EI1501 BIOMEDICAL INSTRUMENTATION

UNIT II NON ELECTRICAL PARAMETERS MEASUREMENT AND

DIAGNOSTIC PROCEDURES
9
Measurement of blood pressure - Cardiac output - Heart rate - Heart sound -
Pulmonary function measurements – spirometer – Photo Plethysmography, Body
Plethysmography – Blood Gas analysers, pH of blood –measurement of blood pCO2,
pO2, finger-tip oximeter - ESR, GSR measurements.
Measurement of blood pressure
 Measurement of blood pressure

Blood pressure refers to the force exerted by circulating blood against the walls of blood vessels,
particularly the arteries.

Blood pressure is measured using two values:

Systolic Pressure: The systolic pressure is the maximum pressure in an artery at the moment when
the heart is beating and pumping blood through the body. It is typically measured in millimeters of
mercury (mmHg).

Diastolic Pressure: This is the lower value and represents the pressure in the arteries when the
heart is at rest between contractions. It is also measured in mmHg.

Blood pressure is expressed as a ratio of systolic pressure to diastolic pressure. For example, a
blood pressure reading of 120/80 mmHg indicates a systolic pressure of 120 mmHg and a diastolic
pressure of 80 mmHg.
 Measurement of blood pressure
Blood pressure is influenced by various factors, including cardiac output, quantity of blood,
blood vessel diameter, and the elasticity of the arterial walls.

Hypertension, or high blood pressure, occurs when the pressure in the arteries is consistently
elevated above the normal range (typically defined as a blood pressure reading of 140/90 mmHg
or higher). Hypertension can strain the cardiovascular system and increase the risk of various
health complications, such as heart disease, stroke, and kidney problems.

Hypotension, or low blood pressure, occurs when the pressure in the arteries is abnormally low
(typically defined as a blood pressure reading below 90/60 mmHg). It can lead to symptoms such
as dizziness and fainting.
 Measurement of blood pressure
BP is a good indicator of status of cardiovascular system measured as BP
Hypertension or Hypotension
1. Direct measurement
 Sensor is placed inside the blood vessel
 Gives continuous recording and more accurate
2. Indirect measurements
 Using sphygmomanometer
 Not a continuous recording
 No waveform
 Only gives SP and DP
Direct methods – invasive
Indirect methods – non invasive
 Measurement of blood pressure

1) Indirect Method
1) Auscultatory method
2) Oscillometric method
3) Ultrasonic method
2) Direct Method
 Measurement of blood pressure

1. AUSCULTATORY METHOD (Blood pressure measurements using sphygmomanometer)

 Auscultatory method uses aneroid sphygmomanometer with a stethoscope. The auscultatory
method comes from the Latin word "listening
 The sphygmomanometer consists of an inflatable pressure cuff and a mercury or aneroid
manometer to measure the pressure in the cuff.
 The cuff consists of a rubber bladder inside an inelastic fabric covering that can be wrapped
around the upper arm and fastened with either hooks or a Velcro fastener.
 The cuff is normally inflated manually with a rubber bulb and deflated slowly through a needle
valve
 First, a cuff is placed around your arm and inflated with a pump until the circulation is cut off.
The pressure in the cuff is then gradually reduced.
Measurement of blood pressure
 Measurement of blood pressure

 As soon as cuff pressure falls below systolic pressure, turbulence is generated in the blood as it
spurts through the tiny arterial opening.
 The sounds generated by this turbulence, Korotkoff sound can be heard through a stethoscope
placed over the artery downstream from the cuff
 The pressure of the cuff that is indicated on the manometer when the first Korotkoff sound is
heard is recorded as the systolic blood pressure.
 As the pressure in the cuff continues to drop, the Korotkoff sounds continue until the cuff
pressure is no longer sufficient to occlude the vessel during any part of the cycle.
 Below this pressure the Korotkoff sounds disappear, marking the value of the diastolic pressure.
 Measurement of blood pressure
ADVANTAGES
Auscultatory technique is simple and does not require much equipment

DISADVANTAGES
 Auscultatory technique cannot be used in noisy environment
 The observations differ from observer to another
 A mechanical error might be introduced into the system e.g. mercury leakage, air leakage,
obstruction in the cuff etc.
 The observations do not always correspond with intra-arterial pressure
 The technique does not give accurate results for infants and hypotensive patients
Measurement of blood pressure
 Measurement of blood pressure

2). Oscillometric method

Widely used approach for automatic cuff blood pressure (BP) measurement. In this approach, a
cuff placed on the upper arm is inflated and then deflated while the pressure inside the cuff is
measured. The oscillometric method does not require the use of a stethoscope

Preparation: Ensure the patient is seated comfortably, with their arm supported at heart level.
Place the cuff around the upper arm, following the manufacturer's instructions for proper cuff
placement.

Inflation: The electronic blood pressure monitor automatically inflates the cuff to a pressure above
the expected systolic pressure. This occludes the brachial artery temporarily.

Deflation and Measurement: The cuff gradually deflates while the electronic monitor measures
the oscillations in cuff pressure. These oscillations are caused by changes in blood flow as the cuff
pressure decreases.
 Measurement of blood pressure
Detection of Oscillometric Waves: As the cuff pressure decreases, the monitor detects the
oscillations in cuff pressure caused by the blood flow. It analyzes these oscillations to identify
characteristic waveforms associated with systolic and diastolic pressures.

Calculation and Display: The electronic monitor employs algorithms to calculate and display the
systolic and diastolic pressures based on the detected oscillometric waveforms. Once the
measurement is complete, the blood pressure reading is displayed on the monitor's screen.
 Measurement of blood pressure

Advantages
 Sound is not used to measure blood pressure in the oscillometric technique, high environmental
noise levels such as those found in a busy clinical or emergency room do not hamper the
measurement
 It does not require a microphone or transducer in the cuff, placement of the cuff is not as critical
as it is with the auscultatory or Doppler methods.
 The oscillometric method works without a significant loss.
 Accurate even when the cuff is placed over a light shirt sleeve.

Disadvantages
 Excessive movement or vibration during the measurement can cause inaccurate readings or
failure to obtain any reading at all.
 Ultrasonic Doppler Shift Method
The Doppler effect or Doppler shift is the apparent change in frequency of a wave in relation to
an observer moving relative to the wave source.

 It is based on the Doppler phenomenon: The frequency of sound waves varies depending on the
speed of the sound transmitted in relation to the sound receiver.
 The Doppler apparatus consists basically of an ultrasound oscillator and transducer which
transmits and receives the generated ultrasound.
 If the ultrasound strikes an immobile structure such as the compressed arterial wall, the
ultrasound frequency is reflected back unchanged.
 If a moving structure (pulsating artery) is encountered, however, the frequency is altered up or
down (Doppler effect) and this is detectable by an audible alteration of the reflected sound.
Ultrasonic Doppler Shift Method
 Ultrasonic Doppler Shift Method
Working Principle
 Ultra-sonic determination of blood pressure employs a transcutaneous Doppler sensor that
detects the motion of blood vessel walls in various states of occlusion.
 Placement of compression cuff over two small transmitting and receiving ultra-sonic crystals.
 Cuff pressure is increased above diastolic but below systolic the vessel opens and closes with
each heartbeat.
 The Doppler ultra-sonic transmitted signal is focused on the vessel wall and the blood.
 The reflected signal with frequency shift is detected by the receiving crystal and decoded.
 The difference in frequency, in the range of 40 to 500 Hz between transmitted and received
signals.
 That frequency shift is proportional to the velocity of wall motion and blood velocity
Direct Method of Blood Pressure Measurements
 Provide continuous measurement
 Reliable information
 Transducers are directly inserted in to the blood stream
 more accurate than the indirect method
CLASSIFICATION of DIRECT METHOD
1. The catheterization method involving the placement of the transducer through a catheter at the
actual site of measurement in the blood stream or by mounting the transducer on the tip of the catheter.
2. Percutaneous methods in which the blood pressure is sensed in the vessel just under the skin by the
use of a needle or catheter.
3. Implantation techniques in which the transducer is more Permanently placed in the blood vessel or
the heart by surgical methods.
Catheterization ( direct method)
 Catheter is a long tube that is inserted in to the heart or major vessels.
 Sterilized catheters are used
 Apart from obtaining blood pressures in the heart chamber and great vessels, this technique is
also used to obtain blood samples from the heart for oxygen-content analysis and to detect the
location of abnormal blood flow pathways.

Measurement of blood pressure with a catheter can be achieved in two ways.

1. Extra vascular pressure sensor
2. Intra vascular pressure sensor
 EXTRA VASCULAR PRESSURE SENSOR
 The catheter is connected to a three way stopcock and then to a pressure sensor
 It is filled with a saline-heparin solution. It must be flushed with solution every few minutes to
prevent blood clotting at the tip.
 The catheter inserted to the human body by surgical cut down or percutaneous insertion.
 Blood pressure information transmitted via catheter fluid to the sensor diaphragm.
 A thin flexible metal diaphragm is stretched across the opening of the transducer top.
 Diaphragm is connected to an Wheatstone bridge strain gauge.
 The strain gauge will move an amount which is proportional to the applied pressure
EXTRA VASCULAR PRESSURE SENSOR
EXTRA VASCULAR PRESSURE SENSOR
 INTRA VASCULAR PRESSURE SENSOR

Sensor is placed at the tip of the catheter.

This enables the physician to obtain high frequency response in detection of pressure at the tip of the
catheter.
Types of sensor
1). Strain gauge – bonded on to a flexible diaphragm at the catheter tip.
2). Fibre optic device – measures the displacement of the diaphragm optically.
2. Percutaneous Insertion
 A local anesthetic is injected near the site of invasion.
 A hollow needle is inserted at a slight angle towards the vessel. When the needle in in place, a
catheter is fed through the hollow needle with some metal guide. When the catheter is
securely placed in the vessel, the needle and guide are withdrawn. Blood pressure is sensed
directly by attaching a transducer built into the tip of the catheter.
 IMPLANTABLE PRESSURE SENSOR

 They have the advantage of keeping the transducer fixed in place in the appropriate vessel for
long periods of time.
 To implant a transducer in an artery, a longitudinal incision is made, the transducer is inserted
with its housing in intimate contact with the arterial walls.
 The wound is closed with interrupted sutures.
 Cardiac Output
 Cardiac output is the volume of blood pumped by the heart per minute (mL blood/min).
 Cardiac Output in mL/min = heart rate (beats/min) X stroke volume (mL/beat)
= 70 (beats/min) X 70 (mL/beat) = 4900 mL/minute.
 The total volume of blood in the circulatory system of an average person is about 5 liters (5000 mL).
 The heart rate is simply the number of heart beats per minute.
Children (ages 6 - 15) 70 – 100 beats per minute
Adults (age 18 and over) 60 – 100 beats per minute
 Stroke volume (SV) refers to the quantity of blood pumped out of the left ventricle with every heart
beat.
SV=End Diastolic Volume – End Systolic Volume
 If the volume of blood is increased then there would be a greater quantity of blood within the system
increasing the pressure within.
 Cardiac Output
Cardiac output Measurement
1. Indicator dilution Method
2. Dye dilution Method
3. Thermal dilution Method

4. Indicator dilution Method

 The volume flow of the fluid (blood) from the heart can be estimated by introducing a known
amount of indicator and measuring the concentration.
 The indicator can be injected at a constant rate or as a bolus.
 In the bolus type of injection a small quantity of indicator is injected into the right heart itself
 The presence of the indicator in the peripheral artery is detected by a photoelectric transducer since
the indicator is a radio isotope and the concentration is displayed on a chart recorder.
 Cardiac Output

 During the first circulation period, the indicator would mix up with the blood and will dilute just a
bit.
 When passing before the transducer, it would reveal a big and rapid change of concentration.
 This is shown by the rising portion of the dilution curve
 The circulation system being a closed one, a fraction of the injected indicator would once again pass
through the heart and enter the arterial circulation.
 Cardiac Output

 A second peak would then appear. When the indicator is completely mixed up with blood, the curve
becomes parallel with the time axis.
 The amplitude of this portion depends upon the quantity of the injected indicator and on the total
quantity of the circulating blood
Q = Cardiac output ;M=Quantity of injected indicator in mg
 Cardiac Output

 if 10 mg of indicator was injected and average concentration from curve is 5 mg/l for curve
duration of 20 seconds, then,
 Cardiac Output
2. Dye Dilution Method
 The indicator used is a dye. Indocyanine green or Cardio-green dye is commonly used.
 Indicator is (1)inert (2)harmless (3)measurable(4)economical (5)intravascular.
 The dye is needed in very small quantities of up to 5 mg.
 The dye is injected into the right atrium
 The concentration of the dye is measured with the help of infra red photocell.
 The blood is drawn from the radial or femoral artery by a motor driven syringe through a cuvette.
 A radiation source illuminates the cuvette from one side and the detector photocell receives the
scattered laser.
 The output of the photocell is connected to a low drift amplifier. It has a high input impedance and
low output impedance.
 Cardiac Output
2. Dye Dilution Method
 The amplification is directly proportional to the resistance value of the potentiometer R.
 A potentiometric recorder records the amplifier signal on a 200 mm wide recording paper and a
paper speed of 10 mm/s.
 After the curve is drawn, an injection of saline is given to flush out the dye from the circulating
blood
 Cardiac Output
3. Thermal Dilution Method
 In this method, a thermal indicator of known volume is introduced into either the right or left
atrium and this will produce a resultant temperature change in the pulmonary artery or the
aorta respectively. The temperature change helps in estimating cardiac output.
 A solution of 5% Dextrose in water at room temperature is injected as a thermal indicator into the
right atrium.
 Cardiac Output
 It mixes in the right ventricle, and is detected in the pulmonary artery by means of a thermistor
mounted at the tip of a miniature catheter probe.
 The injectate temperature is also sensed by a thermistor and the temperature difference between the
injectate and the blood circulating in the pulmonary artery is measured.
 The reduction in temperature in the pulmonary artery is integrated with respect to time and the blood
flow in the pulmonary artery is then computed electronically by an analog computer which also
applies correction factors.
 10 ml of injectate is used for dilution curve. Dextrose solution at a temperature of 18°C - 28°C is
used. Blood temperature is measured over a range of 30°C to 40°C.

Cardiac Output =
 Heart Rate
 Heart rate: The number of heart beats per unit time is measured as the heart rate.
 The heart rate is based on the number of contractions of the ventricles.
 The heart rate may be too fast (tachycardia) or too slow (bradycardia).
 Heart rate can be measured from the ECG signal either by the average or instantaneous time
intervals between two successive R peaks
 Heart Rate
1) Average Calculation: An average rate in beats/min is calculated by counting the number of pulses
in a given time.
2) Beat to Beat Calculation: This is done by measuring the time (say T) in seconds, between two
consecutive pulses, and converting this time into beats/min (60/T).
 Heart Sound Measurement
 The heart sounds may be due to movement of heart wall, closure of walls, flow of blood, leakage
of blood etc.
 The principal instrument used for the clinical detection of heart sounds is the acoustical
stethoscope (listening to heart sounds is called cardiac auscultation)
 An improvement over the acoustical stethoscope is the electronic stethoscope consisting of a
microphone, an amplifier and a head set.
 Electronic stethoscopes can detect heart sounds which are too low in intensity or too high in
frequency
Heart Sound Measurement
 Heart Sound Measurement
 S1 is caused by closure of the mitral and
tricuspid valves at the beginning
of isovolumetric ventricular contraction.

 S1 is normally slightly split (~0.04 sec)

because mitral valve closure precedes
tricuspid valve closure; however, this very
short time interval cannot normally be heard
with a stethoscope, so only a single sound is
perceived.
 Heart Sound Measurement
 S2 is produced by the closure of the aortic
and pulmonic valves at the beginning
of isovolumetric ventricular relaxation, and
the sound is physiologically split because
aortic valve closure normally precedes
pulmonic valve closure.
 This splitting is not of fixed duration. The
timing of S2 splitting changes depending on
the phase of respiration, body posture, and
certain pathological conditions.
 Heart Sound Measurement

 S3 and S4 heart sounds are extra heart sounds

that occur during the cardiac cycle. S3 is a low-
frequency sound that occurs in early diastole,
while S4 is a high-frequency sound that occurs
in late diastole.
 These sounds are caused by the vibration of the
heart walls as blood flows through the heart.
 Heart Sound Measurement

 S3 heart sounds are often associated with heart

failure, as the sound is caused by the rapid filling
of the ventricles due to increased blood volume.
 The fourth heart sound (S4), when audible, is
caused by vibration of the ventricular wall
during atrial contraction. This sound is usually
associated with a stiffened ventricle (low
ventricular compliance), and therefore is heard
in patients with ventricular hypertrophy,
myocardial ischemia, or in older adults.
 Heart Sound Measurement - Phonocardiograph(PCG)
 The phonocardiograph(PCG) is an instrument used for detecting and recording the sounds
connected with the pumping (mechanical action ) of the heart.
 This helps in indicating heart rate and rhythmicity of heart beat, efficiency of pumping of blood,
valve action etc.
 The phonocardiogram is obtained either with a chest microphone or with a miniature sensor in the
tip of a small tubular instrument that is introduced via the blood vessels into one of the heart
chambers.
 The phonocardiograph consists of a microphone, an amplifier and the recorder The crystal
microphone consists of a piezo electric material which generates potentials when subjected to
mechanical stresses due to heart sounds. The amplifier used for a phonocardiograph has wide
bandwidth with a frequency range of 20-2000Hz.
 Heart Sound Measurement - Phonocardiograph(PCG)

 Filters permit selection of suitable frequency bands so that particular heart sound frequencies can be recorded.
 Inkjet recorders, Electrostatic recorders or thermal recorders can be used to record Phonocardiogram waves.
 Pulmonary Function Analysis
 Pulmonary function tests (PFTs) are non-invasive tests that show how well the lungs are
working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This
information can help your healthcare provider diagnose and decide the treatment of certain
lung disorders.
 Three basic types of measurements are made in the pulmonary clinic: ventilation,
distribution and diffusion.
1) Ventilation deals with the measurement of the body as an air pump, determining its ability
to move volumes of air and the speed with which it moves the air.
2) Distribution measurements provide an indication of where gas flows in the lungs and
whether or not disease has closed some sections to air flow.
3) Diffusion measurements test the lung’s ability to exchange gas with the circulatory system.
 Pulmonary Function Analysis
 Ventilation is performed using devices called spirometers that measure volume displacement and
the amount of gas moved in a specific time. Usually this requires the patient to take a deep breath
and then exhale as rapidly and completely as possible. Called the forced vital capacity, this gives an
indication of how much air can be moved by the lungs and how freely this air flows.
 Distribution measurements quantify degrees of lung obstructions and also determine the residual
volume, which is the amount of air that cannot be removed from the lungs by the patient’s effort.
The residual volume is measured indirectly, such as with the nitrogen washout procedure.
 Diffusion measurements identify the rate at which gas is exchanged with the blood stream. This is
difficult to do with oxygen since it requires a sample of pulmonary capillary blood, so it is usually
done by measuring the diminishment of a small quantity of carbon monoxide mixed with the
inhaled air.
 Pulmonary Function Analysis
Respiratory Volumes
 Tidal Volume (TV): The volume of gas inspired or expired during normal quiet breathing(Normal
value=500ml).

 Inspiratory Reserve Volume (IRV): Additional volume of air inspired forcefully after normal inspiration.
(Normal Value 3300ml)
IRV = VC – (TV + FRC)

 Expiratory Reserve Volume (ERV): Additional amount of air that can be expired forcefully after normal
expiration. (Normal value 1000ml)
ERV = FRC – RV
 Residual Volume (RV): The volume of gas remaining in the lungs after a forced expiration. (Normal value
1200ml)
 Pulmonary Function Analysis
Respiratory Capacities
 Functional Residual Capacity (FRC): The volume of gas remaining in the lungs after normal
expiration.
FRC=ERV+RV = 1000+1300=2300ml
 Vital Capacity (VC): Maximum amount of air expelled out forcefully after deep inspiration.
VC=IRV+TV+ERV = 3300+500+1000=4800ml
 Total Lung Capacity (TLC): The volume of air present in the lungs after deep a deep inspiration.
TLC = VC + RV = IRV+TV+ERV+RV=3300+500+1000+1200=6000ml
 Inspiratory Capacity (IC): The maximum volume that can be inspired after normal expiration.
IC=TV+IRV= 500+3300=3800ml
 Dead Space: Dead Space is the functional volume of the lung that does not participate in gas
exchange.
Pulmonary Function Analysis
 Pulmonary Function Analysis - Spirometer
 The process of measurement of the amount (volume) of air that can be inhaled and exhaled is called
spirometry.
 Spirometry is an important tool used for assessing conditions such as asthma, pulmonary fibrosis and chronic
obstructive pulmonary disease.
 Spirometer is a special device that registers the amount of air a subject inhales or exhales into or out of the
lungs.
 The output produced by a spirometer is called a kymograph trace or spirogram. Spirograms are tracings or
recordings of the information obtained from the spirometric test.
There are two types of spirometers,
1) Volume Spirometer: Those that record the amount of air exhaled or inhaled within a certain time. (volume).
2) Flow Spirometer: Those that measure how fast the airflows in or out as the volume of air inhaled or exhaled
increases (flow).
Pulmonary Function Analysis - Spirometer
 Pulmonary Function Analysis - Spirometer

 The basic spirometer consists of a water tank with an inverted covering floating bell made of
light weight material. There is a provision for tubing at the bottom of the tank.

 The subject or patient, whose lung capacity has to be measured, is made to exhale air into the
tubing, which fills up the tank and thus volume in the tank increases.

 This volume of air pushes upwards the floating bell which is balanced by a counter weight. A wire
is suspended to the floating bell such that when volume change takes place the wire moves in
accordance to the floating bell.

 As the wire moves vertically up and down recorder pen attached to it moves over a chart,
simultaneously recording the volume change in the water tank which is proportional to the lung
capacity.
 Pulmonary Function Analysis - Spirometer

 The disadvantage of this set up is that the oscillations caused because of water in the tank
showing inaccurate unsteady volume measure.

 To overcome this effect a central core of chamber for expired air can be made where the area of
water occupied becomes less. This spirometer works effectively only if the subject offers full
cooperation and that they are trained for this purpose.

 The volume change information in the chamber or water tank in proportion to the lung capacity
can be converted to corresponding electrical signals by the usage of appropriate transducers like
bellows element or piston operated devices.
 Photo Plethysmography
 Plethysmography is the determination of blood flow in a part of the body by measurement of volume
changes in the part.

 The photoplethysmography which is also called the pseudoplethysmography is constructed using a

photodetector and a light source.

 The light source is a (LED) light emitting diode and the photodetector is a photoresistor type which is
excited by a constant current source (CCS). Changes in light intensity cause proportional changes in
the resistance of the photodetector.
 Photo Plethysmography

 Since the current through the photoresistor is constant the resistance changes produce voltage
changes (Eo) at the output of the external circuitry.

 As blood flows through the thumb during each contraction of the atrium blood volume also changes,
aiding a change in optical density of the blood.

 The intensity of the light is changed in accordance to the atrial contraction.

 Light from the LED is reflected into the photodetector by scattering and by direct reflection from the
underlying bone structures of the thumb. The change in intensity of light due to blood flow in and out
of the thumb is detected by the photodetector.

 This change in intensity is calibrated in terms of blood flow. The voltage change at the photoresistor
is amplified, sampled, filtered and displayed in terms of blood flow.
Photo Plethysmography
 Body Plethysmography
 Body plethysmography is a noninvasive type of lung function testing known as a pulmonary function
test. It can help determine how much air is in your lungs after you take a deep breath in (inhale). It
also helps determine how much air remains in your lungs after you take a deep breath out (exhale).
Body plethysmography helps diagnose lung and airway diseases, such as:
1. Asthma.
2. Chronic obstructive pulmonary disease (COPD).
3. Pulmonary fibrosis.
Some symptoms for which your healthcare provider may order body plethysmography include:
4. Chest tightness, pain or pressure.
5. Coughing, especially coughing with mucus.
6. Difficulty taking a deep breath.
7. Shortness of breath (dyspnea) and 5. Wheezing.
 Body Plethysmography
Body plethysmography measures the following:
1. Total lung capacity (TLC): TLC is the volume of air in your lungs after taking the biggest
breath you can.
2. Functional residual capacity (FRC): FRC is the volume of air that remains in your lungs after
breathing out normally.
3. Residual capacity (RC): RC is the volume of air that stays in your lungs after breathing out as
much as possible.
 Body Plethysmography

 Plethysmography is basically used to measure the volume changes in any part of the body that
result from the pulsations of blood occurring with each heart beat.
 These measurements are useful in the diagnosis of arterial obstructions and pulse wave velocity
measurements which may lead to determine the heart rate.
 To measure the Total Lung Capacity (TLC) a body plethysmography is used. it consists of a
rigid air tight chamber in which the patient is made to sit.
 Changes in volume reflect as pressure changes of air inside the chamber.
 Thus by measuring pressure change at constant volume condition or measuring volume change
at constant pressure condition one can interpret values for Total Lung Capacity.
 Sensors such as strain gauge, photo electric sensors, capacitive or impedance sensors can be
used.
Body Plethysmography
 Body Plethysmography
Measurement process:
 Lung volume measurements take as little as three minutes, but the entire procedure will take about 20 to
30 minutes.
 Once you are properly positioned inside the chamber, your pulmonary function technologist will instruct
you to use different breathing techniques, such as panting and normal breathing.
 Your chest volume will expand and increase the pressure in the box as you breath against the shutter. This
pressure reading determines lung volume measurements. The technician will guide you through each
step.
Data collection:
 As you perform the breathing, the body plethysmograph measures changes in pressure and volume inside
the chamber.
 These measurements are used to calculate lung volumes, such as total lung capacity (TLC), residual
volume (RV), and functional residual capacity (FRC). It also provides information about airway
 Body Plethysmography

 The principle of operation of the body plethysmograph depends on the Boyle’s law which states
that at a given Kelvin temperature, the pressure of a given mass of gas is inversely proportional
to its volume.
 That is, (1)
where, K is a constant.
 Since for TLC measurement the patient sits inside an air tight chamber whose temperature
remains constant, equation becomes,
Constant (2).
 Body Plethysmography

 Partially differentiating equation (2) we get,

(3)
(or)
(4)
(5)
 Now the door of the air tight chamber is sealed with the patient inside and the valve on the
mouth piece is closed. Since the patient cannot breathe with the valve closed, the air pressure in
the mouth piece is equal to the lung pressure .
 In the body, (6)
where, TLC = thorax Volume PT = thorax pressure.
 Body Plethysmography

 In the Chamber, (7)

where, Chamber Volume Chamber pressure.
 Since the chamber is closed, any increase in the thoracic volume causes a decrease in the
chamber volume of air.
That is, (8)
(9)
 During the measurement, since the changes in pressure induced by breathing motions are small
when the patient is sitting normally. Therefore,
(10)
 Body Plethysmography

Measurement Procedure:
 Mouth piece valve is closed when the patient is sitting inside the sealed chamber.
 The patient is asked to make breathing motions.
 Change in pressure reading in the pressure gauge (1) which reads out is noted down.
 Similarly change in pressure reading in the pressure gauge (2) which reads out is also noted.
Thus by knowing the chamber volume Total Lung Capacity (TLC) is calculated using the
following equation
 Blood gas analyser

 A blood gas test provides a precise measurement of the oxygen and carbon dioxide levels in your
body. It may also be used to determine the pH of the blood.
 Imbalances in the oxygen, carbon dioxide, and pH levels of your blood can indicate the presence
of certain medical conditions. These may include:
 kidney failure
 heart failure
 uncontrolled diabetes
 hemorrhage
 chemical poisoning
 Drug overdoses
 shock
 Blood gas analyser

 A blood gas test is often ordered along with other tests, such a blood glucose test to check blood
sugar levels and a creatinine blood test to evaluate kidney function.
 Blood gas analysers consist of three electrodes measuring pH, PCO2, and PO2 at 37°C.
 From these outputs, internal computers calculate O2 saturation, base excess, bicarbonate, and
other derived variables such as the compensation by the body for acid–base abnormalities
pH of Blood
 The pH of blood in the arteries should be between 7.35 and 7.45 for the body’s metabolic
processes and other systems to work well.
 The pH of the blood can change in both directions.
 Acidosis occurs when the blood is too acidic, with a pH below 7.35. Alkalosis occurs when the
blood is not acidic enough, with a pH above 7.45.
 Blood gas analyser

 There are four main ways in which blood pH can change:

1. Metabolic acidosis: This occurs due to reduced bicarbonate or increased acid levels.
2. Respiratory acidosis: This occurs when the body removes less carbon dioxide than usual.
3. Metabolic alkalosis: This occurs due to increased bicarbonate or reduced acid levels.
4. Respiratory alkalosis: This occurs when the body removes more carbon dioxide than usual.
 pH can be measured using either pH indicators (like phenolphthalein) - in the form of solution or
pH strips – or using potentiometric method.
 In potentiometric methods, potential difference between known reference electrode and the
measuring pH electrode is determined.
 Potential of the pH electrode depends on the activities of hydrogen ions.
 Blood gas analyser

 This dependence is described by Nernst equation, thus once the potential has been measured the
activity is calculated.

Where, E = Electrode Potential ; Eo = Standard Potential ; R = Gas constant; T = absolute temperature

F = Faraday Constant; = Concentration of hydrogen ions.

 Two electrodes which are involved in the measurement of pH, are

1. The glass electrode (Indicating Electrode or Sensing Electrode or Measuring Electrode)
2. The reference electrode (Calomel Electrode)
 For pH measurement silver – silver chloride electrode is used as the measuring electrode.
 Measuring electrode is made of a sealed glass outer body with a special pH sensitive glass bulb
joined at the end which develops an electric potential corresponding to the pH of the solution.
 Blood gas analyser

 The bulb is of 0.5cm in diameter. The bulb provides a thin glass membrane which permits the
passage of only hydrogen ions in the form of .
 This glass bulb has the Ag/ AgCl electrode immersed in chloride buffer solution.
 Chloride buffer solution is nothing but KCl in 0.1M HCl.
 A calomel electrode is used as the reference electrode.
 The reference electrode is a half cell completing the pH electrode pair (along with the glass
electrode).
 The calomel electrode is made of a glass inner tube filled with mercurous chloride paste.
 This glass tube has a porous plug at the bottom.
 A platinum wire is inserted through this which is the lead wire.
 Blood gas analyser

 On top of the paste an elemental mercury layer is formed.

 This whole inner glass set up is now placed in an outer bigger glass tube with the porous plug at
the bottom.
 The outer glass tube is filled with KCl and forms a half cell potential.
 The porous plug at the bottom of the electrode assembly is used to make contact between the
internal KCl electrolyte and the unknown pH test solution into which the electrode is immersed.
 The potential between this electrode and the glass measurement electrode gives the pH of the
unknown solution.
 Since a salt bridge is formed between the KCl in measuring electrode – unknown test solution –
KCl in reference electrode.
 Blood gas analyser

 It with the internal electrolyte solution, (KCl), makes contact with the sample solution via a
porous glass frit.
 The reference electrode provides a stable, known reference potential, against which the glass/ pH
electrode can be measured.
 The reference electrode is nowadays incorporated into the glass/ pH electrode to form a
compound or combination electrode.
 Blood gas analyser

 For making pH measurements, the solution is taken in a beaker.

 A pair of electrodes (glass electrode & calomel electrode) is immersed in the solution.
 The voltage developed across the electrodes is applied to an electronic amplifier, which
transmits the amplified signal to the display.
 The pH meter is usually equipped with controls for calibration and temperature compensation.
 For pH measurement in particular, glass electrodes with accommodation for a small quantity of
blood and yielding accurate results have been developed and put into use.
 One among such electrode is the syringe type in which small samples of blood is taken
anaerobically and the small ‘dead space’ between the electrode bulb and the inner surface of the
syringe barrel is filled with dilute heparin solution to prevent blood coagulation.
 Blood gas analyser

 Electrodes for Blood pH Measurement: Several types of electrodes have been described in
literature for the measurement of blood pH. They are all of the glass electrode type.
 Typically, a micro-electrode for clinical applications requires only 20–25μl of capillary blood for
the determination of pH.
 The electrode is enclosed in a water jacket with circulating water at a constant temperature of
38°C. The water contains 1% NACL for shielding against static interference.
 The capillary is protected with a polyethylene tubing.
 The internal reference electrode is silver/silver chloride and the calomel reference electrode is
connected to a small pool of saturated KCL, through a porous pin.
 An accuracy of 0.001 pH can be obtained with this electrode against a constant buffer
 Blood gas analyser

 Quite often, combination electrodes comprising both measuring and reference electrodes offer
single- probe convenience for all pH measurements.
 Several instruments offer the ability to measure pH in small containers with as little as 250 μl of
the sample
 The pH of blood is found to change linearly with temperature in the range of 18° to 38°C.
 The temperature coefficient for the pH of blood is 0.0147 pH unit per degree centigrade. This
necessitates the use of a highly accurate temperature-controlled bath to keep the electrodes with
the blood sample at 37°C ± 0.01°C.
Blood gas analyser
 BLOOD FLOW
 Blood flow is the continuous circulation of blood in cardio vascular system.
 Science dedicated to describe the physics of blood flow is hemodynamics.
 Blood flow is the volume of blood /time.
 Blood flow is highest in the pulmonary artery and the aorta, where these blood vessels leave the
heart.
 The flow at these points, called cardiac output, is between 3.5 and 5 liters/min in anormal adult at
rest.
 In the capillaries, the blood flow can be so slow that the travel of individual blood cells can be
observed under a microscope.
 The stroke volume is the volume of blood, in milliliters (mL), pumped out of the heart with each
beat.
 BLOOD FLOW
 If the volume of blood increased (waste products not being removed to the kidneys due to kidney
failure for example) then there would be a greater quantity of blood within the system increasing
the pressure within.
 If the blood supply to an organ is reduced by a narrowing of the blood vessels, the function of that
organ can be severely limited.
 When the blood flow in a certain vessel is completely obstructed (e.g., by a blood clot or
thrombus), the tissue in the area supplied by this vessel may die.
 Such an obstruction in a blood vessel of the brain is one of the causes of a cerebrovascular
accident (CVA) or stroke.
 An obstruction of part of the coronary arteries that supply blood for the heart muscle -myocardial
(or coronary) infarct or heart attack,
  ELECTROMAGNETIC BLOOD FLOWMETER
 Magnetic flow meters works based on Faraday’s Law of Electromagnetic Induction. According to
this principle, when a conductive medium passes through a magnetic field B, a voltage E is
generated which is proportional to the velocity v of the medium, the density of the magnetic field
and the length of the conductor.
 The conductive blood is the moving conductor. A permanent magnet or electromagnet positioned
around the blood vessel generates a magnetic field perpendicular to the direction of the flow of the
blood.
 ELECTROMAGNETIC BLOOD FLOWMETER

 The blood stream cuts the magnetic field and voltage

is induced in the blood stream.
 Voltage induced in the moving blood column is
measured with stationary electrodes located on
opposite sides of the blood vessel and perpendicular to
the direction of the magnetic field.

The magnitude of the voltage picked up is directly proportional to the strength of the magnetic field,
the diameter of the blood vessel and the velocity of blood flow, i.e.
Induced Voltage E = CHVd
where E = induced voltage; H = strength of the magnetic field; V = velocity of blood flow; d-
diameter of the blood vessel
 ULTRASONIC BLOOD FLOW METERS

A beam of ultrasonic energy is used to measure the velocity of flowing blood There are basically
two types of ultrasonic blood flow-velocity meters.
1. Transit time flow meter
2. Doppler-shift type

1. Transit-Time Ultrasonic Flow Meters

 Transit time flowmeters measure the time it takes for an ultrasonic signal transmitted from one
sensor, to cross a pipe and be received by a second sensor. One transducer transmits sound
while the other acts as a receiver.
 Upstream and downstream time measurements are compared. The pulsed beam is directed
through a blood vessel at a shallow angle and its transit time is measured.
 Transit-Time Ultrasonic Flow Meters
 The transit time is shortened when the blood flows in the same direction as the transmitted
energy. The transit time is lengthened otherwise.
 With no flow, the transmit time would be equal in both the upstream and downstream
directions. With flow, sound will travel faster in the direction of flow and slower against the
flow.
 Transit-Time Ultrasonic Flow Meters
Downstream travel time =

Upstream travel time =

Time difference = -

Where,
Speed of sound in blood
Acoustic path length
Angle of path with respect to flow
Doppler-shift type Ultrasonic blood flow meter