
Thenodalequat
ionat‘
b’i
s
(
(V3–V1)
/R1)+(
V3/
R2)=0…………….
.(2)
Rear
rangi
ngweget
,
(
(1/
R1)+(
1/R2)
)V3–V2/
R1=Vo/
R2…………….
.(3)
(
(1/
R1)+(
1/R2)
)V3–V1/
R1=0…………….(
4)
Subt
ract
ing(
4)f
rom (
3)weget
,
1/
R1.
(V¬1–V2)=V0/
R2
V0=R2/
R1.
(V1–V2)
I
sol
ati
onAmpl
if
ier
 I
sol
ati
onampl
if
ier
sar
eusedf
orpr
ovi
dingpr
otect
ionagai
nstl
eakagecur
rent
s.
 I
sol
ati
onampl
if
ier
sar
eusedmai
nlyi
nECGr
ecor
ding,
topr
eventacci
dent
ali
nter
nal
car
diacshock.
I
sol
ati
onAmpl
if
ier
 I
sol
ati
onampl
if
ier
spr
ovi
dei
nsul
ati
onbet
weent
hepat
ientconnect
orandt
heacpower
mai
nsl
inecor
d.
 I
sol
ati
onampl
if
ier
sar
emai
nlyusedt
opr
otecthospi
talpat
ient
s,suscept
ibl
eto
el
ect
ri
calshockhazar
ds.
 Theybr
eakt
heohmi
ccont
inui
tyofel
ect
ri
csi
gnal
sbet
weent
hei
nputandout
putoft
he
ampl
if
ier
.
 Theset
ypeofbi
o-el
ect
ri
campl
if
ier
spr deasmuchas1012Ωofi
ovi nsul
ati
on.
 Thei
nsul
ati
onampl
if
ieri
scomposedofani
nputampl
if
ier
,modul
ator
,ani
sol
ati
on
bar
ri
er,
ademodul
atorandanout
putampl
if
ier
.
 Thei
sol
ati
onampl
if
ieri
sreal
lyanener
gyconver
ter
.
 Ther
eisani
nputcommonandanout
putcommont
hatar
eel
ect
ri
cal
lyi
sol
atedf
rom
oneanot
her
.
 I
sol
ati
onbar
ri
ermaybeopt
ical
,magnet
ict
ransf
ormer
,capaci
ti
veorevenheatt
ransf
er.
 I
nthei
sol
ati
onampl
if
ierel
ect
ri
calener
gyont
hemodul
atorsi
dei
sconver
tedt
osome
nonel
ect
ri
cal
lyconduct
iveener
gyi
nthebar
ri
erandt
henconver
tedbackt
oel
ect
ri
cal
ener
gyont
hedemodul
atorsi
de.
 I
sol
ati
onampl
if
ier
sact
ual
lyoper
ateont
hepr
inci
pleofat
tenuat
ion.
 Ahi
ghbar
ri
eri
mpedanceact
sinser
iesbet
weeni
nputandout
put
.
 I
sol
ati
onampl
if
ierbr
eakgr
oundl
oopst
oper
miti
ncompat
ibl
eci
rcui
tst
obei
nter
faced
t
oget
herwhi
ler
educi
ngnoi
se.
 Theyampl
if
ysi
gnal
swhi
lepassi
ngonl
ylowl
eakagecur
rentt
opr
eventshockt
opeopl
e
ordamaget
oequi
pment
.
 Dependi
ngont
hedesi
gnt
hei
sol
ati
onampl
if
ier
sar
ecl
assi
fi
edasbat
ter
ypower
ed,
car
ri
er,
opt
ical
lycoupl
edandcur
rentl
oadi
ng.
Chopperampl
if
ier
s
 Chopperampl
if
ieri
susedi
nmedi
calel
ect
roni
cdevi
cesasi
tachi
evesadequat
elow
f
requencyr
esponsewhi
leavoi
dingdr
if
tpr
esenti
ndi
rectcoupl
edampl
if
ier
.Dr
if
tist
he
changei
ngai
ncausedbyt
her
malef
fect
sont
heampl
if
iercomponent
s.
ChopperAmpl
if
ier
 Chopperampl
if
ier
suseachoppi
ngdevi
ce,
whi
chconver
tsasl
owl
yvar
yingdi
rect
cur
rentt
oanal
ter
nat
ingf
orm wi
thampl
it
udepr
opor
ti
onalt
othei
nputdi
rectcur
rent
.
 Phasedependentonpol
ari
tyoft
heor
igi
nalsi
gnal
.
 Thi
sal
ter
nat
ingvol
tagei
sthenampl
if
iedbyaconvent
ionalampl
if
ierwhoseout
puti
s
r
ect
if
iedbackt
ogetanampl
if
ieddi
rectcur
rent
.
 Thedi
ff
erent
iali
nputchopperampl
if
ieri
sshowni
nfi
gur
ebel
ow,
 Thechopperi
savi
brat
or–dr
ivensi
ngl
epol
e,doubl
ethr
owswi
tcht
hatgr
oundst
he
ampl
if
ieri
nputandout
putt
ermi
nal
sonal
ter
nat
eswi
ngsoft
heswi
tch.
 Thechoppervi
brat
orcoi
lisexci
tedbya400Hzaccar
ri
ersi
gnal
.
 Thechopperi
sont
hei
nputci
rcui
tonl
y.
 Thecent
ret
apoft
hei
nputt
ransf
ormeri
sconnect
edt
othei
nputconnect
or,
whi
let
he
t
wowi
ndi
ngext
remi
ti
esar
econnect
edt
othechopper
.
 Thepol
eoft
hechopperswi
tchbecomest
heot
hert
ermi
naloft
hei
nputconnect
or.
 Gai
nispr
ovi
dedbyt
heac-
coupl
edampl
if
ier
.
ChoppedWavef
orms
 I
nmedi
calf
iel
d,chopperampl
if
ier
sar
eusedi
ntheampl
if
icat
ionofsmal
lDCsi
gnal
sof
af
ewmi
crovol
ts.Chopperampl
if
ier
sar
eusedwi
tht
ransducer
ssuchasst
rai
ngauge,
t
her
mist
ors,
ther
mocoupl
eset
c.
ECG–LeadSyst
em,
Recor
dingMet
hodsandTypi
calWavef
orms
I
ntr
oduct
ion:
 El
ect
rocar
diogr
aphy(
or)El
ect
rokar
diogr
aphydeal
swi
tht
her
ecor
dingandst
udyof
el
ect
ri
calact
ivi
tyoft
hehear
tmuscl
es.
 Thepot
ent
ial
sor
igi
nat
edi
nthei
ndi
vidualf
iber
sofhear
tmuscl
esar
eaddedt
opr
oduce
t
heECGwavef
orm.
 TheECGwavef
ormr
efl
ect
sther
hyt
hmi
cel
ect
ri
caldepol
ari
zat
ionandr
epol
ari
zat
ionof
t
hehear
tmuscl
esassoci
atedwi
tht
hecont
ract
ionsandr
elaxat
ionoft
heat
ri
um and
vent
ri
cles.
 Theel
ect
rocar
diogr
am gi
vesdet
ail
soft
hest
ateoft
hehear
tandanydi
stur
bancei
nthe
hear
trhyt
hmi
c(ar
rhyt
hmi
a)canbedi
agnosed.
 Thet
ypi
calECGwaveconsi
stsofPwave,
QRScompl
exandTwave.
 Theel
ect
ri
calpot
ent
ial
soft
hehear
tar
emeasur
edbypl
aci
ngsui
tabl
eel
ect
rodes.
 Ei
thersur
faceel
ect
rodeswi
thpr
operel
ect
rodepast
eorneedl
eel
ect
rodecanbeused.
ECGLeadsyst
em:
 Ther
ear
efourdi
ff
erentECGl
eadsyst
emsuseduni
ver
sal
ly,
o Bi
pol
arl
imbl
ead(
or)st
andar
dleadsyst
em
o Augment
edl
imbl
eadsyst
em
o Chestl
ead(
or)Pr
e-cor
dialsyst
em
o Fr
ankl
eadsyst
em (
or)cor
rect
edor
thogonall
eadsyst
em
 Bi
pol
arl
imbl
eads:
 I
nbi
pol
arl
imbl
eadssyst
em ECGi
srecor
dedwi
tht
woel
ect
rodesatat
ime.
 Thef
inalt
racei
sduet
odi
ff
erencei
npot
ent
ialof2el
ect
rodeskeptat2di
ff
erent
l
ocat
ionsont
hebody.
 Thi
sisal
socal
ledt
hest
andar
dleadsyst
em.
 Fort
hissyst
em,
thepot
ent
ial
sar
etappedf
rom 4l
ocat
ionsoft
hebodynamel
y,
o Ri
ghtar
m –whi
tecol
ourel
ect
rodes
o Lef
tar
m –Bl
ackcol
ourel
ect
rodes
o Ri
ghtl
eg–Gr
eencol
ourel
ect
rodes
o Lef
tleg–Redcol
ourel
ect
rodes
 Ther
ightl
egel
ect
rodei
susedasr
efer
enceel
ect
rode.
 Thet
hreedi
ff
erentl
eadsoft
hesyst
em ar
e,
o LeadI-V1(
Vol
tagedr
opf
rom l
eftar
m(LA)t
ori
ghtar
m(RA)
o LeadI
I-V2(
Vol
tagedr
opf
rom l
eftl
eg(
LL)t
ori
ghtar
m(RA)
o LeadI
II-V3(
Vol
tagedr
opf
rom l
eftl
eg(
LL)t
olef
tar
m(LA)
 Thecl
osedpat
hbet
weenRAt
oLAt
oLLandbackt
oRAi
scal
ledt
heEi
nthovent
ri
angl
e.
Ei
nthovenTr
iangl
e
 Rwaveampl
it
udeofl
eadI
Iisequalt
osum ofRwaveampl
it
udeofl
eadsIandl
eadsI
II
.
 Forexampl
e,i
fV1=0.
5mV,
V2=0.
7mV,
then,
 V3=0.
2mV.(
i.
e)V2=V1+V3.
2.Augment
edUni
pol
arLi
mbl
eads:
 Thi
stypeofl
eadsyst
em i
sint
roducedbyWi
lson.
 ECGt
racei
sduet
opot
ent
ialbet
weensi
ngl
emeasur
ingel
ect
rodeandcent
ralr
efer
ence
el
ect
rode.
 Thecent
ralr
efer
enceel
ect
rodei
sbui
ltupbyt
yingt
woel
ect
rodeswi
tht
woequaland
l
arger
esi
stor
sinbet
weent
hem.
 Apai
rofl
imbel
ect
rodesi
sti
edupwi
th2l
arger
esi
stor
stomaket
hecent
ralr
efer
ence
el
ect
rodeandt
het
hir
dli
mbel
ect
rodei
sthemeasur
ingel
ect
rode.
aVR–augment
edvol
tageRA
aVL–augment
edvol
tageLA
aVF–augment
edvol
tagef
oot
 ByKi
rchof
f’
slaw,
aVR=-
V1 –V3/
2
aVL=V1–V3/
2
aVF=V2–V2/
2
3.Uni
pol
archestl
ead:
 I
nUni
pol
archestl
eadssyst
em,
inaddi
ti
ont
oel
ect
rodespr
esenti
naugment
edUni
pol
ar
l
imbl
eadst
her
ear
etwomor
eel
ect
rodespl
acedi
nthechest
,cl
oset
ohear
t.
 Byconnect
ing3l
argeequalr
esi
stor
sbet
weenLA,
RAandLLr
efer
enceel
ect
rodecent
re
poi
ntobt
ained,
thi
sist
hecent
ralel
ect
rode.
 Thi
ssyst
em i
ncl
udesani
ntegr
ati
onof3uni
pol
arl
eads,
3bi
pol
arl
eadsand6chest
l
eads.
 Locat
ionofchestl
eads(
V1t
il
lV6)
o V1–4thi
nter
coast
alspaceatr
ightst
ernalmar
gin
t
h
o V2–4 i
nter
coast
alspaceatl
eftst
ernalmar
gin
o V3–Mi
dpoi
ntofV2andV4
o V4–5thi
nter
coast
alspaceatmi
d-cl
avi
cul
arl
ine
o V5–Samel
evelasV4-ant
eri
orauxi
li
aryl
ine
o V6–Samel
evelasV4-Mi
dauxi
li
aryl
ine
4.Fr
ankl
eadsyst
em:
 Sameaschestl
eadsyst
em.
 Hear
t’
sdi
pol
efi
eldi
sresol
vedi
ntot
hreemut
ual
lyper
pendi
cul
arcomponent
sand
hencest
ateofhear
tisst
udi
edt
hreedi
mensi
onal
ly.
ECGr
ecor
dingset
-up(
or)ECGI
nst
rument
ati
on:
 Theconnect
ingwi
resf
ort
hepat
ientel
ect
rodeor
igi
nat
eatt
heendofapat
ientcabl
e.
 Thewi
resf
rom t
heel
ect
rodesconnectt
othel
eadsel
ect
orswi
tch
 Apushbut
tonal
lowst
hei
nser
ti
onofast
andar
dizat
ionvol
tageof1mVt
ost
andar
dize
orcal
ibr
atet
her
ecor
der
.
 Fr
om t
hel
eadsel
ect
orswi
tcht
heECGsi
gnalgoest
oapr
e-ampl
if
ier
,whi
chi
sa
di
ff
erent
ialampl
if
ierwi
thhi
ghcommonmoder
eject
ionr
ati
o,hi
ghgai
nfact
or,
high
i
nputi
mpedanceandl
owout
puti
mpedance.
 I
tisACcoupl
edt
oavoi
dpr
obl
emswi
thsmal
lDCvol
tagest
hatmayor
igi
nat
efr
om
pol
ari
zat
ionoft
heel
ect
rodes.
 Thepr
e-ampl
if
ier
,isf
oll
owedbyaDCampl
if
iercal
ledt
hepenampl
if
ierorpower
ampl
if
ier
,whi
chpr
ovi
dest
hepowert
odr
ivet
hepenmot
ort
hatr
ecor
dst
heact
ualECG
t
race.
 Aposi
ti
oncont
roli
nthepenampl
if
iermakesi
tpossi
blet
ocent
ret
hepenont
he
r
ecor
dingpaper
.
 ECGr
ecor
der
suseheatsensi
ti
vepaper
,andt
hepeni
sact
ual
lyanel
ect
ri
cal
lyheat
ed
st
ylus,
thet
emper
atur
eofwhi
chcanbeadj
ust
edwi
thast
ylusheatcont
rolf
oropt
imal
r
ecor
dingt
race.
ECGr
ecor
dingset
-up(
or)ECGI
nst
rument
ati
on
 Ther
eisamar
kerst
ylust
hatcanbeact
uat
edbyapushbut
tonandal
lowst
heoper
ator
t
omar
kacodedi
ndi
cat
ionoft
hel
eadbei
ngr
ecor
dedatt
hemar
ginoft
he
el
ect
rocar
diogr
am.
 Nor
mal
lyel
ect
rocar
diogr
am i
srecor
dedatapaperspeedof25mm/
secbutaf
ast
er
speedof50mm/
seci
spr
ovi
dedt
oal
lowr
esol
uti
onoft
heQRScompl
exatver
yhi
gh
hear
trat
es.
 Thepowerswi
tchofanECGr
ecor
dhast
hreeposi
ti
ons.I
nthe“
ON”posi
ti
ont
hepower
t
otheampl
if
ieri
stur
nedonbutt
hepaperdr
ivei
snotr
unni
ng.I
n“RUN”posi
ti
onpaper
dr
ivest
art
srunni
ng.I
n“OFF”posi
ti
onpoweri
sswi
tchedof
f.
 Apushbut
tonal
lowst
heoper
atort
ocheckwhet
hert
her
ecor
deri
sconnect
edt
othe
powerl
inewi
thpol
ari
ty.
 Thi
sisdonet
oavoi
danyshockhazar
dfort
hepat
ient
.
 I
sol
atedorf
loat
ingi
nputampl
if
ier
sar
eusedf
ort
hesaf
etyaspectofel
ect
ri
cal
connect
ionst
othepat
ient
.
ECG–Typi
calWavef
orm:
 Thecompl
etewavef
ormi
scal
ledel
ect
rocar
diogr
am wi
thl
abel
sPQRSTUi
ndi
cat
ing
i
mpor
tantdi
agnost
icf
eat
ures.
ECG–Typi
calWavef
orm
 Thei
nst
rument
alsetupusedf
orr
ecor
dingi
scal
ledel
ect
rocar
diogr
aph.
 Thepr
ocessofr
ecor
dingandst
udyi
ngel
ect
ri
calpot
ent
ial
sofhear
tiscal
led
el
ect
rocar
diogr
aphy.
 I
fthePRi
nter
vali
smor
ethan0.
22sec,
theni
tisani
ndi
cat
ionofAVbl
ock(
fi
rstdegr
ee
bl
ock)
 WhenQRScompl
exdur
ati
oni
smor
ethan0.
1sec,
theni
tisani
ndi
cat
ionoft
hebundl
e
bl
ock.
EEG–LeadSyst
em,
Recor
dingMet
hodsandTypi
calWavef
orms
Recor
dingSyst
em:
 El
ect
roencephal
ogr
aphy(
EEG)deal
swi
tht
her
ecor
dingandst
udyofel
ect
ri
calact
ivi
ty
oft
hebr
ain.
 Bymeansofel
ect
rodesat
tachedt
otheskul
lofapat
ient
,thebr
ainwavescanbepi
cked
upandr
ecor
ded.
 El
ect
ri
calpot
ent
ial
soft
hebr
ainar
eduet
ogr
adi
enti
nconcent
rat
ionofdendr
it
egr
aded
pot
ent
ial
s.
 EEGr
ecor
dingsetupi
ncl
udest
hepat
ientcabl
econsi
sti
ngof21el
ect
rodesandi
s
connect
edt
otheei
ghtchannelsel
ect
or.
 Ever
ychanneloft
hechannelsel
ect
orconsi
stsofani
ndi
vidual
,mul
ti
stage,
accoupl
ed,
di
ff
erent
ial
,adj
ust
abl
egai
nampl
if
ier
.
 Theseampl
if
ier
smusthavehi
ghgai
nandl
ownoi
sechar
act
eri
sti
cssi
ncet
heEEG
pot
ent
ial
sar
einmi
croVol
trange.
EEG–Recor
dingSetUp
 Thecommonmoder
eject
ionr
ati
ooft
heEEGampl
if
ier
sshoul
dbehi
ght
omi
nimi
ze
st
rayi
nter
fer
encesi
gnal
s.
 Theyshoul
dhavei
nputi
mpedanceandl
owout
puti
mpedance.
 Theampl
if
iermustbef
reef
rom dr
if
tsoast
opr
eventt
hesl
owmovementofr
ecor
ding
pen.
 TheEEGsi
gnal
frequencyr
angesbet
weenl
argeval
uessoi
tbecomesnecessar
ytouse
setoff
il
ter
sincl
udi
ngl
owpass,
highpassandbandpass.
 Theampl
if
iedEEGsi
gnal
sar
epassedt
hrought
hisf
il
terbank.
 Typi
calcutof
ffr
equenci
esf
ort
hel
owpassf
il
ter
sar
e5.
3,1.
6,0.
53and0.
16Hz.
 Bandpassf
il
ter
stunedf
or60Hzar
eusedt
oel
imi
nat
emai
nsf
requencyi
nter
fer
ence.
 Thehi
ghpassf
il
ter
shavet
ypi
calcutof
ffr
equenci
es15,
30,
70,
300Hz.
 Theout
putvol
tagef
rom t
heampl
if
iermayei
therbeappl
ieddi
rect
lyt
otheei
ghtchannel
di
spl
ayt
hrought
hef
il
terbankori
tmaybest
oredasdat
aonat
aper
ecor
deror
comput
ermemor
yforf
urt
herpr
ocessi
ng.
EEG–Typi
calWavef
orm
 Ther
ear
eot
herf
aci
li
ti
esavai
labl
etor
ecor
devokedpot
ent
ial
sfr
om t
hebr
ainduet
o
ext
ernalst
imul
ili
kevi
sualst
imul
us,
audi
ost
imul
usandt
act
il
est
imul
us.
 Thet
imedel
aybet
weent
hest
imul
usandr
esponsecanal
sobemeasur
edi
nthesi
gnal
pr
ocessi
nguni
tandcanbeaccount
edf
orevokedpot
ent
ial
s.
 EEGhel
psi
ndi
agnosi
ngdi
sor
der
sorabnor
mal
it
iesr
elat
edt
obr
ainsuchas,
tumor
s,
Epi
lepsy,
scl
erosi
s,sl
eepdi
sor
der
s,mi
s-f
unct
ioni
ngofneur
onset
c.
EEG-El
ect
rodeSyst
em:
 Thecommonl
yusedel
ect
rodesyst
em f
orr
ecor
dingEEGsi
gnal
sist
ermedas10-
20
el
ect
rodesyst
em orMont
ageel
ect
rodeSyst
em.
 Theel
ect
rodesar
epl
acedatadi
stanceof10%and20%appr
opr
iat
elyf
rom t
het
otal
di
stancebet
weent
heext
remeendpoi
ntsoft
heskul
lnamel
yappr
opr
iat
elyf
rom t
he
t
otaldi
stancebet
weent
heext
remeendpoi
ntsoft
heskul
lnamel
yappr
opr
iat
elyf
rom
t
het
otal
dist
ancebet
weent
heext
remeendpoi
ntsoft
heskul
lnamel
ynasi
on,
ini
on,
right
andl
eftearl
obes.
 Thi
stypeofasyst
em i
sot
her
wisecal
ledmont
ageel
ect
rodesyst
em.
 I
nmont
agesyst
em t
heel
ect
rodesar
epl
acedsymmet
ri
cal
lyonbot
hsi
desoft
heskul
l.
 Bot
hbi
pol
aranduni
pol
arsyst
em canbeused.I
nbi
pol
art
hedi
ff
erencesi
npot
ent
ialbet
ween
t
wonei
ghbor
ingel
ect
rodesar
econsi
der
ed.
 ForUni
pol
art
ypet
her
efer
enceel
ect
rodesar
epl
acedont
henon-
act
ivepar
toft
hehead
l
ikef
oreheadoront
heearl
obes.
 Fi
rst
lyt
hedi
stancebet
weennasi
onandi
nioni
sdet
ermi
nedandt
hedi
stancebet
ween
t
her
ightandl
eftearl
obei
sal
sodet
ermi
ned.
 Thecent
ralel
ect
rodei
spl
acedatt
hei
nter
sect
ionoft
hei
magi
nar
yli
nesj
oini
ngnasi
on
andi
nionandr
ightearandt
hel
eftear
.
 El
ect
rodepl
acemental
ongi
magi
nar
yli
nebet
weeni
nionandnasi
on,
o Fpz–10%ofdi
stancebet
weennasi
on-
ini
on
o Fz–20%ofdi
stancebet
weennasi
on-
ini
on
o Cz–Cent
repoi
ntofnasi
on-
ini
onandr
ightearl
obe-
lef
tearl
obe
o Pz–20%ofdi
stancebet
weennasi
on-
ini
on
o Oz–10%ofdi
stancebet
weennasi
on-
ini
on
 El
ect
rodepl
acemental
ongi
magi
nar
yli
nebet
weenr
ightearl
obeandl
eftearl
obe,
o T3–10%ofdi
stancebet
weenr
ightandl
eftearl
obe
o C3–20%ofdi
stancebet
weenr
ightandl
eftearl
obe
o Cz–Al
readypl
aced[
cent
repoi
ntofnasi
on-
ini
onandr
ightandl
eftearl
obe]
o C4–20%ofdi
stancebet
weenr
ightandl
eftearl
obe
o T4–10%ofdi
stancebet
weenr
ightandl
eftearl
obe
 El
ect
rodepl
acementbet
weenFpzandOzpassi
ngt
hroughT3
o Fp1–10%ofdi
stancebet
weenFpzandOz
o F7–20%ofdi
stancebet
weenFpzandOz
o T3–al
readypl
aced(
10%di
stancebet
weenr
ightandl
eftl
obeatt
hel
eft
)
o T5–20%ofdi
stancebet
weenFpzandOz
oO1–10%ofdi
stancebet
weenFpzandOz
10-
20EEGEl
ect
rodeSyst
em
 El
ect
rodepl
acementbet
weenFpzandOzt
hroughT4,
o Fp2–10%ofdi
stancebet
weenFpzandOz
o F8–20%ofdi
stancebet
weenF¬pzandOz
o T4–al
readyt
her
e(10%di
stancebet
weenr
ightandl
eftearl
obeatt
her
ight
)
o T6–20%di
stancebet
weenFpzandOz
o O2–10%di
stancebet
weenFpzandOz
 El
ect
rodepl
acementbet
weenFp2andO2t
hroughC4,
o F4–25%ofdi
stanceofFp2andO2
o C4–20%ofdi
stancebet
weenr
ightandl
eftearl
obe(
alr
eadypr
esent
)(r
ightsi
de)
o P4–25%ofdi
stancebet
weenFp2andO2
 El
ect
rodepl
acementbet
weenFp1andO1t
hroughC3,
o F3–25%ofdi
stancebet
weenFp1andO1
o C3–20%ofdi
stancebet
weenr
ightandl
eftearl
obe(
alr
eadypr
esent
)(l
eftsi
de)
o P3–25%ofdi
stancebet
weenFp1andO1
EMG–LeadSyst
em,
Recor
dingMet
hodsandTypi
calWavef
orms:
 El
ect
romyogr
aphi
sthei
nst
rumentf
orr
ecor
dingandi
nter
pret
ingt
heel
ect
ri
calact
ivi
ty
ofmuscl
esact
ionpot
ent
ial
.
 Theel
ect
ri
calact
ivi
tyoft
heunder
lyi
ngmuscl
ecanbemeasur
edbypl
aci
ngsur
face
el
ect
rodesont
heski
n.
 Tor
ecor
dtheact
ionpot
ent
ial
ofi
ndi
vidualmot
oruni
ttheneedl
eel
ect
rodei
sinser
ted
i
ntot
hemuscl
e.
 EMGi
ndi
cat
est
heamountofact
ivi
tyofagi
venmuscl
eoragr
oupofmuscl
es.
 EMGwavef
orm appear
s,ver
ymuchl
ikear
andom noi
sesi
gnal
.
 Cont
ract
ionofamuscl
epr
oducesact
ionpot
ent
ial
.Whenamuscl
eisr
elaxedt
her
eis
noact
ionpot
ent
ial
.
 Thesur
faceoft
heski
niscl
eanedandel
ect
rodepast
eisappl
ied.
 Theel
ect
rodesar
ekepti
npl
acebymeansofel
ast
icbands.
 Theampl
it
udeoft
heEMGsi
gnal
sdependsupont
het
ypeandpl
acementofel
ect
rodes
usedanddegr
eeofmuscul
arexer
ti
ons.
 Thesur
faceel
ect
rodepi
cksupmanyover
lappi
ngspi
kesandpr
oducesanaver
age
vol
tagef
rom var
iousmuscl
esandmot
oruni
ts.
 TheEMGsi
gnalr
angesf
rom 0.
1mVt
o0.
5mV.
 Thef
requencycomponent
soft
heEMGsi
gnalvar
yfr
om 20KHzt
o10KHzandt
heyar
e
r
est
ri
ctedt
othef
requencyr
angeof20Hzt
o200Hzf
orcl
ini
calpur
posesbyusi
ngal
ow
passf
il
ter
.
 Thenor
malf
requencyi
s60Hz.
 Sl
owspeedst
ri
pchar
trecor
der
sandt
hesi
gnal
sar
edi
spl
ayedorCROand
phot
ogr
aphi
crecor
dingsar
eal
somade.
EMG–Recor
dingSetUp
 Usual
lyt
wocat
hoder
ayt
ubesonef
orvi
ewi
ngandot
herf
orr
ecor
dingi
sused.
 Al
ightsensi
ti
vepapermovesovert
her
ecor
dingcat
hoder
ayt
ubeandt
hei
magei
s
pr
oducedont
hatpaper
.
 Forcont
inuousr
ecor
ding,
thepaperspeedi
sabout5t
o25cm/
sec.
 Theampl
if
iershoul
dhaveuni
for
mfr
equencyr
esponsei
nthef
requencyr
angef
rom
10Hzt
o1KHzwi
thhi
ghCMRR(
100dB)andi
nputi
mpedancegr
eat
ert
han10MΩwi
th
l
owout
puti
mpedance.
 Thesi
gnali
sal
sor
ecor
dedi
nat
aper
ecor
derf
orf
utur
eref
erence.
Typi
calEMGWavef
orm
 EMGwavef
ormsar
ever
yusef
ulf
orst
udyi
ngt
heneur
omuscul
arf
unct
ion,
neur
omuscul
arcondi
ti
on,
ref
lexr
esponses,
ext
entofner
vel
esi
onanddi
agnosi
ngt
he
muscul
ardi
seases.
Ner
veconduct
ionVel
oci
ty:
 Ner
veconduct
ionvel
oci
tyi
susedt
oident
if
ythel
ocat
ionandext
entofner
vel
esi
on.
 Tof
indoutt
hener
veconduct
ionvel
oci
tyt
woel
ect
rodesar
eusednamel
y,1)
St
imul
ati
ngel
ect
rodeand2)Measur
ingel
ect
rode.
 Whenashor
tbr
iefel
ect
ri
cpul
seof0.
1msor0.
2msi
sgi
vent
othemuscl
e,t
hemuscl
e
under
goescont
ract
ionort
wit
chgi
vingr
iset
oact
ionpot
ent
ial
.
 Thest
imul
ati
ngel
ect
rodegi
vest
hest
imul
ati
onpul
se.
 Themeasur
ingel
ect
roder
ecor
dst
heEMGandhencet
heact
ionpot
ent
ialduet
o
cont
ract
ion.
 Thet
imebet
weenst
imul
ati
onandcont
ract
ionhel
psi
ndet
ermi
ningvel
oci
ty,
ift
he
di
stancebet
weent
hem i
sknown.
 Fi
rst
ly,
thest
imul
ati
ngandmeasur
ingel
ect
rodear
esepar
atedbyaknowndi
stancel
1.
 Thet
imebet
weenst
imul
ati
onandcont
ract
ioni
snot
edt
1.Thi
sti
mei
sal
socal
l
ed
l
atency.
 Thent
hest
imul
ati
ngandmeasur
ingel
ect
rodear
eremovedandr
epl
acedatdi
ff
erent
l
ocat
ionssepar
atedbyadi
stancel
2,whi
chi
slessert
hanl
1.
 Nowl
atencycor
respondi
ngt
ol2,
whi
chi
st2i
snot
ed.
 Theconduct
ionvel
oci
ty,
Viscal
cul
atedby,
l1–l
2/t
1-t
2.
 Nor
malner
veconduct
ionvel
oci
tyi
s50m/
s.
 I
fiti
sbel
ow40m/
s,t
henadi
sor
derorl
esi
oni
sdet
ect
edatt
hel
ocat
ion.
ERG–LeadSyst
em,
Recor
dingMet
hodsandTypi
calWavef
orms
 Thepr
ocessofr
ecor
dingandi
nter
pret
ingt
heel
ect
ri
calact
ivi
tyofeyei
scal
led
el
ect
ror
eti
nogr
aphy.
 Ther
ear
eel
ect
ri
calpot
ent
ial
spr
esenti
nbet
weent
hecor
neaandt
her
eti
na.
 Thesepot
ent
ial
sar
epr
oducedwhenphot
onsar
eabsor
bedbyphot
opi
gment
spr
esent
i
nther
eti
na.
 I
fthei
ll
umi
nat
ionoft
her
eti
nai
schanged,
thepot
ent
ialchangessl
ight
lyi
nacompl
ex
manner
.
 Thesepot
ent
ialr
ecor
dingsar
ecal
ledel
ect
ror
eti
nogr
aphy.
 AUni
pol
art
ypeofmeasur
ementi
sfol
lowedf
orERG.
 Themeasur
ingel
ect
rodei
sAg/
AgClel
ect
rodepl
acedi
nasal
inef
il
ledcont
actl
ens,
at
tachedt
otheeye.
 Ther
efer
enceel
ect
rodei
spl
acedi
nthecheek.
 TheERGpot
ent
ial
srangef
rom 0t
o1mV.
 Thepot
ent
iali
sampl
i
fiedandt
henr
ecor
dedonaheatsensi
ti
vepaperbyaheat
ed
st
ylus.
Typi
calWavef
orm
A–Responseduet
oear
lyr
ecept
orpot
ent
ial
sgener
atedbyi
nci
dentl
ight
B–Duet
olat
err
ecept
orpot
ent
ial
spr
oducedbysyr
upt
icendi
ngoft
hephot
orecept
ors.
Ct
oD–Waver
ecor
dedatt
heof
fsetoft
hel
ightst
imul
us.
El
ect
ri
calsaf
etyi
nmedi
calenvi
ronment
:shockhazar
ds–l
eakagecur
rent
-
I
nst
rument
sforchecki
ngsaf
etypar
amet
ersofbi
omedi
calequi
pment
s
I
ntr
oduct
ion:
 Medi
calTechnol
ogyhassubst
ant
ial
lyi
mpr
ovedheal
thcar
einal
lmedi
calspeci
alt
ies
andhasr
educedmor
tal
it
yforcr
it
ical
lyi
llpat
ient
s.
 Thei
ncr
easedcompl
exi
tyofmedi
caldevi
cesandt
hei
rut
il
izat
ioni
nmor
epr
ocedur
es
r
esul
tinabout10,
000devi
cer
elat
edpat
ienti
njur
iesaccor
dingt
oasur
vey.
 Mostoft
hesei
njur
iesar
eat
tr
ibut
abl
etoi
mpr
operuseofadevi
ceasar
esul
tof
i
nadequat
etr
aini
ngandl
ackofexper
ience.
 Medi
calpr
ocedur
esusual
lyexposet
hepat
ientt
omor
ehazar
dst
hant
het
ypi
calhome
orwor
kpl
ace,
becausei
nmedi
calenvi
ronment
stheski
nandmucousmembr
anesar
e
f
requent
lypenet
rat
edoral
ter
edandbecauset
her
ear
emanysour
cesofpot
ent
ial
ly
hazar
doussubst
ancesandener
gyf
ormst
hatcoul
dinj
uret
hepat
ient
.
 Sour
cesofpot
ent
ialhazar
dsi
nmedi
calenvi
ronmenti
ncl
udef
ir
e,ai
r,ear
th,
wat
er,
chemi
cal
s,dr
ugs,
micr
oor
gani
sms,
ver
min,
wast
e,sound,
elect
ri
cit
y,nat
ural
and
unnat
uraldi
sast
ers,
sur
roundi
ngs,
gravi
ty,
mechani
calst
ressandpeopl
eresponsi
ble
f
oract
sofomi
ssi
onandr
adi
ati
onf
rom x-
rays,
ult
rasound,
magnet
s,ul
tr
avi
oletl
ight
,
mi
crowavesandl
aser
s.
 El
ect
ri
calsaf
etyi
simpor
tantt
obeconsi
der
edi
nthemedi
cali
nst
rument
ati
onf
iel
d.
Physi
ologi
calEf
fect
sofel
ect
ri
cit
y:
 Foraphysi
ologi
calef
fectt
ooccur
,thebodymustbecomepar
tofanel
ect
ri
cci
rcui
t.
 Cur
rentmustent
ert
hebodyatonepoi
ntandl
eaveatsomeot
herpoi
nt.
 Themagni
tudeoft
hecur
renti
sequalt
otheappl
iedvol
tagedi
videdbyt
hesum oft
he
ser
iesi
mpedancesoft
hebodyt
issuesandt
het
woi
nter
facesatt
heent
rypoi
nts.
 Thel
argesti
mpedancei
sof
tent
heski
nresi
stanceatt
hecont
actsur
face.
 Thr
eephenomenonscanoccurwhenel
ect
ri
ccur
rentf
lowst
hroughbi
ologi
calt
issue:
1)El
ect
ri
cst
imul
ati
onofexci
tabl
eti
ssue(
ner
veandmuscl
e)
2)Resi
sti
veheat
ingoft
issues
3)El
ect
rochemi
calbur
nsandt
issuedamagef
ordi
rectcur
rentandver
yhi
ghvol
tages.
 Psychophysi
calandphysi
ologi
calef
fect
sthatoccuri
nhumanast
hemagni
tudeof
appl
iedel
ect
ri
ccur
rentpr
ogr
essi
vel
yincr
eases.
 Theappr
oxi
mat
erangeofcur
rent
sneededt
opr
oduceeachef
fectwhen60Hzcur
rent
i
sappl
iedf
or1t
o3secvi
acopperwi
rest
hata70Kghumanhol
dineachhand.
Thr
eshol
dofPer
cept
ion:
Whent
hel
ocalcur
rentdensi
tyi
slar
geenought
oexci
tener
veendi
ngsi
ntheski
n,t
he
subj
ectf
eel
sat
ingl
ingsensat
ion.
Cur
rentatt
het
hreshol
dofper
cept
ioni
sthemi
nimalcur
rentt
hatani
ndi
vidualcandet
ect
.
Whensomeonewi
thmoi
stenedhandsgr
aspssmal
lcopperwi
res,
thel
owestt
hreshol
ds
ar
eabout0.
5mAat60Hz,
thr
eshol
dsf
ordccur
rentr
angef
rom 2t
o10mA.
Let–GoCur
rent
:
Thel
et–gocur
rentsdef
inedast
hemaxi
mal
cur
rentatwhi
cht
hesubj
ectcanwi
thdr
aw
vol
unt
ari
ly.Themi
nimalt
hreshol
dfort
hel
et–gocur
renti
s6mA.St
il
lhi
ghercur
rent
s
causei
nvol
unt
arycont
ract
ionofr
espi
rat
orymuscl
essever
eenought
obr
ingabout
asphyxi
ati
oni
fthecur
renti
snoti
nter
rupt
ed.
Mi
cro-
shock&Macr
o-shock:
Manydevi
ceshaveamet
alchassi
sandcabi
nett
hatcanbet
ouchedbyt
hemedi
cal
at
tendant
sandpat
ient
s.I
ftheyar
enotgr
ounded,
thenani
nsul
ati
onf
ail
ureorshor
tci
rcui
t
r
esul
tsandl
eadst
omacr
o-shockormi
cro-
shock.
Mi
cro-
shock:
Aphysi
ologi
calr
esponset
oacur
rentappl
iedt
othesur
faceoft
hehear
tthatr
esul
tsi
n
unwant
edst
imul
ati
onl
ikemuscl
econt
ract
ionsort
issuei
njur
yiscal
ledmi
cro-
shock.Mi
cro
-
shocki
scausedwhencur
rent
sinexcessof10mi
croAmper
esf
lowt
hroughani
nsul
ated
cat
het
ert
othehear
t.Thecat
het
ermaybeani
nsul
ated,
conduct
ivef
lui
dfi
ll
edt
ube,
ora
sol
idwi
repacemakercabl
e.
Mi
cro-
shockHazar
ds:
1)LeakageCur
rent
s:
Mostoft
heacci
dent
soccurduet
oimpr
opergr
oundi
ngandl
eakagecur
rent
s.Thel
eakage
cur
renti
sanext
raneouscur
rentf
lowi
ngal
ongapat
hot
hert
hant
hosewhi
chi
sint
endedt
o
f
low.Leakagecur
rentmaybecausedduet
oresi
sti
ve,
induct
iveorcapaci
ti
vecoupl
ings
wi
tht
hemai
nsorsomeel
ect
roni
cequi
pment
.
Asshowni
nfi
gur
ebel
owapat
ientwi
thapacemakerl
yingi
nanel
ect
ri
cal
lyoper
atedbed
wi
thabi
pol
arcat
het
ergoi
ngt
other
ightvent
ri
cleoft
hehear
tvi
ather
ightj
ugul
arvei
n.The
pacemaker
’scasei
sconnect
edt
othegr
oundoft
hepowercor
d.Thet
hreewi
re2.
5met
re
powercor
disnowconnect
edt
oat
wowi
re3met
reext
ensi
oncor
dwhi
chi
spl
uggedi
nto
t
het
hreewi
repowerout
let
.
Thebedf
ramei
spr
oper
lygr
oundedt
othepowersyst
em.Thepat
ient
’sl
efthandi
srest
ing
ont
hebedf
rame.Si
ncet
hegr
oundoft
hepacemakeri
sfl
oat
ing,
bycapaci
ti
vecoupl
inga
t
otalof180mi
croAmper
esofl
eakagecur
renti
spr
esenti
nthepacemaker
.Int
hiscase
l
eakagecur
renti
spassedf
rom t
hepacemakert
hrought
hecat
het
eri
ntot
hehear
t,t
hrough
t
hebodycor
eoft
hel
efthandandt
hent
othegr
oundvi
athebedf
rame.Thehear
t
under
goesvent
ri
cul
arf
ibr
il
lat
ion.Thi
sdanger
ousacci
dentar
isesbecauseoft
heopen
gr
oundoft
hepacemakerbyusi
ngat
wowi
reext
ensi
oncor
d.Thel
eakagecur
rentf
lowi
s
duet
o1)Ungr
oundedEqui
pment
,2)Br
okengr
oundwi
reand3)Unequalgr
oundpot
ent
ial
s
As
i
ll
ust
rat
edi
nfi
gur
ebel
owt
her
eisapossi
bil
it
ythatadoct
orhol
dingt
hepacemaker
’swi
re
byhi
sonehandandt
ouchi
ngt
heel
ect
ri
calbedf
ramebyhi
sot
herhandcani
ncr
easet
he
r
iskofl
eakagecur
rent
.Br
okengr
oundconnect
ionont
heel
ect
ri
cbedal
lowsavol
taget
o
exi
stont
hebedf
rameduet
ocapaci
ti
vecoupl
ingbet
weent
hebedf
rameandpowerl
ine.
Thepacemakerwi
rei
sgoi
ngi
ntot
hehear
toft
hepat
ient
.
Thehear
tact
ivi
tyi
smoni
tor
edbyanECGr
ecor
der
.Henceal
eakagecur
rentf
lowsf
rom t
he
mot
oroft
hebedf
ramet
othemedi
calat
tendant
shandandt
othepat
ient
’shear
tthr
ough
t
hecat
het
erorpacemakerwi
reandt
hent
othegr
oundoft
heECGuni
t.I
nthef
igur
ebel
ow
Hst
andsf
orhot
,Nf
orneut
ralandGst
andsf
orGr
ound.
2)St
ati
cEl
ect
ri
cit
y:
St
ati
cEl
ect
ri
cit
ymaybedanger
oust
opeopl
eandsensi
ti
veequi
pmenthavi
ngi
ntegr
ated
ci
rcui
ts.Spar
ksf
rom st
ati
cel
ect
ri
cit
ycoul
digni
tef
lammabl
egases,
causi
nganexpl
osi
on.
Shocksf
rom st
ati
cel
ect
ri
cit
ycoul
dcausecar
diacar
resti
fappl
iedt
oapacemakercat
het
er.
Car
pet
susedont
hef
loorar
easour
ceofst
ati
cel
ect
ri
cit
ybui
ldup.
Asi
ll
ust
rat
edi
nfi
gur
eaboveanacci
dentduet
ost
ati
cel
ect
ri
cit
ymaybeduet
oasi
mpl
e
vacuum cl
eaner
.Avacuum cl
eaneri
spl
uggedi
ntoawal
lpowerout
letast
hesameci
rcui
t
ast
heECGmoni
torandt
hear
ter
ialpr
essur
emoni
tor
.Thef
rameoft
hevacuum cl
eaneri
s
connect
edt
ogr
ound.Themot
ori
nthecl
eanerduet
odustcol
lect
ionandmoi
stur
emay
pr
ovi
deal
eakagepat
hfr
om l
inet
otheout
ercasi
ng.I
faf
aul
tcur
rentof1Af
lowsf
rom t
he
vacuum cl
eanercasi
ngt
ogr
oundoft
hepowerboar
dandt
her
esi
stancet
opowerboar
d
gr
oundi
s0.
08ohms,
thenavol
tageof80mVi
sdevel
oped.Foracar
diaccat
het
ersal
ine
sol
uti
ont
her
esi
stancemaybe500ohms.80mVacr
oss500ohmsdr
ives160mAcur
rent
whi
chi
sver
ymuchgr
eat
ert
han10mi
croAmper
e,t
hemaxi
mum saf
ecur
rentt
hrought
he
hear
tint
hecaseofmi
cro-
shock.Themi
cro-
shockar
isesduet
ost
ati
cel
ect
ri
cit
yduet
o
dustcol
lect
ioni
nthemot
oroft
hevacuum cl
eanerandbyt
hesal
inecat
het
erof
fer
ingal
ow
r
esi
stancepat
hther
ebyr
aisi
ngt
hecur
rentdensi
tyoft
hehear
t.Evenapot
ent
ialdi
ff
erence
of5mVacr
osst
heel
ect
roni
cinst
rumentpr
obescanbepot
ent
ial
lyl
ethalpr
obl
em i
nthe
caseofmi
cro-
shock.
3)I
nter
rupt
ionofpower
:
I
nter
rupt
ionofel
ect
ri
cal
powert
oli
fesuppor
tequi
pmentcanbehazar
dous.I
fadel
ay
occur
sbef
oreemer
gencypoweri
sbr
oughti
ntooper
ati
on,
thef
ail
ureofar
espi
rat
or,
moni
tor
,def
ibr
il
lat
or,
pacemakerorot
herl
if
esuppor
tequi
pmentcanbef
atal
.The
possi
bil
it
yofapowerf
ail
uremustbeconsi
der
edi
nthepl
anni
ngofapowerdi
str
ibut
ion
syst
em.El
ect
ri
calser
vicet
oli
fesuppor
tsyst
em shoul
dbeun-
int
err
upt
ibl
e.
Macr
o-shock:
Aphysi
ologi
calr
esponset
oacur
rentappl
iedt
othesur
faceoft
hebodyt
hatpr
oduces
unwant
edorunnecessar
yst
imul
ati
onl
ikemuscl
econt
ract
ionsort
issuei
njur
yiscal
led
macr
o-shock.Al
lhospi
talpat
ient
sandmedi
calat
tendant
sar
eexposedt
omacr
o-shocks
f
rom def
ect
iveel
ect
ri
cdevi
cesandbi
omedi
calequi
pment
.
Macr
o-shockHazar
ds:
Macr
o-shockoccur
swi
tht
wowi
resyst
ems.Wi
tht
wowi
reequi
pmenti
tisal
ways
danger
oust
ogetbet
weent
hehotHandneut
ralNwi
res.I
fthepat
ientt
ouchesHandN
wi
ressi
mul
taneousl
ywi
tht
wol
imbs,
thent
hecur
rent
sar
efl
owi
ngdi
rect
lyt
hroughvi
tal
or
gansofci
rcul
ati
onand
r
espi
rat
ion.BecauseNwi
resar
eint
ernal
lygr
ounded,
touchi
ngHandGwi
rescanpr
oduce
macr
o-shock.
Fi
gur
eabovei
ll
ust
rat
esaddi
ti
onalhazar
doussi
tuat
ionst
hatr
esul
tfr
om f
aul
tst
hatmay
occuri
ntheequi
pment
.Inpar
t(a)
,theHl
eadshor
tst
othepat
ientl
eadP.Thusamacr
o-
shockr
esul
tsi
fthepat
ientt
ouchesgr
oundort
hechassi
s.I
npar
t(b)
,thehotwi
reHand
neut
ralNar
ereser
vedbecauset
het
wowi
repl
ughasbeenr
eser
ved.Agr
oundedpat
ienti
s
t
her
efor
eshockedupont
ouchi
ngt
hechassi
s.I
npar
t(c)t
heHwi
reshor
tedt
othechassi
s,
causi
ngt
heshockconf
igur
ati
onshownast
hepat
ientt
ouchesei
therneut
ralorgr
oundand
t
hechassi
s.
I
npar
t(d)t
heneut
ral
wir
eacci
dent
all
yshor
tst
otheequi
pmentcase,
leadi
ngt
oashock
si
tuat
ionofHt
ochassi
sorHt
ogr
ound.I
ftheHl
inef
aul
tst
oN,
noshockoccur
sunl
ess
t
hepat
ientt
ouchesHorNandgr
ound.
Topr
otectf
rom hazar
dsofat
wowi
repl
ug,
athi
rdgr
oundwi
rei
saddedasi
na3-
pinpl
ug.
Thi
swi
rei
susual
lyconnect
edt
othechassi
soft
heequi
pmentandensur
est
hati
twi
llnot
r
iset
oahi
ghvol
tage.Anot
hermet
hodi
stodoubl
e-i
nsul
atet
hatchassi
sthati
stopl
acea
l
ayerofi
nsul
ati
onbet
weent
heci
rcui
tboar
dchassi
sandt
heequi
pmentcasewhi
chi
s
exposedt
otheuser
.
Devi
cest
opr
otectagai
nstel
ect
ri
calHazar
ds:
Sever
aldevi
cesar
eavai
l
abl
etopr
otectpat
ient
sfr
om heal
thcar
ecowor
ker
sfr
om
hazar
dousel
ect
ri
calcur
rent
s.Theser
angef
rom devi
cest
opr
otectagai
nsthi
ghvol
tage
macr
o-shockhazar
dst
opr
ocedur
est
hatmi
nimi
zet
hepr
obabi
li
tyt
hatami
cro-
shockwi
ll
occur
.Someoft
hedevi
cesi
ncl
ude,
1.Gr
oundFaul
tInt
err
upt
er:
Agr
oundf
aul
tint
err
upt
er(
GFI
)pr
otect
sagai
nstashockt
hatoccur
sifaper
sont
ouches
t
hehotl
eadwi
thonehandandt
hegr
oundwi
tht
heot
her
.TheGFIopenst
hepowerl
eadi
f
t
hehotl
eadcur
rentdi
ff
ersbymor
ethanappr
oxi
mat
ely2mAf
rom t
heneut
rall
eadcur
rent
f
oradur
ati
onofl
ongert
han0.
2second.TheGFIasshowni
nfi
gur
ebel
owconsi
stsofa
magnet
iccoi
lonwhi
cht
hehotl
eadandt
heneut
ral
leadar
emoundwi
tht
hesamenumber
oft
urns,
buti
nopposi
tedi
rect
ions.Whent
hesyst
em i
snor
mal
,I
Nisequalt
oIH,
andt
he
magnetf
lux,
Φ,i
nthecoi
lduet
othesecur
rent
scancel
s.Undert
hiscondi
ti
ont
hesensi
ng
coi
ldoesnothaveavol
tagei
nducedi
nit
.However
,whent
hehotl
eadf
aul
ts,
ori
stouched
byaper
son,
thef
aul
tcur
rentI
Fisshunt
edt
ogr
ound.ThenI
N =I
H –I
FandI
Hisnotequalt
o
I
N.undert
hisf
aul
tcondi
ti
ont
hecor
respondi
ngf
luxesi
nthecoi
lar
eunequal
,andanetf
lux
exi
stsi
nthecoi
l.Thi
sinducesavol
tagei
ntot
he
sensi
ngampl
if
ier
.Ift
hecur
rentI
Fexceeds2mAf
or0.
2second,
ther
elayopenst
hel
ine
andpr
event
samacr
o-shockf
rom i
njur
ingt
heper
son,
aswel
laspr
event
ingf
urt
her
damaget
otheequi
pment
.TheGFIcanbeconveni
ent
lymount
edi
nthepowerr
ecept
acl
e.I
t
i
srequi
redi
nwetar
eas.
2.I
sol
ati
onTr
ansf
ormer
:
Thei
sol
ati
ont
ransf
ormerpr
ovi
desasecondmeansofpr
otect
ingagai
nstanH-
leadt
oG-
l
eadmacr
o-shock.I
tal
sopr
event
sspar
kswhent
heHl
eadt
ouchesgr
ound,
apar
ti
cul
arl
y
i
mpor
tantpr
otect
ionIanexpl
osi
veorf
lammabl
eenvi
ronment
,suchaswhenf
lammabl
e
anest
het
icsorexcessi
veoxygeni
spr
esent
.Fi
gur
ebel
owcl
ear
lyshowst
hataf
aul
tsuch
asashor
tci
rcui
tfr
om ei
thersecondar
yleadoft
het
ransf
ormert
ogr
oundwi
llcar
ryno
cur
rent
.Ther
efor
e,asecondar
yleadt
ogr
oundspar
k,orshock,
ispr
event
ed.However
,
whent
hei
sol
ati
ont
ransf
ormeri
sinuse,
andequi
pmenti
spl
uggedi
ntot
hesecondar
y,t
he
st
raycapaci
tanceandt
hei
nputi
mpedanceoft
hehar
dwar
etendt
omakeaconduct
ive
pat
htogr
ound.Thi
sreducest
hei
sol
ati
onbycompl
eti
ngt
heci
rcui
tfr
om ei
thersecondar
y
l
eadt
ogr
oundandt
hent
otheot
hersecondar
ylead.I
faf
aul
toccur
sint
hesecondar
y,a
hazar
douscur
rentwi
llf
low.
3.Li
neI
sol
ati
onMoni
tor
:
ALi
neI
sol
ati
onmoni
tor(
LIM)put
sar
elat
ivel
ylar
gei
mpedancef
rom ei
thersecondar
ylead
t
hroughanammet
ert
ogr
oundoft
hei
sol
ati
ont
ransf
ormer
.Ift
her
eisaconduct
ivepat
h
t
hrought
heequi
pmentshowni
nfi
gur
ebel
ow,
themet
eri
ntheLI
M wi
llr
eadacur
rent
.The
met
eront
heLI
Miscal
ibr
atedt
oreadwhatcur
rentwoul
dfl
owt
hroughashor
tci
rcui
tfaul
t
i
fitshoul
doccurf
rom ei
thersecondar
ytogr
ound.Anal
armi
ntheLI
Misusual
lysetof
f
wheni
tiscal
cul
atedt
hatashor
tci
rcui
tfaul
tbet
weenasecondar
yleadandgr
oundwoul
d
dr
aw2t
o5mAofcur
rent
.Thi
sal
arm mer
elyi
ndi
cat
est
hatt
hebackupsyst
em f
ail
edand
t
heequi
pment
sisnol
ongeri
sol
ated.I
tdoesnotmeant
hatt
hedanger
ouscur
rent
sar
e
al
readyf
lowi
ng.Ther
efor
e,i
ftheequi
pmenti
scr
it
ical
lyneeded,
theLI
M al
arm may,
somet
imes,
just
if
iabl
ybeover
ri
dden.
UNITIV:IMAGINGMODALI TI
ESANDANALYSI S
Radio graphi
c and fl
uoroscopictechniques – Comput er t
omography – MRI –
Ul
tr
asonography–Endoscopy–Ther mography–Di f
ferentt
ypesofbiot
elemetr
ysyst
ems-
Ret
inalI
maging-I
magingapplicat
ioni
nBiomet r
icsystems-Analysi
sofdigit
ali
mages.
Radi
ogr
aphi
candf
luor
oscopi
ctechni
ques
I
ntr
oduct
ion:
X-
raysgener
atedbyspeci
all
ydesi
gnedx-
raymachi
nesar
efocusedont
hepar
toft
hebodyt
obe
scanned.Thescat
ter
ed r
adi
ati
on f
rom t
hebodyi
sthen caughton adet
ect
orwhi
ch i
sthen
conver
tedi
ntoavi
sibl
eimage.I
faf
luor
escentscr
eeni
sused,
thepr
ocessi
scal
ledr
adi
ology.
I
faphot
ogr
aphi
cpl
atei
sused,t
hepr
ocessi
scal
ledr
adi
ogr
aphy.Fl
uor
oscopyi
susedwher
ethe
dynami
coft
hebody,
suchast
heswal
lowi
ngpr
ocesscanbedi
agnosed.
X-
rayMachi
nesf
orGener
ati
onofX-
rays:
Whenf
astmovi
ngel
ect
ronsent
eri
ntot
heor
bitoft
heanodemat
eri
alat
om,t
her
eisal
ossof
ener
gyoft
hesei
nci
dentel
ect
ronswhi
ch appear
sint
hef
orm ofx-
rays.Thi
slossi
sduet
o
scat
ter
ingofor
bit
ingel
ect
ronsi
ntheanodemat
eri
al.Whent
hei
nci
dentel
ect
ronsej
ectoutoft
hek-
shel
lorl
-shel
lel
ect
ronoft
het
arget
edanodeat
om,t
her
eisl
ossofener
gyi
nthef
orm ofx-
rays
cal
ledchar
act
eri
sti
cx-
rayr
adi
ati
on.Thesex-
raysar
eusedi
nmedi
calf
iel
dal
so.
X-
rayTube
Thex-
rayout
put
,Q=K.
Iв.
tVa2
.
I
в–Beam cur
rent
(mA)
t-
Timeofexposur
e
Va–Anodevol
tage(
100kv)
X-
raysar
egener
atedi
nahi
ghvaccum x-
rayt
ube.Thi
stubeconsi
stsofat
ungst
enf
il
amentcoi
l
whi
chwi
llact
sast
hecat
hodeandananodedi
scofhi
ghat
omi
cnumbermat
eri
al.
Thecat
hodef
il
amenti
sheat
edbyel
ect
ri
calmeanssot
hati
trel
easesel
ect
rons.Theseel
ect
rons
ar
eaccel
erat
ed,f
ocussedandmadet
oimpi
ngeont
heanode.Now x-
raysar
isef
rom t
het
arget
anodedi
scatr
ightangl
est
oitandar
efocussedbyt
hecol
li
mat
or.Outoft
het
otalener
gyduet
o
el
ect
ronsf
rom t
hecat
hode,apar
tisut
il
izedf
orpr
oduct
ionofx-
rays.Ther
estoft
heener
gyi
s
t
ransmi
tt
edasheat
.Theef
fectoft
hisheatener
gyont
heanodedi
sccanbeavoi
dedbyt
womeans.
Toconst
ructt
het
argetanodeoft
ungst
enal
loywhi
chi
sembeddedi
nal
argemassofcopperand
f
ocusi
ngt
heel
ect
ronbeam t
oaver
ysmal
lar
ea.Byt
hisheati
sdi
ssi
pat
edandal
sogoodr
esol
uti
on
i
sbr
oughtabout
.Thenextmet
hodi
stousear
otat
inganode.Thet
argetar
eai
sal
ongt
her
im oft
he
di
sc.Byt
his,
thef
ocusar
eai
skeptsmal
l
erandt
hear
eaf
orheatdi
ssi
pat
ioni
slar
ger
.Ther
otat
ion
oft
heanodei
sbymagnet
iccoupl
ingbr
oughtaboutbyst
atorcoi
lskeptout
sidet
hegl
asscasi
ng
encl
osi
ngt
hecat
hodef
il
ament
,theanodedi
scandt
heshaf
ttowhi
chi
tisat
tached.Thi
stubei
s
mai
ntai
nedofvacuum sot
hatt
heel
ect
ronbeam i
sundi
stur
bed.Moder
nx-
raymachi
nesi
ncl
ude
mi
crocomput
erst
otr
iggeral
arm whenanodei
sover
heat
ed.St
ati
onar
yanodesar
eusedi
nlow
ener
gyl
evelx-
raymachi
nesandr
otat
inganodesar
eusedf
orhi
ghener
gyx-
raymachi
nes.
Thex-
raymachi
neshoul
dbepr
oper
lyshi
elded,
i
)Pr
otect
ionf
rom r
adi
ati
onmet
alcasi
ng
i
i)
Prot
ect
ionf
rom over
heat
ing–oi
lfi
ll
edhousi
ng
i
ii
)Pr
otect
ionf
rom hi
ghvol
tage-
groundedmet
alhousi
ng.
Bl
ockdi
agr
am andoper
ati
onofanx-
raymachi
ne:
TheX-
raymachi
nei
smadeoft
hef
oll
owi
ngbl
ocks,
1.Mul
ti
tapacl
inet
ransf
ormer
2.X-
rayt
ubef
il
amentci
rcui
tandt
ransf
ormer
3.X-
rayt
ubehi
ghvol
tageci
rcui
tandt
ransf
ormerwi
thbr
idger
ect
if
ier
4.Ti
mingci
rcui
t
1)Mul
ti
tapACl
inet
ransf
ormer
:
Sel
ect
ionoft
apst
ocompensat
efori
ncomi
ngl
i
nevar
iat
ions.
Vol
tagesf
orspeci
fi
cappl
icat
ionscanbechosen.
2)X-
rayt
ubef
il
amentci
rcui
tandt
ransf
ormer
s:
Thi
str
ansf
ormst
heACl
inet
osuppl
ypowerf
orheat
ingt
hecat
hodef
il
ament
.
Thi
spowercanbesel
ect
edbyt
aps.
3)X-
rayt
ubehi
ghvol
tageci
rcui
t,t
ransf
ormerandbr
idger
ect
if
ier
:
Thi
str
ansf
ormsACl
i
net
ohi
ghvol
tagef
oraccel
erat
ingel
ect
ronsf
rom cat
hodet
o
anode.
Thehi
ghvol
tagecanbesel
ect
edbyt
aps.
Abr
idger
ect
if
ierci
rcui
tisal
sot
her
etoconver
tACl
inesuppl
ytoDChi
ghvol
tage.
4)Ti
mingci
rcui
t:
Thi
scont
rol
stheexposur
eti
me.
Thi
scont
rol
stur
non,
tur
nof
ftheX-
raymachi
nesot
hatt
her
adi
ati
ont
imei
scont
rol
led.
Bl
ockDi
agr
am ofX–r
ayMachi
ne
TheX-
rayr
adi
ati
oni
ntensi
tyi
scont
rol
ledby,
1.Fi
lamentheatcont
rol(
mA)f
orexposur
est
rengt
h.
2.Ki
lovol
tcont
rol(
KV)f
orpenet
rat
iondept
h.
3.Ti
mingcont
rolf
orexposur
eti
mel
engt
h.
Af
terX-
rayi
sgener
atedi
tispassedt
hroughal
umi
num f
il
ter
s.
Theemi
tt
edX-
rayscont
ainabr
oadr
angeoff
requenci
es.
Theunwant
edf
requenci
esi
ncr
easet
hedoseont
hepat
ientanddecr
easei
magecont
rast
.
Al
umi
num f
il
ter
sabsor
blowerx-
rayf
requenci
esandhencei
ntensi
tyofl
owf
requency
x-
raysi
nci
dentont
hepat
ienti
sreduced.
Af
tergoi
ngt
hroughal
umi
nium f
il
ter
s,t
hex-
raysar
efocussedbyusi
ngcol
loi
mat
or.
I
tismadeofamet
alshut
terwi
thar
ect
angul
arorci
rcul
arhol
eofsui
tabl
esi
ze.Thesi
ze
oft
hehol
eisadj
ust
abl
ewi
thl
eadst
ri
pswhi
chcanbemovedr
elat
ivet
oeachot
her
.
Ther
eisl
ampandr
efl
ect
ivemi
rr
orar
rangement
,whi
chmakesavi
sibl
epat
ter
nont
he
pat
ientwher
ethex-
rayi
sexposedsot
hatt
hemedi
calat
tendantcanposi
ti
ont
hepat
ient
pr
oper
ly.
Thent
hex-
rayt
ransmi
tt
edf
rom t
hepat
ienti
spassedt
hrought
heBuckyGr
id.
TheBuckyGr
idi
sint
roducedbet
weent
hepat
ientandt
hef
il
m casset
tet
oimpr
ovet
he
shar
pnessoft
hei
mage.
Thi
sconsi
stsoft
hinl
eadvanessepar
atedbyspacer
sofal
owat
tenuat
ionmat
eri
al.
Thent
hepr
imar
yradi
ati
onwi
thi
nfor
mat
ioni
spassedt
hroughi
magei
ntensi
fi
ersot
hat
t
heshar
pnessi
simpr
ovedf
urt
her
.
I
magei
ntensi
fi
eri
nradi
ogr
aphy:
Thei
magei
ntensi
fi
erhashi
ghat
omi
cnumbermat
eri
alscr
eensont
het
opandbot
tom oft
he
x-
rayf
il
m.
I
mageI
ntensi
fi
er(
Radi
ogr
aphy)
Af
tert
hatt
her
ear
ephosphor
saboveandbel
owt
hex-
rayf
il
m andt
heyi
ntr
oducesecondar
y
vi
sibl
eli
ghtr
adi
ati
onbyscat
ter
ingpr
ocess.
Thehi
ghz-
scr
eensar
eusedt
ocapt
uremor
eamountofx-
rays.
Fi
nal
lyt
her
ear
esi
lverbr
omi
degr
ainsi
nthef
il
m whi
chabsor
bst
hesecondar
yradi
ati
onand
pr
eser
vest
hex-
rayi
mage.
I
ncaseswher
ehi
ghr
esol
uti
oni
srequi
redf
il
mswi
thdensersi
lverbr
omi
degr
ainsar
eal
one
usedwi
thouti
magei
ntensi
fyi
ngscr
eens.
I
magei
ntensi
fi
eri
nfl
uor
oscopy:
Thex-
rayi
magei
ntensi
fi
ercombi
nest
hef
unct
ionsofx-
raydet
ect
ionandl
ightampl
if
icat
ion
i
nasi
ngl
egl
assenvel
ope.
X-
raysst
ri
ket
hei
nputscr
een-
usual
lyal
ayerofcesi
um i
odi
de-
whi
chf
luor
escesi
npr
opor
ti
on
t
othex-
rayi
ntensi
ty.
Thei
nputphosphori
sincl
osepr
oxi
mit
ytoaphot
ocat
hode,sot
hel
ightst
imul
atest
he
emi
ssi
onofel
ect
rons.
Theseel
ect
ronsar
eaccel
erat
edt
hrought
he25KVel
ect
ri
cfi
eldandf
ocussedbyshapi
ngt
he
el
ect
ri
cfi
eld.
I
mageI
ntensi
fi
er(
fl
uor
oscopy)
Theyst
ri
ket
heout
putphosphor
,whi
chpr
oducesani
maget
hati
ssmal
lerbutbr
ight
ert
han
t
hatpr
oducedatt
hei
nputphosphor
.
A l
ensmount
edont
hei
magei
ntensi
fi
erser
vest
ocol
li
mat
orf
ocust
heout
puti
maget
o
i
nfi
nit
y.
Anot
herl
ensi
susedast
hecol
li
mat
ingl
enswhi
chhasmaxi
mall
ightgat
her
ingpower
.
Theobj
ect
ivel
ensoft
hecamer
acol
lect
sthel
ightoft
hecol
li
mat
ingl
ensandr
efocusesi
ton
t
hef
il
m pl
ane.
Theobj
ect
ivel
ensoft
hecamer
acol
lect
sthel
ightoft
hecol
li
mat
ingl
ensandr
efocusesi
ton
t
hef
il
m pl
ane.
Comput
edTomogr
aphy
I
ntr
oduct
ion:
I
tisadi
agnost
ici
magi
ngpr
ocedur
einwhi
chanat
omi
cali
nfor
mat
ioni
sdi
git
all
yreconst
ruct
ed
f
rom x-
rayt
ransmi
ssi
ondat
aobt
ainedbyscanni
nganar
eaf
rom manydi
rect
ionsi
nthesame
pl
anet
ovi
sual
izei
nfor
mat
ioni
nthatpl
ane.
Measur
ement
sar
etakenf
rom t
het
ransmi
tt
edx-
rayst
hrought
hebodyandcont
aini
nfor
mat
ion
onal
ltheconst
it
uent
soft
hebodyi
nthepat
hoft
hex-
raybeam.
Byusi
ngmul
ti
dir
ect
ionalscanni
ngoft
heobj
ect
,mul
ti
pledat
aar
ecol
lect
ed.
Themat
hemat
icalbasi
sforpr
oduci
ngani
mageoft
hecr
osssect
ionoft
hebodyi
sthatt
he
t
otalat
tenuat
ional
ongr
owsandcol
umnsofamat
ri
xist
heat
tenuat
ionoft
hemat
ri
xel
ement
s
att
hei
nter
sect
ionsoft
her
owsandcol
umns.
Ver
ylar
genumber
sofmat
hemat
icalequat
ionsar
enecessar
ytoyi
eldcl
ini
cal
lyappl
icabl
eand
accur
atei
mageshenceacomput
eri
susedt
oper
for
mtheseoper
ati
ons.
Thecal
cul
atedi
nfor
mat
ion,obt
ainedf
rom t
hecomput
ercanbepr
esent
edi
naconvent
ional
Rast
erf
orm andf
rom t
heser
esul
tsat
wodi
mensi
onalpi
ctur
e(sl
ice)canbeobt
ained.
Gener
alI
nst
rument
ati
on-CT:
Thet
imi
ng,anodevol
tage(
KV)andbeam cur
rent(
mA)ar
econt
rol
ledbyacomput
ert
hrougha
cont
rolbus.
Thehi
ghvol
tageDCpowersuppl
ydr
ivesanx-
rayt
ubet
hatcanbemechani
cal
lyr
otat
edal
ong
t
heci
rcumf
erenceofagant
ry.
Thepat
ienti
slyi
ngi
nat
abl
ethr
ought
hecent
reoft
hegant
ry.
Thex-
rayspasst
hrought
hepat
ientandar
epar
ti
all
yabsor
bedandt
her
emai
ningx-
rayphot
ons
i
mpi
ngeuponsever
alofasmanyas1000r
adi
ati
ondet
ect
orsf
ixedar
oundt
heci
rcumf
erence
oft
hegant
ry.
Bl
ockDi
agr
am -CT
Thedet
ect
orr
esponsei
sdi
rect
lyr
elat
edt
othenumberofphot
onsi
mpi
ngi
ngoni
tandsot
o
t
issuedensi
tysi
nceagr
eat
erpr
opor
ti
onofx-
rayspassi
ngt
hroughdenset
issuesar
eabsor
bed
t
hant
hatar
eabsor
bedbyt
hel
essdenset
issues.
Whent
heyst
ri
ket
hedet
ect
or,
thex-
rayphot
onsar
econver
tedt
osci
nti
ll
ati
ons.
Thecomput
ersensest
heposi
ti
onoft
hex-
rayt
ubeandsampl
est
heout
putoft
hedet
ect
or
al
ongadi
amet
erl
ineopposi
tet
othex-
rayt
ube.
Acal
cul
ati
onbasedondat
aobt
ainedf
rom acompl
etescani
smadebyt
hecomput
er.
Theout
putuni
tthenpr
oducesavi
suali
mageofat
ransver
sepl
anecr
osssect
ionoft
hepat
ient
ont
hecat
hoder
ayt
ube.
I
tcanal
sobephot
ogr
aphedwi
thacamer
atopr
oduceahar
dcopyr
ecor
d.
Thepr
esentdayCTmachi
nescanobt
ainsl
icesi
n1-
2secondsi
nhi
ghr
esol
uti
onand5-
10
secondsi
npr
eci
sionmodes.
CT-Scanni
ngsyst
em:
Thescanni
ngsyst
em acqui
resx-
rayt
ransmi
tt
edi
nfor
mat
ionf
orani
maget
ober
econst
ruct
ed.
I
tincl
udesx-
raysour
ceanddet
ect
ors.
X-
rayt
ransmi
tt
edi
nfor
mat
ionar
eoff
ourki
ndsnamel
y,
1. Posi
ti
oni
nfor
mat
ion-i
nfor
mat
iononwhi
cht
raver
sei
sbei
ngper
for
medandhowf
or
i
sthescanni
ngf
rameal
ongi
tst
raver
se.
2. Absor
bti
oni
nfor
mat
ion-
inf
ormat
iononval
uesofat
tenuat
ioncoef
fi
cient
.
3. Ref
erencei
nfor
mat
ion-
inf
ormat
ionf
rom r
efer
encedet
ect
ors.
4. Cal
ibr
ati
oni
nfor
mat
ion-
obt
ainedatt
heendofeacht
raver
se.
Al
ltheabovei
nfor
mat
ionar
eacqui
redandt
akeni
nthef
orm ofpr
ofi
les.
Thedi
ff
erentscanni
nggant
rycommer
cial
lyusedcanbecat
ogar
isedasf
ivegener
ati
ons,
namel
y,
1.Fi
rstgener
ati
on-Par
all
elbeam Geomet
ry:
 I
nthi
scol
li
mat
edx-
raybeam passest
hrought
hebodyandi
tsat
tenuat
ioni
sdet
ect
edbya
sensorf
rom t
heopposi
tesi
de.
 Thex-
rayt
ubemovest
ransl
ati
onal
lyal
ongt
hepat
ientbodyl
engt
hwi
tht
hesensoront
he
ot
hersi
deal
somovi
ngt
ransl
ati
onal
ly.
 Af
teraf
ullt
ransl
ati
onalmot
iont
hex-
rayt
ubeandt
hedet
ect
orbot
hmakea1degr
eet
il
tfor
t
henextnewl
inearscan.
 Thust
hex-
rayt
ubeanddet
ect
orscanst
hepat
ient180t
imesar
oundt
hepat
ientt
ocol
lectx-
r
ayt
ransmi
tt
edi
nfor
mat
ion.
 Thi
ssetupi
scal
ledt
het
raver
seandi
ndexar
rangement
.
 For each t
ransl
ati
onalmot
ion t
her
e ar
e 180 measur
ement
s and t
hus a t
otalof
32,
400i
ndependentmeasur
ement
sofat
tenuat
ionar
eobt
ainedt
opr
oduceani
mage.
 Thedi
sadvant
ageoft
hissyst
em i
sthatt
hescant
imei
smor
e.
 Andt
husi
tbecomesessent
ial
thatt
hepat
ientst
ayst
il
lthr
oughoutt
heent
ir
escanper
iod.
 Thepi
ctur
equal
it
yfr
om t
hist
ypeofscanni
ngsyst
em i
sgood.
2.Secondgener
ati
on:
 Theset
ypesofscanni
ngsyst
emsar
eal
sosi
mil
art
othef
ir
stgener
ati
onsyst
ems.
 Thei
ndexangl
eint
hissyst
em i
sgr
eat
er(
10degr
ee)
 Ther
efor
eforeach1degr
eet
il
t,i
tispossi
blet
otake10pr
ofi
lest
huscover
ingt
hef
ullsetof
180pr
ofi
lesi
n18t
raver
ses.
 Thescant
imei
nthi
smet
hodi
sconsi
der
abl
yreduced.
 Foreacht
raver
semovei
ttakesandt
hust
hef
ullscanni
ngt
imei
sthe18-
20sr
ange.
3.Thi
rdgener
ati
on:
 Thi
sgener
ati
onscanni
ngsyst
emsdoesnotequi
panx-
rayt
ubewhi
chhast
otr
aver
se
t
ransl
ati
onal
ly.
 Thex-
rayt
obeexposedont
hepat
ienti
saf
anbeam whi
chi
slar
geenought
ocovert
he
whol
epat
ient
.
 Ther
e ar
e mul
ti
ple det
ect
ors syst
em al
ong wi
tht
he x-
ray t
ube whi
ch det
ect
s x-
ray
t
ransmi
tt
edi
nfor
mat
ionf
rom t
hepat
ient
.
 Thef
anbeam angl
eisusual
lybet
ween30degr
eeand50degr
ee.
 Thecompl
eter
otat
ionget
soveri
naf
ewseconds.
 Thedi
sadvant
ageoft
hissyst
em i
sthati
tcannotchangegeomet
ryandt
husaf
anbeam set
f
ort
hel
argestpat
ienti
sinef
fi
cientf
orsmal
lerobj
ect
s.
 Anot
herdi
sadvant
ageoft
hir
dgener
ati
onscanni
ngsyst
emsi
sthatt
hedet
ect
orscannotbe
cal
ibr
atedatscant
ime.
4.Four
thgener
ati
on:
 Theset
ypesofdevi
cesdonothaver
otat
ingdet
ect
or.
 Thex-
rayt
uber
otat
esar
oundt
hepat
ientexposi
ngx-
raybeam ont
hem andt
hex-
ray
t
ransmi
tt
edi
nfor
mat
ionf
rom t
hepat
ienti
srecei
vedbydet
ect
orssur
roundi
ngt
hepat
ient
.
 Ther
ear
easmanyas2000det
ect
ors.
 Thedet
ect
orsar
epl
acedsocl
oset
hatx-
rayt
ransmi
tt
edf
rom pat
ienti
snotwast
ed.
 Cal
ibr
ati
onofdet
ect
orsatscant
imei
spossi
blei
nfour
thgener
ati
onscanni
ngdevi
ces.
5.Fi
ft
hgener
ati
on:
 Ther
ear
etwot
ypes
i
)El
ect
ronbeam t
raver
sei
i)
Spi
ral
scanni
ng
 I
nel
ect
ronbeam t
raver
seorel
ect
ronbeam t
omogr
aphybot
hthex-
rayt
ubex-
raydet
ect
ors
ar
est
ati
onar
y.
 Theel
ect
ronbeam f
rom anel
ect
ronguni
smadet
ost
ri
keonat
ungst
enar
rayar
ranged
semici
rcul
arl
yunder
neat
hthepat
ient
.
 Byt
hisx-
raysi
spr
oducedandf
ocussedont
hepat
ientandt
hescanni
ngt
imef
orasl
icei
s
oft
heor
derof50ms.
Fi
ft
hGener
ati
on
 Thex-
rayt
ransmi
tt
edi
nfor
mat
ionf
rom t
hepat
ienti
srecei
vedbydet
ect
orsar
rangedi
na
semi
cir
cul
arf
ashi
onabovet
hepat
ient
.
 Si
li
conphot
odi
odescombi
nedwi
thl
umi
nescentcr
yst
alsar
eusedasdet
ect
ors.
 I
nspi
ral
scanni
ngsyst
em,
thex-
rayt
uber
otat
escont
inuosl
yar
oundt
hepat
ient
.
 Thepat
ientunder
goessl
ow,
cont
inuoust
ransl
ati
onalmot
ion.
 Thust
hef
ocalpoi
ntorsotoft
hex-
rayf
anbeam t
racesonhel
ix.
 I
nthi
smet
hodf
astmul
ti
plescansf
or3Di
magi
ngi
spossi
ble.
 I
nthi
smet
hodi
magesar
ereconst
ruct
edatsecondar
yposi
ti
onsandsecondar
yspaci
ng
t
husr
esul
ti
ngi
nover
lappi
ngdat
a.
 Byt
hisevenasmal
lersi
zel
esi
oni
snotmi
ssed.
 Thedi
sadvant
ageoft
hissyst
em i
sthat
,si
ncet
hepat
ienti
smovedt
her
eisbl
urr
ingof
i
mages.
 Themovementoft
hepat
ienti
nfl
uencest
hespat
ialr
esol
uti
onper
pendi
cul
art
othescan
sl
ice.But
,thi
sbl
urr
ingcanber
educedbydel
i
lur
ri
ngsof
twar
e.
I
mageReconst
ruct
ion:
 Dat
arel
ati
ngt
oposi
ti
onali
nfor
mat
ion,
Absor
pti
onali
nfor
mat
ion,
ref
erencei
nfor
mat
ionand
cal
ibr
ati
oni
nfor
mat
ion,obt
ainedf
rom det
ect
orscanner
satt
hegant
ryar
epr
ocessedby
sui
tabl
eal
gor
it
hmsf
orr
econst
ruct
ionofi
mages.
 Ther
ear
emanyr
econst
ruct
ionmet
hodsavai
l
abl
e,3ar
emostcommonl
yused,
1)Backpr
oject
ion-
mor
eli
kegr
aphi
cal
reconst
ruct
ed
2)I
ter
ati
vemet
hod-
Algebr
aicsol
uti
ons.
3)Anal
yti
cal
met
hods-
usageoff
ormul
aFour
iert
ransf
orm,
fastFour
iert
ransf
orms.
 I
nbackpr
oject
ionr
econst
ruct
iont
echni
quet
hemeasur
edpr
ofi
leshavi
ngdat
afr
om x-
ray
t
ransmi
tt
edi
nfor
mat
ionar
epr
oject
edbackovert
hei
magear
eaatt
hesameangl
efr
om
whi
chi
tist
aken.
 Eachpr
oject
ioncont
ri
but
esnotonl
ytot
hepoi
ntst
hator
igi
nal
lyf
ormedt
hepr
ofi
l
esbutal
so
t
otheot
herpoi
ntsi
nit
spat
h.Pr
ofi
lei
sasetofx-
rayt
ransmi
tt
eddat
a.
 Thei
ter
ati
vemet
hodsucceededt
hebackpr
oject
ionmet
hodandi
mpr
ovi
sedt
hei
mage
qual
it
ybymodi
fyi
ngt
heor
igi
nalpr
ofi
lei
ntoasetofpr
ofi
leswhi
chcanbepr
oject
edbackt
o
acl
eari
mage.
 Ar
ti
fact
swhi
chcausebl
urr
ingef
fect
scanal
sor
emovedbyconvol
uti
onorf
ett
eri
ng.
 Backpr
oject
ionr
econst
ruct
ioncanbei
ll
ust
rat
edbyasi
mpl
eexampl
ecal
cul
ati
on.
 Theact
ualat
tenuat
ionval
ues,
nor
mal
izedt
ozer
o,ar
erepr
esent
edbya2*
2mat
ri
x.
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
- 1)
 Eachnumberi
nthemat
ri
xrepr
esent
stheat
tenuat
ionoft
hespacewher
eiti
slocat
ed.
 Theat
tenuat
ionval
uesar
emeasur
edf
rom t
heout
sideast
hoseseenal
ongt
her
owsgi
ving
t
hesums2and4.
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
- 2)
Thi
sisf
ir
stest
imat
e.
 Addi
ngval
uesmeasur
eal
ongt
hecol
umns,
wehave,
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
- 3)
Thi
smat
ri
xisaddedt
othef
ir
stest
imat
etoobt
ain,
+ = -
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
4)
Thi
sissecondest
imat
e.
 Addi
ngt
heval
uesal
ongt
henor
theastdi
agonal
,weget
,
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
5)
 Addi
ng(
5)wi
th(
4)wehave,
+ = -
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
6)
Thi
sist
het
hir
dest
imat
e.
 Addi
ngt
heval
uesmeasur
edal
ongt
henor
thwestdi
agonalwehave,
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
7)
 Addi
ng(
7)wi
th(
6),
+ = -
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
 (
8)
Thi
sist
hef
our
thest
imat
e
 Nor
mal
iset
hef
our
thest
imat
etozer
obysubt
ract
ing6f
rom eachel
ement
.
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
9)
 Di
vidi
ngt
hisby3weget
,
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-(
- 10)
Thi
sist
hef
inali
mage.
 Thef
inalmat
ri
xissameast
hef
ir
stone.
 Thenumber
sint
hemat
ri
xcor
respondst
otheat
tenuat
ionsofl
ocat
ionsonat
issuesl
ice
havi
ngt
hesamespar
ti
alr
elat
ionshi
past
hemat
ri
xnumber
s.
 I
tisseent
hatt
hef
inali
magehast
hesameat
tenuat
ionval
uesast
heact
ualt
ransver
sesl
ice
butt
heval
uesar
eobt
ainedf
rom ext
ernal
measur
ement
sofat
tenuat
ionusi
ngCT.
 Thecomput
erdoessi
mil
arcal
cul
ati
oni
nal
argescal
eandf
indst
hemat
ri
xval
ues.
Vi
ewi
ngpar
t:
 Thef
inalpi
ctur
eoft
heCTi
svi
ewedonat
elevi
siont
ypepi
ctur
etube.
 Thepi
ctur
eisact
ual
lyconst
ruct
edofanumberofel
ement
sinasquar
emat
ri
xwher
eeach
el
ementi
stheabsor
pti
onval
ueoft
hepoi
nti
nthebodyi
trepr
esent
s.
St
ori
ngpar
t:
 CTpi
ctur
esar
est
oredf
orf
urt
herpr
ocessi
ngandeval
uat
ion.
 CTpi
ctur
eisst
oredi
ndi
git
alf
orm sot
hatpr
ocessi
ngbecomeseasy.
 CTpi
ctur
escanbest
oredi
nmagnet
icdi
sc,
magnet
ict
apeandf
loppydi
sc.
 Fl
oppydi
scpr
ovi
desamedi
um st
orager
ange.
 Abi
lat
eral
lycoat
edf
loppydi
sccanbeaccomodat
eupt
o20CTpi
ctur
esof256*
256mat
ri
x.
 Fl
oppydi
scar
eeasyt
ohandl
e,havel
owmai
ntenancecost
s.
 Har
dcopypr
int
-out
scanbemadei
nthegr
ayscal
eori
ncol
ourshades.
 Gr
ayshadesar
erest
ri
ctedbet
ween8and10.
Ul
tr
asoni
cimagi
ng
I
ntr
oduct
ion:
Ul
tr
asoundr
efer
stoacoust
icalandmechani
calwavesoff
requency2000Hzandabove.Ul
tr
asound
can be gener
ated f
rom pi
ezoel
ect
ri
c cr
yst
alsl
ike quar
tz,bar
ium t
it
anat
e,Rochel
le sal
t,l
ead
zi
rconat
eti
tanat
eet
c.Pi
ezocr
yst
alspr
oduceavol
tageacr
osst
hei
rtwosur
faceswhendef
ormed
ordef
orm andpr
oduceul
tr
asoni
cwavesi
favol
tagei
spl
acedacr
osst
heel
ementf
rom t
hosesame
sur
faces.Theul
tr
asoundscanni
ngt
echni
quei
samet
hodbywhi
chul
tr
asoni
cener
gyi
ssenti
nto
t
hebodybypl
aci
ngt
het
ransducerovert
hear
eat
obescanned.
Bur
stsoful
tr
asoni
cener
gyar
etr
ansmi
tt
edf
rom api
ezoel
ect
ri
cormagnet
ost
ri
cti
vet
ransducer
t
hrought
heski
nandi
ntot
hei
nter
nalanat
omy.Whent
hisener
gyst
ri
kesani
nter
faceofdi
ff
erent
acoust
icali
mpedancet
hreet
hingscan happen i
)Ref
lect
ion i
i)Scat
ter
ing i
ii
)Ref
ract
ion and
di
ff
ract
ion.
(
i)Ref
lect
ion:
Thet
issuesoft
hehumanbodyr
ayi
nthei
rdensi
ti
esandst
if
fness.Hencet
hevel
oci
tyoft
hesound
bur
stal
sovar
ies.Soundwavespassi
ngf
rom onet
issuet
otheot
herar
eref
lect
edatt
hei
nter
face
oft
het
issuesandr
etur
ntot
het
ransducerasechoes.
Var
ioust
issuesof
fervar
yingdegr
eesofr
esi
stancet
othepassageofsoundt
hrought
hem andt
his
i
scal
ledacoust
ical
impedance.
Z=d*Cwher
e,
Z–Acoust
icali
mpedance(
inRay/
s)
d–Densi
tyoft
hemedi
um ( cm3)
gm/
C–Vel
oci
tyofsoundwave(
cm/
s)
I
fthedi
ff
erencei
sacoust
ici
mpedanceoft
wot
issuesi
ssmal
l,t
henapar
toft
hesoundwavei
s
r
efl
ect
ed.I
fthedi
ff
erencei
slar
get
hent
heper
cent
ageofr
efl
ect
ionofsoundi
squi
tel
arge.
Forexampl
e–whensoundwavepassest
hroughsof
tti
ssuesandmeet
sabonei
nter
facei
nthe
acoust
ici
mpedancebet
weent
hesof
tti
ssueandbonei
squi
tel
arge.Ther
efor
e99%ofsoundwave
i
sref
lect
ed.Ther
ear
etwot
ypesofRef
lect
ionnamel
y,
i
)Specul
arr
efl
ect
ion:
 Occur
swhent
hesur
facei
slar
gert
hant
hesoundbeam.
 Angl
eofi
nci
dence=Angl
eofr
efl
ect
ion
 I
fangl
eofi
nci
dence=90°
,ther
efl
ect
edechoi
sdepi
ctedont
hescr
eeni
sahi
ghi
ntensi
ty
dot
.
 Usedi
nar
eassuchaski
dney,
aor
ta,
gal
lbl
adder
.
i
i)NonSpecul
arr
efl
ect
ion:
 Occur
swhent
hei
nter
facei
ssmal
lert
hant
hesoundbeam.
 Gr
ayscal
escanni
ngi
smadeusedher
e,wher
eref
lect
ionsanddi
ff
erentampl
it
udesof
echoesar
erecor
dedi
ndi
ff
erentshadesofgr
ay.
 Usedar
eas–par
enchymal
tissues.
(
ii
)Scat
ter
ing:
Thi
soccur
swhent
het
issuei
nter
facei
sir
regul
arandsmal
lert
hant
hesoundbeam.
(
ii
i)Ref
ract
ionandDi
ff
ract
ion:
Whensoundwavesr
efr
actandt
raveli
ndi
ff
erentpat
hther
eoccur
sadecr
easei
ntheampl
it
udeof
t
her
etur
ningechoesduet
othebendi
ngofsoundwaves.
Di
spl
aymodes:
Ther
efl
ect
edechoesar
edi
spl
ayedont
hescr
eenasusef
uli
mage.Thevar
iousdi
spl
aymodesar
e,
 A–mode
 B–mode
 M –Mode(
or)T–M mode.
A–Modedi
spl
ay:
A-Modemeansampl
it
udemode.I
nthi
smode,
ther
efl
ect
edechoesar
edepi
ctedasver
ti
calspi
kes
al
ongt
hehor
izont
albasel
ine.Aonedi
mensi
onali
magedi
spl
ayi
ngt
heampl
it
ude(
str
engt
h)oft
he
r
etur
ningechosi
gnal
sal
ongt
hever
ti
calaxi
sandt
ime(
asdi
stancef
rom t
ransducer
)al
ongt
he
hor
izont
alaxi
siscal
ledanA-modei
mage.Thedi
stancebet
weent
het
ransducerandast
ruct
ure
det
ermi
neswher
eanechoi
sseenal
ongt
het
imeaxi
s.Ti
meanddi
stancear
eint
erchangeabl
e,
becauseanechoi
sassumedt
otr
avelataconst
antspeedi
nabodyt
issue(
1540m/
s),t
het
imei
t
t
akesf
ort
heechot
oret
urnt
othet
ransducercanbeconver
tedt
odi
stance.A-Modei
sthemost
basi
cfor
m ofdi
agnost
icul
tr
asound.Her
easi
ngl
ebeam oful
tr
asoundi
sanal
yzed.
At
ypi
calA–Modewavei
sshownabove.Her
ethest
rengt
hoft
heacoust
ici
mpedancei
sshownas
t
hesi
zeoft
heecho.
Shownabovei
stheechof
rom f
lui
dfi
ll
edor
ganwi
thast
rongbackwal
lref
lect
ion.Exampl
e:gal
l
bl
adder
,ur
inar
ybl
adder
,si
mpl
ecyst
.
Shownabovei
sanechof
rom ast
ruct
urewi
thweakbackwal
lref
lect
ion.
Shownabovei
stheechoofast
ruct
urewi
thacompl
exmasshavi
ngbot
hsol
idandf
lui
d.
‘
A’modeechoeshaveposi
ti
veandnegat
ivepeaksduet
othemovementofar
ter
ialwal
lsi
nthe
bl
oodvessel
s.Thi
stypeofmodehel
psi
ncystpunct
ure.I
thel
psi
ndet
ermi
ninganyt
umouri
nthe
i
nnereyeandbr
ain.
B–Modedi
spl
ay:
Thi
sisknownast
hebr
ight
nessmode.Her
ether
efl
ect
edechoesar
edepi
ctedasdot
sont
he
scr
een.Ever
yref
lect
ionpr
oducesasi
ngl
edot
.Thebr
ight
nessoft
hedotdependsont
hei
ntensi
ty
oft
her
efl
ect
edecho.Thi
smodecr
eat
esat
wodi
mensi
onalcr
osssect
ionoft
hebodyt
hati
s
obt
ainedbysummi
ngmany‘
A’modebeamsandconver
ti
ngt
heechoest
odot
sofabr
ight
nesst
hat
var
ies f
rom t
he st
rengt
h oft
he echo.I
nthi
s mode t
he i
ntensi
ty oft
he sound r
efl
ect
ed i
s
pr
opor
ti
onalt
othebr
ight
nessoft
hedot
s.TheB modei
magi
ngi
nvol
vesscanni
ngal
ongt
wo
sect
ionsnamel
ylongi
tudi
nalandt
ransver
se.
Thel
ongi
tudi
nal
sect
ionhas,
1.Ant
ero-
post
eri
or
2.Cephal
ocaudal(
Top-
Bot
tom)
Thet
ransver
sesect
ionhas,
1. Ant
ero-
post
eri
or
2.Lateral(
Right
-l
eft
)
Bycombi
ningthetwosecti
onst
hreedi
mensi
onal
imagi
ngcanbedone.
B–Modedi
spl
ayI
mage
Obl
iquesect
ionalscanni
ngi
sal
sopossi
ble.Ast
het
ransducermovesacr
osst
hebody,dot
sar
e
cr
eat
edandr
etai
nedont
heosci
ll
oscopebyt
hehel
pofascanconver
ter(
memor
y).Thi
sgi
vest
wo
di
mensi
onali
magesi
neachsect
ion.Byper
for
mingbot
hlongi
tudi
nalandt
ransver
semovement
s,
3Di
magei
sobt
ainedwhi
chhel
psi
nunder
standi
ngt
heanat
omybet
ter
.Ar
rayscal
ingr
efer
stot
he
depi
cti
on ofechoesi
n var
iousshadesofgr
ayaccor
ding t
othei
ntensi
tyofr
efl
ect
ed beam.
Machi
neswi
th8,
16,
32,
and64gr
ayshadesar
eavai
labl
e.Ar
ealt
imescani
spr
ovi
dedbyaB-
Scan
syst
em i
nwhi
cht
hescanr
ateoft
het
ransduceri
sfastenought
ocapt
uret
hemovement
soft
he
or
gansbei
ngi
maged.Movement
sofhear
t,pul
sat
ingaor
ta,andf
oet
almovement
sar
ecapt
ured,
al
lowi
ngt
hephysi
ciant
oobser
vei
tsmot
ion.Ti
megai
ncompensat
ion(
TGC)ci
rcui
tsar
eusedi
nB-
Mode.Si
ncet
hedeeperechoesar
emor
eat
tenuat
edbyt
hegr
eat
estt
issuepat
hlengt
h,TGC
cont
rol
sthi
stoobt
aint
heechoont
hescr
een,
bypr
oduci
ngcompensat
iont
hrought
hei
ncr
easeof
gai
noft
het
ransducer
.
T-
M ModeDi
spl
ay:
T-
M modest
andsf
orTi
me–Mot
ionMode.Thi
sisact
ual
lyt
heA–Modescanbutwi
thsuccessi
ve
l
ooksatt
het
argetcr
eat
edbyscanni
ngt
het
imebasever
ti
cal
ly.Thi
smodei
spr
imar
il
yusedt
o
st
udymovi
ngobj
ect
sli
keval
vesandwal
lsoft
hehear
t.Themachi
nehasal
inecal
ledt
heM –
Cur
sorandbyposi
ti
oni
ngt
hecur
soratt
her
equi
redpoi
ntt
heT-
M Modet
raci
ngoft
hehear
tis
obt
ained.M – Modei
sver
yusef
uli
nst
udyi
ngcar
diacf
unct
ions,bymaki
ngvar
iousaccur
ate
measur
ement
soft
heshambl
esandval
vemovement
s.
Ul
tr
asoni
cImagi
ngI
nst
rument
ati
on
Acomput
ercont
rol
ledul
tr
asoni
cimagef
ormi
ng,syst
em consi
stofsomanyper
ipher
alsubuni
ts
whi
char
econt
rol
ledbyacomput
ert
hrought
hecont
roll
ayer
s.Thet
ransducerposi
ti
ondat
aar
efed
t
othecomput
er.Thecomput
ersendst
hisi
nfor
mat
ion t
o si
gnalpr
ocessi
ng uni
twhi
ch al
so
r
ecei
ves t
he si
gnalf
rom t
he r
ecei
ver
.Itcont
rol
srecei
ver sensi
ti
vit
y.Pr
oper dept
h gai
n
compensat
ioni
scal
cul
atedbyt
hecomput
erar
egi
vent
othesi
gnalpr
ocessi
nguni
t.I
magest
orage
uni
t,st
orespat
ienti
nfor
mat
iondat
awhi
chcanbedi
spl
ayedagai
nfordet
ail
edexami
nat
ion.The
ul
tr
asoni
cvel
oci
tyi
scal
cul
atedandgi
vent
othedi
spl
ayuni
t.Thehi
ghspeedanal
ogt
odi
git
al
conver
terhaveenabl
eddi
git
izat
ionofhi
ghf
requencysi
gnal
s.Theechoesf
rom t
hepat
ientbody
sur
facear
ecol
lect
edbyt
her
ecei
verci
rcui
t.
Pr
operdept
hgai
ncompensat
ioni
sgi
venbyTGCci
rcui
ts.Ther
ecei
vedsi
gnal
sar
econver
tedi
nto
di
git
alsi
gnal
sandst
oredi
nmemor
y.Thest
oreddi
git
alcol
orcodedandconver
tedt
oanal
og
si
gnal
s.Fi
nal
lyt
hesear
efedi
ntovi
deosect
ionoft
heTVmoni
torwher
eiti
sdi
spl
ayed.
Bl
ockDi
agr
am -Ul
tr
asoni
cImagi
ngI
nst
rument
ati
on
Bi
omedi
calAppl
icat
ionsofUl
tr
asoni
cImagi
ng:
1.Usedi
neval
uat
ionofl
esi
onsofsof
tti
ssuesandor
gansl
ikel
iver
,gal
lbl
adder
,pancr
eas,
ki
dneys,
uter
usandovar
ies.
2.Used i
n ear
ly di
agnosi
s of congeni
talanomal
ies,eval
uat
ion of pl
acent
a and i
ts
abnor
mal
it
ies.
3.Foet
alt
her
apyi
sal
sopossi
bleusi
ngul
tr
asound–gui
dedpr
ocedur
es.
4.Dr
ainageoff
lui
d,col
lect
ions,
biopsi
esofsmal
llesi
onsar
edoneef
fect
ivel
yusi
ngdi
agnost
ic
ul
tr
asound.
5.Thecar
diacanat
omyandf
unct
ioni
sal
soi
magedandst
udi
ed.
6.Bl
oodf
lowchar
act
eri
sti
cs,
flowacr
ossval
ves,
movementofhear
twal
lscanbeassessed.
7.I
tisusef
uli
nlocat
ingdeepl
ysi
tuat
edl
esi
onsi
nthebr
ain.
Magnet
icResonanceI
magi
ng(
MRI
)
(
OR)
Nucl
earMagnet
icResonanceI
magi
ng(
NMRI
)
Pr
inci
ple:
Thehumanbodyconsi
stsofmi
ll
ionsofat
omsi
nwhi
ch80%oft
heat
omsar
eH2at
oms.Apat
ient
i
spl
acedi
ntheext
ernalmagnet
icf
iel
dwhi
chcausest
hemagnet
izat
ionofpr
otonsofH2 i
nthe
body.Due t
o magnet
izat
ion,t
hese pr
otons al
ign t
hemsel
ves i
n accor
dance t
othe ext
ernal
magnet
icf
iel
dandt
hepr
otonsunder
gosomepr
eci
sionorwobbl
ingataf
requencycal
ledLar
mor
f
requency.
TheLar
morf
requencyi
sgi
venbyω0=γ.
B0,wher
eγi
saconst
antcal
ledmagnet
ogyr
icr
ati
oand
B0i
sthest
rengt
hoft
heappl
iedmagnet
icf
iel
d.
EachH2 at
om pr
ecessati
tsownLar
morf
requencyandhencepossessadi
ff
erentener
gies
r
espect
ivel
y(E=hω)
Pr
inci
ple–MRI
Atequi
li
bri
um st
atel
owerener
gynucl
eiar
emor
einnumbercompar
edt
ohi
gherener
gynucl
ei.
Nowusi
ngr
efer
encer
adi
ati
onatr
esonancewi
thener
gyequalt
othedi
ff
erencei
nener
gyofl
ower
st
ateandhi
gherst
ate,al
llowerener
gynucl
eiar
epushedt
ohi
gherener
gyl
evel
.Theseexci
ted
nucl
eiwi
llsl
owl
yfal
lbackf
rom hi
gherener
gyl
evelt
olowerener
gyl
evelsi
mul
taneousl
ygi
vingout
r
efer
encesi
gnal
scal
ledNucl
earMagnet
icResonancesi
gnal
s.TheNMR si
gnal
sar
edet
ect
ed,
pr
ocessedandi
magei
sobt
ained.TheNMR si
gnal
sar
epi
ckedbyRFcoi
lsandpr
ocessedby
comput
ersusi
ngFour
ierTr
ansf
ormi
ngt
echni
quest
opr
oduceani
mage.
I
nst
rument
ati
on:
Thebasi
ccomponent
sofMRIsyst
em i
ncl
udes,
1.Magnet
2.Coor
dinat
esyst
em
3.RFTr
ansmi
tt
ersyst
em
4.RFDet
ect
ionsyst
em
5.I
magersyst
em
Themagnetpr
oducesast
rong,uni
for
m,st
eadymagnet
icf
iel
dB0.Thegr
adi
entcoi
lspr
oducea
t
imevar
ying,
nonuni
for
m magnet
icf
iel
dandt
hisgr
adi
entf
iel
disusedt
oobt
ainspat
ialdi
str
ibut
ion
i
nfor
mat
ion.
Ther
ear
etr
ansmi
tt
ersandr
ecei
vingRFcoi
lssur
roundi
ngt
hesi
teonwhi
cht
hei
magesi
stobe
const
ruct
ed.
Ther
eisasuperposi
ti
onofal
inearmagnet
icgr
adi
entf
iel
dandt
heuni
for
m magnet
icf
iel
dappl
ied
t
othepat
ient
.
Whent
hissuperposi
ti
ont
akespl
acet
her
esonancef
requenci
esoft
hepr
ocessi
ngnucl
eiwi
ll
dependpr
imar
il
yont
heposi
ti
onsal
ongt
hedi
rect
ionofmagnet
icf
iel
dgr
adi
ent
.
Thi
spr
oducesaonedi
mensi
onal
proj
ect
ionoft
hest
ruct
ureoft
he3Dobj
ect
.
Byt
aki
ngaser
iesoft
hesepr
oject
ionsatdi
ff
erentgr
adi
entor
ient
ati
onsusi
ngX,
Y,Zgr
adi
entcoi
ls,
a2Dor3Di
magecanbeobt
ained.
Thesl
iceoft
hei
magedependsont
hegr
adi
entmagnet
icf
iel
d.
Thegr
adi
entmagnet
icf
iel
discont
rol
ledbycomput
erandt
hatf
iel
dcanbeposi
ti
onedi
nthr
eet
ime
i
nvar
iantpl
anes(
X,Y,
andZ)
.
Thet
ransmi
tt
erpr
ovi
dest
heRFsi
gnalpul
sest
her
ecei
vednucl
earmagnet
icResonancei
spi
cked
byt
her
ecei
vercoi
landi
sfedi
ntot
her
ecei
verf
orsi
gnalpr
ocessi
ng.
By2DFour
iert
ransf
ormt
hei
magei
sconst
ruct
edbyt
hecomput
erandi
sdi
spl
ayedont
heTV
scr
een.
Bl
ockDi
agr
am –MRII
nst
rument
ati
on
Advant
agesofMRIoverot
hermedi
cal
imagi
ngt
echni
ques:
1.Super
iorcont
rastr
esol
uti
on
2.Di
rectMul
tipol
ari
magi
ng,
sli
cesi
nthesagi
tt
alandconsol
ingandobl
iquedi
rect
ionscanbe
obt
aineddi
rect
ly.
3.Ther
eisat
otalabsenceofhar
mful
radi
ati
onsl
ikeX–r
ays,
gammar
ays,
posi
tr
ons,
etc.
MRI–Magnet
:
Ther
ear
edi
ff
erentvar
iet
iesofmagnet
susedf
orMRI
.
Theyar
eper
manentmagnet
s,el
ect
romagnet
s,r
esi
sti
vemagnet
sandsuperconduct
ingmagnet
s.
1.Per
manentMagnet
s:
Whi
leusi
ngper
manentmagnet
sthepat
ienti
spl
acedi
nthegapoft
heper
manent
lymagnet
ized
pol
epi
eces.
Car
bon–i
onal
loys,
alni
co,
neodymi
um i
onar
ethedi
ff
erentper
manentmagnet
icmat
eri
als.
Theadvant
ageofper
manentmagneti
sthati
tcanpr
oducesmal
lmagnet
icf
iel
dswi
thoutpower
suppl
y.
Butt
hesemagnet
sar
eheavyandt
heypr
oducel
owf
iel
dsoft
heor
derof0.
3Tesl
a.
2.El
ect
romagnet
s:
Theseusesof
tmagnet
icmat
eri
alswhi
chmagnet
izeonl
ywhenel
ect
ri
ccur
renti
spassedt
hrough
coi
lswoundar
oundt
hem.
El
ect
romagnet
srequi
reext
ernal
elect
ri
cpowersuppl
y.
3.Resi
sti
veMagnet
s:
Theseusel
argecur
rentcar
ryi
ngcoi
lsofal
umi
nium st
ri
psorcoppert
ubes.
Thesecoi
lsr
equi
rever
yhi
ghel
ect
ri
cal
poweral
mostsquar
eoft
hef
iel
dst
rengt
hiti
spr
oduce.
Ashi
gherf
iel
dst
rengt
har
erequi
redel
ect
ri
cal
powersuppl
yhast
obei
ncr
eased
Thepoweri
nthecoi
lisconver
tedi
ntoheatwhi
chi
sdi
ssi
pat
edbyl
iqui
dcool
ingsyst
em.
Foraf
iel
dst
rengt
hofnear
ly0.
2Tesl
athepowerr
equi
rementi
snear
ly70KW.
4.Superconduct
ingMagnet
s:
Thi
sismadeofsuperconduct
ingmat
eri
als.
Theset
ypeofmat
eri
alsl
oset
hei
rresi
sti
vepr
oper
tyorr
atherbecomesabsol
utel
yconduct
ivebel
ow
acer
tai
nspeci
fi
ctemper
atur
e.
Forexampl
e,NbTi(
Niobi
um Ti
tani
um)l
osesi
tsr
esi
stancepr
oper
ti
esbel
owaspeci
fi
ctemper
atur
e
(
-264°C)
.
Thust
hepowerr
equi
redt
omagnet
izet
hesemat
eri
alsi
sless.
Poweri
sneededf
orj
ustener
gizi
ngt
hemat
eri
alt
other
equi
redmagnet
icf
iel
dst
rengt
h.
Oncet
hecoi
lisener
gizedat
empor
arymagnet
icf
iel
dissetup.Cont
inuouspowerr
equi
rementi
s
notnecessar
y.
Af
teracqui
ri
ngt
her
equi
redmagnet
icf
iel
dst
rengt
h,t
hecoi
lsar
eshor
tci
rcui
ted.
Themagnet
sar
ekeptatcr
it
ical
temper
atur
e(264°C)byl
- iqui
dhel
ium andl
iqui
dni
tr
ogent
oppi
ngs.
Cr
yogeni
cref
ri
ger
ator
sreduceorel
imi
nat
etheneedf
orr
efi
ll
ingt
hel
iqui
dhel
ium r
eser
voi
r.
SuperConduct
ivemagnet
susedf
orwhol
ebodyexami
nat
ionshaveanopeni
nter
naldi
amet
erof1
m,
andcanpr
oduceupt
o2Tesl
a.
Thecur
rentr
equi
redf
orener
gizi
ngi
soft
heor
derof200A.
RFTr
ansmi
tt
ersyst
em:
TheRFt
ransmi
tt
ersyst
em act
ivat
est
henucl
eisot
hatwheni
tcomesbackt
otheequi
li
bri
um st
ate
i
tgi
vesoutNMRsi
gnal
.
TheRFt
ransmi
tt
ersyst
em consi
stsofRFgener
ator
,RFt
ransmi
tt
er,RFpowerampl
if
ierandRF
t
ransmi
tt
ingcoi
ls.
Thegener
atorconsi
stsofRFcr
yst
alosci
ll
ator
.
TheRFpul
segener
atedi
sampl
if
iedt
olevel
sbet
ween100W t
osever
alKW.
Thepul
sesar
ethenf
edt
othet
ransmi
tt
ercoi
lwhi
chexposest
heRFsi
gnal
stot
hepat
ient
s.
TheRFcoi
lgener
atesandt
ransmi
tRFf
iel
dsor
thogonalt
othedi
rect
ionoft
hemai
nfi
eld.
TheRFcoi
lsar
esaddl
eandsol
enoi
dshaped.
Thecoi
lsar
etunedt
oNMRf
requencyandar
eisol
atedf
rom t
her
estofsyst
em RFshi
eldi
ngcage.
RFdet
ect
ionsyst
em:
Thi
sisusedt
odet
ectandpi
ckupnucl
earmagnet
icr
esonancesi
gnal
sfr
om t
hehumanbodyand
t
ogener
ateanout
putsi
gnalf
orpr
ocessi
ngbyt
hecomput
er.Thedet
ect
orsyst
em consi
stsof
r
ecei
ving coi
ls,mat
chi
ng net
wor
ks,ampl
if
ier
,fi
lt
erand A t
o D conver
ter
s.The r
ecei
vercoi
l
sur
roundst
hear
eaofi
nter
estandpi
ckst
heNMRsi
gnal
sandconver
tst
hem t
oout
putvol
tageV(
t)
.
V(
t)=-
d/dt
.M(
t,x)
.Bc(
x).dx.
M(
t,x)=Tot
alMagnet
izat
ion
Bc(
x)=Sensi
ti
vit
yoft
her
ecei
vercoi
l
Thedet
ect
edRFsi
gnali
sofweakampl
it
udei
nthenanovol
tager
angeandt
husr
equi
resspeci
all
y
desi
gnedRFant
ennas.
Thecommonl
yavai
labl
eRFcoi
lsar
e,
1.Bodycoi
ls
Thesear
econst
ruct
edoncyl
indr
icalcoi
ls,Wi
thDi
amet
er50cm t
o60cm.Andsur
rounds
pat
ient
’sbody.
2.Sur
facecoi
ls
Thesear
efl
at,
planar
,ri
ngshapedcoi
lwi
thDi
amet
er10cm usedasearcoi
ls.
Adapt
abl
etoi
ndi
vidualpat
ientanat
omy–neckcoi
l-10cm *20cm
Ri
ngshapedcoi
l–15cm i
ndi
amet
er–spi
necoi
l.
3.Or
ganencl
osi
ngcoi
ls
Br
eastcoi
l–cyl
indr
ical
,ri
ngcoi
l–15cm i
ndi
amet
er.
Hel
mhot
zcoi
l–pai
roff
latr
ingcoi
ls15cm i
ndi
amet
er–separ
atedbydi
stance12t
o22cm.
Themat
chi
ngci
rcui
tconnect
sther
ecei
vingcoi
ltot
hepr
eampl
if
ier
.
Thepr
eampl
if
ieri
sal
ownoi
seampl
if
ierwhi
champl
if
iest
heNMRsi
gnal
s.
Thenaphasedet
ect
orsi
gnaldet
ect
sal
lthesi
gnal
swhosef
requenci
esar
ecent
eredar
ound
t
ransmi
tt
edf
requencyandaf
il
terr
eject
sther
estoft
hesi
gnal
.
ThenanAt
oDconver
terconver
tst
heanal
ogNMRsi
gnal
stodi
git
alf
orm,
whi
chi
sgi
vent
othe
comput
erf
orf
urt
herpr
ocessi
ng.
Gr
adi
entSyst
em:
Thegr
adi
entsyst
em i
susedt
ohavespat
ial
dist
ri
but
ioni
nfor
mat
ion.
Byvar
yingt
hef
iel
dinaspeci
fi
cfashi
on,t
her
egi
onf
rom whi
cht
hei
nfor
mat
ion(
NMR)i
s
obt
ainedcanbesel
ect
ed.
Thest
rengt
hoft
hesi
gnal
ispr
opor
ti
onal
tot
hedensi
tyoft
heH2nucl
eii
nthatpl
ane.
Ther
ear
evar
iousmet
hodsf
orsel
ect
ingasl
ice,butt
hesel
ect
iveexci
tat
ionmet
hodi
sused
wi
del
y.
Her
e,t
hechar
act
eri
sti
csoft
hesl
icewi
llbedet
ermi
nedbyt
heshapeoft
hepul
seandt
he
t
hicknessoft
hesl
icei
sdet
ermi
nedbyt
hewi
dthoft
hepul
se.
Thegr
adi
entf
iel
disusedt
opr
ovi
dedi
scr
ete,movabl
eti
mevar
iantpl
anesot
hatvar
ious
l
ocat
ionsmaybesensedwi
thoutmovi
ngt
hesampl
eormagnetsyst
em.
Thegr
adi
entsyst
em compr
isesofsubsyst
ems.
Thef
ir
stsubsyst
em i
ncl
udest
hei
nter
facewhi
chi
nter
facest
hecomput
erandt
hegr
adi
ent
cont
rolsyst
em.
Thi
ssubsyst
em hel
psi
nposi
ti
oni
ngoft
het
hreet
imei
nvar
iantpl
anes(
X,Y,
andZ)
.
I
magersyst
em:
Thi
scompr
isesoft
hecomput
er,
displ
aysyst
em andt
hecont
rolconsol
e.
Thecomput
erdoesi
magepr
ocessi
ng,t
imi
ngandcont
rolofRFandgr
adi
entpul
sesequences,
i
tal
sohel
psi
ndi
spl
ay.
Ami
nicomput
eri
sused,t
hiscol
lect
sthenucl
earmagnetr
esonantsi
gnali
ndi
git
alf
orm,t
hen
pr
ocessi
t,di
spl
ayst
hei
mageandal
sost
oresi
t.ADCwi
th16bi
tsorhi
gheri
susedt
opr
oduce
di
git
alNMR.
Thecomput
erwi
thar
raypr
ocessordesi
gnedf
ort
her
api
dper
for
manceofspeci
fi
cal
gor
it
hms
l
ikeFFTor2D Four
ierTr
ansf
ormt
oconver
tdi
git
alt
imedomai
ndat
atoi
magedat
a.The
r
econst
ruct
edi
magedat
aar
etr
ansmi
tt
edt
othedi
spl
ayconsol
e.
Thei
magecanbest
oredi
naf
loppydi
skormagnet
ict
ape.
Thecont
rolconsol
ecompr
isest
heoper
ati
on sect
ion,syst
em cont
rolsect
ion and di
spl
ay
sect
ion.A mi
cro cont
rol
lercont
rol
sthe gr
adi
entmagnet
icf
iel
ds,RF pul
ses and t
he AD
conver
ter
sti
ming.Thedi
spl
aysect
ioni
ncl
udeshi
ghr
esol
uti
onmoni
tor
,keyboar
d,i
mage
memor
yandpaneli
ndi
cat
ors.
Ther
mogr
aphy
Thet
echni
quebywhi
cht
hepat
ter
nofi
nfr
aredr
adi
ati
onemi
tt
edbyt
hehumanski
nisf
ormed
i
nto an i
magei
scal
led t
her
mogr
aphy.Theconst
it
uentpar
tsoft
her
mogr
aphyequi
pment
i
ncl
udei
nfr
aredr
adi
ati
ondet
ect
or,
scanni
ngmi
rr
ors,
focusi
ngopt
ics,
andel
ect
roni
cci
rcui
tr
yto
ampl
if
ydet
ect
edi
nfr
aredsi
gnal
.
Thedet
ect
orsusedar
ephot
oconduct
orswhoser
esi
stancesdecr
easewi
thi
ncr
easei
ninci
dent
r
adi
ati
on.Li
qui
dni
tr
ogeni
susedt
ocoolt
hedet
ect
or.Thedet
ect
orsusedi
nther
mogr
aphy
possesshi
ghsensi
ti
vit
yandshor
tresponset
ime.Thet
her
mogr
aghi
cimagei
sthenobt
ainedby
scanni
ngt
hei
nfr
areddet
ect
orf
rom l
eftt
ori
ghtandf
rom t
opt
obot
tom.
Ther
mogr
aphy–Bl
ockDi
agr
am
Typi
cal
Ther
mogr
aph–setup
Thei
magi
ngsyst
em consi
stsofaf
rontsur
facedconver
gingmi
rr
orandahexagonalf
ront
sur
facedmi
rr
ort
hatr
otat
esat20r
ev/
sec.Ast
hismi
rr
orr
otat
es,
iti
sti
lt
edcont
inuousl
y,sot
hat
t
hepoi
ntofexami
nat
ionbyt
hedet
ect
ori
smovedacr
osst
hescenewi
thasl
ightangl
e.Ther
ate
oft
il
toft
hemi
rr
ori
ssucht
hatwhol
escenei
sexami
nedwi
th125l
inesi
n4.
5sec.Thent
het
il
t
ont
hemi
rr
ori
srever
sed,andi
tret
urnst
oit
sun-
ti
lt
edposi
ti
oni
n1.
5sec,andt
hescenei
s
scannedagai
n.I
nthi
sway,t
hedet
ect
orpr
ovi
desanout
putasi
tcont
inuousl
yexami
nest
he
i
nfr
aredener
gyemi
tt
edbyt
heobj
ectunderi
nvest
igat
ion.Thedet
ect
orout
puti
sledt
oan
ampl
if
ierwhi
chi
ntur
nmodul
atest
hei
ntensi
tyoft
hebeam ofcat
hoder
aydi
spl
ayt
ube.One
phot
oforeachi
sot
her
mleveli
stakenf
orquant
it
ati
veanal
ysi
sandeval
uat
ion.
Avi
deor
ecor
dingonmagnet
ict
apeoft
het
her
mali
magesf
rom CRTscr
eencanal
sobedone,
andpl
ayedbackf
orl
atereval
uat
ion.Forcol
orr
ecor
ding,eachi
sot
her
m set
ti
ngi
sexposed
t
hroughadi
ff
erentcol
orf
il
teronasi
ngl
efr
ameofcol
orf
il
m.Thi
sgi
vesconcent
rat
edand
easi
lyi
nter
pret
ingi
nfor
mat
ionont
het
emper
atur
edi
str
ibut
ion.Eachcol
orcor
respondst
oa
speci
fi
ctemper
atur
e.
Endoscopy
Endoscopymeansl
ooki
ngi
nsi
deandr
efer
stol
ooki
ngi
nsi
det
hehumanbodyf
ormedi
cal
r
easonsusi
ngani
nst
rumentcal
ledanendoscope.Endoscopyi
susedt
oassesst
hei
nter
ior
sur
facesofanor
ganbyi
nser
ti
ngat
ubei
ntot
hebody.Thei
nst
rumentmayhaveaf
lexi
blet
ube
andi
tpr
ovi
desani
magef
orvi
suali
nspect
ionandphot
ogr
aphy.I
tal
soenabl
esust
aki
ng
bi
opsi
esandr
etr
ievaloff
orei
gnobj
ect
s.Anendoscopeconsi
stsof1)Af
lexi
blet
ube,
2)Al
ight
del
iver
ysyst
em t
oil
lumi
nat
etheor
ganorobj
ectunderi
nspect
ion.Thel
ightsour
cei
snor
mal
ly
out
sidet
hebodyandt
hel
ighti
stypi
cal
lydi
rect
edvi
aanopt
icalf
ibersyst
em,
3)Al
enssyst
em
t
ransmi
tt
ingt
hei
maget
othevi
ewerf
rom t
hef
iber
scopeand4)Addi
ti
onalchannelt
oal
low
ent
ryofmedi
cal
inst
rument
sormani
pul
ator
s.
Moder
nEndoscopehas,
1)Twol
ightchannel
stoi
ll
umi
nat
est
hear
eaofi
nter
est
;
2)Ani
magechannel
toenabl
ethedoct
ort
oseewhati
shappeni
ng
3)Ani
nst
rumentchannelt
hroughwhi
chi
nst
rument
scanbepl
aced.
4)Cont
rolcabl
est
ocont
rol
thef
ibermovement
5)Ar
angeofspeci
ali
nst
rument
scanbei
nser
tedwhi
chenabl
esdoct
orsnotonl
yto
seei
nsi
det
omakeanaccur
atedi
agnosi
s,butal
sot
ooper
ateont
hedi
scussedar
ea.
Thesespeci
ali
nst
rument
smi
ghtbeneededt
oa)cutoutdi
seasedt
issue,b)t
akea
bi
opsy,
c)sealasi
teofbl
eedi
ngwi
thheat(
caut
eri
zing)andd)r
emoveanobj
ectt
hat
i
scausi
nganobst
ruct
ion.
6)Aneyepi
ecewhi
chi
ncor
por
ates,a)ATVcamer
ab)st
il
lcamer
aandc)Amovi
e
camer
a
Endoscope
Theendoscopehasal
soenabl
eddoct
orst
ocar
ryoutkeyhol
esur
ger
ywher
esur
gicalt
reat
ment
s
canbeappl
iedwi
thouthavi
ngt
omakemaj
ori
nci
sions.Thi
sleadst
olesscompl
icat
ionsandmor
e
r
api
drecover
yoft
hepat
ient
.Ther
ear
emanyt
ypesofendoscopesbasedont
heor
gansonwhi
ch
t
heyar
etobeusedandar
east
heyexpl
ore.Endoscopesusedt
olookdi
rect
lyatt
heovar
ies,
appendi
xorot
herabdomi
nalor
gans,f
orexampl
eiscal
ledl
apar
oscopesandt
het
echni
quei
s
cal
ledl
apar
oscopy.Ot
herendoscopesar
einser
tedt
hroughi
nci
sionst
olookatj
oint
s(ar
thr
oscopy)
ort
hel
ungs(
bronchoscopy)andst
il
lot
her
susedt
ovi
ew t
hei
nsi
deoft
hebl
adder(
cyst
oscopy)
.
Thel
atestdevel
opmenti
stohaveavi
deocamer
aatt
heendoft
heendoscope.Endoscopycanbe
usedt
odi
agnosevar
iouscondi
ti
onsbycl
oseexami
nat
ionofi
nter
nalor
ganandbodyst
ruct
ures.
Endoscopycanal
sogui
det
her
apyandr
epai
r,suchast
her
emovaloft
orncar
ti
lagef
rom t
he
bear
ingsur
facesofaj
oint
.Bi
opsy(
ti
ssuesampl
ingf
orpat
hol
ogi
ctest
ing)mayal
sobeper
for
med
underendoscopi
c gui
dance.Localorgener
alanest
het
ic may be used dur
ing Endoscopy,
dependi
ng upon t
he t
ype ofpr
ocedur
e bei
ng per
for
med.Endoscopyi
s a mi
nimal
lyi
nvasi
ve
pr
ocedur
eandcar
ri
eswi
thi
ncer
tai
nmi
norr
isksdependi
ngupont
het
ypeofpr
ocedur
ebei
ng
per
for
med.However
,theser
isksar
etypi
cal
lyf
aroverwei
ght
edbyt
hedi
agnost
icandt
her
apeut
ic
pot
ent
ialoft
hepr
ocedur
e.Endoscopepr
ocedur
edoesnotr
equi
rehospi
taladmi
ssi
on.Acut
ecar
e
andobser
vat
ionmaybeper
for
medout
sidet
hepr
emi
sesofahospi
tal
.Thi
sal
lowst
hepat
ientt
ogo
homeorr
etur
ntowor
kwi
thi
nashor
twhi
leaf
tert
hepr
ocedur
e.
Di
ff
erentt
ypesofbi
otel
emet
rysyst
ems
Def
ini
ti
on:
Thi
sisat
echni
quei
nwhi
chphysi
ologi
calvar
iabl
esar
emeasur
edatapoi
ntandt
ransmi
tt
edovera
di
stance.Thet
echni
queofbi
otel
emet
rymakesi
tpossi
blet
omoni
torphysi
ologi
calevent
sfr
om a
di
stance.
Appl
icat
ionsofBi
otel
emet
ry:
1)Usedt
oMoni
torECGevenunderer
gonomi
ccondi
ti
ons.
2)Usedt
omoni
torpat
ienti
nanambul
anceandot
herl
ocat
ionsawayf
rom hospi
tal
3)Col
lect
ionofmedi
caldat
afr
om ahomeorof
fi
ce
4)Moni
tor
ingt
heheal
thofast
ronaut
sinspace
5)Resear
chonun-
anest
het
izedani
mal
s
6)I
sol
ati
onofanel
ect
ri
cal
lysuscept
ibl
epat
ientf
rom powerl
ineoper
atedECGequi
pmentt
o
pr
eventacci
dent
alshock.
Desi
gnConsi
der
ati
onsf
orat
elemet
rySyst
em:
1)Si
mpl
i
cit
yoft
het
elemet
rysyst
em
2)Tr
ansmi
ssi
onshoul
dbewi
thmaxi
mum f
idel
i
ty
3)I
nst
all
ati
onofmeasur
ingsyst
em ont
hel
ivi
ngsyst
em shoul
dnoti
nter
fer
ewi
tht
hel
ivi
ng
syst
em
4)Tel
emet
rycomponent
sshoul
dbeorl
esswei
ghtandsi
ze
5)Hi
ghr
eli
abi
li
tyandst
abi
li
tyi
smust
6)Powerconsumpt
ionshoul
dbesmal
l
7)Shi
eldi
ngoft
hecabl
eisamusti
nwi
rebasedt
ransmi
ssi
on.
Tel
emet
rySyst
em:
Tel
emet
ryi
s def
ined as t
he pr
ocess bywhi
ch t
he i
nfor
mat
ion r
egar
ding t
he quant
it
ybei
ng
measur
edi
str
ansmi
tt
edt
oaemot
elocat
ionf
orappl
icat
ionl
ikedat
apr
ocessi
ng,r
ecor
dingor
di
spl
ayi
ng.I
n ot
herwor
ds t
elemet
rymeans measur
ing ata di
stance.Ther
efor
eitbecomes
essent
ialt
otr
ansmi
tdat
athr
oughsomef
orm ofcommuni
cat
ionchannel
s.
Met
hodsofcl
assi
fi
cat
ionofTel
emet
rySyst
ems:
1.Ont
hebasi
soft
hechar
act
eri
sti
csofel
ect
ri
csi
gnalsuchasvol
tage,cur
rent
,posi
ti
on,
f
requencyandpul
se.
2.Basedont
hef
orm ofdat
atr
ansmi
tt
ed–anal
og&Di
git
al.
3.Basedont
ransmi
ssi
ondi
stance–Shor
tdi
stancet
ype&Longdi
stancet
ype.
4.Basedonwhet
heruserhascont
rol
overt
ransmi
ssi
onchannelornot
.
Tel
emet
ry–Bl
ockDi
agr
am
Thephysi
ologi
calquant
it
ytobemeasur
edi
smeasur
edbyasui
tabl
edet
ect
orandgi
vent
othe
t
ransmi
tt
er.Thef
unct
ionoft
het
elemet
ryt
ransmi
tt
eri
stoconver
ttheout
putofapr
imar
ydet
ect
or
i
ntoar
elat
edquant
it
ywhi
chcanbet
ransmi
tt
edoverat
elemet
rychannel
.Thef
unct
ionoft
he
t
elemet
ryr
ecei
veratar
emot
elocat
ioni
stoconver
tthet
ransmi
tt
edsi
gnali
ntoar
elat
edsui
tabl
e
quant
it
y.Ther
efor
einal
lmostal
lel
ect
ri
calt
elemet
rysyst
emst
hequant
it
ytobemeasur
edi
s
conver
tedi
ntoel
ect
ri
calsi
gnalwi
tht
hehel
poft
ransmi
tt
erandi
str
ansmi
tt
edt
hroughat
elemet
ry
channelandi
srecei
vedbyar
ecei
vert
odr
ivedevi
cesatt
heuserend.Theel
ect
ri
calt
elemet
ry
syst
em i
sbr
oadl
ycl
assi
fi
edasDCsyst
emsandACsyst
ems.
DCTel
emet
ry:
I
nDCt
elemet
ri
ngsyst
ems,
thesi
gnali
str
ansmi
tt
edt
hroughat
elemet
ryorcommuni
cat
ionchannel
whi
chusesdi
rectt
ransmi
ssi
onvi
acabl
esi
nor
dert
oconveyt
hedesi
redi
nfor
mat
ion.Thi
sisknown
asl
andl
inet
elemet
ry.
ACTel
emet
ry:
Physi
ologi
calquant
it
iescanal
sobet
ransmi
tt
edusi
ngt
elemet
ri
ngci
rcui
tssuchast
elephone
cabl
es usi
ng t
ransf
ormerand ampl
i
fier
s.AC t
elemet
ryi
s used bot
hforl
and l
ine and r
adi
o
f
requencyai
rbor
net
elemet
ryt
echni
ques.El
ect
roni
cmeansar
eusedf
orsensor
sthatpr
ovi
dean
ACout
put
/vol
taget
ofr
equencyconver
ter
.Thedat
aavai
labl
eint
hef
orm ofcur
rentorvol
tage
whi
chi
ngener
ali
sweakt
obecar
ri
edoverasi
tis.Hencei
tismodul
atedwi
thcar
ri
ersi
gnal
sfor
t
ransmi
ssi
on.These modul
ated si
gnal
s ar
e demodul
ated att
he r
ecei
ving end whi
ch means
r
ecover
ingt
heor
igi
nalsi
gnalf
rom car
ri
erwave.Basi
cal
lyt
her
ear
ethr
eet
ypesofmodul
ati
on
dependi
ngupont
hesi
gnal
stobet
ransmi
tt
ed,
theyar
e,
1.Ampl
it
udeModul
ati
on:I
nthi
stypeofmodul
ati
ont
heampl
it
udeoft
hecar
ri
eri
svar
iedi
n
accor
dancewi
tht
hesi
gnalt
obet
ransmi
tt
ed.
2.Fr
equencyModul
ati
on:I
nthi
stypeofmodul
ati
ont
hei
nst
ant
aneousf
requencyoft
hecar
ri
eri
s
var
iedi
naccor
dancewi
tht
heampl
it
udeoft
hemodul
ati
ngsi
gnal
.
3.PhaseModul
ati
on:Her
ePhaseangl
eQi
svar
iedi
naccor
dancet
othet
ransmi
tt
edsi
gnal
.
Communi
cat
ionChannel
s(or
)Tr
ansmi
ssi
onMedi
a:
1.Themostwi
del
yusedcommuni
cat
ionchannel
sar
ecabl
esandel
ect
romagnet
icr
adi
ati
onr
adi
o
l
inks.Opt
ical
,ul
tr
asoni
candmagnet
ici
nduct
iondat
ali
nksar
eal
sousedf
ormanyappl
icat
ions.
2.Landl
inet
elemet
ryut
il
izescabl
esorwi
rest
otr
ansmi
tdat
a.
3.Whendat
aist
obet
ransmi
tt
edf
ormor
ethan1Km,r
adi
oli
nksar
epr
efer
redf
orwhi
chcer
tai
n
r
adi
ofr
equencyspect
rum ar
eal
locat
edf
ort
elemet
rypur
pose.
4.Forf
requencyabove30MHzmi
crowavel
inksar
eusedwhi
chr
equi
rer
epeat
erst
ati
onsata
di
stanceofever
y30Km ast
her
adi
owavet
ravel
sinast
rai
ghtl
ine.
5.Forshor
tranget
ransmi
ssi
onupt
o50met
ersf
orexampl
esomer
otar
ymachi
ner
yandpower
l
inesuseei
therf
requencymodul
atedsyst
em.
6.Opt
icall
inksusi
ngl
aserar
eusedf
ormostbi
omedi
calappl
icat
ions.
Bi
otel
emet
ryTr
ansmi
tt
er:
Bi
otel
emet
ryTr
ansmi
tt
er–Bl
ockDi
agr
am
Physi
ologi
calsi
gnal
sar
eobt
ainedf
rom t
hesubj
ectbymeansofappr
opr
iat
etr
ansducer
s.The
si
gnali
sthenpassedt
hroughast
ateofampl
if
icat
ionandpr
ocessi
ngci
rcui
ts.Thent
hesi
gnali
s
modul
atedwi
thacar
ri
erandpassedont
othet
ransmi
ssi
onmedi
um.
Bi
otel
emet
ryRecei
ver
:
Bi
otel
emet
ryRecei
ver–Bl
ockDi
agr
am
Att
her
ecei
versi
deoft
hebi
otel
emet
rysyst
em,
thet
ransmi
tt
ingf
requencyi
ssel
ect
edbyat
uner
.A
demodul
atort
hendemodul
atest
het
ransmi
tt
edsi
gnalt
orecovert
heor
igi
naldat
a.Theor
igi
naldat
a
si
gnali
sthenst
oredordi
spl
ayedasneeded.
Tr
ansmi
ssi
onofBi
omedi
calAnal
ogsi
gnal
overTel
ephoneLi
nes:
Tel
ephonet
elemet
rysyst
em maybeusedf
ort
ransmi
tt
ingandr
ecei
vingmedi
calsi
gnal
s.For
f
requencymodul
ati
on,ar
eact
ancemodul
atorhasbeenusedwi
thacent
ref
requencyof1500Hz.
Thi
sfr
equencyi
smodul
atedt
o+200Hzf
orapeak–t
o–peaksi
gnal
.Thi
sdevi
ati
oni
sli
near
wi
thi
na1%r
ange.Thedemodul
atorconsi
stsofanaudi
oampl
if
ier
,acar
ri
err
eject
ionf
il
ter
,anda
l
ow passi
ntegr
atorout
putci
rcui
ttor
ecovert
hei
nputsi
gnal
.Bot
hatt
het
ransmi
tt
ingaswel
las
r
ecei
vingends,coupl
ingori
sol
ati
ont
ransf
ormer
sar
eusedt
omat
cht
hest
andar
dtel
ephonel
ine
i
mpedance.Tel
ephonel
inescanhavenoi
sei
nter
fer
ence.Thi
snoi
sewi
llpr
oducesi
gni
fi
cance
ar
ti
fact
sint
heAM andFM modul
ati
onschemes.Ther
efor
e,nowadaysonl
ineer
rorcor
rect
ion
t
echni
quesar
efol
lowed.
Tr
ansmi
ssi
onofBi
omedi
cal
Anal
ogsi
gnal
overTel
ephoneLi
nes–Bl
ockDi
agr
am
Radi
oPi
ll
:
Radi
oPi
lli
susedi
nbi
otel
emet
ry.Bi
otel
emet
ryi
sthet
ransmi
ssi
onofbi
ologi
calsi
gnal
s.The
pr
inci
palmet
hod oft
ransmi
ssi
on i
n any bi
omedi
calmeasur
ementsyst
em i
s el
ect
ri
cal
.A
t
ransducerconver
tst
hesi
gnalt
obemeasur
edi
ntoanel
ect
ri
calf
orm whi
chcant
henbeampl
if
ied,
di
git
izedori
not
herwor
dspr
ocessedsot
hati
tissui
tabl
efort
ransmi
ssi
on,
eit
hert
oot
herpar
tsof
t
hesyst
em,
ort
oadi
ff
erentpl
ace.
Ther
ear
eanumberofsi
tuat
ionsi
nwhi
chdi
rectel
ect
ri
calconnect
ionsar
eei
theri
mpossi
bleor
undesi
rabl
e.Forexampl
e,moni
tor
ingofmot
her
sinl
abor
,moni
tor
ingast
ronaut
sinspaceand
moni
tor
ingcar
diacpat
ient
sdur
ingr
ecover
y.I
nsuchci
rcumst
ances,amet
hodoft
ransmi
tt
ing
si
gnal
soveradi
stancebecomesnecessar
y.Thi
siscal
ledbi
otel
emet
ry.Oneoft
hesi
mpl
est
exampl
esofbi
otel
emet
rysyst
emsi
sthest
ethoscope.Her
e,t
hesound oft
hehear
tbeati
s
ampl
if
iedacoust
ical
lyandt
ransmi
tt
edvi
aat
ubet
otheearoft
hephysi
cian.
Tr
ansmi
ssi
onofel
ect
ri
calsi
gnalofhear
tist
hemostcommonexampl
eofbi
otel
emet
ry.Theuseof
car
diacsi
gnalbasedbi
otel
emet
ryi
ssucht
hatt
hecar
diol
ogi
sti
nter
pret
stheel
ect
ri
calsi
gnalofan
emer
gencypat
ientandi
nst
ruct
stheambul
ancecr
ew/
per
sonneli
nresusci
tat
ionpr
ocedur
es.The
met
hodsofcommuni
cat
ionar
eusual
lyr
adi
omeans,andhencecal
l
edr
adi
otel
emet
ry. Ot
her
f
requentusesar
einmoni
tor
ingpat
ient
swhohavecer
tai
ncondi
ti
onswhi
chputt
hem atr
isk.I
n
t
hesecasesi
tmaybenecessar
ytoi
mpl
antt
het
ransducer
,tr
ansmi
tt
erandpowersuppl
yina
si
ngl
eassembl
y.Thi
sassembl
yiscal
ledt
her
adi
opi
ll
.Ther
adi
opi
lli
sei
therswal
lowedor
i
ntr
oducedsur
gical
ly.Ther
adi
otr
ansmi
tt
eri
sessent
ial
lyanel
ect
roni
cci
rcui
twhi
chpr
oducesan
al
ter
nat
ingcur
rent(
osci
ll
ator
).Thi
sgener
atesar
adi
owavewhi
chi
sdet
ect
edi
nacor
respondi
ng
coi
l,(
recei
ver
).Ther
adi
opi
llmeasur
eimpor
tantpar
amet
erssuchaspr
essur
e,t
emper
atur
eof
var
iousbodycavi
ti
es(
vascul
arsyst
em,st
omach,i
ntest
ine)
,pH ofst
omachandesophagusand
t
ransmi
tsi
ttocor
respondi
ngr
ecei
ver
s.Thewhol
eassembl
ycompr
isi
ngoft
ransducer
,si
gnal
pr
ocessor
,tr
ansmi
tt
er,andpowersuppl
yal
lcomemi
niat
ure,encapsul
atedpi
ll
ssot
hatt
heyar
e
pr
otect
edf
rom bodyf
lui
ds.
Pat
ientMoni
tor
ingSyst
em
Bedsi
dePat
ientMoni
tor
ing:
Pat
ientMoni
tor
ingsyst
em i
nvol
vescont
inuousmeasur
ementandmoni
tor
ingofphysi
ologi
cal
par
amet
ersl
iker
espi
rat
oryr
ate,
bodyt
emper
atur
e,bl
oodpr
essur
eandhear
trat
e.I
nspeci
alcases,
addi
ti
onalmoni
tor
ing oft
heECG,EEG,EMG,phonocar
diogr
am,GSR ar
eal
so measur
ed and
moni
tor
ed.I
napat
ientmoni
tor
ingsyst
em,t
het
ransducer
susedmustber
eli
abl
eandsi
mpl
ein
const
ruct
ion.Thebedsi
demoni
tor
sconsi
stofi
ndi
vidualuni
tswhi
chmaybewal
lorshel
fmount
ed.
Al
lthet
ransducer
stomeasur
evar
iousphysi
ologi
calpar
amet
ersar
elocat
edatt
her
egi
onof
i
nter
estont
hepat
ientandt
heel
ect
ri
cal
lyconver
tedphysi
ologi
calsi
gnal
sar
etr
ansmi
tt
edt
hrough
wi
rest
othebed si
demoni
torwher
eiti
sdi
spl
ayed asei
theranal
og ordi
git
alsi
gnal
s.For
measur
ingt
her
espi
rat
ionr
ateat
her
mist
ori
spl
acedneart
henasalopeni
ngi
sused.Whent
he
pat
ientbr
eat
hesoutt
hevar
iat
ionofr
esi
stancecangi
veani
ndi
cat
ionoft
her
espi
rat
oryr
ate.For
pr
essur
emeasur
ement
,thest
rai
ngauget
ransduceri
sused.Forpul
semeasur
ementphot
oel
ect
ri
c
f
ingerpul
semoni
tori
sused.
Bl
ockDi
agr
am –Bedsi
deMoni
tor
ing
Cent
ralMoni
tor
ingSyst
em:
Thecent
ralmoni
tor
ingsyst
em t
hephysi
ologi
calval
uesofpat
ient
sar
emeasur
edatbedsi
deand
t
hesear
edi
spl
ayedandr
ecor
dedatacent
ralst
ati
on.Thephysi
ologi
calpar
amet
ersmeasur
edat
t
hebedsi
dei
ncl
ude,
 ECG
 Respi
rat
ionRat
e
 Bl
oodPr
essur
e
 Temper
atur
e
 Pul
seRat
e
 OxygenSat
urat
ioni
nbl
ood
Theel
ect
roni
cswhi
chai
dformeasur
ementandt
hesi
gnalcondi
ti
oner
sar
elocat
edatt
hebedsi
de
wher
eas t
he di
spl
ay,r
ecor
der
s,al
arms et
c.,ar
elocat
ed att
he cent
ralst
ati
on.The cent
ral
moni
tor
ingsyst
em i
nbui
ltupwi
thmanymi
cropr
ocessor
swhi
chenabl
ethesmoot
hdi
spl
ayof
wavef
orms,
alphanumer
icsandgr
aphi
csonasi
ngl
eCRT.Thecent
ralmoni
tor
ingsyst
em pr
ovi
des
al
lmeasur
edi
nfor
mat
ionatagl
ance.I
tgener
atesaudi
bleandvi
sualal
armsi
ftheval
uesmeasur
ed
exceedt
hei
rpr
esetl
imi
t.I
tdi
spl
ayst
hepat
ient
’svi
talsi
gndat
a.Tr
endpl
otsofpat
ient
’svi
talsi
gn
ar
eal
soavai
l
abl
ewhi
chwi
llgui
def
orpat
ient
’st
her
apy.Tr
endpl
otsmaybel
ongt
rend(
9hourt
o24
hour
)orshor
ttr
end(
90mi
nut
es)
.Thei
nfor
mat
ion(
physi
ologi
calpar
amet
ers)f
rom pat
ientbedsi
de
l
ikebl
oodpr
essur
es,
ECG,
hear
trat
e,r
espi
rat
ion,
endt
idalCO2andt
emper
atur
ear
etr
ansmi
tt
edas
anal
ogsi
gnal
sthr
oughcabl
es.St
atussi
gnal
sli
keal
arm si
gnal
sar
eal
socar
ri
edbyt
hesamecabl
e.
Thei
ncomi
ngphysi
ologi
calval
uesar
esampl
edanddi
git
izedby10–bi
tanal
ogt
odi
git
alconver
ter
.
ECGwavef
ormsar
esampl
edever
ytwomi
ll
isecondst
omai
ntai
nthe0–100Hz.Temper
atur
eis
sampl
edever
yfourseconds.
Thedi
spl
ayhast
wosect
ions,
i
) Rast
erTypeDi
spl
ay–ForWavef
orms
i
i) 300*200pi
ctur
eel
ementbi
tmap–Foral
phanumer
ics
Thehar
dcopyoft
hewavef
ormscanal
sobeobt
ained.Wavef
ormscanal
sobet
empor
ari
lyst
ored
f
oratl
east24hour
s.CMOSRAM i
sused.Al
armscanbebot
haudi
bleandvi
sual
.Audi
bleal
arms
canbedi
sti
ngui
shedbyvar
yingt
hepi
tch,
vol
ume,
dur
ati
onandsequenci
ngoft
ones.Vi
sualal
arms
canbei
ndi
cat
edbyvar
yingt
hecol
orofdi
spl
ayont
hemoni
torscr
een.Al
arm condi
ti
onscanbe
capt
uredi
nhar
dcopy.Cent
ralmoni
tor
ingi
nst
all
ati
ons,
stor
esal
lwavef
orms,
numer
icsandr
etai
ns
i
tforaccessupt
o3daysoft
hedi
schar
geofpat
ientf
rom hospi
tal
.Att
hebedsi
deel
ect
rodesand
t
ransducer
sorsensor
sar
eat
tachedf
ormeasur
ingvar
iousphysi
ologi
calpar
amet
ers.
Bl
ockDi
agr
am –Cent
ral
Moni
tor
ingSyst
em
Si
gnal
sfr
om t
heset
ransducer
sampl
if
iedt
hroughanar
rayofi
nputampl
if
ier
sandpassedt
hrough
cer
tai
nsi
gnalcondi
ti
oni
ngci
rcui
tsf
orf
urt
herpr
ocessi
ng.Thesi
gnal
sar
elocal
lydi
spl
ayedona
moni
torandal
sor
ecor
dedbyal
ocalst
ri
pchar
trecor
der
.Localal
armsar
eal
sopr
ovi
dedt
oal
ert
t
hest
affi
fanypar
amet
ergoesbeyondt
hreshol
dli
mit
s.Ther
eisat
ransmi
ssi
onpat
hbet
weent
he
bedsi
deandcent
ralst
ati
onal
socal
ledt
henur
sest
ati
on.Thi
str
ansmi
ssi
onpat
hmaybeanal
ogor
di
git
alandt
hrought
hist
hecondi
ti
onedphysi
ologi
calpar
amet
ersar
etr
ansmi
tt
edt
othecent
ral
si
de.Att
hecent
ralsi
dedat
afr
om numberofpat
ient
sar
eobt
ainedanddi
spl
ayedsi
mul
taneousl
y
ont
hescr
eenofavi
deot
ermi
nal
.
Amul
ti
-conduct
orcabl
eact
sast
het
ransmi
ssi
onpat
hinmostcent
ralmoni
tor
ingsyst
ems.Thi
s
cabl
ecar
ri
esal
lphysi
ologi
calpar
amet
ersl
ikeECG,
pressur
e,oxygensat
urat
ionet
c.,
I
ntr
oduct
iont
oBi
omet
ri
cSyst
ems
Bi
omet
ri
cs:Def
ini
ti
on
Bi
omet
ri
csi
sagener
alt
erm usedal
ter
nat
ivel
ytodescr
ibeachar
act
eri
sti
corapr
ocess.
Asachar
act
eri
sti
c,bi
omet
ri
cscanbedef
inedasameasur
abl
ebi
ologi
cal(
anat
omi
caland
physi
ologi
cal
)andbehavi
oral
char
act
eri
sti
cthatcanbeusedf
oraut
omat
edr
ecogni
ti
on.
Asapr
ocess,
biomet
ri
cscanbedef
inedasan
aut
omat
edmet
hodsofr
ecogni
zingani
ndi
vidual
basedonmeasur
abl
ebi
ologi
cal(
anat
omi
cal
andphysi
ologi
cal
)andbehavi
oralchar
act
eri
sti
cs.
Bi
omet
ri
cSyst
em:Def
ini
ti
on
Bi
omet
ri
cSyst
em canbecal
ledt
hest
ati
sti
cal
studyofbi
ologi
calphenomena.I
tcanbecal
ledas
t
hesyst
em f
ormeasur
ementofphysi
cal
char
act
eri
sti
cs,
suchasf
inger
pri
nts,
DNA,
orr
eti
nal
pat
ter
ns,
signat
urer
ecogni
ti
onf
orusei
nver
if
yingt
hei
dent
it
yofi
ndi
vidual
s.
Bi
omet
ri
cSyst
em:Appl
icat
ion
Bi
omet
ri
ctechnol
ogyhasbeenusedi
nmanyappl
icat
ionst
oincr
easet
hesecur
it
yofpasswor
d
basedi
dent
it
y.
Bi
omet
ri
cSyst
em:
Agoodbi
omet
ri
csyst
em mustensur
ethat(
1)t
hebi
omet
ri
cinf
ormat
ioncomesf
rom al
i
veper
son
att
het
imeofver
if
icat
ion,
and(
2)t
hebi
omet
ri
cinf
ormat
ionmat
chest
hemast
erbi
omet
ri
cdat
aon
f
il
e.Bi
omet
ri
cSyst
em compr
isesofmul
ti
plei
ndi
vidualcomponent
s(suchassensor
,mat
chi
ng
al
gor
it
hm,
andr
esul
tdi
spl
ay)t
hatcombi
net
omakeaf
ull
yoper
ati
onalsyst
em.
Abi
omet
ri
csyst
em i
sanaut
omat
edsyst
em capabl
eof
:
1.Capt
uri
ngabi
omet
ri
csampl
efr
om anenduser
2.Ext
ract
ingandpr
ocessi
ngt
hebi
omet
ri
cdat
afr
om t
hatsampl
e
3.St
ori
ngt
heext
ract
edi
nfor
mat
ioni
nadat
abase
4.Compar
ingt
hebi
omet
ri
cdat
awi
thdat
acont
ainedi
noneormor
eref
erencer
efer
ences
5.Deci
dinghowwel
ltheymat
chandi
ndi
cat
ingwhet
herornotani
dent
if
icat
ionorver
if
icat
ionof
i
dent
it
yhasbeenachi
eved.
Thebl
ockdi
agr
am ofabi
omet
ri
csyst
em i
sshownbel
ow.Themai
noper
ati
onsabi
omet
ri
csyst
em
canper
for
m ar
e1)enr
oll
ment
and
2)t
est
.Dur
ingt
heenr
oll
ment
,bi
omet
ri
cinf
ormat
ionf
rom an
i
ndi
viduali
sst
ored.Dur
ingt
het
est
,bi
omet
ri
cinf
ormat
ioni
sdet
ect
edandcompar
edwi
tht
he
st
oredi
nfor
mat
ion.
Thef
ir
stbl
ock(
sensor
)ist
hei
nter
facebet
weent
her
ealwor
ldandt
hebi
omet
ri
csyst
em.I
thast
o
acqui
real
lthenecessar
ydat
a.I
tismost
lyani
mageacqui
sit
ionsyst
em.
Thesecondbl
ock(
prepr
ocessor
)per
for
msal
lthenecessar
ypr
e-pr
ocessi
ng.I
tremovesar
ti
fact
sif
anyf
rom t
hesensor
,toenhancet
hei
nput(
e.g.r
emovi
ngbackgr
oundnoi
se)
,tousesomeki
ndof
nor
mal
izat
ion,
etc.
Bl
ockDi
agr
am –Asi
mpl
eBi
omet
ri
cSyst
em
I
nthet
hir
dbl
ock(
feat
ureext
ract
ion)f
eat
uresneededar
eext
ract
ed.Thi
sst
epi
sani
mpor
tantst
ep
ast
hecor
rectf
eat
uresneedt
obeext
ract
ed.
Thenextbl
ocki
s(Templ
ateGener
ator
).Avect
orofani
magewi
thpar
ti
cul
arpr
oper
ti
esi
susedt
o
cr
eat
ea
templ
ate.At
empl
atei
sasynt
hesi
sofal
lthechar
act
eri
sti
csext
ract
edf
rom t
hesour
ce,
in
t
heopt
imalsi
zet
oal
lowf
oradequat
eident
if
iabi
li
ty.I
fenr
oll
menti
sbei
ngper
for
medt
het
empl
ate
i
ssi
mpl
yst
oredsomewher
e(onamemor
ycar
dorwi
thi
nadat
abaseorbot
h).
I
famat
chi
ngphasei
sbei
ngper
for
med,
theobt
ainedt
empl
atei
spassedt
oamat
cher(
thenext
bl
ock)t
hatcompar
esi
twi
thot
herexi
sti
ngt
empl
ates,
est
imat
ingt
hedi
stancebet
weent
hem usi
ng
anyal
gor
it
hm (
e.g.Hammi
ngdi
stanceal
gor
it
hm)
.Themat
chi
ngpr
ogr
am wi
llanal
yzet
het
empl
ate
wi
tht
hei
nput
.Thi
swi
llt
henbeout
put(
appl
icat
iondevi
ce)f
oranyspeci
fi
eduseorpur
pose(
e.g.
ent
rancei
nar
est
ri
ctedar
ea)
.
Abi
omet
ri
csyst
em canpr
ovi
det
hef
oll
owi
ngt
wof
unct
ions:
 Ver
if
icat
ion:
Aut
hent
icat
esi
tsuser
sinconj
unct
ionwi
thasmar
tcar
d,user
nameorI
Dnumber
.
Thebi
omet
ri
ctempl
atecapt
uredi
scompar
edwi
tht
hatst
oredagai
nstt
her
egi
ster
eduserei
ther
onasmar
tcar
dordat
abasef
orver
if
icat
ion.
I
dent
if
icat
ion:
Aut
hent
icat
esi
tsuser
sfr
om t
hebi
omet
ri
cchar
act
eri
sti
cal
onewi
thoutt
heuseof
smar
tcar
ds,
user
namesorI
Dnumber
s.Thebi
omet
ri
ctempl
atei
scompar
edt
oal
lrecor
ds
wi
thi
nthedat
abaseandacl
osestmat
chscor
eisr
etur
ned.Thecl
osestmat
chwi
thi
ntheal
lowed
t
hreshol
disdeemedt
hei
ndi
vidual
andaut
hent
icat
ed.
UNI
TV
LI
FEASSI
STI
NG,
THERAPEUTI
CANDROBOTI
CDEVI
CES:Pacemaker
s–Def
ibr
il
lat
ors–
Vent
il
ator
s–Ner
veandmuscl
est
imul
ator
s–Di
ather
my–Hear
t–Lungmachi
ne–Audi
o
met
ers–Di
alyser
s–Li
thot
ri
psy-I
CCUpat
ientmoni
tor
ingsyst
em -NanoRobot
s-Robot
ic
sur
ger
y–Advanced3Dsur
gicalt
echni
ques-Or
thopedi
cpr
ost
hesesf
ixat
ion.
Pacemaker
s
I
ntr
oduct
ion:
Ther
hyt
hmi
cact
ionofhear
tisi
nit
iat
edbyr
egul
arl
yrecur
ri
ngact
ionpot
ent
ial
sor
igi
nat
ing
att
he nat
uralcar
diac pacemaker
,whi
ch i
slocat
ed att
he si
noaur
icul
arnode.Each
t
ri
gger
ingpul
seoft
hepaci
ngi
mpul
sei
spr
opagat
edt
hrought
hemyocar
dium,spr
eadi
ng
overt
othesur
faceoft
heat
ri
atot
heAVnodewhi
chi
slocat
edwi
thi
nthesept
um,
adj
acent
t
otheat
ri
ovent
ri
cul
arval
vesanddepol
ari
zingt
heat
ri
a.Af
terabr
iefdel
ayatt
heAVnode,
t
he i
mpul
se i
srapi
dly conduct
ed t
othe vent
ri
cles t
o depol
ari
ze,t
he vent
ri
cul
ar
muscul
atur
e.I
nabnor
malsi
tuat
ions,t
henat
uralpacemakerceasest
ofunct
ion,becomes
unr
eli
abl
e ort
he t
ri
gger
ing pul
se does notr
each t
he hear
tmuscul
atur
e because of
bl
ockageduet
odamagedt
issues.Sot
her
hyt
hmi
chear
tact
ionget
sdi
stur
bed.Becauseof
t
hist
hepumpi
ngmechani
sm i
sal
sodi
stur
bed,
leadi
ngt
osei
zur
eanddeat
h.
Ther
efor
ebygi
vingext
ernalel
ect
ri
calst
imul
ati
oni
mpul
sest
othehear
tmuscl
e,i
tis
possi
blet
oregul
atet
hehear
trat
e,whent
henat
ural
car
diacpacemakerf
ail
stof
unct
ion.
Theel
ect
roni
cinst
rumentwhi
chgi
vest
hesei
mpul
sesi
scal
ledapacemaker
.
Pacemaker–El
ect
rodesyst
em,
Par
ts,
Types:
I
ngener
al,
pacemaker
sar
eusedi
nthet
reat
mentofbr
adycar
dia,
tachycar
diaandot
her
ar
rhyt
hmi
arel
atedt
opat
hol
ogi
calabnor
mal
it
iesi
ntheSAnode,
AVnodeandPur
kinj
e
syst
em.
Car
diacpacemaker
sar
eessent
ial
lyl
owcur
rent
,lowdut
ycycl
est
imul
ator
sandt
heydel
iver
per
iodi
cel
ect
ri
cali
mpul
sesconduct
edt
oel
ect
rodespl
acedont
hesur
faceoft
hehear
t
muscl
e.Thewavef
ormsusedf
orpaci
ngar
eroundt
oppedr
ect
angul
arpul
sesof1t
o3ms
dur
ati
onandhaver
atesadj
ust
abl
efr
om 50t
o150pul
sespermi
nut
e.Theel
ect
rodescan
bebot
hbi
pol
aranduni
pol
arsyst
ems.I
nbi
pol
arsyst
ems,
twoel
ect
rodesar
epl
acedont
he
hear
tformyocar
dialst
imul
ati
on.I
nuni
pol
arsyst
em oneel
ect
rodei
spl
acedont
hehear
t
andt
heot
herel
ect
rodei
sconnect
edt
othenegat
ivet
ermi
naloft
hepacemaker
,soast
o
r
esembl
ethenor
mal
depol
ari
zat
ionoft
hehear
t.Apacemakerbasi
cal
lyconsi
stsoft
wo
par
tsnamel
y,
1.Anel
ect
roni
cuni
twhi
chgener
atesst
imul
ati
ngi
mpul
sesofcont
rol
ledr
ateand
ampl
it
ude.
2.Al
eadwhi
chcar
ri
est
heel
ect
ri
calpul
sesf
rom t
hepul
segener
atort
othehear
t.
Pacemakercanbecl
assi
fi
edasext
ernalpacemakerandi
nter
nalpacemakerdependi
ngon
t
hei
rpl
acement
.
Ext
ernalPacemaker
:
Thesear
epl
acedout
sidet
hebodyandt
hewi
regoest
othehear
tvi
athevei
n.
Repl
acementofbat
ter
iesandci
rcui
ttr
oubl
eshoot
ingi
seasy.
Thesear
eusedi
ncaseoft
empor
aryhear
tir
regul
ari
ti
es.
Thesear
epr
onet
oext
ernalenvi
ronment
alef
fect
s.
I
nter
nalPacemaker
:
Al
socal
ledi
mpl
ant
edpacemaker
sbecauset
heysur
gical
lyi
mpl
ant
edbeneat
htheski
n
neart
hechestorabdomenwi
thi
tsout
putl
eadsconnect
eddi
rect
lyt
othehear
tmuscl
e.
Repl
acementofbat
ter
iesandt
roubl
eshoot
ingofci
rcui
tcanbedoneonl
yaf
tersur
ger
y.No
ext
ernalenvi
ronment
aldi
stur
bances.
TypesofPacemaker
sbasedonOper
ati
on:
1.Vent
ri
cul
arasynchr
onouspacemaker
2.Vent
ri
cul
arsynchr
onouspacemaker
3.Vent
ri
cul
ari
nhi
bit
edpacemaker
4.At
ri
alsynchr
onouspacemaker
5.At
ri
alsequent
ialvent
ri
cul
ari
nhi
bit
edpacemaker
1.Vent
ri
cul
arAsynchr
onousPacemaker
:
Anasynchr
onouspacemakeri
saf
reer
unni
ngosci
ll
atorwhoseel
ect
ri
calpul
sesappearat
auni
for
mrat
e.Thevar
iousbl
ocksar
easf
oll
ows,
Vent
ri
cul
arAsynchr
onousPacemaker-Bl
ock
PowerSuppl
y:
Pr
imar
ybat
ter
iesgi
ving6t
o9vol
tsar
ether
efor
ecommonl
yusedasapowersuppl
y
sour
ce.Li
thi
um bat
ter
ieswhi
chhaveal
if
eti
meoft
enyear
sar
eused.Anext
ernalpower
sour
cecanbeusedespeci
all
yfori
mpl
ant
abl
epacemaker
s.Her
ethepr
imar
yoft
he
i
nduct
ioncoi
lispl
acedcl
oset
othesur
faceoft
heski
n.Undert
heski
nisasmal
leri
nter
nal
subcut
aneouscoi
l,
whi
chi
spl
acedi
nahar
nessal
ongwi
thi
tspowerampl
if
ierandbat
ter
y
powerRFosci
ll
ator
.
Basi
cPacemaker
Char
gingi
sdonet
othei
nduct
ionoft
hevol
tagef
rom t
heext
ernalcoi
ltot
hei
nter
nalcoi
l.
Thei
nducedvol
tagei
srect
if
ied,
fil
ter
edandf
edt
oavol
tager
egul
atorsot
hataconst
ant
vol
tagei
spr
ovi
dedt
othei
mpl
ant
edpacemakerevenwhent
hepat
ientmoves.Thi
svol
tage
char
gesabat
ter
ywhi
chpower
sthei
mpl
ant
edpacemaker
.
Osci
ll
ator
:
Theosci
ll
atorpr
ovi
desst
imul
uspul
sesataconst
antr
ate.Af
reer
unni
ngbl
ocki
ng
osci
ll
atororamul
tivi
brat
ori
scommonl
yused.Thef
igur
ebel
owshowsabl
ocki
ng
osci
ll
ator
.Whenpoweri
sappl
ied,
the3mi
croFar
adcapaci
tori
schar
gedt
hrought
he1MΩ
r
esi
storandr
eachesavol
taget
hatf
orwar
dbi
asest
hebase–emi
tt
erj
unct
ionoft
ransi
stor
Q1andQ2i
sthust
urnedON.Thi
sresul
tsi
nacol
lect
orcur
rentpassi
ngt
hrought
he
t
ransf
ormerpr
imar
yandanemi
tt
ercur
rentf
lowi
ngt
hrought
he10KΩemi
tt
err
esi
stance.
Thecol
lect
orcur
renti
nQ1causescur
rentt
obei
nducedi
nthesecondar
yoft
he
t
ransf
ormert
hatdi
schar
gest
hecapaci
torandt
urnsOFFQ1.Thepr
ocesst
henr
epeat
s
i
tsel
ftopr
oduceapul
set
rai
n.Theout
putci
rcui
twhi
champl
if
iest
heel
ect
ri
calpul
se
consi
stsofat
ransi
storoper
atedasaswi
tchandanappr
opr
iat
ecoupl
ingci
rcui
ttot
he
el
ect
rodes.Q2oper
atesasani
nver
terandi
scoupl
edt
otheel
ect
rodest
hrough5mi
cro
Far
adcapaci
tor
.
Osci
ll
ator
Theasynchr
onouspacemakerpr
oducespul
sesataf
ixedr
atebet
ween70t
o90beat
sper
mi
nut
e,t
hei
rwi
dthr
angesf
rom 0.
5to2msandampl
it
udef
rom 5t
o9Vol
ts.
LeadWi
res:
Leadwi
resar
eint
erwoundhel
icalcoi
lsofspr
ingwi
real
loymoul
dedi
nasi
li
conr
ubber
cyl
i
nder
.Thebasi
crequi
rement
sar
ethatt
heyshoul
dbegoodel
ect
ri
calconduct
ors,
they
shoul
dbemechani
cal
lyst
rongandshoul
dwi
thst
andst
ressofmovement
s.
El
ect
rodes:
Theel
ect
rodesmustwi
thst
andf
lexi
ngduet
othepumpi
ngact
ionoft
hehear
tandmustbe
abl
etost
il
lremai
ninpl
ace.Pl
ati
num whi
chi
schemi
cal
lyi
ner
tisusedf
orpacemaker
el
ect
rodes.Thesear
ewel
dedt
ospeci
all
eadwi
real
loyst
oavi
dleadwi
rel
eakage.Car
diac
pacemaker
suseei
theruni
pol
arorbi
pol
art
ypeofel
ect
rodepl
acement
.Int
heuni
pol
ar
syst
em,
oneel
ect
rodei
sincont
actwi
tht
hehear
ttowhi
chnegat
ivegoi
ngpul
sesar
e
connect
edf
rom t
heosci
ll
atorandal
argei
ndi
ff
erentel
ect
rodei
slocat
edel
sewher
eint
he
body.I
nthebi
pol
art
echni
que,
twoel
ect
rodesar
epl
acedont
hehear
tandt
hest
imul
usi
s
appl
iedacr
osst
heseel
ect
rodes.Theel
ect
rodesar
epl
acedei
theront
heext
ernalsur
faces
oft
hehear
t,bur
iedwi
thi
nthehear
twal
lorpr
essedagai
nstt
hei
nsi
desur
faceoft
hehear
t,
i
nwhi
chcasei
tispossi
blet
oint
roducet
heel
ect
rodesi
ntot
hehear
tthr
oughashoul
deror
aneck-
vei
n.
2.Vent
ri
cul
arSynchr
onousPacemaker
:
Thi
stypeofpacemakeri
susedonpat
ient
swi
thonl
yshor
tper
iodsofAVbl
ockorbundl
e
bl
ock.
Vent
ri
cul
arSynchr
onousPacemaker–Bl
ock
I
tconsi
stsofasi
ngl
etr
ansver
seel
ect
rodepl
acedi
nther
ightvent
ri
clewhi
chsensest
heR
waveandal
sodel
iver
sthest
imul
ati
onpul
ses.I
mmedi
atel
yaf
tersensi
ngt
heRwavef
rom
anat
ri
algener
atedvent
ri
cul
arcont
ract
ion,
thi
spacemakerpr
ovi
desani
mpul
sef
all
ingi
n
t
hel
owerpar
toft
henor
malQRScompl
ex.Pul
sesar
epr
ovi
dedonl
ywhent
heat
ri
al
gener
atedvent
ri
cul
arcont
ract
ionsar
eabsent
.Ifanat
uralcont
ract
ionoccur
s,t
he
pacemakert
imi
ngci
rcui
tisr
esetsucht
hati
twi
l
lti
mei
tsnextpul
set
odet
ecthear
tbeat
.
Thi
ssynchr
onouspacemakeremi
tsani
mpul
sewi
tht
heoccur
renceofeachsensedR
wave.Thei
mpul
sesar
etr
ansmi
tt
edt
othemyocar
dium dur
ingi
tsabsol
uter
efr
act
ory
per
iodsot
hati
twi
ll
havenoef
fectont
henor
malhear
tact
ivi
ty.Absol
uter
efr
act
oryper
iod
i
sthet
imedur
ingwhi
cht
heampl
i
fieri
nthesensi
ngci
rcui
twi
llnotr
espondt
oout
side
si
gnal
s.
3.Vent
ri
cul
arI
nhi
bit
edPacemaker
:
Thevent
ri
cul
ari
nhi
bit
edpacemakeri
ssi
mil
art
ovent
ri
cul
arsynchr
onouspacemaker
.Thi
s
al
sosensest
hepr
esenceorabsenceofanat
ural
lyoccur
ri
ngRwave.I
nthi
stypeof
pacemakert
heout
puti
ssuppr
essedasl
ongast
henat
ural
Rwavesar
epr
esent
.
Vent
ri
cul
arI
nhi
bit
edPacemaker–Bl
ock
I
ntheabsenceoft
heRwavei
tal
lowst
heosci
ll
atori
nthet
imi
ngci
rcui
ttodel
iverpul
sesat
apr
esetr
ate.Thet
imi
ngci
rcui
tisf
edi
ntopul
sewi
dthci
rcui
twhi
chi
sal
soaRCnet
wor
k.
Thepul
sewi
dthci
rcui
tdet
ermi
nest
hedur
ati
onoft
hepul
sedel
iver
edt
othehear
t.Thent
he
out
putoft
hepul
sewi
dthci
rcui
tisf
edi
ntot
her
atel
imi
ti
ngci
rcui
twhi
chl
imi
tst
hepaci
ng
r
atet
oamaxi
mum of120pul
sespermi
nut
e.Theout
putci
rcui
tpr
ovi
desapr
operpul
set
o
st
imul
atet
hehear
t.Thevol
tagemoni
torci
rcui
tsensest
hecel
ldepl
eti
onandsi
gnal
sthe
r
atesl
owdownci
rcui
tandener
gycompensat
ionci
rcui
t.Ther
atesl
owdownci
rcui
tshut
s
of
fsomeoft
hecur
rentt
othebasi
cti
mingnet
wor
ktocauset
her
ateofsl
owdownby8+3
beat
spermi
nut
ewhencel
ldepl
eti
onhasoccur
red.Theener
gycompensat
ionci
rcui
t
pr
oducesani
ncr
easei
nthepul
sedur
ati
onast
hebat
ter
yvol
tagedecr
easest
omai
ntai
n
const
antst
imul
ati
onener
gyt
othehear
t.Thi
stypeofpacemakeri
sal
socal
ledt
hedemand
pacemaker
.
4.At
ri
alSynchr
onousPacemaker
:
Thi
stypeofpacemakercanbeusedt
oter
minat
eat
ri
alf
lut
terandpar
oxysmalat
ri
al
t
achycar
dia.I
tcanactasat
empor
arypacemakerf
ort
heat
ri
alf
ibr
il
lat
ion.Theat
ri
al
act
ivi
tyi
spi
ckedupbyasensi
ngel
ect
rodepl
acedi
nat
issuecl
oset
othedor
salwal
loft
he
at
ri
um.
At
ri
alSynchr
onousPacemaker–Bl
ock
Thedet
ect
edPwavei
sampl
if
iedandadel
ayof0.
12secondi
spr
ovi
dedbyt
heAVdel
ay
ci
rcui
t.Thi
sisnecessar
ycor
respondi
ngt
otheact
ualdel
ayi
nconduct
ingt
hePwavet
othe
AVnodei
nthehear
t.Thesi
gnali
sthenusedt
otr
iggert
her
eset
abl
emul
ti
vibr
atorwhose
out
puti
sgi
vent
otheampl
if
ierwhi
chpr
oducest
hedesi
redst
imul
ust
obeampl
if
iedt
othe
hear
t.
Thent
hest
imul
usi
sdel
iver
edt
othevent
ri
clest
hrought
hevent
ri
cul
arel
ect
rode.I
fther
ate
ofat
ri
alexci
tat
ionbecomest
oof
astasi
nat
ri
alf
ibr
il
lat
ionort
oosl
oworabsentapr
eset
f
ixedr
atepacemakert
akesoverunt
ilt
heabnor
mal
sit
uat
ioni
sover
.Inor
dert
oavoi
dthe
det
ect
ionofnoi
seorunwant
edspi
kest
hatcoul
dbemi
sint
erpr
etedf
ort
ri
ggerpul
sea
r
efr
act
oryper
iodcont
rolci
rcui
tisused.Anysi
gnal
det
ect
edont
heat
ri
all
eadwi
thi
n400
mi
ll
isecondsofapacedhear
tbeati
signor
ed.
5.At
ri
alSequent
ialVent
ri
cul
arI
nhi
bit
edPacemaker
:
Thi
shast
hecapabi
li
tyofst
imul
ati
ngbot
htheat
ri
aandvent
ri
cles.I
fat
ri
alf
unct
ionf
ail
s,
t
hispacemakerwi
llst
imul
atet
heat
ri
um andt
hensenset
hesubsequentvent
ri
cul
arbeat
.If
i
tiswor
kingpr
oper
lyi
twi
lldi
scont
inuei
tsvent
ri
cul
arst
imul
ati
ngf
unct
ion.I
ftheat
ri
albeat
i
snotconduct
edt
othevent
ri
cle,
thepacemakeronsensi
ngt
hiswi
llt
ri
ggert
hevent
ri
cleat
apr
esenti
nter
valof0.
12seconds.
Def
ibr
il
lat
ors
I
ntr
oduct
ion:
Thehear
tisabl
etoper
for
mit
spumpi
ngact
iononl
ythr
ought
hesynchr
oni
zedact
ionoft
he
hear
tmuscl
efi
ber
s.Car
diacf
ibr
il
lat
ioni
sacondi
ti
onwher
ethi
ssynchr
oni
sm i
slost
,the
i
ndi
vidualmyocar
dialcel
ls,
cont
ractasynchr
onousl
yandi
nar
api
dir
regul
arcar
diac
r
hyt
hm.Thi
scondi
ti
oni
soneofmostser
iousmedi
calemer
genci
esandt
hiscondi
ti
on
r
educest
hecar
diacout
putt
onearzer
o.Thef
ibr
il
lat
ionofat
ri
almuscl
esi
scal
ledat
ri
al
f
ibr
il
lat
ionandt
hatofvent
ri
clesi
scal
ledvent
ri
cul
arf
ibr
il
lat
ion.Def
ibr
il
lat
ioni
sthemet
hod
ofr
ever
singt
hesi
tuat
ionorbr
ingi
ngbackf
ibr
il
lat
ioncondi
ti
ont
onor
mal
cy.Devi
cesused
f
ort
hisar
ecal
leddef
ibr
il
lat
ors.Def
ibr
il
lat
ioni
stheappl
icat
ionofel
ect
ri
cshockt
othear
ea
oft
hehear
twhi
chmakesal
lhear
tmuscl
efi
ber
sent
ert
hei
rref
ract
oryper
iodt
oget
her
,af
ter
whi
chnor
malhear
tact
ionmayr
esume.
TypesofDef
ibr
il
lat
ors:
1.ACDef
ibr
il
lat
or:
Thi
sisanear
li
estf
orm ofdef
ibr
il
lat
orwhi
chappl
iessever
alcycl
esofal
ter
nat
ingcur
rentt
o
t
hehear
tfr
om t
hepowerl
inet
hroughast
epupt
ransf
ormer
.Toachi
evedef
ibr
il
lat
ionwi
th
i
nter
nalel
ect
rodespl
acedont
hesur
faceoft
hehear
t,vol
tager
angi
ngf
rom 80Vt
o300V
r
msi
srequi
red.Whenext
ernalel
ect
rodesar
eusedont
hechest
,vol
tagesoft
wicet
his
val
uear
erequi
red.Buti
nACdef
ibr
il
lat
ionsuccessi
veat
tempt
stocor
rectvent
ri
cul
ar
f
ibr
il
lat
ionar
eof
tenr
equi
red.ACdef
ibr
il
lat
ioncannotbesuccessf
ull
yusedt
ocor
rectat
ri
al
f
ibr
il
lat
ion.DCdef
ibr
il
lat
orshavet
her
efor
enowr
epl
acedACdef
ibr
il
lat
ors.
2.Capaci
ti
veDi
schar
geDCDef
ibr
il
lat
ors:
The220VACmai
nssuppl
yisconnect
edt
oavar
iabl
eaut
otr
ansf
ormeri
nthepr
imar
y
ci
rcui
t.
Capaci
ti
veDi
schar
geDCDef
ibr
il
lat
ors
Theout
putoft
heaut
otr
ansf
ormeri
sfedt
oast
epupt
ransf
ormert
opr
oducehi
ghvol
tage
ofabout8000V.Thenahal
fwaver
ect
if
ierr
ect
if
iest
hishi
ghACvol
taget
oobt
ainhi
ghDC
vol
tage,
whi
chchar
gest
hecapaci
torC.Thevol
taget
owhi
chCi
schar
gedi
sdet
ermi
nedby
t
heaut
otr
ansf
ormeri
nthepr
imar
yci
rcui
t.Aser
iesr
esi
stance,
Rs,
li
mit
sthechar
ging
cur
rentt
opr
otectt
heci
rcui
tcomponent
s.AnACvol
tmet
eracr
osst
hepr
imar
yiscal
ibr
ated
t
oindi
cat
etheener
gyst
oredi
nthecapaci
tor
.Ener
gyst
oredi
nthecapaci
tori
sgi
venby,
½)*C*V2
W =(
C=Capaci
tance(
10mi
croFar
adt
o50mi
croFar
ad)
V=Vol
taget
owhi
cht
hecapaci
tori
schar
ged(
2kVt
o9kV)
Theener
gyf
rom t
hecapaci
tori
sdi
schar
gedbyf
ir
mlypl
aci
ngt
heel
ect
rodesatappr
opr
iat
e
posi
ti
onsont
hechest
.
3.Del
ay-
LineCapaci
ti
veDi
schar
geDCDef
ibr
il
lat
or:
DCsi
gnalhasf
ewerdel
eter
iousef
fect
sont
hehear
tthant
heACpul
seandi
slessl
ikel
yto
pr
oducevent
ri
cul
arf
ibr
il
lat
ionwhenappl
iedatr
andom dur
ingt
hecar
diaccycl
e.
Del
ay-
LineCapaci
ti
veDi
schar
geDCDef
ibr
il
lat
or
Butevenwi
thDCdef
ibr
il
lat
ion,
ther
eisadangerofdamaget
othemyocar
dium andt
he
chestwal
ls,
becausepeakvol
tagesashi
ghas6000Vmaybeused.Tor
educet
hisr
isk,
somedef
ibr
il
lat
orspr
oducedual
-peakwavef
ormsofl
ongerdur
ati
onatamuchl
ower
vol
tage.
I
nthi
sdef
ibr
il
lat
ort
hepar
all
elcombi
nat
ionofC1andC2st
orest
hesameener
gyast
he
si
ngl
ecapaci
tori
ncapaci
ti
vedi
schar
gei
sappr
oxi
mat
ely10ms.Wi
tht
hist
ypeof
wavef
orm ef
fect
ivedef
ibr
il
lat
ioncanbeachi
evedwi
thl
owerl
evel
sofener
gydel
iver
ed.
Ener
gyl
evel
srangebet
ween50and200Wat
tsecond.
4.Squar
eWaveDef
ibr
il
lat
or:
I
nsquar
ewavedef
ibr
il
lat
or,
thecapaci
tori
sdi
schar
gedt
hrought
hesubj
ectbyt
urni
ngona
ser
iessi
li
concont
rol
ledr
ect
if
ier(
SCR)
.
Squar
eWaveDef
ibr
il
lat
or-Wavef
orm
Whensuf
fi
cientener
gyi
sdel
iver
edt
othesubj
ect
,ashuntSCRshor
tci
rcui
tst
hecapaci
tor
andt
ermi
nat
est
hepul
se.Thi
sel
imi
nat
est
hel
ongdi
schar
get
ailoft
hewavef
orm.Di
git
al
ci
rcui
tscanal
sopr
oduceasquar
epul
sef
ordef
ibr
il
lat
ion.
Advant
ages:
1.I
trequi
resf
ewerpeakscur
rent
.
2.I
trequi
resnoi
nduct
or.
3.I
tmakesi
tpossi
blet
ousephysi
cal
lysmal
lerel
ect
rol
yti
ccapaci
tor
s.
5.DCDef
ibr
il
lat
orswi
thsynchr
oni
zerCi
rcui
t:
I
tisessent
ial
touseadef
ibr
il
lat
orwi
thsynchr
oni
zerci
rcui
tfort
het
ermi
nat
ionof
vent
ri
cul
art
achycar
dia,
atr
ialf
ibr
il
lat
ionandot
herar
rhyt
hmi
a.Atdef
ibr
il
lat
ionoft
hehear
t
i
nat
ri
alf
ibr
il
lat
ion,
theshockmaybr
ingt
hevent
ri
clesi
ntof
ibr
il
lat
ionsi
ncepumpi
ngact
ion
ofvent
ri
clesst
il
lexi
sts.
DCDef
ibr
il
lat
orswi
thsynchr
oni
zerCi
rcui
t
Ther
eishoweveraper
iodi
nthehear
tcycl
einwhi
cht
hedangeri
sleast
.Def
ibr
il
lat
ionmust
t
akepl
acedur
ingt
hatper
iod.Thi
siscal
ledcar
diover
sion.
I
nthi
smet
hodol
ogy,
theECGoft
hepat
ienti
sfedt
othedef
ibr
il
lat
orandt
heshocki
sgi
ven
att
her
ightmoment
.Her
ethef
unct
ionoft
hesynchr
oni
zerci
rcui
tist
oper
mitpl
acementof
shockordi
schar
geatt
her
ightpoi
ntont
hepat
ient
’sel
ect
rocar
diogr
am.
Thust
heappl
icat
ionofshockdur
ingt
hevul
ner
abl
eTwavei
savoi
dedandt
hechanceof
pr
oduct
ionofvent
ri
cul
arf
ibr
il
lat
ioni
sal
soavoi
ded.Wi
tht
hehel
poft
hesynchr
oni
zer
ci
rcui
t,t
heshocki
sdel
iver
edappr
oxi
mat
ely20t
o30msaf
tert
hepeakoft
heRwaveof
pat
ient
’sECG.Thesynchr
oni
zercont
ainsanECGampl
if
ierwhi
chr
ecei
vest
heQRS
compl
exoft
heECGandusest
hist
ri
ggert
imedel
ayci
rcui
t.Af
tert
hedesi
reddel
ayt
ime,
t
hedef
ibr
il
lat
ingcapaci
tori
sdi
schar
gedacr
osst
hechestt
hrought
heel
ect
rodes.
6.Doubl
eSquar
ePul
seDef
ibr
il
lat
orWavef
orm:
Doubl
eSquar
epul
sedef
ibr
il
lat
ori
susednor
mal
lyaf
tert
heopenhear
tsur
ger
y.
Doubl
eSquar
ePul
seDef
ibr
il
lat
or-Wavef
orm
I
fthechesti
sopened,
onl
ylowerener
gyel
ect
ri
cshockshoul
dbegi
ven.Vol
tagel
evel
s
r
angebet
ween8and60Vwi
thmeanener
gy2.
4wat
t-
second.
However
,cel
lswhi
char
eref
ract
orydur
ingt
heoccur
renceoff
ir
stpul
sewi
llcont
inuet
o
f
ibr
il
lat
e.I
nor
dert
oobt
ainat
otaldef
ibr
il
lat
ion,
thesecondpul
seoper
atesont
hesetof
cel
lswhi
chwer
eref
ract
oryt
othef
ir
stpul
se.Thuscompl
etedef
ibr
il
lat
ioncanbeobt
ained
bymeansofsel
ect
ingpr
operpul
sespacer
ati
o.
7.Bi
-phaseDCDef
ibr
il
lat
or:
Thi
stypedef
ibr
il
lat
ori
ssi
mil
art
osquar
epul
sedef
ibr
il
lat
orsucht
hati
tdel
iver
sDCpul
ses
al
ter
nat
ivel
yinopposi
tedi
rect
ion.Thi
sismor
eef
fi
cienti
nter
minat
ionofvent
ri
cul
ar
def
ibr
il
lat
ion.
El
ect
rodesusedi
nDef
ibr
il
lat
orCi
rcui
ts:
Thedef
ibr
il
lat
orel
ect
rodesappl
iedont
othet
hor
aci
cwal
lsar
e,
1.Ant
eri
or–Ant
eri
orpaddl
eel
ect
rodes
2.Ant
eri
or–Post
eri
orpaddl
eel
ect
rodes.
I
nAnt
eri
or-
Ant
eri
orpaddl
eel
ect
rodesbot
hthepaddl
esar
eappl
iedt
othechest
.Wi
th
Ant
eri
or-
Post
eri
orpaddl
esar
eappl
iedt
othepat
ient
’schestwal
landback,
sot
hatt
he
ener
gyi
sdel
iver
edt
hrought
hehear
t.Tomai
ntai
ngoodcont
act
,theel
ect
rodesmustbe
f
ir
mlypl
acedagai
nstt
hepat
ient
.Thepost
eri
orpaddl
eisf
latandhasal
argerdi
sct
hant
he
ant
eri
orpaddl
e.Theel
ect
rodesmustbesuf
fi
cient
lywel
linsul
ated,
sot
hatt
heoper
ator
,
hol
dingt
heel
ect
rodesi
ssaf
e.Theseel
ect
rodesconsi
stofal
argemet
aldi
sc,
appr
oxi
mat
ely100mm i
ndi
amet
eri
nani
nsul
atedhousi
ng.Acont
rolswi
tchi
slocat
edon
t
hehandl
esot
hat
,oncet
heel
ect
rodesar
einpl
ace,
theoper
atorcanpusht
heswi
tcht
o
i
nit
iat
ethepul
se.Whi
lebei
ngused,
theel
ect
rodessur
facei
scoat
edwi
thaconduct
inggel
.
Thei
nter
nalt
ypeofdef
ibr
il
lat
orel
ect
rodesar
eusedi
nter
nal
ly,
(i.
e.,
)fordi
rectappl
icat
ion
ont
hemyocar
dium,
dur
ingopen-
chestsur
ger
y.Theset
ypesofdef
ibr
il
lat
orel
ect
rodesar
e
spoonshaped.I
nint
ernalusage,
theener
gyl
evel
srequi
redf
ordef
ibr
il
lat
ionmayr
ange
f
rom 10t
o50wat
t-
sec.I
nter
nalpaddl
escanbeei
thergasst
eri
li
zedoraut
ocl
aved.
Paddl
eTypeExt
ernalDef
ibr
il
lat
orEl
ect
rode
Typi
calDef
ibr
il
lat
ingVal
ues:
Typi
calDef
ibr
il
lat
ingval
uesused(
inwat
t-
sec)ar
easf
oll
ows,
S.
No. Pat
ient Def
ibr
il
lat
ingVal
ue(
wat
t-
sec)
1. Adul
t(Ext
ernal
) 200–400
2. Adul
t(I
nter
nal
) 35–75
3. Pedi
atr
ic(
Ext
ernal
) 100–200
4. Pedi
atr
ic(
Int
ernal
) 25–50
Vent
il
ator
s
Vent
il
atori
sadevi
cewhi
chpr
ovi
desassi
stancewi
thbr
eat
hingt
othepat
ient
s.I
tpr
ovi
des
oxygenenr
iched,
medi
cat
edai
ratcont
rol
ledt
emper
atur
etot
hepat
ient
s.
Ther
ear
e3modesofoper
ati
onofvent
il
ator
s,t
heyar
e,
1.Cont
rol
ledbr
eat
hingmode:
I
nCont
rol
ledbr
eat
hingmode,
breat
hingi
sini
ti
atedbyat
imi
ngmechani
sm.I
tpr
ovi
des
i
nspi
rat
ionsandexpi
rat
ionsatf
ixedr
atesexceptdur
ingt
her
estper
iodf
ort
hepat
ient
.Thi
s
modei
sforpat
ient
swhocannotbr
eat
heont
hei
rown.
2.Assi
stedbr
eat
hingmode:
I
nassi
stedbr
eat
hingmode,
thevent
il
atoroper
ateswi
tht
hepat
ient
’sownspont
aneous
at
temptt
obr
eat
he.Thi
smodei
susedf
orpat
ient
swhohavedi
ff
icul
tyi
nbr
eat
hing.
3.Assi
st-
cont
rolbr
eat
hingmode:
Byt
heassi
st-
cont
rolmode,
thepat
ientcont
rol
sandmai
ntai
nshi
s/herbr
eat
hingasl
ongas
he/
shecan,
buti
fhe/
shef
ail
s,t
hevent
il
atorst
art
swor
king.Aut
omat
icswi
tchi
ngdevi
ces
ar
eat
tachedt
othevent
il
ator
ssot
hatt
hevent
il
atorwor
ksi
ntheassi
st-
cont
rolmode.
Cl
assi
fi
cat
ionofVent
il
ator
s:
1.Basedonusage:
a)Anest
hesi
aVent
il
ator
s:
Thesear
egener
all
ysmal
landsi
mpl
eequi
pment
susedt
ogi
ver
egul
arassi
stedbr
eat
hing
dur
inganoper
ati
on.
b)I
ntensi
vecar
eVent
il
ator
s:
I
ntensi
vecar
event
il
ator
sar
emor
ecompl
icat
ed,
whi
chi
ncor
por
atespat
ientt
ri
gger
ing
f
aci
li
tywhi
chenabl
esi
ndel
iver
ingai
rtot
hepat
ientwhent
hepat
ientt
ri
est
oinhal
e.
2.BasedonPowerTr
ansmi
ssi
on:
a)Di
rectpowerTr
ansmi
ssi
onvent
il
ator
s:
Vent
il
ator
swhi
chdel
ivert
hegasdi
rect
lyf
rom t
hesour
ceofcompr
essedgast
othepat
ient
ar
ecal
leddi
rectpowert
ransmi
ssi
onvent
il
ator
s.
b)I
ndi
rectpowerTr
ansmi
ssi
onvent
il
ator
s:
Vent
il
ator
swhi
chhavesepar
atepat
ientandpowersyst
emsandwher
egasf
lowr
atei
s
det
ermi
nedbyt
hepr
essur
eint
hepowersyst
em ar
ecal
ledi
ndi
rectpowert
ransmi
ssi
on
vent
il
ator
s.
3.BasedonPr
essur
epat
ter
n:
a)Posi
ti
ve-
Atmospher
event
il
ator
:
Avent
il
atorwhi
chpr
oducesaposi
ti
vepr
essur
eint
hepat
ient
’sl
ungsdur
ingi
nspi
rat
ion,
wi
thanendexpi
rat
orypr
essur
ethati
sequalt
otheat
mospher
icpr
essur
eiscal
leda
posi
ti
ve-
Atmospher
event
il
ator
.
b)Posi
ti
ve-
Posi
ti
vevent
il
ator
:
Avent
il
atorwhi
chpr
oducesaposi
ti
vepr
essur
eint
hepat
ient
’sl
ungsdur
ingi
nspi
rat
ion,
wi
thanendexpi
rat
orypr
essur
ethati
sgr
eat
ert
hant
heat
mospher
icpr
essur
eiscal
leda
posi
ti
ve-
posi
ti
vevent
il
ator
.
4.Basedont
het
ypeofsaf
etyl
imi
t:
a)Vol
umeLi
mit
edVent
il
ator
:
Avent
il
atori
nwhi
chpr
e-det
ermi
nedvol
umeofgascannotbeexceededdur
ingi
nspi
rat
ion
i
scal
ledavol
umel
imi
tedvent
il
ator
.
b)Pr
essur
eLi
mit
edVent
il
ator
:
Avent
il
atori
nwhi
chpr
e-det
ermi
nedpr
essur
eofgascannotbeexceededdur
ing
i
nspi
rat
ioni
scal
ledapr
essur
eli
mit
edvent
il
ator
.
5.Basedonsour
ceofpower
:
a)Pneumat
icVent
il
ator
:
Avent
il
atorwhi
chi
spower
edbycompr
essedgasi
scal
ledapneumat
icvent
il
ator
.
b)El
ect
ri
cVent
il
ator
:
Avent
il
atorwhi
chi
spower
edbyanel
ect
ri
cdevi
cesuchasanel
ect
ri
cmot
ori
scal
leda
el
ect
ri
cvent
il
ator
.
Moder
nVent
il
ator
s–Wor
king:
Moder
nvent
il
ator
sconsi
stsoft
wosyst
emsnamel
y,1)t
hepneumat
icf
lowsyst
em and2)
t
heel
ect
roni
ccont
rol
syst
em.Thepneumat
icf
lowsyst
em enabl
est
hef
lowofgast
hrough
t
hevent
il
ator
.Oxygenandmedi
cat
edai
rent
ert
hevent
il
atorat3.
5bar(
50psi
)pr
essur
e
t
hroughf
il
ter
s.Thesegasesent
ert
heai
r/oxygenmi
xerwher
etheycombi
neatt
her
equi
red
per
cent
age.Thegasest
henent
eral
arger
eser
voi
rtankwhi
chhol
dsabout8l
it
ersofmi
xed
gasesatacompr
essedpr
essur
eof350cm ofH2O.Thegasi
sthenf
edt
othepat
ient
br
eat
hingci
rcui
tatdesi
redpr
opor
ti
onscont
rol
ledbyaf
lowcont
rolval
vesoast
oenabl
e
br
eat
hingassi
stancet
othepat
ient
.Ther
eisaf
uelcel
ltypeoxygenanal
yzerwhi
chi
sused
t
oanal
yzeoxygenbef
orei
nspi
rat
ion.Af
lowsensori
sat
tachedt
omeasur
efl
owr
ateof
i
nspi
redai
r.Var
iabl
eOr
if
icei
sgener
all
yusedt
omeasur
efl
owr
ate.Anambi
entval
ve
whi
chpr
ovi
dest
hepat
ientt
heabi
li
tyt
obr
eat
her
oom ai
rwhent
hevent
il
atorf
ail
sort
he
pr
essur
eint
hepat
ientci
rcui
tdr
opsbel
ow–10cm ofH2Oi
sat
tachedt
othepat
ient
br
eat
hingci
rcui
t.
Theexhal
edgasesexi
tthr
oughanel
ect
roni
cal
lycont
rol
ledexhal
ati
onval
vel
ocat
edatt
he
vent
il
ator
.Themi
cropr
ocessorwhi
chi
sincl
udedi
ntheel
ect
roni
ccont
rolsyst
em cont
rol
s
eachval
vet
odel
ivert
hedesi
redi
nspi
rat
oryai
randoxygenf
lowsf
ormandat
oryand
spont
aneousvent
il
ati
on.
Apar
tfr
om vent
il
ati
on,
humi
dif
icat
ionofbr
eat
hinggasi
sal
sosi
gni
fi
cant
.Inor
dert
o
pr
eventdamaget
othepat
ient
’sl
ungs,
theappl
iedai
roroxygenmustbehumi
dif
iedei
ther
byheatvapor
izat
ionorbybubbl
inganai
rst
ream t
hroughaj
arofwat
er.Ahumi
dif
ieri
s
usedf
ort
hispur
pose.Aneubl
izeri
sal
sousedal
ongwi
tht
hevent
il
ator
.Aneubl
izer
pr
oducesaf
inespr
ayofwat
erormedi
cat
ioni
ntot
hepat
ient
’si
nspi
redai
rint
hef
orm of
aer
osol
s.
Ner
veandMuscl
est
imul
ator
s
I
ntr
oduct
ion:
St
imul
ati
onr
efer
stoanext
ernali
nfl
uencegener
all
y,el
ect
ri
cal
,mechani
calorchemi
cal
bei
ngappl
iedt
othecel
lwhi
chr
esul
tsi
nthecel
ldepol
ari
zingandt
henr
epol
ari
zing.Thi
s
ki
ndofext
ernal
,ar
ti
fi
cialst
imul
ati
oni
sbr
oughtaboutbyusi
ngapul
segener
atort
opassa
cur
rentt
hrought
hecel
lsconcer
nedf
orabr
iefper
iodoft
ime.Thusst
imul
ator
sar
edevi
ces
whi
char
eusedt
ost
imul
atecel
ls.Toei
theranal
yzeabi
omedi
calphenomenonort
otr
eat
anabnor
mal
it
yiti
snecessar
ytost
imul
ateagr
oupofcel
ls.
UsesofSt
imul
ator
s:
1.Usedt
ost
imul
atei
nner
vat
edmuscl
es.
2.Usedt
ost
imul
atedener
vat
edmuscl
esandner
ves.
3.Usedf
ort
het
reat
mentofpar
alysi
s.
4.Usedf
ort
het
reat
mentofmuscul
arspasms.
5.Usedt
otr
eatper
ipher
alci
rcul
ator
ydi
stur
bance.
Nat
ureofcur
rentusedf
orSt
imul
ati
on:
Basi
cal
lyl
owvol
tage,
lowf
requencyi
mpul
secur
rent
sar
eusedf
orst
imul
ati
on.Ther
ear
e
f
ivedi
ff
erentf
ormsofcur
rent
sthatcanbeused,
theyar
e,
i
)Gal
vani
cCur
rent
:
Thi
sisal
socal
leddi
rectcur
rent
,gal
vani
sm orcont
inuouscur
rent
.Thi
sisusedf
or
pr
eli
minar
ytr
eat
mentofpar
alysi
sandf
ort
het
reat
mentofdi
stur
bancesi
nbl
oodf
low.I
tis
al
sousedf
ort
hei
ntr
oduct
ionofdr
ugsi
ntot
hebodyt
hrought
heski
nbyel
ect
rol
yti
cmeans.
Gal
vani
c
I
tsi
ntensi
tyr
angesbet
ween0.
3and0. cm2oft
5mA/ heel
ect
rodeanddur
ati
onr
anges
bet
ween10t
o20mi
nut
es.
i
i)I
nter
rupt
edGal
vani
cCur
rent
:
Thesear
eser
iesofnegat
ivel
ygoi
ngr
ect
angul
arpul
seswi
thpul
sedur
ati
onof100msand
r
epet
it
ionr
ateof12pul
ses/
mint
o70pul
ses/
min.
I
nter
rupt
edGal
vani
c
Toover
comedi
scomf
ortandi
nfl
ammat
ionduet
otheappl
icat
ionofuni
dir
ect
ional
i
nter
rupt
edpul
sesposi
ti
vecur
renti
nbet
weenpul
sesar
eappl
ied.
i
ii
)Far
adi
cCur
rent
:
Thesear
easequenceofpul
sewi
thadef
inedshape(
tri
angul
ar)andcur
renti
ntensi
tywi
th
apul
sedur
ati
onof1msandi
nter
valdur
ati
onof20ms.
Far
adi
c
I
tisusedf
ort
het
reat
mentofmuscl
eweakness.
i
v)Sur
gedFar
adi
ccur
rent
:
I
tisasur
gingwavef
ormt
hati
speakcur
renti
ntensi
tyappl
iedt
othepat
ienti
ncr
easesand
decr
easesr
hyt
hmi
cal
ly.Thi
sisusedf
ort
het
reat
mentoff
unct
ionalpar
alysi
s.
Sur
gedFar
adi
c
Thesur
ger
atecommonl
yusedi
s6t
o60permi
nut
e.Eachsur
gedur
ati
oni
s1500ms.
Repet
it
ionr
atei
s2t
o3seconds.Thi
sisusedf
ort
het
reat
mentofspasmsandpai
n.
v)Exponent
ialCur
rent
:
Usi
ngt
hesl
opeofexponent
ialcur
rentsel
ect
ivest
imul
ati
oni
spr
ovi
ded.Thi
sisusedf
or
t
het
reat
mentofsever
epar
alysi
s.
Exponent
ial
Commer
cialNer
ve/
Muscl
eSt
imul
ator
:
Thecommer
cialner
ve/
muscl
est
imul
atorconsi
stsofavar
iabl
emul
ti
vibr
ator(
M1)whi
chi
s
usedt
osett
hebasi
cst
imul
usf
requency.Theout
putoft
hemul
ti
vibr
ator(
M1)t
ri
gger
sona
monost
abl
emul
ti
vibr
ator(
M2)whi
chpr
ovi
desani
nter
rupt
edgal
vani
ccur
rentwhoser
ate
anddur
ati
oncanbei
ndependent
lycont
rol
led.Anot
hermul
ti
vibr
ator(
M3)pr
oducesFar
adi
c
cur
rent
s.Far
adi
ccur
rent
sar
eusual
lymodul
atedatt
hef
requencysetby(
M1)i
nami
xer
ci
rcui
t(M4)
.Theout
putofM4t
akespl
acewi
thasl
owr
ateofi
ncr
easeanddecr
ease.By
i
ntegr
ati
ngt
heout
putof(
M2)
,thei
nter
rupt
edgal
vani
cpul
sescanbemodi
fi
edt
ohavean
exponent
ialr
iseandf
all
.
Ner
veSt
imul
ator–Bl
ockDi
agr
am
Thesepul
sesar
esi
mil
art
otr
iangul
arwavef
orm.Gal
vani
ccur
renti
sobt
ainedbysui
tabl
y
t
appi
ngt
heDCsuppl
y.Asperneedanyoneoft
hesewavef
ormscanbesel
ect
edbyt
he
sel
ect
orswi
tch.Af
tersel
ect
iont
hecur
renti
sfedt
oanemi
tt
er-
fol
loweri
nputt
oobt
ainl
ow
out
puti
mpedanceconst
antcur
rent
.
Per
ipher
alNer
veSt
imul
ator
:
Thi
sconsi
stsofanast
abl
emul
ti
vibr
atorwhi
chgener
atesr
epet
it
ivenegat
iver
ect
angul
ar
pul
ses,
whi
cht
ri
gger
sthemonost
abl
evi
brat
or.Theast
abl
emul
ti
vibr
atordet
ermi
nest
he
pul
ser
epet
it
ionr
ateandt
hemonost
abl
emul
ti
vibr
atorgener
atest
hepul
sewi
dth.The
out
putoft
hemonost
abl
emul
ti
vibr
atordr
ivesanemi
tt
er-
fol
lowerandat
ransconduct
ance
ampl
if
ierwhi
chi
ncr
easest
hemaxi
mum out
putvol
tage.At
ransf
ormeri
susedt
ocoupl
e
t
hest
imul
atorandt
heski
nwi
thsui
tabl
eener
gyt
ost
imul
atet
hener
vet
runk.
Bl
adderSt
imul
ator
:
Thebl
adderst
imul
atori
sadevi
cesi
mil
art
oper
ipher
alner
vest
imul
ator
.Thest
imul
usi
s
pr
ovi
dedi
nthef
orm ofabi
phasi
cpul
sewi
thapul
sewi
dthof0.
2msandt
hepul
se
i
ntensi
tyof0.
5Vt
o25Vandapul
ser
ateof10t
o500Hz.Theel
ect
rodeconsi
stsoft
wo
i
nsul
atedpl
ati
num wi
res,
2.5mm i
nlengt
h,wi
th1.
5mm coni
calt
ip,
mount
ed2.
5mm apar
t
onepoxyst
ri
p.Thet
wol
eadoutwi
resar
efl
exi
blesi
last
iccoat
edandar
emadeofst
ainl
ess
st
eelandconnectt
oar
ecei
verwi
thaci
rcumf
erenceof3cm.Ther
ecei
veri
spl
acedi
nthe
subcut
aneoust
issueont
hel
eftorr
ightsi
deoft
hepat
ient
’swai
st.
Cer
ebel
larSt
imul
ator
:
St
imul
ati
ont
othecer
ebel
lum i
spr
ovokedbyt
ranscut
aneousi
nduct
ivecoupl
ing,
thr
ough
anant
ennaf
ixedsubcut
aneousl
yont
hechest
.Iti
sdel
iver
edt
hroughf
ourpai
rsof
pl
ati
num di
scsf
ixedonapl
ateofsi
li
concoat
edmesh.Theel
ect
rodesar
eappl
iedbeneat
h
t
het
ent
ori
um oft
hecor
texofant
eri
orl
obeofcer
ebel
lum ordi
rect
lyt
othepost
eri
orl
obe.
Rect
angul
arpul
sesof1mswi
dth,
wit
har
ateof7-
200Hzandani
ntensi
tyof0.
5-14Var
e
gener
all
yusedf
orst
imul
ati
on.Forepi
lept
icsei
zur
esst
imul
ati
onat10Hzi
sef
fect
ive.
Di
ather
my
Thet
erm di
ather
mymeans“
thr
oughheat
ing”orpr
oduci
ngdeepheat
ingi
nthet
issuesof
t
hebody.Theext
ernal
lyappl
iedsour
cesofheatl
ikehott
owel
s,heatl
ampsandel
ect
ri
c
heat
ingpadspr
oducedi
scomf
ortandski
nbur
nsl
ongbef
oreadequat
eheathaspenet
rat
ed
t
othedeepert
issues.Wi
thdi
ather
myt
echni
quet
hesubj
ect
’sbodybecomesapar
toft
he
el
ect
ri
calci
rcui
tandheati
spr
oducedwi
thi
nthebodyandnott
ransf
err
edt
hrought
heski
n.
Appl
icat
ionofheatt
oapar
ti
cul
arar
eaoft
hebodyi
ncr
easest
het
emper
atur
eoft
he
t
issuesandt
hef
lowofbl
oodi
nthatar
eabecauseoft
hedi
lat
ingofbl
oodvessel
s.
Appl
icat
ionofheatbyel
ect
ri
calst
imul
ati
onmeansi
sanef
fect
ivewayofr
eli
evi
ngpai
n.
Accor
dingt
othegat
econt
rolt
heor
y,usageofel
ect
ri
calst
imul
ati
onpr
event
spai
n
i
mpul
sesf
rom r
eachi
ngt
hecor
tex.Theel
ect
ri
calst
imul
ati
oncancr
eat
eimpul
se
t
ransmi
ssi
onwi
thi
nlar
gef
iberandst
imul
ateenoughposi
ti
veexci
tat
iont
osubsequent
ly
i
nhi
bitpai
nimpul
ses.Thei
mpul
sesar
epr
oducedi
nabat
ter
ypower
edpul
segener
atort
o
whi
chapai
rofel
ect
rodet
ippedwi
rescanbeat
tached.Theseel
ect
rodespr
ovi
de
cont
inuousmi
ldel
ect
ri
calst
imul
ati
onwhenappl
iedt
otheski
nover
lyi
nganypai
nfular
ea
oft
hebody.Theseel
ect
ri
calst
imul
ati
onsi
gnal
sjam t
hepai
nsi
gnal
str
avel
ingal
ongt
he
ner
vepat
hwaysbef
oret
heycanr
eacht
hebr
ain.Themai
nadvant
ageofdi
ather
myi
sthat
t
het
reat
mentcanbepr
eci
sel
ycont
rol
led.Car
efulpl
acementoft
heel
ect
rodesper
mit
sthe
l
ocal
izat
ionoft
hehear
ttot
her
egi
ont
obet
reat
ed.Theamountofheatcanbecl
osel
y
adj
ust
edbymeansofci
rcui
tpar
amet
ers.Thususi
nghi
ghf
requencyener
gy,
deeperl
ying
t
issuessuchasmuscl
es,
bones,
int
ernalor
ganset
ccanbepr
ovi
dedwi
thheat
.
TypesofDi
ather
my:
1.Shor
twavedi
ather
my
2.Di
apul
seshor
twavedi
ather
my
3.Mi
crowavedi
ather
my
4.Ul
tr
asoni
cdi
ather
my
1.Shor
twavedi
ather
my:
Heat
ingoft
issuesi
scar
ri
edoutahi
ghf
requencyof27.
12MHzandawavel
engt
hof11m.
whensuchhi
ghf
requencycur
rent
sar
eused,
themot
ororsensor
yner
vesar
enot
st
imul
atedandt
hust
her
eisnocont
ract
ionoft
hemuscl
esandhencenodi
scomf
ortt
othe
pat
ient
.
Shor
tWaveDi
ather
my-Bl
ock
Her
etheout
putoft
heR.
Fosci
ll
atori
sappl
iedt
othepai
rofpat
ientel
ect
rodes.TheRF
ener
gyheat
sthet
issuesandpr
omot
est
heheal
ingofi
njur
edt
issuesandi
nfl
ammat
ions.
Thepowerdel
iver
edbyt
heuni
tisabout500W.Ther
ear
esever
alpr
ovi
sionst
oregul
atet
he
i
ntensi
tyoft
hecur
rentpassedt
hrought
hepat
ientci
rcui
t.Theel
ect
rodesorpadsar
enot
di
rect
lyi
ncont
actwi
tht
heski
n.Layer
soft
owel
sar
ekeptbet
weent
hemet
alsandt
he
sur
faceoft
hebody.Ther
ear
etwot
echni
quesbywhi
chel
ect
ri
calst
imul
ati
oni
sappl
iedt
o
t
hebody,
theyar
e,
i
)Capaci
torMet
hodandi
i)I
nduct
orMet
hod(
or)I
nduct
other
my.
I
ncapaci
tormet
hod,
thepadsar
epl
acedsot
hatt
hepor
ti
onoft
hebodyt
obet
reat
edi
s
sandwi
chedbet
weent
hem.Thepadsf
orm capaci
torpl
atesandt
hebodyt
issuesbet
ween
t
hepadsactasadi
elect
ri
c.Thewhol
ear
rangementf
ormsacapaci
tor
,whenRFcur
renti
s
appl
iedt
othepads,
thedi
elect
ri
clossoft
hecapaci
torpr
oducesheati
nthei
nter
veni
ng
t
issues.
I
ninduct
ormet
hod,
afl
exi
blecabl
eiscoi
ledar
oundt
hear
m orkneeoranyot
herpor
ti
onof
t
hepat
ient
’sbody.Theyar
eusedi
nlocat
ionswher
epl
ateel
ect
rodesar
einconveni
entt
o
use.WhenRFcur
renti
spassedt
hrought
hecabl
e,deepheat
ingi
nthet
issuer
esul
tsf
rom
t
heel
ect
rost
ati
cfi
eldsetupbet
weeni
tsendsandt
hesuper
fi
cialt
issuesar
eheat
edby
eddycur
rent
ssetupbyt
hemagnet
icf
iel
dar
oundt
hecabl
e.
2.Di
apul
seShor
twaveDi
ather
my:
I
nst
eadofcont
inuousRFwaves,
RFpul
sesof65mi
crosecond,
wit
hani
nter
valbet
ween
pul
sesof1600mi
crosecondar
eal
soused.Thi
siscal
ledDi
apul
seshor
twavedi
ather
my.
Ther
ateofpul
sat
ionsi
sadj
ust
abl
einst
epsf
rom 80t
o600pul
sespersecond,
wit
hthe
peakpoweroft
hepul
ser
angi
ngf
rom 290t
o980W.
Advant
age:
 Heal
ingr
atei
shi
gh.
 Dept
hofpenet
rat
ioncanbecor
rect
lyadj
ust
ed.
 Nodangerofbur
nsorhyper
ther
miccompl
icat
ions.
3.Mi
crowaveDi
ather
my:
Thest
imul
ati
onener
gyf
requencyi
s2450MHzandt
hewavel
engt
his12.
25cm.Heat
ing
upoft
het
issuesi
sduet
otheabsor
pti
onofmi
crowaveener
gy.Mi
crowaveener
gyi
s
t
ransmi
tt
edi
ntot
hepor
ti
onoft
hebodyt
obet
reat
eddi
rect
lyf
rom t
hedi
rect
oroft
heuni
t.
Magnet
ronsar
eusedf
ort
hepr
oduct
ionofmi
crowaves.Themagnet
rononcer
eadyt
o
del
iveri
tsout
put
,gi
vesani
ndi
cat
iont
othedi
rect
orandt
henmi
crowaveener
gyi
sdi
rect
ed
ont
othepat
ient
.
Themagnet
roni
sal
sopr
ovi
dedwi
thpr
opercool
ingmechani
sm.Excessi
vedosagecan
causeski
nbur
nsanddependi
ngont
hesensat
ionexper
iencedbyt
hepat
ientmi
crowave
dosagei
sal
ter
edoradj
ust
ed.Themi
crowaveexposur
eti
mer
angesbet
ween10t
o25
mi
nut
es.Pat
ient
swi
thi
mpl
ant
edmet
alobj
ect
ssuchaspacemaker
sshoul
dnotr
ecei
ve
mi
crowaver
adi
ati
onbecauseoft
hepossi
bil
it
yofover
heat
ing.Al
socar
eshoul
dbet
aken
t
orest
ri
ctt
reat
mentneart
heeyes.
4.Ul
tr
asoni
cDi
ather
my:
Ul
tr
asoni
cdi
ather
myi
susedwher
elocal
izat
ionofheatef
fecti
sdesi
red.Her
etheheat
ing
upt
issuesi
sduet
oabsor
pti
onoful
tr
asoni
cener
gy.Theef
fectoful
tr
asoni
csont
he
t
issuesi
sahi
ghspeedvi
brat
ionormi
cromassage,
whi
chi
sver
yusef
uli
nthet
reat
mentof
sof
tti
ssuel
esi
ons.Ul
tr
asoni
cdi
ather
myuni
tsar
ever
yusef
uli
ncur
ingdi
seasesoft
he
per
ipher
alner
voussyst
em l
ikeneur
it
is,
oft
heskel
etalmuscl
eli
kear
thr
it
isandal
soski
n
ul
cer
s.
Theul
tr
asoni
cdi
ather
myuni
tconsi
stsofanRFosci
ll
atort
hatpr
oducesahi
ghf
requency
al
ter
nat
ingcur
rent
.Thi
shi
ghf
requencyal
ter
nat
ingcur
rentexci
test
hepi
ezoel
ect
ri
c
t
ransducer
.Thet
ransduceri
smadeofbar
ium t
it
anat
eorl
eadzi
rconat
eti
tanat
ecr
yst
al
wi
t 6cm2ef
h5- fect
iver
adi
ati
ngar
ea.I
ful
tr
asoni
cwavesar
eappl
iedi
npul
sedmodet
hen
mi
cromassagei
spossi
blewi
thoutanyt
her
malef
fectul
tr
asoni
cener
gycanbeappl
iedi
n
cont
inuousmodeal
so.Amet
alf
acepl
atei
spl
acedi
nfr
ontoft
hecr
yst
al.Thi
smet
alf
ace
pl
atei
smadet
ovi
brat
ebyt
heosci
ll
ati
onsoft
hecr
yst
alandt
husul
tr
asoni
cwavesar
e
emi
tt
edf
rom t
hispl
ate.Fort
her
apeut
icr
easonsul
tr
asoni
cwavesoff
requencyr
angi
ng
bet
ween800kHzand1MHzar
esui
tabl
e.Theout
putvar
iesbet cm2.The
ween0and3W/
i
ntensi
tyoful
tr
asoni
cwavesar
emoni
tor
edi
nter
msofel
ect
ri
cpower
.Anel
ect
roni
cal
ly
oper
atedt
imeri
ssetf
rom 1mi
nut
eto15mi
nut
es,
whi
chswi
tchesOFFt
heout
putpower
af
tert
hest
imul
atedpr
esett
ime.Theul
tr
asoni
ctr
ansducerpr
obei
sindi
rectcont
actwi
th
t
hebodyt
hroughacoupl
antorgel
.Incasesofl
argear
east
obet
reat
ed,
thepr
obei
s
movedupanddownori
naci
rcul
arf
ashi
ont
oobt
ainauni
for
m di
str
ibut
ionoful
tr
asoni
c
ener
gy.I
fther
eisawoundoranunevenpar
tli
keaj
oint
,thet
reat
menti
scar
ri
edouti
na
war
m wat
erbat
htoavoi
dmechani
cal
cont
actwi
tht
heal
readyi
njur
edt
issues.
Sur
gicalDi
ather
my:
Hi
ghf
requencycur
rentcanbeusedf
orsur
gical
pur
posesi
nvol
vingcut
ti
ngand
coagul
ati
on.Thef
requencyofcur
rent
susedi
nsur
gicaldi
ather
myuni
tsr
angebet
ween1
and3MHz.
Whenhi
ghf
requencycur
rentf
lowst
hrought
heshar
pedgeofawi
rel
ooporbandl
oopor
t
hepoi
ntofaneedl
eint
othet
issue,
ther
eisahi
ghconcent
rat
ionofcur
renti
nthi
spoi
nt.
Thet
issuei
sheat
edt
osuchanext
entt
hatt
hecel
lsi
mmedi
atel
ybeneat
h,t
heel
ect
rodear
e
t
ornapar
tbyt
heboi
li
ngoft
hecel
lfl
uid.Coagul
ati
onoft
issuei
scausedbyt
hehi
gh
f
requencycur
rentf
lowi
ngt
hrought
het
issueandheat
ingi
tlocal
lysot
hati
tcoagul
ates
f
rom t
hei
nsi
de.Thecoagul
ati
onpr
ocessi
saccompani
edbyagr
ayi
shwhi
tedi
scol
orat
ion
oft
het
issueatt
heedgeoft
heel
ect
rode.Theconcur
rentuseofcont
inuousr
adi
o
f
requencycur
rentf
orcut
ti
ngandabur
stwaver
adi
ofr
equencyf
orcoagul
ati
oni
scal
ledt
he
Hemost
asi
smode.
Sur
gicalDi
ather
my
Thesepar
ati
onoft
issuesbyel
ect
ri
ccur
rental
wayst
akespl
acei
mmedi
atel
yinf
rontoft
he
cut
ti
ngedgeandi
snotcausedbyi
t,t
her
efor
eel
ect
ri
ccur
rentdoesnotr
equi
reany
appl
icat
ionoff
orce.Thi
senabl
esel
egantandef
for
tl
esssur
ger
y.Theel
ect
rodevi
rt
ual
ly
mel
tst
hrought
het
issuei
nst
ant
aneousl
yandseal
scapi
ll
ari
esorot
hervessel
sand
pr
event
scont
ami
nat
ionbybact
eri
a.Thef
requencyofoper
ati
onofsol
idst
atedi
ather
my
machi
nesi
s250kHzt
o1MHz.Theydel
iver400W i
n500Ωl
oadat2000Vi
nthecut
ti
ng
modeandar
ound150W i
nthecoagul
ati
onmode.Thesemachi
nesal
soi
ncor
por
atean
i
ndependentbi
pol
arRFgener
atorf
ormi
crosur
ger
ydi
ather
myuni
t.
Hear
t-
lungmachi
ne
Dur
ingopenhear
tsur
ger
yfori
nst
all
ati
onofaval
vepr
ost
hesi
sorcor
rect
ionofa
congeni
talmal
for
mat
ion,
thehear
tcannotmai
ntai
nci
rcul
ati
onofbl
ood.Ther
efor
eit
becomesnecessar
ytopr
ovi
deci
rcul
ati
onwi
thaspeci
almachi
necal
ledt
hehear
t-
lung
machi
ne.Thehear
t-
lungmachi
ner
epl
acest
hef
unct
ionsoft
hehear
tandl
ungst
her
eby
pr
ovi
dingt
her
estoft
hebodywi
thacont
inuoussuppl
yofoxygenat
edbl
oodwhi
l
ethe
hear
tisst
opped.Thehear
tlungmachi
neconsi
stsoft
wocannul
aswhi
char
einser
tedi
nto
t
her
ightsi
deoft
hehear
ttocol
lectt
her
etur
ningvenousbl
ood.Thi
sdeoxygenat
edvenous
bl
oodi
sdi
rect
edi
ntot
her
ecei
vingr
eser
voi
r.
Schemat
icRepr
esent
ingf
lowofbl
oodi
nahear
tlungmachi
ne
Bl
oodaccumul
atedi
ntheoper
ati
ngar
eai
sal
socol
lect
edandpassedont
other
ecei
ving
r
eser
voi
r,wher
ebubbl
es,
ifanyar
eremoved.Thent
hebl
oodi
spassedont
othe
oxygenat
or,
wher
eiti
sexposedt
oanat
mospher
eri
chi
noxygen.Fr
om t
heoxygenat
or,
a
pumpr
aisest
hepr
essur
efr
om whi
chi
tfl
owsi
ntoanar
ter
ial
heatexchanger
.Thear
ter
ial
heatexchangermai
ntai
nsbl
oodatnor
malbodyt
emper
atur
e.Thent
hebl
oodpasses
t
hroughaf
il
tert
opr
eventt
hepossi
bil
it
yofpar
ti
clesorbubbl
esr
etur
ningt
othebody.
Fi
lt
ered,
oxygenat
edbl
oodi
sthusci
rcul
atedt
hroughoutbodyvi
aar
ter
ies.I
tisal
so
ensur
ed,
thatt
hehear
tit
sel
frecei
vesbl
ooddur
ingsur
ger
yti
me.
Fi
lt
er
Cor
pump
ar
y
on
exchange
Reser
Recei
Ar
heat
Cor
ter
g
r
pump
si
voi
i
vi
onar
nus
al
n
r
exchanger
y
Cor
hear
onar
t
y
Ar
r
pump
Set
eser
ter
t
i
l
al
voi
ing
r
Oxyge
nator
Audi
omet
ers
I
ntr
oduct
ion:
 Audi
omet
ryi
sthepr
ocessoft
est
ingoft
hehear
ingabi
li
tyofasubj
ect
.
 Audi
omet
ri
ctest
sdet
ermi
neapat
ient
’shear
ingl
evel
swi
tht
hehel
pofanaudi
omet
er.
 I
tal
someasur
est
heabi
li
tyofapat
ientt
odi
scr
imi
nat
ebet
weendi
ff
erentsound
i
ntensi
ti
es,
recogni
zepi
tchordi
sti
ngui
shspeechf
rom backgr
oundnoi
se.
 Resul
tsofaudi
omet
ri
ctest
sar
eusedt
odi
agnosehear
ingl
ossordi
seasesoft
heear
.
Audi
omet
er:
Anaudi
omet
eri
samachi
neusedf
ort
est
ingt
hehear
ingcapabi
li
ty.Audi
omet
erconsi
stsof
anembeddedhar
dwar
euni
tconnect
edt
oapai
rofheadphonesandaf
eedbackbut
ton,
cont
rol
ledbyast
andar
dPC.Thehar
dwar
emai
nlyconsi
stsofanosci
ll
atordr
ivi
ngt
he
headphone.Audi
omet
ersuset
ransducer
sli
keearphones,
Micr
ophone,
BoneVi
brat
osand
l
oudspeaker
s.Thef
requencyandacoust
icout
putoft
heosci
ll
atorcanbeadj
ust
edovera
r
ange.Agr
aphshowi
nghear
ingl
ossasaf
unct
ionoff
requencyasmeasur
edbyan
audi
omet
eri
scal
ledt
heaudi
ogr
am.At
ypi
calaudi
ogr
am compar
ingnor
malandi
mpai
red
hear
ingi
sshownbel
ow.0dBonanaudi
ogr
am denot
est
hehear
ingt
hreshol
dlevelt
hati
s
r
egar
dedast
henor
malaudi
omet
ri
cst
andar
datt
hatf
requency.Poi
ntsbel
ow0ont
he
scal
edenot
eloudert
hreshol
dlevel
s,wher
east
hoseabove,
expr
essedi
nnegat
ivedeci
bel
s
wi
thr
espectt
othezer
olevel
,ar
elessi
ntensel
evel
swhi
ch,
becauseofi
ndi
vidualhear
ing
di
ff
erences,
somepeopl
emaynor
mal
lyhear
.
Basi
cAudi
omet
er
TypesofAudi
omet
ers:
Ther
ear
etwot
ypesofaudi
omet
ersbasedont
het
ypeofst
imul
ust
heypr
ovi
denamel
y,
1.Pur
etoneaudi
omet
er
2.Speechaudi
omet
er
1.Pur
eToneAudi
omet
er:
Pur
etonei
sawavewhi
chi
nvol
vesonl
yonef
requencyofvi
brat
ion.Pur
etonei
sthe
si
mpl
estt
ypeofaudi
tor
yst
imul
us.Thi
sist
hemostcommonl
yusedt
echni
quef
or
det
ermi
ninghear
ingl
oss.Pur
etoneaudi
omet
ersgener
atesoundwavesoff
requency125
t
o8000Hzandi
ntensi
ti
es-
10dBt
o+100dB.Apur
etoneaudi
omet
erconsi
stsofLC
osci
ll
ator
swher
ethei
nduct
anceandcapaci
tanceval
uesdet
ermi
net
hef
requencyof
osci
ll
ati
ons.Theosci
ll
ati
onsar
eampl
if
iedbyampl
if
ier
stoobt
ainr
equi
redpowerl
evel
s.
Thent
hesi
gnal
sar
epr
esent
edacoust
ical
lyt
otheearbyoneoft
het
ransducer
sli
keear
phoneorsmal
lloudspeaker
s.
2.SpeechAudi
omet
er:
I
nspeechaudi
omet
ert
est
s,t
esti
scar
ri
edoutwi
thspokenvoi
ces.Thi
stesti
shel
pfuli
n
i
dent
if
yingt
hedet
eri
orat
ionofspeechunder
standi
ngi
npat
ient
s.Aspeechaudi
omet
er
consi
stsofagoodqual
i
tyt
aper
ecor
derwhi
chpl
aysr
ecor
dedspeech.Adoubl
ebandt
ape
r
eor
dermaybeusedt
oint
erf
acet
het
wochannelaudi
omet
eruni
tswhi
chsuppl
ythet
wo
headphonesorl
oudspeaker
s.Theusageoft
aper
ecor
derenabl
est
oaccountf
ort
he
consi
stencyofspeechi
nput
.Testwor
dsandsent
encescanal
sobesel
ect
edwhi
leusi
ng
t
aper
ecor
der
ssot
hatt
est
scanbeconduct
edf
ordi
ff
eri
ngneedsofage,
int
ell
igence,
di
alectandl
anguage.
BekesyAudi
omet
er:
BekesyAudi
omet
erwasi
nvent
edbyGeor
geVonBekesy.
Thi
sisani
nst
rumentt
omeasur
ecapabi
li
tyofhear
ing.Her
ethesoundi
ntensi
tyi
nanear
phonei
sgr
adual
lyi
ncr
easedunt
ilt
hesoundi
sper
cei
vedbyt
hepat
ient
.Thehear
ingi
nthe
ot
hereari
smaskedbyappl
yingwhi
tenoi
set
otheear
.Nor
mal
ly,
thet
hreshol
dofhear
ing
i
sdet
ermi
nedatanumberoff
requenci
es.I
nor
dert
oper
for
m ameasur
ement
,thepat
ient
f
ir
stpr
essesacont
rolbut
ton,
thusst
art
ingar
ever
sibl
emot
orwhi
chdr
ivesavol
ume
cont
rolpot
ent
iomet
erandi
ncr
easest
heampl
it
udeoft
hest
imul
ussi
gnalunt
ili
tis
per
cei
vedbyt
hepat
ient
.Thepat
ientt
henr
eleasest
hebut
ton,
openi
ngt
heswi
tch,
andt
he
mot
orr
ever
ses.Byal
ter
nat
elycl
osi
ngandopeni
ngt
heswi
tch,
thesubj
ectmai
ntai
nst
he
vol
umeatal
evel
atwhi
cht
het
onecanj
ustbehear
d.Apen,
connect
edt
othevol
ume
cont
rolmechani
sm,
drawsal
ineonamovi
ngpaper
.
Att
hesamet
imet
hepaperdr
ivemechani
sm,
whi
chi
sli
nkedt
othei
nst
rument
’sf
requency
cont
rol
,sl
owl
ychangest
hef
requencyoft
het
one.Wi
thi
nabout15mi
nut
esar
ecor
ding,
cal
ledt
heaudi
ogr
am,
isobt
ained.
Theaudi
ogr
am i
sof
tencal
ibr
ated,
noti
nabsol
uteval
uesoft
heper
cept
iont
hreshol
dbuti
n
r
elat
iveval
uesr
efer
redt
otheacui
tyofnor
malsubj
ect
s.Ther
esul
tantcur
vecor
responds
di
rect
lyt
othehear
ingl
ossasaf
unct
ionoff
requency.
Di
alyzer
s
I
ntr
oduct
ion:
Di
alysi
s:
Di
alysi
sispr
imar
il
yusedt
opr
ovi
deanar
ti
fi
cialr
epl
acementf
orl
ostki
dneyf
unct
ion(
renal
r
epl
acementt
her
apy)duet
orenalf
ail
ure.Di
alysi
smaybeusedf
orsi
ckpat
ient
swhohave
t
empor
ari
ly,
lostt
hei
rki
dneyf
unct
ion(
acut
erenalf
ail
ure)orf
orpat
ient
swhohave
t
empor
ari
lyl
ostt
hei
rki
dneyf
unct
ion(
stage5chr
oni
cki
dneydi
sease)
.Di
alysi
sthr
ought
he
di
ff
usi
onpr
ocesshel
psi
nwast
eremovalandconvect
ionpr
ocesshel
psi
nfl
uidr
emoval
.
Di
alysi
sdoesnotcor
rectt
heendocr
inef
unct
ionsoft
heki
dney,
hencecanbecal
l
ed
i
mper
fectt
reat
ment
.
Funct
ionsofki
dney:
1.Mai
ntai
ningt
hebody’
sint
ernalequi
li
bri
um ofwat
er.
2.Mai
ntai
ningt
hebody’
sint
ernalequi
li
bri
um ofmi
ner
alsl
ikesodi
um,
pot
assi
um,
chl
ori
de,
cal
cium,
phosphor
ous,
magnesi
um andsul
phat
e.
3.Theki
dneysal
sor
emovet
hedai
lymet
abol
icl
oadoff
ixedhydr
ogeni
onsf
rom t
he
bl
ood.
4.Theki
dneysal
sof
unct
ionasapar
toft
heendocr
inesyst
em pr
oduci
ng
er
ythr
opoi
eti
nand1,
25–di
hydr
oxychol
ecal
if
erol
.
Pr
inci
ple:
Di
alysi
swor
ksont
hepr
inci
plesofdi
ff
usi
onandosmosi
sofsol
utesandf
lui
dacr
ossa
semi–per
meabl
emembr
ane.Bl
oodf
lowsbyonesi
deofasemi–per
meabl
emembr
ane,
andadi
alysat
eorf
lui
dfl
owsbyt
heopposi
tesi
de.Smal
lersol
utesandf
lui
dpasst
hrough
t
hemembr
ane.Thebl
oodf
lowsi
nonedi
rect
ionandt
hedi
alysat
efl
owsi
ntheopposi
te.
Theconcent
rat
ionsofundesi
redsol
utesexampl
epot
assi
um,
cal
cium andur
eaar
ehi
ghi
n
t
hebl
ood,
butar
eabsenti
nthedi
alysi
ssol
uti
onandconst
antr
epl
acementoft
hedi
alysat
e
ensur
est
hatt
heconcent
rat
ionofundesi
redsol
utesi
skeptl
owont
hissi
deoft
he
membr
ane.Thedi
alysi
ssol
uti
onhasl
evel
sofmi
ner
alsl
ikepot
assi
um andcal
cium t
hat
ar
esi
mil
art
othei
rnat
uralconcent
rat
ioni
nheal
thybl
ood.Foranot
hersol
ute,
bicar
bonat
e,
di
alysi
ssol
uti
onl
evel
issetatasl
ight
lyhi
gherl
evelt
hani
nnor
malbl
ood,
toencour
age
di
ff
usi
onofbi
car
bonat
eint
othebl
ood,
toneut
ral
izet
hemet
abol
icaci
dosi
sthati
sof
ten
pr
esenti
nthesepat
ient
s.
TypesofDi
alysi
s:
1.Hemodi
alysi
s
2.Per
it
onealDi
alysi
s
1.Hemodi
alysi
s:
Thepr
inci
pleofHemodi
alysi
sinvol
vesdi
ff
usi
onofsol
utesacr
ossasemi
-per
meabl
e
membr
ane.Hemodi
alysi
sut
il
izescount
ercur
rentf
low,
wher
ethedi
alysat
eisf
lowi
ngi
nthe
opposi
tedi
rect
iont
obl
oodf
lowi
ntheext
racor
por
ealci
rcui
t.Count
ercur
rentf
low,
mai
ntai
nst
heconcent
rat
iongr
adi
entacr
osst
hemembr
aneatamaxi
mum andi
ncr
eases
t
heef
fi
ciencyoft
hedi
alysi
s.Fl
uidr
emoval(
ult
raf
il
tr
ati
on)i
sachi
evedbyal
ter
ingt
he
hydr
ost
ati
cpr
essur
eoft
hedi
alysi
scompar
tment
,causi
ngf
reewat
erandsomedi
ssol
ved
sol
utest
omoveacr
osst
hemembr
aneal
ongacr
eat
edpr
essur
egr
adi
ent
.Thedi
alysi
s
sol
uti
ont
hati
susedi
sast
eri
li
zedsol
uti
onofmi
ner
ali
ons.Ur
eaandot
herwast
epr
oduct
s
al
ongwi
thpot
assi
um andphosphat
edi
ff
usei
ntot
hedi
alysi
ssol
uti
on.However
,
concent
rat
ionsofsodi
um andchl
ori
dear
esi
mil
art
othoseofnor
malpl
asmat
opr
event
l
oss.Bi
car
bonat
eisaddedi
nahi
gherconcent
rat
iont
hanpl
asmat
opr
eventl
oss.
Bi
car
bonat
eisaddedi
nahi
gherconcent
rat
iont
hanpl
asmat
ocor
rectbl
oodaci
dit
y.
Hemodi
alysi
s
Asmal
lamountofgl
ucosei
sal
socommonl
yused.Her
ethepat
ient
’sbl
oodi
spumped
t
hrought
hebl
oodcompar
tmentofadi
alyzer
,exposi
ngi
ttoasemi
-per
meabl
emembr
ane.
Thecl
eansedbl
oodi
sthenr
etur
nedvi
atheci
rcui
tbackt
othebody.Thi
susual
lyi
sdoneby
appl
yinganegat
ivepr
essur
etot
hedi
alysat
ecompar
tmentoft
hedi
alyzer
.Thi
spr
essur
e
gr
adi
entcauseswat
eranddi
ssol
vedsol
utest
omovef
rom bl
oodt
odi
alysat
e,andal
lows
r
emovalofsever
all
it
ersofexcessf
lui
ddur
ingt
ypi
cal3t
o5hourt
reat
ment
.Hemodi
alysi
s
i
saf
lexi
blemodal
it
yandschedul
escanbechangeddayt
oday,
weekt
oweek.I
ngener
al,
st
udi
eshaveshownt
hatbot
hincr
easet
reat
mentl
engt
handf
requencyar
ecl
ini
cal
ly
benef
ici
al.
2.Per
it
oneal
Dial
ysi
s:
Per
it
onealDi
alysi
sisamet
hodf
orr
emovi
ngwast
esuchasur
eaandpot
assi
um f
rom t
he
bl
ood,
aswel
lasexcessf
lui
d,whent
her
eisr
enalf
ail
ure.I
tisaf
orm ofr
enaldi
alysi
s,and
i
sthusar
enalr
epl
acementt
her
apy.Per
it
onealdi
alysi
swor
ksont
hepr
inci
plet
hatt
he
per
it
onealmembr
anet
hatsur
roundst
hei
ntest
ine,
canactasanat
uralsemi
-per
meabl
e
membr
ane.Bydi
ff
usi
ngaspeci
all
yfor
mul
ateddi
alysi
sfl
uidar
oundt
hemembr
anedi
alysi
s
i
sdone.Excessf
lui
disr
emovedbyosmosi
s,byal
ter
ingt
heconcent
rat
ionofgl
ucosei
n
t
hef
lui
d.Her
e,t
hedi
alysi
sfl
uid,
ast
eri
lesol
uti
oncont
aini
ngmi
ner
alsandgl
ucosei
srun
t
hroughat
ubei
ntot
heper
it
onealcavi
ty,
theabdomi
nalbodycavi
tyar
oundt
hei
ntest
ine,
wher
etheper
it
oneal
membr
aneact
sasasemi
-per
meabl
emembr
ane.Di
alysi
sfl
uidi
s
di
ff
usedvi
aaper
it
onealdi
alysi
scat
het
ercal
ledt
heTenckhof
fcat
het
erwhi
chi
spl
acedi
n
t
hepat
ient
’sabdomen,
runni
ngf
rom t
heper
it
oneum outt
othesur
face,
neart
henavel
.
Per
it
onealDi
alysi
s
Thedi
alysat
eisl
eftt
her
eforaper
iodoft
imet
oabsor
bwast
epr
oduct
s,andt
heni
tis
dr
ainedoutt
hrought
het
ubeanddi
scar
ded.Thi
scycl
eorexchangei
snor
mal
lyr
epeat
ed4
t
o5t
imesdur
ingt
heday.Per
it
onealdi
alysi
scat
het
ersmayal
sobet
unnel
edundert
heski
n
andexi
tal
ter
nat
elocat
ionssuchasneart
her
ibmar
ginorst
ernum cal
ledapr
est
ernal
cat
het
er.Thi
sisdoneasashor
tsur
ger
y.Theexi
tsi
tei
schosenbasedon1)Sur
geon’
s
Pr
efer
ence,
2)Pat
ient
’sPr
efer
enceand3)Anat
omyandhygi
enei
ssues.Per
it
onealdi
alysi
s
canbedoneatt
hepat
ient
’shome.
Ul
tr
afi
lt
rat
ionoccur
svi
aosmosi
s;t
hedi
alysi
ssol
uti
onusedcont
ainsahi
ghconcent
rat
ion
ofgl
ucose,
andt
her
esul
ti
ngosmot
icpr
essur
ecausesf
lui
dtomovef
rom t
hebl
oodi
nto
t
hedi
alysat
e.Asar
esul
t,mor
efl
uidi
sdr
ainedt
hatwasi
nst
il
led.Per
it
onealdi
alysi
sisl
ess
ef
fi
cientt
hanHemodi
alysi
s,butbecausei
tiscar
ri
edoutf
oral
ongerper
iodoft
imet
henet
ef
fecti
nter
msofr
emovalofwast
epr
oduct
sandofsal
tandwat
erar
esi
mil
art
o
Hemodi
alysi
s.
Li
thot
ri
psy
I
ntr
oduct
ion:
Li
thot
ri
psyr
efer
stononi
nvasi
veormi
nimal
lyi
nvasi
vesur
gicalt
echni
quesf
orr
emovi
ng
ki
dneyst
oneswi
thoutr
isksandcompl
icat
ionst
hatar
einvol
vedi
nanopeni
nci
sion
sur
gicalt
echni
que(
li
thot
omy)t
hatwasusedt
oremovet
hest
one.Li
thot
ri
psyi
nvol
ves
di
sint
egr
ati
onoft
hest
one‘
i
nvi
vo’
sot
hati
tcanpasst
hrought
heur
inar
ytr
acti
nthef
orm
ofsmal
lpar
ti
clessot
hatt
her
eisnodi
scomf
ortorpai
ntot
hepat
ient
.
Ther
ear
etwot
ypesofl
it
hot
ri
psyt
echni
quesnamel
y,1.Per
cut
aneousLi
thot
ri
psy–I
n
Per
cut
aneousl
it
hot
ri
psy,
apr
obei
sgui
dedunderx-
rayf
luor
oscopyt
hroughasmal
l
i
nci
sioni
ntot
hel
ocat
ionoft
heki
dneyst
one.Ei
thermechani
calshockwavesar
epr
oduced
att
het
ipoft
hepr
obebyacont
rol
ledel
ect
ri
cdi
schar
ge(
spar
k),
ort
hepr
obecont
ainsan
ul
tr
asoni
ctr
ansducert
hatpr
oducesul
tr
asoni
cwaves.Eachoft
hesef
ormsofener
gyi
s
usedt
obr
eakupt
heki
dneyst
onesot
hati
tcanbewi
thdr
awni
npi
ecest
hrought
hepr
obe
gui
deel
ementorcanbeal
lowedt
opasst
hrought
heur
inar
ytr
act
.
2.Ext
racor
por
eal
ShockWaveLi
thot
ri
psy–Thi
sisanent
ir
elynoni
nvasi
vemet
hodt
hat
canbeusedt
obr
eakupki
dneyst
ones.Manymechani
calshockwavesar
epr
oducedat
onef
ocusofanel
li
psoi
dal
ref
lect
orsucht
hatt
hesewavesconver
get
oanot
herf
ocalpoi
nt
sever
alcent
imet
ersawayf
rom t
her
efl
ect
or.Ther
efl
ect
orandt
hepat
ientar
esubmer
ged
i
ndemi
ner
ali
zed,
degassedwat
eri
nsuchawayt
hatt
hepat
ientcanbemovedunt
ilt
he
st
onei
slocat
edatt
hef
ocal
poi
ntoft
heshockwave.Thi
sposi
ti
oni
ngoft
hepat
ienti
s
cr
it
ical
,andabi
planex-
raysyst
em i
susedt
oest
abl
isht
heposi
ti
onoft
hest
oneatt
he
f
ocalpoi
ntaswel
last
omoni
tori
tsdi
sint
egr
ati
on.
Ahi
ghvol
tagepul
se(
about20kV)i
sappl
iedt
othespar
kgap,
andt
hedi
schar
gepr
oduces
ashockwavet
hati
spr
opagat
edt
hrought
hewat
ert
othef
ocalpoi
nt.Thepat
ienti
spl
aced
onagant
rysuppor
tthatcanbepr
eci
sel
yposi
ti
onedast
heoper
atorobser
vest
hest
oneon
t
hebi
planex-
raymoni
tor
s.Oncet
hepat
ienti
sappr
opr
iat
elyposi
ti
oned,
mul
ti
pleshock
wavesar
egener
atedbymul
ti
pledi
schar
gesacr
osst
hespar
kgap.Upt
o2000shock
wavesmaybenecessar
ytor
educeaki
dneyst
onet
o1t
o2mm f
ragment
sthatcanpass
t
hrought
heur
inar
ytr
act
.
Moder
nShockWaveLi
thot
ri
pterSyst
ems:
ShockWavel
it
hot
ri
psymachi
nescur
rent
lyavai
labl
eint
hemar
ketvar
yfr
om t
heear
li
er
onesi
nter
msofsever
aloper
ati
onalf
act
orssuchast
heener
gysour
ce,
thef
ocusi
ng
syst
em andst
onel
ocal
izat
ionsyst
em.I
ngener
alt
hemai
ncomponent
sofal
it
hot
ri
pter
syst
em ar
e,
 Focusedshockwavesour
ce
 Meansofacoust
iccoupl
ingoft
heshockwavet
othebody
 I
magi
ngmodal
it
iesf
orst
onel
ocal
izat
ionandt
her
apycont
rol
 Apat
ientt
abl
ewi
thei
thert
het
abl
eort
heshockwavesour
cemovabl
e
 Syst
em f
ort
hemeasur
ementofphysi
ologi
calvar
iabl
esandt
hei
rmoni
tor
ing
 Tr
iggergener
ati
onandcont
rolsyst
em
Focusedacoust
icshockwavesoff
ocalpr
essur
esofabout10t
o100MegaPascalar
e
used.Theseshockwavesar
egener
atedbyanemi
tt
erout
sidet
hebodyandt
ransmi
tt
edas
pul
sedl
ongi
tudi
nalwavest
hroughaf
lui
dcoupl
ingmedi
um andt
hebodyt
issuet
othe
t
arget
.
Ther
ear
ethr
eebasi
ctypesofshockwavesour
cesnamel
y,
1.Pl
asmaexpl
osi
onmet
hod
2.El
ect
romagnet
icsyst
em
3.Pi
ezo-
cer
ami
csyst
em
Thecommonl
yusedf
ocusi
ngmet
hodsar
eel
li
psoi
dalr
efl
ect
or,
focusi
ngwi
thanacoust
ic
l
ensandsel
ffocusi
ngsour
ce.X-
rayf
luor
oscopyandul
tr
asoundB-
scanar
eusedas
i
magi
ngpr
ocedur
esi
nli
thot
ri
psy.I
nx-
rayf
luor
oscopyf
orl
it
hot
ri
psy,
twox-
raygener
ator
s
andi
magei
ntensi
fi
ersar
eusedatdi
ff
erenti
magi
ngpl
anes.Thei
mageappear
sont
he
hi
ghr
esol
uti
oncomput
erscr
eenmount
edont
hecont
rolpanel
.Usi
ngdi
git
ali
magecont
rol
,
t
hecomput
ercanenhancet
hecont
rastoft
hei
mageandcanst
oref
orf
utur
eusei
nthe
t
reat
mentpr
ocedur
es.Wher
easwhi
leusi
ngB–scani
magi
ngmodal
it
ythei
llef
fect
sof
i
oni
zingr
adi
ati
onasi
nx-
rayar
eabsent
.Usi
ngB–scanul
tr
asoundi
magi
ngi
nli
thot
ri
psy
al
soai
dsi
nonl
inei
magi
ng.
Fort
het
reat
mentofki
dneyandur
inar
yst
ones,
shockwavesour
cesar
ear
rangedbel
ow
t
hest
ruct
uressuppor
ti
ngt
hepat
ient
.Forai
mingt
heshockwavesatt
het
argetst
ones,
ei
thert
het
abl
ewi
tht
hepat
ienti
smovedor
,af
teranappr
oxi
mat
eposi
ti
oni
ng,
theshock
wavesour
cei
sadj
ust
ed.Thepat
ientt
abl
eismot
ori
zedt
hatenabl
esmovementi
nal
lthr
ee
di
rect
ions.Thet
abl
ecanbecont
rol
leddi
rect
lyf
rom t
hecont
rolpanel
.Thet
abl
ehasan
openi
ngper
mit
ti
ngt
hepat
ient
’sl
umbarar
eat
ocont
actanoi
lcoat
edmembr
anet
hat
acoust
ical
lycoupl
est
hepat
ientwi
tht
hewat
ersyst
em.
Br
eakt
hroughsi
nMedi
calRobot
ics:Whatt
oExpecti
n2015
Medicalrobot
icsisnolongeranewi dea.Theglobalmedicalr
oboti
csindustryhas
experi
encedunprecedentedgrowthinrecentyear
s,mostlyduetorapidtechnol
ogical
advancementsandchangesi npatientmindsetwit
hregardtoaccepti
ngr obot
s’
i
nvolvementintheirmedical
care.
Awi derangeofrobotshaveemer gedtoservevari
ous
speci
ali
zedrolesi
nt hemedical
envi
ronment.Forsi
mpli
cit
y,Iwil
lcl
assi
fytheser
obotsint
o
twobroadcategori
esandassesswhichoftheserobott
ypesarebestposi
ti
onedforgr
owth
thi
syear.
Thet womai ncat
egori
esare:
1.Robot sspecializi
ngi nhumant reatment ,i
ncl udingsur gi
calr obots,micr o-
bot s,and
rehabi l
it
ati
onr obots
2.Robot sspecializi
ngi nheal thfaciliti
esmanagement ,
suchasmedi caltranspor tati
onand
telepr esence,sanitationanddi si
nf ecti
onr obots, andr oboticpr escri
ptiondi spensi ng
syst ems
Sur gicalrobots arebei ngdevel opedt oovercomet hel i
mitationsofmi ni mal l
y-invasive
sur ger yandtoenhancet hecapabi li
ti
esofsur geons.Theser obotsarest i
llveryexpensi ve
andhavei ssueswi thl at
ency, hardmani pulators, and3Dvi sualizat
ionofi nt ernalbody
par ts,amongot herchal l
enges.Iexpectt oseemaj ordevelopment sont wof ront sinthe
sur gicalroboti
csspace:
 So ftrobot i
carms –Resear chl absar oundt hewor l
dar ecur rentl
ytryi
ngt odesi gnsuch
arms.Oneoft heEur opeanr esear chpr oj
ect s,
STI FF-FLOP,
hasbeenabl et oachi evethe
compl eterobotsof ar.Model edonbi ologicalmani pulati
onl iketheoctopusar m andt he
elephantt r
unk, wit
hcont r
olledst i
ffnessandhavi ngt heabi l
itytosqueezet hroughnar row
gapsandopeni ngs,theser obot i
car mswi l
lincreaset hesaf etymani f
ol dswhenbei ng
oper at edonsof thumant issues.
(Source:STI
FF-FLOP)
 Nextgenerati
on3DHDvi suali
zat
ionandsurf
acereconstr
uction
–3DHDt echnologygives
surgeonsthespatialr
eferencesneededt
odohi ghlycomplexsurger
ybyeli
mi nati
ngthe
l
ackofdept hpercepti
on.Thistechnol
ogyisavail
ableint
he daVi
nciSur
gicalSystem.Inthe
nextgener ationof3DHD, t
herewillbemor eenhancednat uralstereovi suali
zati
onoft he
scenecombi nedwi thaugment edreali
ty.
Micro-bots couldbet henextbigthinginmedi calrobots.Theser obotscanbei nj
ectedint
o
thebodywi thoutleavingawound.Theser obotscandel iverthemedi cineoroper at
eat
preciselocat i
onswi t
hinthebody, assi
sti
ngdoct orstodi agnoseandcur e.Severalkey
appli
cationsf orthesemi cro-
botsarefi
ghti
ngcancer ,

mi nimally-i
nvasiveeye
surgery,
and monitori
nginsuli
n (
nanobots).Thef i
rsthumancl ini
caltrialwillbeginthi
syear.
Mor efuturi
st i
cappl i
cati
onsfortheserobot scouldincluder epair
ingspi nalcordsand
i
mpr ovingepi lepsy.
(Source:Nanot echnologyNewsNet work)

Rehabi l
it
ati
onr obots playacr ucialr oleinimprovingther ecoveryofpeopl ewi t
h
disabili
ti
esandcont ribut etoimprovedmobi l
it
y,strength,coordinati
on, andqualityofli
fe.
Tracticaexpectsthegl obalr ehabilitati
onroboti
csmar kettogr owrapidlyinthenextf ew
years.Meani ngfulprogr esscouldt akeplaceinthef oll
owi ngtechnologyar easin2015:
 Ne uro-r
ehabili
tati
ont echnology/ neur o-r
oboti
cs combi nesneur osciencewi t
har ti
fi
cial
i
nt el
li
gence.Accor dingt o I
nteractiveMot ionTechnol ogies,neuro-r
ehabi l
it
ationtechnology
willenablerobotsthatcancont i
nual lyadapttothei ndivi
dualconditionsandchal l
engesof
eachpat i
entf ollowingstroke,spinalcor dinj
ury,tr
aumat i
cbr ai
ni njury,anddisorderssuch
asmul ti
plescl erosis.
 Virt
ualr eali
tyi ntegratedwithr ehabili
tat
ionrobots willexpandt her angeoft herapyby
combi ningent ertai
nmentwi tht ask-ori
entedexercisesf orthepat i
ent ,i
ncreasingmot ivati
on
andphysi cal tr
eat menteffects.Itwillbealsousedt odi agnoseandt reatpsychol ogi
cal
conditionsofpat i
entsalongwi t
hthedesi gnofmor eef f
ectiveandat tracti
verehabi l
it
ation
trai
ningpr ogr ams.Recent l
y,
Toyot a hasbegunl endingi t
s“ WalkTr ainingAssist”and
“BalanceTr ainingAssi st
”rehabi l
it
ation-ai
dpartnerr obotsforclinicaltrial
sinmedi cal
faci
lit
iesacr ossJapan.
(Source:Toyota)
Medi calt
ransportati
onr obot
s l
ike
TUGRobot
deli
versuppl
ies,
medicat
ions,
andmeal s
whilemedi calt
elepresencerobotsli
ke
RP-VITA ar
especial
lydesi
gnedtocatertot
he
needsofcommuni cati
onbetweendoctors,hospit
alstaf
fmembers,andpati
ents.Mostof
theserobot shavehi ghlydedi cat edcapabi l

iti
esf orsel f-navigati
ont hroughoutt hef acil
it
y.
Ther ei
saneedf orhi ghlyadvancedandcost -eff
ect i
vei ndoornavi gati
onsyst emsbasedon
sensorf usionl ocat i
ont echnol ogyi nordert omaket henavi gati
onalcapabi l
it
iesof
transportati
onr obot smor er obust .
Sanitati
onanddi sinfectionrobot s aregaini ngpopul ar i
tyaf terther i
seofsuper bugsand
theoutbr eakofepi demi cslikeEbol a.Currently,thepr imar ymet hodsusedf ordi sinfect
ion
are UVlightand hydr ogenper oxidevapor s.Theser obot scandi sinf ectaroom f rom deadl y
bacteri
aandvi ruseswi t
hinmi nut es.Thisyear ,
onecanhopef ormor enewmet hodsof
germ zappi ngi ncor poratedwi thaut onomousmobi ler obot i
cuni ts.
Robot i
cpr escr i
pt i
ondi spensi ngsyst ems areaut omat eddi spensi ngequi pmentf or
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