Medical Electronics

MEDICAL ELECTRONICS
UNIT I
ELECTRO-PHYSIOLOGY AND BIO POTENTIAL RECORDING
Origin of biopotential:
Cell is the basic building unit of human body.
Components of blood plasma

Blood cells are transported by blood plasma a liquid that accounts for about 55% of blood
volume and is itself about 90% water, it contains many important substances.
Plasma Proteins: Such as albumins (stop water leaking into tissues) fibrinogen (involved
blood clotting) and globulins (such as antibodies).
Electrolytes:Mainly mineral salts that form ions when dissolved principally sodium
chloride, potassium, calcium and phosphate.
Hormones:Like insulin and glucagon (regulate blood glucose levels) thyroid
hormones (control rate of cell metabolism) and sex hormones.
Nutrients:Such as glucose (for energy) amino acids and lipids, such as cholesterol
and triglycerides (for cellular components and energy).
Waste: Such as Carbon dioxide, lactic acids, creatine and uric acid. These are transported out
of the blood circulation by the kidneys.
Blood and Blood Vessels

Blood is collection of specialized cells suspended in straw colored liquid called
plasma. Blood delivers oxygen and nutrients to body cells, collects waste, distributes
hormones, spreads heat around the body to control temperature and plays a part in fighting
infection and healing injuries.
1
MEDICAL ELECTRONICS
Arteries
Arteries carry blood away from the heart towards organs and tissues. Apart from the
pulmonary arteries, all arteries carry oxygenated blood. Their thick walls and muscular and
elastic layers can withstand the high pressure that occurs when the heart contracts. An artery
narrows when the heart relaxes, helping to push blood onwards. The largest artery is aorta.
Veins
A vein is more flexible than an artery and its walls are considerably thinner. The blood
inside a vein is under relatively low pressure and as a result, it flows slowly and smoothly.
Many larger veins particularly the long veins in the legs contain valves that are formed from
pouch
like pockets of single cell lining tissue (endothelium). These prevent blood flowing back
down the legs; a job helped by muscles around the veins that contract during movement. The
two main veins returning from the upper and lower halves of the body are known as the
superior and inferior vena cava.
Capillaries
The smallest and most numerous of the blood vessels capillaries convey blood between
arteries and veins. Many capillaries enter tissue to form a capillary bed, the area where
oxygen and other nutrients are released. Capillary bed connects small arteries (arterioles) to
veins (venules).
RESTING POTENTIALS AND ACTION POTENTIALS
When a cell membrane moves molecules or ions uphill against a concentration gradient, then
the process is known as active transport. The transport of the substances through the cell
membrane occurs by diffusion is called passive transport. The diffusion and drift processes
give rise to membrane potential.
The interface of metallic ions in solution (or) with their associated metal results in an
electrode potential. The voltage developed at an electrode- electrolyte interface is designated
as half- cell potential or electrode potential. In the case of a metal- solution interface electrode
potential results from the difference in the rates between two opposing processes. They are
passage of ions from the metal into the solution, combination of metallic ions in solution with
electrons in the metal to form atoms of the metal.
Various ions seek balance between the inside and outside of the cell by diffusion and drift
process give rise to membrane potential. The membrane potential caused by the different
concentration of ions is called the resting potential of the cell. Resting potential is defined as
the electrical potential of an excitable cell relative to its surroundings when not stimulated or
involved in passage of an impulse. It ranges from -60mV to -100mV
The nerve and muscle cells permit the entry of potassium and chloride ions it blocks the entry
of sodium ions. The permeability of sodium ions is about 2 x 10-8 cm/s and for potassium and
2
MEDICAL ELECTRONICS
chloride ions is 4 x 10-6 cm/s

Action potential is defined as the change in electrical potential associated with the passage of
an impulse along the membrane of a cell.
The various ions seek a balance between the inside and outside of the cell by diffusion and
drift. When the cell is in resting state, then it is said to be polarized. The process of changing
from the resting potential state to the action potential state is called depolarization.
When the cell fires however, the outside of the cell becomes momentarily negative with
respect to the interior. A short time later, the cell regains the normal state in which the inside
is again negative with respect to outside. The discharging and recharging of the cell is known
as depolarization and repolarization.
Regardless of the method of excitation of cells or the intensity of the stimulus, this is assumed
to greater than the threshold of stimulus. The action potential is always- the same for any
given cell. This is known as all- or nothing law.
Absolute refractory period is the time duration of the cell non response to further stimuli. It is
about 1 millisecond in nerve cell. Following the absolute refractory period there is a brief
period of time during which another action potential can be triggered but a much stronger
stimulation is required. This period is called relative refractory period.
The rate at which an action potential moves down a fiber of a nerve cell or is propagated from
cell to cell is called the propagation rate or conduction velocity. The conduction velocity
varies in nerves depending on the type and diameter of the fiber and is from 20 n/s to 140 m/s.
But in heart muscle, it is very slower ranging from 0.2 to 0.4 m/s.
Due to the difference in permeability the concentration of sodium ions inside the cell becomes
much lower than the outside the cell. Since the sodium ions are positive, the outside of the
cell is more positive than inside. The concentration of potassium and chloride ions is negative
on the inside and positive on the outside.
An equation relating the potential across the membrane and the two concentrations of the ion
is called Nernst equation.
C 1 f1
RT
Where,
E
ln
nF
C2 f2
R
MEDICAL ELECTRONICS
7
gas constant(8.315 x 10 ergs/mole/degree Kelvin)
T
n
F
C1, C2
f1, f2
absolute Temperature, degrees Kelvin

valence of the ion (the number of electrons added or removed to ionize the atom)
Faraday constant (96,500 coulombs)
two concentrations of the ion on the two sides of the membrane
respective activity coefficients of the ion on the two sides of the membrane
The approximate value of the resting potential for living cell is 70mV. The resting potential
ranges from -60 to -100nV.
The Characteristics Of Resting Potential Are .
The value of the resting potential is maintained as a constant until some kind
of disturbance occurs.
It is strongly depending on the temperature.
Since the permabilities of the different cell types vary, the corresponding resting
potentials vary.
Bio electric potential related to
ElectroCardioGram (ECG)
Heart
Brain
ElectroEncephaloGram (EEG)
Muscle
ElectroMyoGram (EMG)
Eye (Retina)
ElectroRetinoGram (ERG)
Eye (Cornea - Retina)
ElectroOculoGram (EOG)
Bioelectric potential
Function
Peak
amplitude
0.1 to 4mV
Frequency Observation
response
ElectroCardioGram
Records
0.05 to
Used to measure
(ECG)
electrical
120 Hz
heart
rate,
activity of heart
arrhythmia and
abnormalities
ElectroEncephaloGram Records
2 to 200V 0.1 to 100 Used to analysis
(EEG)
electrical
Hz
evoked potential,
activity
of
certain patterns,
brain
frequency
response
ElectroMyoGram
Records
50V
to 5 to 2000 Used as indicator
(EMG)
muscle
1mV
Hz
of muscle action
potential
for measuring
fatigue
Biopotential electrodes:
Electrode behaviour & circuit model:
When a bar of metal is immersed in a solution, it becomes ionized at the vicinity of
contact with a cloud of electrons inside and an adsorbed layer of positive ions at the bars
4
MEDICAL ELECTRONICS
surface. This adsorbed fixed layer of positive ions attracts nearby negative ions drifting
around in the solution. This forms a diffused mobile layer of negative ions near the bars
surface. These two layers form the electrical double layer.
When an ac signal is applied, the double layer behaves like an ideal capacitor. When
a dc signal is applied, the double layer behaves like a resistor called Faradic resistor. Thus an
electrode in a solution (under the influence of ac & dc signals) can be modeled as a leaky
capacitor i.e., an ideal capacitor in parallel with a resistor.
MEDICAL ELECTRONICS
MEDICAL ELECTRONICS
MEDICAL ELECTRONICS
Types of Electrodes: The major categories are the (I) Surface electrodes, (II) Internal or subcutaneous electrodes and (III) Micro electrodes.
(I) Surface electrodes:
The surface electrodes are used to pick up bio-potentials non-invasively from the
surface of the skin. This provides sufficient information for most of the clinical purposes.
There is a variety of surface electrodes intended for variety of clinical purposes. Here
are some of them.
(i) Metal plate electrode: It is made up of Ag-AgCl (Silver-Silver Chloride). It is used
to pick up ECG from the limb lead positions. It is fixed to the skin surface by means of
conductive gel & rubber belt.
(ii) Metal disc electrode: It is made up of Ag-AgCl. It is used to pick up EEG from the scalp.
It is fixed to the scalp by means of adhesive tape.
MEDICAL ELECTRONICS
BIO-AMPLIFIER:
The bio-amplifier consists of a preamplifier and power amplifier. The sensitivity or the
gain of the amplifier can be varied. Folllowed by the preamplifier, there is a power amplifier
which is used to drive the recorder. Pen motors in the recorder requires suffficient electrical
power to activate the recording or display. therefore power amplifiers are required with high
power gain. Generally transistor circuits are favourable because a relatively large surface area
is necessary to dissipate the heat genertd in the circuit due to passage of high current.
Power amplifier circuit used to drive ECG chart recorder stylus. It is push pull type.
Furtehr it is provided with crossover distortion compenstation and offset control. It consists of
two silicon power transistors such that the emitters of the transistors are joined together and
connected with a load resistor RL.when VB is sufficiently positive, transistor Q1 is forward
biased and conducts while Q2 is reverse biased and remains off.
2
Output power POUT =V OUT / RL.
To avoid the crossover distortion in a pushpull amplifier, an ideal noninverting amplifier is
inserted at the input. Since the input impedance of the noninverting amplifier approaches
infinity, the power gain also approaches infinity. The crossover distortion is eliminated
9
MEDICAL ELECTRONICS
because the feedback resistance., Rf is so large and hence it raises the gain in a linear manner
and in turn raises the output voltage. The offset control is provided by the resistance R2 and is
used to position the output stylus pen. Gain adjustment is provided with the resistance Ro.
AUXILIARY AMPLIFIER:
Since the electrode impedances are not equal, a differential amplifier does not
completely reject the common mode signals. The common mode signals can be reduced to a
minimum level by means of adding an auxiliary amplifier between the driven right leg lead
and the ECG unit. By this way, the right leg is not connected to ground but it is connected to
the output of the auxiliary amplifier. If the body common mode voltage is different from zero,
a summing network produces the sum of all common mode voltages from all other electrodes
and feeds that sum of the voltages as input to inverting terminal of the auxiliary amplifier.
Meanwhile its noninverting terminal is grounded. The output of the auxiliary amplifier is
connected to the right leg. Therefore it drives the body to zero common voltage. Thus the
common mode rejection ratio of the overall system is increased. Further in the right leg
electrode the current flow is reduced.
ISOLATED POWER SUPPLY:

The isolated power supply is used to give power to the bio-amplifier and by means of
that, the electrical safety for the patient is increased.
OUTPUT UINT:
The output unit is a cathode ray oscilloscope. Or a paper chart recorder. In case of
paper chart recorder, the power amplifier or pen amplifier supplies the required power to drive
pen motor that records the ECG trace on the wax coated heart sensitive paper. A position
control on the pen amplifier is used to position the pen at the center on the recording paper.
The stylus pen is heated electrically and the temperature of the stylus pen can be adjusted with
a stylus heat control. There is a marker stylus which is actuated by a push button and allows
the technician to mark a coded indication of the lead being recorded. The paper speed is about
25 mm/s or 50 mm/s. the faster speed of 50 mm/s is provided to allow better resolution of the
QRS complex at very high heart rates.
POWER SWITCH:
The power switch of the recorder has three positions. In the on position the powet to
the amplifier is turned on; but the paper drive is not running. In order to start the paper drive
the switch must be placed in the RUN position. In the off position, the ECG unit is in
switched off condition.
ECG: ElectroCardioGram: ECG is the record of electrical activity of the heart.
Typical bandwidth: 0.5 125 Hz
Typical amplitude: 1 10 mV
10
MEDICAL ELECTRONICS
Typical waveform:
USES OF ECG :
It is the gold standard for the evaluation of cardiac arrhythmias .

The 12 lead ECG stands at the center of risk stratification for patients with suspected
acute myocardial infraction .
It can be useful for detecting electrolyte disturbances (e.g. potassium or calcium).
Allows the detection of conduction abnormalities (e.g. right and left bundle branch
block).
As a screening tool for ischemic heart disease during an cardiac stress test.
Can suggest non-cardiac disease (e.g. pulmonary embolism or hypothermia).
ECG lead configurations
Surface electrodes are used with jelly as electrolyte between skin and electrodes.
The potentials generated in the heart are conducted to the body surface.
The potential distribution changes in a regular and complex manner during each
cardiac cycle.
To record electrocardiograms standard electrode positions must be selected.
four types of electrode systems are there. They are:
Bipolar limb leads (or) standard leads.
Augumented unipolar limb leads.
Chest leads (or) precordial leads.
Frank lead system (or) corrected orthogonal leads.
The baseline voltage of the electrocardiogram is known as the isoelectric line.
A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex and
a T wave.
A small U wave is normally visible in 50 to 75% of ECGs.
Bipolar limb leads
In standard leads the potentials are tapped from four locations of our body.
They are
Right arm
11
MEDICAL ELECTRONICS
Left arm
Right leg
Left leg.
Usually right leg electrode is acting as ground reference electrode.
Gives voltage VI, the voltage drop from left arm(LA) to right
arm (RA).
+
Electrode from
LA
Output VI
Electrode from RA
Ground electrode RL
Einthoven triangle.
-
Lead I +
Right arm
Left arm Cardiac vector

Lead III
Lead II
+
+
Left leg
The closed path RA to LA to LL and back to RA is called Einthoven triangle.

The ECG is measured from any one of the three limb leads is a time variant single
dimensional component of that vector.
According to kirchoffs voltage law ,
the R wave amplitude of lead II is equal to the sum of the R wave amplitudes of leads
I and leadIII
VII = VI + VIII
Augmented unipolar limb leads
Unipolar limb lead system is introduced by Wilson.

Here ECG is recorded between a single exploratory electrode and the central
12
MEDICAL ELECTRONICS
terminal.The central terminal has a potential corresponding to the center of the

body.Two equal and large resistors are connected to a pair of limb electrodes and the
center of this resistive network acts as central terminal. The remaining limb electrode
acts as the exploratory electrode. By means of augmented ECG lead connections, a
small increase in the ECG voltage can be realized.
The augmented lead connections are
Augmented voltage right arm (aVR)
Augmented voltage left arm (aVL)
Augmented voltage foot (aVF)
Unipolar chest leads
In case of unipolar chest leads, the exploratory electrode is obtained from one of the
chest electrodes.The chest electrodes are placed are placed on the six different points
on the chest closed to the heart.
V1 : fourth intercostal space at right sternal Margin.
V2: fourth intercostal space at left
sternal Margin.
V3: midway between V2 and V4.
V4: fifth intercostal space at mid-clavicular line
V5: same level as V4 on anaterior axillary line
V6: same level as V4. On mid-axillary line.
Color codes for ECG leads
The ECG potentials are measured with color coded leads according to the convention:
White right arm
Black left arm.
Green right leg.
Red left leg.
Brown - chest
Frank lead system
The corrected orthogonal leads system (or ) frank lead system is used in vector
cardiography. Here we can get informations from above said 12 leads.
ANALYSIS OF ECG SIGNALS
If PQ segment has prolonged condition I.e. extended f normal condition

means Result :First degree AV block
If QRS complex is widened I.e. QRS interval extended from the normal condition
means Result : Bundle block.
If ST segment is elevated means Result : Myocardial infraction.

13
MEDICAL ELECTRONICS
If train of pulses occurs instead of PQRST waves means Result : Ventricular

fibrillation which may lead to death if it is not properly corrected by defibrillator.
Block diagram of a ECG recording system:

Electrode system: Metal plate electrodes made of Ag/AgCl are placed at desired limb
positions. Good contact between electrodes & skin is ensured with the help of gel and belts.
]Lead fault detect: The function of this block is to detect the improper connection of the
electrodes on to the skin by continually measuring the contact resistance and to warn the
operator of this via either an audible tone or a visual indication.
Amplifier protection circuitry: The function of this block is to protect the remaining part of
the circuit from large electrical discharges resulting from defibrillation process.
Lead selector: The function of this block is to select a desired lead system from 12 possible
lead systems. This can be carried out either manually by an operator or automatically by
microprocessor or microcontroller or microcomputer.
Preamplifier: The function of this block is to eliminate noise such as other biopotentials and
various electromagnetic interferences resulting from nearby communication links etc.
Generally a differential amplifier with high input impedance and CMRR is used for this
purpose.
Calibration signal: The function of this block is to calibrate the display or the recorder for
predetermined amplitude. A sine wave of 1 mV is generally used for this purpose.
14
MEDICAL ELECTRONICS
Baseline restoration: The function of this block is to restore any baseline shift resulting from
the low operating frequency of the amplifier.
Right leg driven system: The function of this block is to provide a reference point on the
patient generally at ground potential.
Isolation circuitry: The function of this block is to provide electrical isolation between the
high power section that is generally driven by 230 V 50 Hz ac mains and the low power
patient section that is generally driven by a low power battery. This is required to protect the
patient from any electrical hazards resulting from leakage currents.
Driver amplifier: The function of this block is to amplify the ECG signal sufficiently to level
required for the display or the recorde/
ADC & memory: The ECG signal can be digitized and stored for future analysis.
Microcomputer: A microcomputer along with a user-friendly software packagedeveloped on
a high-level language such as VC++ can be used
(i)
to control the entire process of acquiring the ECG and
(ii)
to analyze it automatically for various parameters such as heart rate, PR interval,
QRS interval etc using sophisticated digital signal processing techniques. Recorderprinter/display: A heat sensitive paper can be used to get a hard copy of the
ECG signal obtained or a CRO can be used to display the ECG signal obtained for visual
analysis.
Holter ECG: Continuous recording of ECG at a stretch up to 24 hour and playing it in as
minimum as 12 minutes used to diagnose certain arrhythmias which occur under certain
physiological conditions such as emotional stress.
EEG lead system:
The most popular scheme of placing the surface electrodes (usually Ag/AgCl discs) on
the scalp is the 10-20 electrode placement system suggested by the International Federation
of EEG Societies. In this scheme, the shaved head is mapped by four points: (i) nasion, (ii)
inion, (iii) left preauricular point and (iv) right preauricular point as shown below.
15
MEDICAL ELECTRONICS
Three electrodes are placed (1 in frontal lobe, 1 in central lobe and 1 in parietal lobe) by
measuring the nasion-inion distance via the vertex and marking points on the shaved head at
10%, 20%, 20%, 20%, 20% and 10% of this length.Similarly five electrodes are placed on
either side (2 in frontal lobe, 2 in temporal lobe and 1 in occipital lobe) by measuring the
nasion-inion distance via the temporal lobes and marking points on the shaved head at 10%,
20%, 20%, 20%, 20% and 10% of this length on either side.
The remaining six electrodes (2 in frontal lobe, 2 in central lobe and 2 in parietal lobe) are
placed on the peripheries of the circles joining these electrodes.Thus there are 19 electrodes
on the scalp plus one electrode for grounding the subject (usually at ear lobes). This makes the
popular 10-20 EEG electrode system.
16
MEDICAL ELECTRONICS
Block diagram of a EEG recording system:

Electrode system: Metal disc electrodes made of Ag/AgCl are placed at scalp positions.
Good contact between electrodes & skin is ensured with the help of gel and adhesive tapes.
Channel selector: The function of this block is to select a desired combination of 19
possible electrodes. This can be carried out either manually by an operator or automatically
by microprocessor or microcontroller or microcomputer.
Preamplifier: The function of this block is to eliminate noise such as other biopotentials and
various electromagnetic interferences resulting from nearby communication links etc.
Generally a differential amplifier with high input impedance and CMRR is used for this
purpose. A minimum gain of 1000 is required as typical amplitude range of EEG is from 1 to
few microvolts.
Calibration signal: The function of this block is to calibrate the display or the recorder for
predetermined amplitude. A sine wave of 1 V is generally used for this purpose.
Isolation circuitry: The function of this block is to provide electrical isolation between the
high power section that is generally driven by 230 V 50 Hz ac mains and the low power
patient section that is generally driven by a low power battery. This is required to protect the
patient from any electrical hazards resulting from leakage currents.
Driver amplifier: The function of this block is to amplify the EEG signal sufficiently to level
required for the display or the recorder.
17
MEDICAL ELECTRONICS
ADC & memory: The EEG signal can be digitized and stored for future analysis.
Microcomputer: A microcomputer along with a user-friendly software packagedeveloped on
a high-level language such as VC++ can be used
(iii) to control the entire process of acquiring the EEG and
(iv)
to analyze it automatically for various parameters using sophisticated digital
signal processing techniques.
Recorder-printer/display: A heat sensitive paper can be used to get a hard copy of the EEG
signal obtained or a CRO can be used to display the EEG signal obtained for visual analysis.
ELECTROMYOGRAPHY:
Electromyography is the science of recording and interpreting the electrical activity of the
muscles action potentials. Meanwhile the recording of the peripheral nerves action potentials is
called electroneurography. The electrical activity of the under lying muscle can be measured
by placing surface electrodes on the skin. To determine whether the muscle is contracting or
not, or displaying on the CRO and loud speaker the action potentials spontaneously present in
a muscle or induced by voluntary contraction as a means of detecting the nature and location
of the motor unit lesions. So to record the action potentials of individual motor units, the
needle electrode is inserted into the muscle. The EMG indicates the amount of activity of a
given muscle or a group of muscles and not an individual nerve fiber.
The action potentials occur both positive and negative polarities at a given pair of
electrodes, so they may add or cancel each other. Thus EMG appears, very much like a
random noise waveform. The contraction of a muscle produces action potentials. Where there
is stimulation to a nerve fiber, all the muscle fiber contract simultaneously developing action
potentials. In a relaxed muscle, there is no action potential. EMG is usually recorded by using
surface electrodes or more often needle electrodes inserted directly into the muscle. The
surface electrodes pick-up the potentials produced by the contracting muscle fibers. The
signal can then
be amplified and displayed on the screen of an audio amplifier connected to the loud speaker.
The oscilloscope displays EMG waveforms. The tape recorder is included in the system to
facillate play-back and study of the EMG sound waveforms at a later convenient time. the
waveform can also be photographed from the CRT screen by using a synchronized camera.
The surface electrodes or needle electrodes pickup the potentials produced by the
contracting muscle fibers. The surface electrodes are from Ag-Agcl and are in disc shape. The
surface of the skin is cleaned and electrode paste is applied. The electrodes are kept in place
by means of elastic bands. By that way, the contact impedance is reduced below 10kiloohms.
There are two types of conventional electrodes: bipolar and unipolar type electrodes. In the
case of bipolar electrode, the potential difference between two surface electrodes resting on
the skin is measured. In case of unipolar electrode, the reference surface electrode is placed on
the skin and the needle electrode which acts as active electrode, is inserted into the muscle.
Because of small contact area, these unipolar electrodes have high impedances ranging from
0.5 to 100mega ohms. With needle electrodes, it is possible to pickup action potentials from
the selected nerves or muscles and individual motor units. In the case of coaxial electrode
18
MEDICAL ELECTRONICS
which consists of an insulated wire threaded through a hyperdermic needle with a oblique tip
for easy penetration, the surrounding steel jacket acts as reference and the metallic wire acts
as exploring electrode. The needle is inserted into the muscle further to record the action
potentials for a single nerve microelectrodes are used.
The amplitude of the EMG signals depends upon the type and placement of
electrodes used and the degree of muscular exertions. That is the surface electrode pick up
many
overlapping spikes and produces an average voltage from various muscles and motor units.
The needle electrodes pick up the voltage from a single nerve fiber. Generally EMG signals
range from 0.1 to 0.5 mv. They may contain frequency components from 20 Hz to 10 KHz.,
which are in the audio range, but using low pass filter, the electromyography restricts this
frequency range fro 20 Hz to 200 Hz for clinical purposes. The normal frequency of EMG is
about 60 Hz. Therefore the slow speed strip chart recorders are not useful and the signals are
displayed on a cathode ray oscilloscope and photographic recordings are made. Normally
there are two cathode ray tubes, one for viewing and other one for recording. A light sensitive
paper moves over the recording cathode ray tube and the image is produces on that paper.
After developing it, one can see the visible image. For continuous recording, the paper speed
is about 5 to 25 cm/second. For short duration it is about 50 to 400 cm/second. The paper
width is about 10 cm. treading a needle, and an array of facial expressions. Smooth muscles
occur in the walls of internal body organs and perform actions such as food through the
intestines contracting the uterus (Womb) in child birth and pumping blood through blood
vessels.
19
MEDICAL ELECTRONICS
ELECTRORETINOGRAPHY:
The recording and interpreting the electrical activity of eye is called
electroretinography. All sense organs are connected to the brain but the eye has a special
relationship as the retina is an extension of the cerebral cortex. Potentials within the eye may
be recorded relatively easily because of its exposed position. The cornea is about 20mv
positive relative to the fundus of the eye. The fundus is the back of the interior of the eye ball.
If the illumination of the retina is changed, the potential changes slightly in a complex
manner. The recording of these changes is called retinogram. A silver- silver chloride
electrode on a contact lens and a distinct electrode on the cheek are used to record the eye
potential changes.
Electrode placement:
The bipolar recording technique is used. The exploring electrode is placed on a saline
filed contact lens. The contact lens is placed on a saline filled contact lens. The contact lens is
tightly attached to the eye. During eye movement there is no slip of contact lens by using
negative pressure (between the corneal cavity and the cornea) attachment techniques. The
common contact lenses used for corrections or cosmetic purposes ride on a tear film over the
cornea, do not follow eye movements well and are unsuitable for recording purposes.
Therefore specially made contact lenses used to record the action potentials of eye during
flash of light incident on eye.
Recording Techniques:
When light falls on the retina, the absorption of photons by photo pigments localized in
the outer segment of the retinas photoreceptors is taking place. This causes the breakdown
or bleaching of photo pigments which results in the liberation of ions that cause a change in
the membrane potential. This in turn results in the development of action potential that is
transmitted down the optic nerve. This action potential is picked up the electrodes and are fed
to the bio amplifier and then to the recorder. The recording set up is similar to the ECG
recorder.
20
MEDICAL ELECTRONICS
Figure shows the typical eletroretinogram. Before the flash of light is incident on eye, there is
a constant d.c. horizontal line in the recorder. In response to a 2 seconds flash of light, a
retinogram is developed. Probably the curve originates from the pigment layer beyond photo
receptors (extra retinal).
The first part A of the response to a brief flash of light is due to the early receptor
potential (ERP) generated by the incident light which induces changes in the photo pigment
molecules. The second component part B with a delay of 1 to 5 milliseconds is due to later
receptor potential (LRP) produced by syruptic ending of the photoreceptors. This is the
maximum output of the receptors. The part C wave recorded with the off response of ERP
and LRP.
In the earlier recording of the eye potentials, the corneal electrodes were not used.
Instead the rotation of the contact lens was measure by means of a mirror (on contact lens)
which reflects
the incident light on a moving photographic film or photo cell. After developing the
photographic film, we can see the image and from that we can get some informations about
the
eye potentials. In the case of photocells, the output from the photocell was amplified and then
given to the recorder. There was also a nonoptical method for measuring contact lens rotation.
Two sets of magnetic coils, normal in the space and oscillating in phase quadrature at 4.8kHz
create crossed magnetic fields which excite two small search coils embedded in the contact
lens. Rotations of the eye cause induced voltages of few millivolts, which can give
information about the eye potential.
The diseases which affect the steady potential of the eye.
The effects of certain drugs on the eye movement system can be determined.
The state of semicircular canalizes analyzed by EOG.
Diagnosis of the neurological disorders may be possible.
The level of anesthesia can be indicated by characteristic eye movements.
21
MEDICAL ELECTRONICS
UNIT II
BIO-CHEMICAL AND NON ELECTRICAL PARAMETER MEASUREMENTS
Blood gases and their clinical significance:
(i) pO2:
Normal range: 80-100 mm Hg.
Hypoxemia: Lack of O2 i.e., reduction in pO2 due to bronchial obstruction,
blood vessel and hemoglobin abnormalities.
(ii) pCO2:
Normal range: 35-45 mm Hg.
Hypercapnia: Increase in pCO2 due to cardiac arrest, chronic obstructive lung
disease, chronic metabolic acid-base disturbances.
(iii) pH:
Normal range: 7.35-7.45
Alkalosis: Increase in pH due to increase in bicarbonates (HCO3-)
Acidosis: Decrease in pH due to decrease in bicarbonates (HCO3-)
Blood gas analyzer:
The blood gas analyzer measures the pH value i.e. H+ ion concentration, the partial
pressure of oxygen (pO2) and the partial pressure of carbon dioxide (pCO2) in an arterial blood
sample.
The blood gas analyzer consists of three types of electrode systems for the measurement
of pH, pO2 and pCO2 respectively and a sample chamber. The electrode systems and the sample
chamber are located inside a temperature-controlled block maintained at 37oC (human body
temperature). The blood sample is first injected into the sample chamber where it undergoes a
temperature equilibration before measurement.
22
MEDICAL ELECTRONICS
Two electrodes are used: (i) a calomel or Ag/AgCl reference electrode immersed in a Kcl
solution and closed by a leaky membrane that permits a current flow from the reference electrode
via the sample in the sample chamber to the measuring electrode and (ii) a Ag/AgCl measuring
electrode immersed in a solution of constant pH and closed by a glass membrane that is sensitive
to H+.
As the sample passes through the chamber, the difference in H+ ion concentration on
either side of the glass membrane changes the potential at the measuring electrode whereas the
reference electrode produces a constant potential irrespective of H+ concentration in the sample.
The change in the potential at the measuring electrode is detected by a voltmeter, which has been
calibrated in pH units.
pO2 measurement:
23
MEDICAL ELECTRONICS
Movement of a solid phase with respect to a liquid called the buffer solution under the
influence of an electric current. The buffer solution is supported by a solid substance called the
medium. The purpose of the buffer solution is to carry the current and the purpose of the solid
medium is to provide a base for the migration of particles.
Under the influence of electric current, groups of particles that are similar in charge, size
and shape migrate at similar rates. This results in separation of particles into zones on the solid
medium. The factors that affect the speed of migration are (i) magnitude of charge, (iii) ionic
strength of the buffer, (iii) temperature, (iv) time and (v) type of support medium.
24
MEDICAL ELECTRONICS
Cellulose acetate is the most commonly used solid medium. Other possible mediums are
paper, starch gel, agar gel, sucrose, etc.
Buffer solution is taken in two beakers. Electrodes are placed in the buffer solutions as
anode and cathode. A strip of cellulose acetate is placed as a bridge between the buffer solutions.
A voltage of 250V with an initial current of 4-6mA is applied across the medium through the
buffer solution for 15-20 min. Then the electric voltage is removed.
A fixative and a dye are used to fix and stain the migrated particles on the medium.
Finally a densitometer is used to measure the densities of the migrated particles on the medium.
A plot of density versus migration distance is made from this measurement.
Colorimeter:
The colorimeter (filter-photometer) is an optical electronic device that measures the color
concentration of a substance in a solution.
25
MEDICAL ELECTRONICS
26
MEDICAL ELECTRONICS
27
MEDICAL ELECTRONICS
28
MEDICAL ELECTRONICS
29
MEDICAL ELECTRONICS
30
MEDICAL ELECTRONICS
31
MEDICAL ELECTRONICS
32
MEDICAL ELECTRONICS
33
MEDICAL ELECTRONICS
Figure shows the block diagram of one popular CO computer. The bridge produces zero
output when the thermistor is at normal blood temperature, and the balance adjustment is made.
After injection of the saline or D5W, the bridge produces an output potential of 1.8 mV/oC. This
signal is amplified in the preamplifier stage to a level of 1 V/o C. The high-level output signal is
passed through an isolator to the remainder of the circuit. Part of the signal goes to an output jack
so that it may be recorded on a strip-chart recorder. It is simultaneously applied to the input of an
operational amplifier electronic integrator stage. The integrator output is supplied to the
denominator of the equation.
The numerator input of the divider is obtained from a stage that multiplies together the
constants and a signal entered by the operator or, in more sophisticated models, taken from
another electronic temperature measurement circuit that indicates the differences between blood
and injectate temperature. A control logic circuit is required to time the operation of the CO
measurement cycle.
The CO computers have a circuit to compensate for the recirculation artifact. Two
different techniques are commonly used: (i) The time period before the appearance of the artifact
is used to predict the path of the ideal curve. (ii) The technique of geometric integration is used
to approximate the ideal curve.
Respiratory measurements:
Respiration rate measurement:
1.
Impedance pneumography:
Measurement of respiration rate by measuring changes in thoracic impedance during

respiration activity via electrodes placed across the chest.
Measurement of respiration rate by measuring changes, which are produced by thoracic

movements during respiration activity, in impedance of a piezoresistive device via a
strain gauge placed across the chest. Piezoresistive devices used are: (i) Mercury strain
34
MEDICAL ELECTRONICS
gauge: It is an elastic tube filled with mercury and fitted on both ends with amalgamated
Cu, Ag or Platinum; later mercury is replaced by copper sulphate which provides high
resistance thereby reducing the current needed to produce readable output voltage. (ii)
Wire or Foil or Semiconductor strain gauge.
Thoracic or transducer impedance change amplitude-modulates a high frequency carrier

signal.
Thoracic or transducer impedance change waveform representing the respiration activity is
extracted by a synchronous detector.
35
MEDICAL ELECTRONICS
36
MEDICAL ELECTRONICS
The spirometer consists of a water tank, a bell-jar immersed upside down into the water
and a tube extending into the air space inside the bell-jar.
One end of a string is attached to the bell-jar and the other to a weight via two bulleys.
The subject is asked to breathe into the tube via the mouth piece. During every cycle of
inspiration and expiration, the bell-jar moves up and down depending on the volume of air
inspired or expired into or from the air space inside the jar. The weight attached to the other end
of the string moves up and down accordingly.
A pen may be attached to the weight to make a graph on a paper attached to a rotating
drum. Otherwise the third arm of a potentiometer may be attached to the weight to obtain an
electrical signal corresponding to the movement of the weight. The resultant graph is called the
Kymograph.
Blood pressure measurement:
Indirect method: (Sphygmomanometer):
The sphygmomanometer consists of (i) an inflatable rubber bladder called the cuff, (ii) a
rubber squeeze ball pump and valve assembly and (iii) a manometer.
Procedure for measurement of blood pressure:

(1) The cuff is wrapped around the patients upper arm (at a point midway between the
elbow and shoulder). A stethoscope is placed over a brachial artery distal (i.e.,
downstream) to the cuff.
37
MEDICAL ELECTRONICS
(2) The cuff is inflated so that the cuff pressure becomes slightly greater than the
anticipated systolic pressure. This pressure compresses the artery against the
underlying bone. This causes occlusion that stops the blood flow in the vessel. (3)
The cuff is then slowly deflated so that the cuff pressure drops slowly. (i) Whenthe
cuff pressure drops slightly below the systolic pressure, a sudden rush of blood flow
(through the occlusion in the artery) takes place. This causes crashing and snapping
sounds called the Korotkoff sounds in the stethoscope. (ii) When the cuff pressure
drops slightly below the diastolic pressure, these sounds disappear.
The pressure indicated by the monometer on the onset of these Korotkoff sounds is the
systolic pressure and the pressure indicated by the manometer on the disappearance of these
sounds is the diastolic pressure.
The onset of the Korotkoff sounds in the stethoscope indicates the systolic pressure and
the disappearance of these sounds in the stethoscope indicates the diastolic pressure.
38
MEDICAL ELECTRONICS
39
MEDICAL ELECTRONICS
The ultrasonic blood pressure measurement system consists of (i) an inflatable rubber
bladder called the cuff (ii) piezoelectric crystals for the transmission and reception of
ultrasonic waves (iii) a pump and valve assembly to inflate and deflate the cuff and (iv) an
electronic control system to coordinate all events.
Piezoelectric crystals are placed between the patients arm and the cuff. Generally 2 or
8MHz ultrasonic waves are used.
The blood pressure is measured by measuring the Doppler shift caused in the incident
ultrasonic wave by a moving wall of a brachial artery.
Initially the cuff pressure is increased slightly above the anticipated systolic pressure.
Then the cuff is deflated slowly at a fixed rate. When the cuff pressure drops to the systolic
pressure, high frequency Doppler shifts corresponding to the opening event from a heart beat are
detected. At this point the reading on the systolic manometer is the systolic pressure value. The
valve v2 is closed to fix the manometer on this value. Low frequ4ency Doppler shifts
corresponding to the closing event from the same heartbeat are not detected as they overlap with
the high frequency Doppler shifts at this point.
When the cuff pressure drops further, the opening and closing events from a heartbeat
start to separate and hence high and low frequency Doppler shifts detected alternatively. When
the cuff pressure drops to the diastolic pressure, the closing event from a heartbeat coincides with
the opening event from the next heartbeat and hence once again only the high frequency Doppler
shifts are detected. At this point the reading on the diastolic manometer is the diastolic pressure
value. The valve v3 is closed to fix the manometer on this value.
Blood cell counter:
Two methods: (i) conductive method and (ii) dark field method.
40
MEDICAL ELECTRONICS
Construction details:
A beaker with diluted blood, a glass tube with a small orifice of few m diameter dipped
into it, conductance between the solution in the glass tube and that in the beaker is measured by
two electrodes, one in the glass tube and the other in the beaker, the glass tube is connected to a
suction pump via a U-tube with a column of mercury.
Working principle:
As long as the orifice is left open, there is a zero-resistance conductivity between the
electrodes via the solutions. As long as there is a zero resistance conductivity, the output of the
conductivity circuit is zero. The suction pump draws the diluted blood in the beaker along with
the blood cells into the glass tube through the orifice. When a blood cell crosses the orifice, it
obstructs the conductivity between the electrodes. The degree of obstruction depends on the size
of the blood cell. This results in a pulse at the output of the conductivity circuit. The amplitude of
the pulse depends on the degree of obstruction in the conductivity i.e., on the size of the blood
cell. The threshold circuit allows only those pulses that exceeds a threshold, to be counted. The
control logic opens the gate thereby starting the counting process when the mercury column
reaches the point labeled as start and closes the gate thereby stopping the counting process
when the Hg column reaches the point labeled as stop. This facilitates the counting process to
be performed for a known volume of the solution passing through the orifice.
41
MEDICAL ELECTRONICS
42
MEDICAL ELECTRONICS
UNIT III
ASSIST DEVICES
Artificial pacemaker:
A device consisting of a pulse generator to generate artificial pacing impulses and
appropriate electrodes to deliver them to the heart.
Classification based on location of device:
Two types namely (i) External and (ii) Internal.
External pacemaker:
Pulse generator is located outside the body and electrodes are introduced into the right
ventricles via a catheter. It is used on patients with temporary heart irregularities and on patients
during and after a cardiac surgery for temporary management of certain heart arrhythmias.
Internal pacemaker:
Pulse generator is placed inside the body in a surgically formed pocket and electrodes are
introduced into the right ventricle or onto the surface of the myocardium. It is used on patients
with permanent heart arrhythmias such as permanent heart block.
Competitive or fixed rate or asynchronous:
It discharges artificial pacing impulses at a fixed rate asynchronously with the natural
pacing impulses thereby competing with any natural cardiac activity.
Non-competitive pacemaker:
It discharges artificial pacing impulses synchronously with the natural pacing impulses
thereby not competing with any natural cardiac activity. Types: (i) Ventricular programmed and
(ii) Atrial programmed.
Ventricular programmed:
Types: (a) R-wave inhibited (demand) and (b) R-wave triggered (standby).
R-wave inhibited (demand) type pacemaker: R-waves discharges artificial pacing impulses at a
fixed rate either in case of absence of natural R-waves or in case of fall of intrinsic heart rate
below a preset value.
43
MEDICAL ELECTRONICS
R-wave triggered (standby) type pacemaker: It senses natural R-waves and discharges artificial
pacing impulses either every time when it senses a natural R-wave or at a fixed rate in case of
fall of intrinsic heart rate below a preset value.
Atrial programmed:
It is synchronized with natural P-wave to pace the ventricles in case of complete heart
block in which case the natural pacing impulses are able to depolarize the atria but they fail to
depolarize ventricles.
Signal characteristics of artificial pacing impulses:
Rectangular pulse of duration 0.15-3 ms and amplitude 5-15 mA for adults, less for
children and 10 times higher for emergency cases.
The shorter the duration of the pulse, the higher the amplitude is required to capture a
heartbeat. e.g., 2 ms pulse requires 3 mA amplitude while 0.8 ms pulse requires 6 mA amplitude.
The ability to capture depends also on the contact of the electrodes.
Electrodes:
Types: (i) unipolar and (ii) bipolar electrodes.
Unipolar type: There is one electrode in the heart and the other electrode is away from
the heart.
Bipolar type: Both the electrodes are in the heart.
Pacemaker
Pacemaker is an electrical pulse generator for starting /maintaining the normal heart beat.
The output of the pacemaker is either externally to the chest or internally to the heart
muscle. In the case of cardiac stand still, the use of the pacemaker is temporary just
long enough to start a normal heart rhythm. In the cases requiring long term pacing, the
pacemaker is surgically implanted in the body and its electrodes are in direct contact with
the heart. The contraction of heart (cardiac) muscle in all animals with hearts is initiated
by electrical impulses. The rate at which these impulses fire controls the heart rate. The
cells that create these rhythmical impulses are called pacemaker cells, and they directly
control the heart rate. The normal heart rate is 60-100 beats per minute.
A higher rate than this ( above 100 beats per minute) is called Tachycardia. slower
rate(Below 60 beats per minute) than this is called Bradycardia .
Inroduction
44
MEDICAL ELECTRONICS
IMPLANTING THE PACEMAKER
Definition of Pacemaker
A small battery powered device, implanted into a patient Paces the heart when normal
rhythm is slow, when there is a heart block not allowing the ventricles to contract when the SA
node fires, or any arrhythmia causing a slow rate.
Determining Pacemaker Types
45
MEDICAL ELECTRONICS
In humans, and occasionally in other animals, a mechanical device called an artificial pacemaker
(or simply "pacemaker") may be used after damage to the body's intrinsic conduction system to
produce these impulses synthetically. The pacemaker is located in the wall of the right atrium.
Cardiac Pacemaker
The sinoatrial node (SA node) is a group of cells positioned on the wall of the right atrium, near
the entrance of the superior venacava. These cells are modified cardiomyocyte. They possess
rudimentary contractile filaments, but contract relatively weakly.
Primary Pacemaker
Cells in the SA node spontaneously depolarize, resulting in contraction, approximately 100 times
per minute. This native rate is constantly modified by the activity of sympathetic and
parasympathetic nerve fibers, so that the average resting cardiac rate in adult humans is about 70
beats per minute. Because the sinoatrial node is responsible for the rest of the heart's electrical
activity, it is sometimes called the primary pacemaker.
Secondary Pacemaker
If the SA node does not function, a group of cells further down the heart will become the ectopic
pacemaker of the heart. These cells form the atrioventricular node(or AV node), which is an area
between the left atrium and the right ventricle, within the atrial septum. The cells of the AV node
normally discharge at about 40-60 beats per minute, and are called the secondary pacemaker.
Pacemaker Potential
The pacemaker potential (also called the pacemaker current) is the slow, positive increase in
voltage across the cells membrane (the membrane potential) that occurs between the end of
one action potential and the beginning of the next action potential. This increase in membrane
potential is what causes the cell membrane, which typically maintains a resting membrane
potential of -70 mV, to reach the threshold potential and consequently fire the next action
potential; thus, the pacemaker potential is what drives the self-generated rhythmic firing
(automaticity) of pacemaker cells, and the rate of change (i.e., the slope) of the pacemaker
46
MEDICAL ELECTRONICS
potential is what determines the timing of the next action potential and thus the intrinsic firing
rate of the cell.
In a healthy sinoatrial node (SAN, a complex tissue within the right atrium containing pacemaker
cells that normally determine the intrinsic firing rate for the entire heart), the pacemaker potential
is the main determinant of the heart rate. Because the pacemaker potential represents the noncontracting time between heart beats ( diastole), it is also called the diastolic depolarization. The
amount of net inward current required to move the cell membrane potential during the
pacemaker phase is extremely small, in the order of few pAs, but this net flux arises from time to
time changing contribution of several currents that flow with different voltage and time
dependence
Artificial Cardiac Pacemaker
A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural
pacemaker) is a medical device that uses electrical impulses, delivered by electrodes contracting
the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to
maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough,
or there is a block in the heart electrical conduction system. Modern pacemakers are externally
programmable and allow the cardiologist to select the optimum pacing modes for individual
patients. Some combine a pacemaker and defibrillator in a single implantable device. Others
47
MEDICAL ELECTRONICS
have multiple electrodes stimulating differing positions within the heart to improve
synchronization of the lower chambers (ventricles) of the heart.
Pacemaker Pulses
Pulses should have the pulse to space ratio 1:10000.
These
It should be negatively going pulses to avoid the ionization of the muscles.

The pulse voltage is made variable to allow adjustments in the energy delivered by
the pacemaker to the heart during each pulse.
Methods of stimulation
External
stimulation
Internal stimulation
External stimulation is employed to restart the normal rhythm of the heart in the case of
cardiac standstill. Internal stimulation is employed in cases requiring long term pacing
because of permanent damage that prevents normal self triggering of the heart.
External Stimulation
It is employed to restart the normal rhythm of the heart in the case of cardiac stand still.
Stand still can occur during openheart surgery or whenever there is a sudden physical shock
or accident.
Internal Stimulation
Internal stimulation is employed in cases requiring long term pacing because of permanent
damage that prevents normal self triggering of the heart.
Comparision between external pacemaker and internal pacemaker.
External pacemaker
Internal pacemaker
48
MEDICAL ELECTRONICS
It does not necessitate open heart surgery
The pacemaker is surgically implanted

beneath
The skin near the chest or abdomen with its It requires open chest minor surgery to
output leads are connected directly to he
place the circuit
heart muscle
These are used for temporary heart
These are used for permanent heart
irregularities. There is no safety or
damages. There is cent percent safety for
pacemaker.
circuit from external disturbances
Electrodes for Stimulation
and unipolar electrodes are used.
Bipolar
In the bipolar electrode, there are stimulating electrode and contact electrode which
serves as a return path for current to the pacemaker.
In the unipolar electrode, there is only stimulating electrode.
The return path for current to the pacemaker is made through the body fluids.
Modes
of operation of pacemaker
Ventricular asynchronous pacemaker ( Fixed rate pacemaker)
Ventricular synchronous pacemaker

Ventricular inhibited pacemaker ( Demand pacemaker)
Atrial synchronous pacemaker.
Atrial sequential ventricular inhibited pacemaker.
Ventricular asynchronous pacemaker

It can be used in atrium or ventricle. It has simplest mechanism and longest battery life.
This pacemaker is suitable for patients with either a stable, total AV block, a slow atrial rate
or atrial arrhythmia. This produces a stimulus at a fixed rate irrespective of the behavior of
heart rhythm. There may be competition between the natural heart beats and pacemaker
beats.It is possible that such an event can be dangerous because if the pacemaker impulse
reaches the heart during a certain vulnerable period, the ventricular fibrillation may occur.
Advantages and disadvantages of ventricular synchronous pacemaker.
Advantages:
To arrest the ventricular fibrillation, this circuit can be used.
If the R wave occurs with its normal value in amplitude and frequency, then it would
not work. Therefore the power consumption is reduced, and there is no chance of
getting side effects due to competition between natural and artificial pacemaker
pulses.
Disadvantages:
Atrial and ventricular are not synchronized.
49
MEDICAL ELECTRONICS
I the olden type when the pacemaker is attached with the patients, the circuit is more
sensitive to external electromagnetic interferences such as electric shavers, microwave
ovens, ignition systems.
Ventricular synchronous Pacemaker
Patients with only short periods of AV block or bundle block can be supplied with a
ventricular synchronized pacemaker.This type of pacemaker does not compete with normal
heart activity
Working of Ventricular Synchronous Pacemaker

Using the sensing electrode, the heart rate is detected and is given to the timing circuit in the
pacemaker. If the detected heart rate is below a certain minimum level, the fixed rate
pacemaker
is turned on to pace the heart. The lead used to detect the R wave is now used to stimulate the
heart. If the natural contraction occurs, the asynchronous pacers timing circuit is reset so
that it
will time its next pulse to detect the heart beat
of ventricular synchronous pacemaker:

To arrest the ventricular fibrillation, this circuit can be used.
If the R wave occurs with its normal value in amplitude and frequency, then it would not
work. Therefore the power consumption is reduced, and there is no chance of getting side
effects due to competition between natural and artificial pacemaker pulses.
Advantages
Disadvantages of ventricular synchronous pacemaker:
Atrial and ventricular are not synchronized.
I the olden type when the pacemaker is attached with the patients, the circuit is more
sensitive to external electromagnetic interferences such as electric shavers, microwave
ovens, ignition systems.
Ventricular inhibited Pacemaker (Demand Pacemaker)
The R- Wave inhibited pacemaker also allows the heart to pace at its normal rhythm when it
is able to . However if the R- wave is missing for a preset period of time, the pacer will
supply the stimulus. Therefore if the heart rate is below a predetermined minimum,
50
MEDICAL ELECTRONICS
pacemaker will turn on and provide the heart a stimulus. For this reason it is called demand
pacemaker.
The sensing electrode pickup R wave. The refractory circuit provides a period of time
following an output pulse or a signals. The sensing circuit detects the R wave and resets the
oscillator. The reversion circuit allows the amplifier to detect the R- wave in low level signal
to noise ratio. In the absence of R wave, it allows the oscillator in the timing circuit to deliver
pulses at its preset rate. The timing circuit consists of an RC network, a reference voltage
source and a comparator which determines the basic pulse rate of the pulse generator. The
output of the timing circuit is fed into pulse delivered to the heart. Then the output of the
pulse width circuit is fed into the rate limiting circuit which limits the racing rate to a
maximum of 120 pulses per minute.
Atrial synchronous pacemaker
This type of pacing is used for young patients with a mostly stable block. Atrial pacing as a
temporary pacing is used in stress testing and coronary artery diseases. It is used to terminate
atrial flutter and in the evaluation of various conduction mechanisms. The atrial activity is
picked up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium. The
detected P wave is amplified and a delay of 0.12 second is provided by the AV delay circuit.
This is necessary corresponding to the actual delay in conducting the P wave to the AV node
in the heart. The signal is then used to trigger the resetable multivibrator and the output of the
multivibrator is given to the amplifier which produces the desired stimulus to be applied to
the heart
Heart
Electrical conduction system of the heart
51
MEDICAL ELECTRONICS
The EKG complex.

P=P wave,
PR=PR interval,
QRS=QRS complex,
QT=QT interval,
ST=ST segment,
T=T wave
The normal electrical conduction in the heart allows the impulse that is generated by
the Sinoatrial node (SA node) of the Heart to be propagated to (and stimulate) the
myocardium (muscle of the heart).
After myocardium is stimulated, it contracts.
It is the ordered stimulation of the myocardium that allows efficient contraction of
the heart, thereby allowing blood to be pumped throughout the body.
SA node:
52
MEDICAL ELECTRONICS
P wave
Under normal conditions, electrical activity is spontaneously generated by the SA

node, the physiological pacemaker.
This electrical impulse is propagated throughout the right and left atria, stimulating
the myocardium of the atria to contract.
The conduction of the electrical impulse throughout the atria is seen on the ECG as
the P wave.
INTERNODAL TRACTS,
As the electrical activity is spreading throughout the atria,

it travels via specialized pathways, known as internodal tracts,
from the SA node to the AVnode.
The P wave is the electrical signature of the current that causes atrial depolarization.
Both the left and right atria contract simultaneously. Its relationship to QRS
complexes determines the presence of a heart block.
Irregular or absent P waves may indicate arrhythmia.
The shape of the P waves may indicate atrial problems.
AV node/Bundles: PR interval
The AV node functions as a critical delay in the conduction system.

Without this delay, the atria and ventricles would contract at the same time, and blood
wouldn't flow effectively from the atria to the ventricles.
The delay in the AV node forms much of the PR segment on the ECG.
And part of atrial repolization be represented by PR segment.
Bundle of His
The distal portion of the AV node is known as the Bundle of His .

The Bundle of His splits into two branches in the interventricular septum, the left bundle
branch and the right bundle branch.
The left bundle branch activates the left ventricle, while the right bundle branch activates
the right ventricle.
The left bundle branch is short, splitting into the left anterior fascicle and the left
posterior fascicle.
The left posterior fascicle is relatively short and broad, with dual blood supply, making it
particularly resistant to ischemic damage.
Purkinje fibers/ventricular myocardium: QRS complex
53
MEDICAL ELECTRONICS
The two bundle branches taper out to produce numerous Purkinjie fibers,
which stimulate individual groups of myocardial cells to contract.
The spread of electrical activity through the ventricular myocardium produces the QRS
Complex on the ECG.
The QRS complex corresponds to the current that causes contraction of the left and right
ventricles,
which is much more forceful than that of the atria and involves more muscle mass,
thus resulting in a greater ECG deflection.
The Q wave, when present,
represents the small horizontal (left to right) current as the action potential travels through
the interventricular septum.
Very wide and deep Q waves do not have a septal origin, but indicate myocardial
infraction that involves the full depth of the myocardium and has left a scar.
Abnormalities in the QRS complex
Bundle branch block (when wide), ventricular origin of tachycardia, ventricular

hyperthrophy or other ventricular abnormalities.
The complexes are often small in pericarditis or pericardial effusion
R and S wave
The R and S waves indicate the spread of the action potential along the ventricular
myocardium itself.
ST Segment
The ST segment connects the QRS complex and the T wave.

ST segment elevation or ST segment depression) may indicate coronary ischemia or
myocardial infraction.
Ventricular repolarization: T wave
The last event of the cycle is the repolarization of the Ventricles.

In most leads, the T wave is positive.
An impulse (action potential) that originates from the SA node at a rate of 60 - 100
beats/minute (bpm) is known as normal sinus rhythm.
If SA nodal impulses occur at a rate less than 60 bpm, the heart rhythm is known as
sinus bradycardia.
If SA nodal impulse occur at a rate exceeding 100 bpm, the consequent rapid heart
rate is sinus tachycardia.
54
MEDICAL ELECTRONICS
These conditions are not necessarily bad symptoms, however.

Trained athletes, for example, usually show heart rates slower than 60bpm when not
exercising
ECG waveforms Lead III
USES OF ECG :
It is the gold standard for the evaluation of cardiac arrhythmias .

The 12 lead ECG stands at the center of risk stratification for patients with suspected
acute myocardial infraction .
It can be useful for detecting electrolyte disturbances (e.g. potassium or calcium).
Allows the detection of conduction abnormalities (e.g. right and left bundle branch
block).
As a screening tool for ischemic heart disease during an cardiac stress test.
Can suggest non-cardiac disease (e.g. pulmonary embolism or hypothermia).
Normal ECG

A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex
and a T wave.
55
MEDICAL ELECTRONICS
ECG lead configurations
Surface electrodes are used with jelly as electrolyte between skin and electrodes.
The potentials generated in the heart are conducted to the body surface.
The potential distribution changes in a regular and complex manner during each
cardiac cycle.
To record electrocardiograms standard electrode positions must be selected.
four types of electrode systems are there. They are:
Bipolar limb leads (or) standard leads.
Augumented unipolar limb leads.
Chest leads (or) precordial leads.
Frank lead system (or) corrected orthogonal leads.
A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex
and a T wave.
Bipolar limb leads

In standard leads the potentials are tapped from four locations of our body.
They are
Right arm
Left arm
Right leg
Left leg.
Usually right leg electrode is acting as ground reference electrode.
Gives voltage VI, the voltage drop from left arm(LA) to right
arm (RA).
+
Electrode from
LA
Output VI
Electrode from RA
Ground electrode RL
Einthoven triangle.
-
Lead I +
Right arm
Left arm Cardiac vector

Lead III
56
MEDICAL ELECTRONICS
Lead II
+
+
Left leg
The closed path RA to LA to LL and back to RA is called Einthoven triangle.

The ECG is measured from any one of the three limb leads is a time variant single
dimensional component of that vector.
According to kirchoffs voltage law ,
the R wave amplitude of lead II is equal to the sum of the R wave amplitudes of leads
I and leadIII
VII = VI + VIII
Augmented unipolar limb leads
Unipolar limb lead system is introduced by Wilson.

Here ECG is recorded between a single exploratory electrode and the central
terminal.The central terminal has a potential corresponding to the center of the
body.Two equal and large resistors are connected to a pair of limb electrodes and the
center of this resistive network acts as central terminal. The remaining limb electrode
acts as the exploratory electrode. By means of augmented ECG lead connections, a
small increase in the ECG voltage can be realized.
The augmented lead connections are
Augmented voltage right arm (aVR)
Augmented voltage left arm (aVL)
Augmented voltage foot (aVF)
Unipolar chest leads
In case of unipolar chest leads, the exploratory electrode is obtained from one of the
chest electrodes.The chest electrodes are placed are placed on the six different points
on the chest closed to the heart.
V1 : fourth intercostal space at right sternal Margin.
V2: fourth intercostal space at left
sternal Margin.
V3: midway between V2 and V4.
V4: fifth intercostal space at mid-clavicular line
V5: same level as V4 on anaterior axillary line
V6: same level as V4. On mid-axillary line.
Color codes for ECG leads
The ECG potentials are measured with color coded leads according to the convention:
White right arm
Black left arm.
Green right leg.
Red left leg.
Brown - chest
57
MEDICAL ELECTRONICS
Frank lead system
The corrected orthogonal leads system (or ) frank lead system is used in vector
cardiography. Here we can get informations from above said 12 leads.
ANALYSIS OF ECG SIGNALS
If PQ segment has prolonged condition I.e. extended f normal condition

means Result :First degree AV block
If QRS complex is widened I.e. QRS interval extended from the normal condition
means Result : Bundle block.
If ST segment is elevated means Result : Myocardial infraction.
If train of pulses occurs instead of PQRST waves means Result : Ventricular

fibrillation which may lead to death if it is not properly corrected by defibrillator.
DIFFERENT TYPES OF HEART BLOCK
I degree AV block: due to prolonged conduction time.

II degree AV block : Due to conduction of few pulses instead of all from atrium
III degree AV block: Due to asynchronous action of atrium and ventricle
Adams-stokes attack: Due to sudden attack of total block.
Bundle block: due to improper conduction of the stimulus to the ventricle.
Atrial fibrillation: Due to fast beating rate (300-500 beats/minute) of the atrium.
Here ventricles beat very slowly.s
Ventricular fibrillation: due to fast beating rate of the ventricles. No pumping of the
blood to different parts of the body.
Heart Transplantation
58
MEDICAL ELECTRONICS
allo graft
Heart transplantation or cardiac transplantation, is a surgical transplant procedure
performed on patients with end-stage heart failure or severe coronary artery disease.
The most common procedure is to take a working heart from a recently deceased
organ donor (allo graft) and implant it into the patient.
The patient's own heart may either be removed (orthotopic procedure) or, less
commonly, left in to support the donor heart (heterotopic procedure).
xenograft
It is also possible to take a heart from another species (xenograft), or implant a manmade artificial one,
although the success of these two procedures has been less successful in comparison
to the far more commonly performed allograft
Indications
In order for a patient to be recommended for a heart transplant they will generally
have advanced, irreversible heart failure with a severely limited life expectancy.
Other possible treatments, including medication, for their condition should have been
considered or attempted prior to recommendation.
Causes of heart failure
Cardiomyopathy
Congential heart disease
Coronary artery disease
Heart valve disease
Life-threatening arrhythmias.
Patient cable and defibrillator protection circuit:

The patient cable connects the different leads from limbs and chest to the defibrillator
protection circuit.. it consists of buffer amplifiers and over voltage protection circuit. The
leads are connected with the buffer amplifiers such that one buffer amplifier for each patient
lead. By this meanss the input impedance is increased and the effects arising from the
variations in the electrode impedance are reduced.further the over voltage protection circuit is
necessary to avoid any damage to the bioamplifiers in the recorder. The over voltage of the
order of 1000V may occur when the electrocardiograph is used during surgery in conjunction
with radio frequency diathermy units for cutting and coagulation or during the treatment pf
ventricular fibrillation using defibrillators. This over voltage protection circuit consists of a
network kof resistors and neon lamps which fire when a pulse from a defibrillator is present.
During firing of the neon lamp, there is no input to the preamplifier of the recorder.
LEAD SELECTOR SWITCH:
After the defibrillator protection circuit, there is lead selector switch which is used to
feed the input voltage from the appropriate electrode to the preamplifier.
59
MEDICAL ELECTRONICS
CALIBRATOR:
A push button allows the insertion of a standardization voltage of 1mV to the
preamplifier. This enables the technician to observe the output on the display unit and adjust
the scale so that a known deflection corresponds to a 1mV input signal. Changing the setting
of the lead selector switch introduces an artifact on the recorded trace. But by means of a
special contact on the lead selector switch the amplifier is momentarily turned off during the
change of setting of the lead selector switch and after the passage of the artifact the amplifier
is turned on. From the lead selector swithc the ECG signal goes to bio-amplifier.
BIO-AMPLIFIER:
The bio-amplifier consists of a preamplifier and power amplifier. The sensitivity or
the gain of the amplifier can be varied. Folllowed by the preamplifier, there is a power
amplifier which is used to drive the recorder. Pen motors in the recorder requires suffficient
electrical power to activate the recording or display. therefore power amplifiers are required
with high power gain. Generally transistor circuits are favourable because a relatively large
surface area is necessary to dissipate the heat genertd in the circuit due to passage of high
current.
Power amplifier circuit used to drive ECG chart recorder stylus. It is push pull type.
Furtehr it is provided with crossover distortion compenstation and offset control. It consists
of two silicon power transistors such that the emitters of the transistors are joined together
and
connected with a load resistor RL.when VB is sufficiently positive, transistor Q1 is forward
biased and conducts while Q2 is reverse biased and remains off.
2
Output power POUT =V OUT / RL.
To avoid the crossover distortion in a pushpull amplifier, an ideal noninverting amplifier is
inserted at the input. Since the input impedance of the noninverting amplifier approaches
infinity, the power gain also approaches infinity. The crossover distortion is eliminated
because the feedback resistance., Rf is so large and hence it raises the gain in a linear manner
and in turn raises the output voltage. The offset control is provided by the resistance R2 and is
used to position the output stylus pen. Gain adjustment is provided with the resistance Ro.
AUXILIARY AMPLIFIER:
Since the electrode impedances are not equal, a differential amplifier does not
completely reject the common mode signals. The common mode signals can be reduced to a
minimum level by means of adding an auxiliary amplifier between the driven right leg lead
and the ECG unit. By this way, the right leg is not connected to ground but it is connected to
the output of the auxiliary amplifier. If the body common mode voltage is different from
zero, a summing network produces the sum of all common mode voltages from all other
electrodes and feeds that sum of the voltages as input to inverting terminal of the auxiliary
amplifier. Meanwhile its noninverting terminal is grounded. The output of the auxiliary
amplifier is connected to the right leg. Therefore it drives the body to zero common voltage.
Thus the common mode rejection ratio of the overall system is increased. Further in the right
leg electrode the current flow is reduced.
ISOLATED POWER SUPPLY:

The isolated power supply is used to give power to the bio-amplifier and by means of
that, the electrical safety for the patient is increased.
60
MEDICAL ELECTRONICS
OUTPUT UINT:
The output unit is a cathode ray oscilloscope. Or a paper chart recorder. In case of
paper chart recorder, the power amplifier or pen amplifier supplies the required power to
drive pen motor that records the ECG trace on the wax coated heart sensitive paper. A
position control on the pen amplifier is used to position the pen at the center on the recording
paper. The stylus pen is heated electrically and the temperature of the stylus pen can be
adjusted with a stylus heat control. There is a marker stylus which is actuated by a push
button and allows the technician to mark a coded indication of the lead being recorded. The
paper speed is about 25 mm/s or 50 mm/s. the faster speed of 50 mm/s is provided to allow
better resolution of the QRS complex at very high heart rates.
POWER SWITCH:
The power switch of the recorder has three positions. In the on position the powet to
the amplifier is turned on; but the paper drive is not running. In order to start the paper drive
the switch must be placed in the RUN position. In the off position, the ECG unit is in
switched off condition.
Echocardiography
An echocardiogram. Image shows that the human heart has four chambers. Apical view left side of the heart to the right. Right side-up - heart's apex at bottom. The trace in the
lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the
image was captured.
61
MEDICAL ELECTRONICS
An abnormal echocardiogram. Image shows a mid-muscular ventricular septal defect. The

trace in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle
that the image was captured. Colours are used to represent the velocity of the blood.
The echocardiogram is an ultrasound of the heart. Using standard ultrasound techniques,
two-dimensional slices of the heart can be imaged. The latest ultrasound systems now employ
3D real-time imaging.
In addition to creating two-dimensional pictures of the cardiovascular system, the
echocardiogram can also produce accurate assessment of the velocity of blood and cardiac
tissue at any arbitrary point using Pulsed or Continuous wave Doppler ultrasound. This
allows assessment of cardiac valve areas and function, any abnormal communications
between the left and right side of the heart, any leaking of blood through the valves (valvular
regurgitation), and calculation of the cardiac output as well as the ejection fraction.
Echocardiography was the first medical application of ultrasound. Echocardiography was
also the first application of intravenous contrast-enhanced ultrasound. This technique injects
gas-filled microbubbles into the venous system to improve tissue and blood delineation.
Contrast is also currently being evaluated for its effectiveness in evaluating myocardial
perfusion. It can also be used with Doppler ultrasound to improve flow-related
measurements.
Echocardiography is usually performed by cardiologists or cardiac sonographers
Transthoracic echocardiogram
The standard echocardiogram is also known as a transthoracic echocardiogram, or
TTE. In this case, the echocardiography transducer (or probe) is placed on the chest wall (or
thorax) of the subject, and images are taken through the chest wall. This is a non-invasive,
highly accurate and quick assessment of the overall health of the heart. A cardiologist can
quickly assess a patient's heart valves and degree of heart muscle contraction (an indicator of
the ejection fraction).
The TTE is commonly used to help diagnose endocarditis. Diagnostic findings by the
Echocardiogram include definitive evidence of vegetation or thrombus on valves or other
endocardiac structures, abscesses, or disruption of a prosthetic heart valve.
The TTE is highly accurate for identifying vegetations, but the accuracy can be reduced in up
to 20% of adults because of obesity, chronic obstructive pulmonary disease, chest-wall
deformities, or otherwise technically difficult patients. Transesophageal echocardiography, if
available, may be more accurate than TTE because it excludes the variables previously
mentioned and allows closer visualization of common sites for vegetations and other
abnormalities. Transesophageal echocardiography also affords better visualization of
prosthetic heart valves.
62
MEDICAL ELECTRONICS
Transesophageal echocardiogram
Another way to perform an echocardiogram is to insert a specialised scope containing an
echocardiography transducer (TEE probe) into the patient's esophagus, and record pictures
from there. This is known as a transesophageal echocardiogram, or TEE (TOE in the United
Kingdom). The advantages of TEE over TTE are usually clearer images. The transducer is
closer to the heart and doesn't have the ribs and lungs to deflect the ultrasound beam. Some
structures are better imaged with the TEE. These structures include the aorta, the pulmonary
artery, the valves of the heart, and the left and right atria. While TTE can be performed easily
and without pain for the patient, TEE may require light sedation and a local anesthetic
lubricant for the esophagus. Children are anesthetized. Unlike the TTE, the TEE is considered
an invasive procedure.
In some centers, sedation is used to ease the discomfort to the individual. The use of local
anesthetic agents and sedation can decrease the gag reflex, making the ultrasound probe
easier to pass into the esophagus. The transducer and cable are then coated in a lubricant,
placed in the
patients mouth, and then passed down the patient's throat. The individual is instructed
to swallow while the probe is being passed down, to prevent it from going into the trachea.
Although the placement of the thumb-wide transducer is uncomfortable, there are very few
complaints of gagging from the patient once the transducer is in the correct location.
Heart Lung Machine:

Nasal cavity:
Main route for air to and from the lungs, lined with a sticky mucus covered
membrane that traps dust particles and germs; divided into two by central plate of cartilage
(nasal septum) fuzzy looking patches (olfactory epithelia)in roof of cavity are the sensory
organs of smell.
Nose hairs:
Situated inside entrance of nostrils help in filter large particles of dust and debries.
Epiglotis:
Cartilage flap that tilts over entrance to larynx when swabling to prevent food and
drink and saliva entering trachea.
Larynx:
Short cartiginous tube joining pharynx with trachea together with vocal cards within
the larynx, it has a vital role in speech production.
Rib:
Twelve pairs of ribs curve around chest and protect lungs and heart from physical
damage.
Intracostal muscles:
63
MEDICAL ELECTRONICS
Double layer of muscles between each pairs of ribs; external layer lifts ribs up and out
during contraction enlarging the lungs to that air is breathed in; inner layer does the opposite
forcing air out.
Right lung:
Slightly larger than the left lung, averaging 55 -60 percent of total lung volume.
Pleural cavity:
Space occupied by the lings; lined
membranes.
with lubricated double layer of pleural
Pleural membrane:
Sac composed of two thin membrane layer encloses each lung; fluid secreted by one
of the membranes allows them to slide smoothly over each other during breathing.
Diaphragm:
Dome-shaped muscle that divides chest and abdomen and together with inter costal
muscles from bodys main breathing muscle; during contraction it flattens and increases size
of chest cavity.
Nasopharynx:
Allows the passage of air only.
Oropharynx:
Permits passage of foods and fluids.
Pulmonary artery:
Thick-walled vessel that transports deoxygenated blood lungs from right side of heart.
Pulmonary vein:
Vessel carrying bright red oxygenated blood from each lung to left side of heart for
supply to the rest of the body.
Primary bronchus:
One of the five branches of the primay bronchus each one supplies a defined segment
of the lung, bronchus further divides into air ways of diminishing diameter called tertiary
bronchi.
Lobes of Left lung:
64
MEDICAL ELECTRONICS
Has only two lobes, to make room for heart (right lung is tri-lobed)
Bronchioles:
Miniscule terminals of the bronchi; gas exchange occurs in tiny sacs (alveoli) at their
ends.
Heart :
Nested in the pericardial cavity.
Pericardial cavity:
Formed mainly by a scoop like shape in the left lung.
Alveoli:
The lungs microscopic air sacs, alveoli are elastic thin walled structures
arranged in clumps at the ends of respiratory bronchioles. They resemble bunches of grapes,
although the alveoli are partly merged with each other. White blood cells known as
macrophages are always present on their surfaces, where they in digest and destroy air borne
irritants such as bacteria, chemicals and dust.
Around the alveoli are networks of capillaries. Oxygen passes from the air in the
alveoli into the blood by diffusion through the alveolar and capillary walls. Carbon di oxide
diffuses from blood into the alveoli. There are more than 00 million alveoli in both lungs.
Breathing and vocalization:
The movements of breathing also known as bodily respiration, bring fresh air
containing oxygen deep into the lungs and then remove stale air containing the waste product
carbon di oxide.
65
MEDICAL ELECTRONICS
UNIT IV
PHYSICAL MEDICINE AND BIO-TELEMETRY
TELEMEDICINE
Introduction :
Wireless telemetry:
Wireless telemetry gives analysis of the physiological data of man or animal under
normal conditions and in natural surroundings without any discomfort or obstruction to the
person or animal
Biotelemetry is the branch of biomedical instrumentation that deals with the
measuring physiological variables to a method of transmission of resulting data. Telemetry
is most convenient during transportation within the hospital area as well for the continuous
monitoring of patients sent to other wards or clinics for check-up or therapy.
Biotelemetry is the measurement of biological parameters over a distance. The
means of transmitting the data from the point of generation to the point of reception can take
many forms.
Measurements can be applied to two categories.
Biological variables such as EEG, ECG and EMG.

Physiological variables that require transducers such as
pressure,
gastrointestinal pressure, blood flow and temperatures.
blood
In first category, a signal is obtained directly in electrical form, whereas the second category
requires a type of excitation. The physiological parameters are eventually measured as
variations of resistance, inductance or capacitance. The differential signals obtained from
these variations can be calibrated to represent pressure, flow, temperature and so on.
The analog signal that is obtained from the electrodes (the signal may be in the form
of voltage, current etc) is converted into a form or code capable of being transmitted at the
transmitter end with the help of transmitter set up.
The transmitter end comprises of transducer that converts physical signals into analog
electrical signal. That electrical signal has to be amplified with the help of preamplifier set
up. The amplified signal has been modulated with the help of modulator and encoder, this
processed signal is transmitted through the multiplexer circuit.
At the receiver end the signal is converted back into its original form. The receiver
end comprises of demultiplexer, decoder, and demodulator circuit.
The demultiplexer circuit demultiplexes the received signal. Now this demultiplexed
signal is passed through the decoder and demodulator. Finally the original signal is retrieved
back for analyzing purpose.
Currently the most widespread use of biotelemetry for biotelemetric potentials is in
the form of the electrocardiogram. A simple set up is sufficient in the transmitting end. That
set up comprises of only electrodes and amplification circuit that is needed to prepare the
66
MEDICAL ELECTRONICS
signal for transmission.

Telemedicine:
It is the application of telecommunications and computer technology to deliver health
care from one location to another. This telemedicine uses the modern information technology
to deliver timely health services to those in need by the electronic methods. The patient may
be present at the remote location. In that location, the specialized doctors are not there means,
we can give protection to the life of the patient with the help of this telemedicine. Nowadays
for investigation purpose only, we are using this telemedicine. In future with the help of this
set up and robot, the doctor can able to do operation for the needed patient who is present in
remote location.
Components of biotelemetry system
Direct
biopotential
Amplifier
Subject
Processor
Transducer
Modulator
Exciter
Carrier
Block Diagram of a Biotelemetry transmitter
67
MEDICAL ELECTRONICS
Tuner
Demodulator
Chart Recorder
or Oscilloscope
Tape Recorder
Receiver Storage Display units
Modulation systems:
Wireless telemetry system uses modulating systems for transmitting biomedical
signals. Two modulators are used here. A lower frequency sub-carrier is employed in
addition to very-high frequency (VHF). This transmits the signal from the transmitter. The
purpose behind this double modulation , it gives better interference free performance in
transmission, and this enables the reception of low frequency biological signals. The
submodulators can be a FM (frequency modulation) system, or a PWM (pulse width
modulation) system or a final modulator is practically always an FM system.
Frequency modulation ( FM ):
In FM systems, the signal can be trasnsmitted by varying the instantaneous frequency
in connection with the signal to be modulated on the wave. Here the amplitude of the signal
t(plus carrier wave) is constant. The rate at which the instantaneous frequency varies is the
modulating frequency. The magnitude to which the carrier frequency varies away from the
centre frequency is called frequency deviation. This is proportional to the modulating
signal. Generally FM signal is produced by controlling the frequency of an oscillator by the
amplitude of the modulating voltage. The frequency of oscillations for most oscillators
depend on a particular value of capacitance.
In the above diagram, the tuned oscillator serves as a frequency modulator. The diode used
here is a varactor diode. The varactor diode is operating in a reverse biased mode, because
of this; the varactor diode gives a depletion layer capacitance to the tank circuit.
This capacitance is a function of the reverse biased voltage across the diode and therefore
produces an FM wave with modulating signal applied.
Pulse width Modulation (PWM):
68
MEDICAL ELECTRONICS
PWM method has an advantage of being less perspective to distortion and noise.
Figure shows a typical pulse width modulator, transistor q1 and Q2 from free running
multivibrator.
Transistors Q3 and Q4 provide constant current sources for charging the timing
capacitors
C1 and C and driving transistors Q1 and Q. when Q1 is off and Q is on , capacitor
C21 chrges through R1 to the amplitude of the modulating voltage em . the other side of this
capacitor is connected to the base voltage of Q2 drops from approximately zero to em.
transistor Q2 will remain off until the base voltage charges to zero volt. Since the charging
current is constant at I, the time required to charge C2 and restore the circuit to the initial
stage is
T2 = (C2/I ).em
Similarly, the time that the circuit remains in the original stage is
T1 = ( C1/I ).em
Variation of Pulse width with amplitude
W= Pulse width generated by the multi-vibrator

P= Variable pulse width, in accordance with input signal
Q = off Period, which also gets varied.
Choice of radio carrier frequency:
In every country, there are regulations governing the use of only certain frequency
and bandwidth for medical telemetry. Therefore, the permission to operate a particular
telemetry system needs to be obtained from the postal department of the country concerned.
69
MEDICAL ELECTRONICS
The transmitter is typically of 50 ohms, which can give a transmission range of about 1.5 Km
in the open flat country. The range will be less in built-up areas. In USA, two frequency
bands have been designated for short range medical telemetry work by the FCC ( federal
communication commision). The lower frequency band of 174-216 MHz, coincides with the
VHF television broad cast band(channels 7-13) therefore the output of the telemetry
transmitter must be limited to avoid interference with TV sets. In higher frequency band of
450-470 MHz, greater transmitter power is allowed but an FCC license has to be obtained for
operating the system.
Radio waves can travel through most of non-conducting material such as air, wood
and plaster with relative ease. But these radio waves are hindered, blocked or reflected by
most conductive material and by concrete. This is due to the presence of reinforced steel in
the concrete buildings. Because of this phenomenon, transmission may be lost or be of poor
quality
when a patient with a telemetry transmitter moves in an environment with a concrete wall or
behind a structure. Reception may also get affected by radio frequency reception or null
spots. One of the important problems can be minimized by the careful selection of transmitter
frequencies by the use of suitable antenna system and by the equipment design.
Based on the output power and frequency obtained, it is possible for us to decide the
range of the radio system. Care should be taken for designing the receiver and antenna. Only
the transmitted signal from the remote location can be analyzed properly otherwise it is
difficult for the doctor to give proper medicine.
The transmitter:
The commonly used FM transmitter is shown below. This circuit can be used for medical
telemetry also. The circuit comprises of a transistor, feedback circuit, and a tank circuit. The
transisytor used here is a grounded base colpitts R.F. oscillator with L1, C1, C2 as the tank circuit.
70
MEDICAL ELECTRONICS
Transmitter circuit diagram:
Inductor
help of C1 and C2. inductor L1 functions both as a tuning coil and a transmitting
antenna. With the help of this set up, a positive feedback is provided to the amplifier circuit.
We can able to set the transmission frequency to a precise level. This can be done by
adjusting the trim capacitor C2. with this set up, we can able to set the frequencyrange of 88
to 188 MHz. Frequency modulation can be achieved by variation in the operating point of the
transistor, which in turn varies its collector capacitance, thus changing the resonant frequency
of the tranistor circuit. The operating point can be changed by the sub-carrier input. Thus the
transmitter,s output consists of an RF signal, tuned in the FM broad cast band and frequency
modulated by the sub-carrier oscillator (SCO), which in turn is frequency modulated by the
physiological signals of interest.
The Receiver:
The receiver can be a common broadcast receiver with a sensitivity of 1 microvolt.
The output of the hf unit of the receiver is fed to the sub cab-modulator HF unit of the
receiver is fed to the sub-modulator to extract the modulating signal. In a FM/FM system, the
sub-modulator first converst the FM signal into an AM signal. This is followed by an AM
detector, which demodulates the newly created AM waveform. With this arrangement, the
output is linear with frequency deviation only for small frequency deviations. Other types of
detectors can be used to improve the linearity. Two major problems that has been faced in
biotelemetry at the system interfaces. The first problem is the interface between the
biological system and the electrical system.
The second problem is the interface between transmitter and receiver.
Radio Pill
The earliest biotelemetry units was the endoradiosonde, developed by Mackay and
3
Jacobson. The pressure sensing electrode is a radio pill less than 1 cm .in volume. This
radio pill can be swallowed by the patient. Radio pill now travels through the
71
MEDICAL ELECTRONICS
gasterointestinal tract on the way of passing into the gastrointentinal tract, the radio pill is
capable of measuring various parameters that are available in the tract. With the help of radio
pill type devices, it is possible for us to measure or sense temperature, pH, enzyme activity,
and oxygen tesion values. These measurements can be made in associated with transducers.
Pressure can be sensed by using variable inductance, temperature can be measured by using
temperature-sensitive transducer.
Radiation therapy:
Radiation therapy (also called radiotherapy, x-ray therapy, or irradiation) is
the
use of a certain type of energy (called ionizing radiation) to kill cancer cells and shrink
tumors. Radiation therapy injures or destroys cells in the area being treated (the
target tissue) by damaging their genetic material, making it impossible for these
cells to
continue to grow and divide. Although radiation damages both cancer cells and
normal cells, most normal cells can recover from the effects of radiation and function
properly. The goal of radiation therapy is to damage as many cancer cells as possible,
while limiting harm to nearby healthy tissue.
Uses of radiation therapy:

Radiation therapy may be used to treat almost every type of solid tumor,
including cancers of the brain, breast, cervix, larynx, lung, pancreas, prostate, skin,
spine, stomach, uterus, or soft tissue sarcomas. Radiation can also be used to treat
leukemia and lymphoma (cancers of the blood-forming cells and lymphatic system,
respectively). Radiation dose to each site depends on a number of factors, including the
type of cancer and whether there are tissues and organs nearby that may be damaged by
radiation.
For some types of cancer, radiation may be given to areas that do not have evidence
of cancer. This is done to prevent cancer cells from growing in the area receiving the
radiation. This technique is called prophylactic radiation therapy.
Radiation therapy also can be given to help reduce symptoms such as pain from
cancer that has spread to the bones or other parts of the body. This is called palliative
radiation therapy.
Difference between external radiation therapy and internal radiation

therapy:
Radiation may come from a machine outside the body (external radiation),
may be placed inside the body (internal radiation), or may use unsealed radioactive
materials that go throughout the body (systemic radiation therapy). The type of
radiation to be
given depends on the type of cancer, its location, how far into the body the radiation will
need to go, the patients general health and medical history, whether the patient will
have
72
MEDICAL ELECTRONICS
other types of cancer treatment, and other factors.

Most people who receive radiation therapy for cancer have external radiation. Some
patients have both external and internal or systemic radiation therapy, either one after
the other or at the same time.
External radiation therapy usually is given on an outpatient basis; most

patients do not need to stay in the hospital. External radiation therapy is used to
treat most types of cancer, including cancer of the bladder, brain, breast, cervix,
larynx, lung, prostate, and vagina. In addition, external radiation may be used to
relieve pain or ease other problems when cancer spreads to other parts of the
body from the primary site.
Intraoperative radiation therapy ( IORT) is a form of external

radiation that is given during surgery. IORT is used to treat localized
cancers that cannot be completely removed or that have a high risk of
recurring (coming back) in nearby tissues. After all or most of the cancer is
removed, one large, high-energy dose of radiation is aimed directly at the
tumor site during surgery (nearby healthy tissue is protected with special
shields). The patient stays in the hospital to recover from the surgery. IORT
may be used in the treatment of thyroid and colorectal cancers,
gynecological cancers, cancer of the small intestine, and cancer of the
pancreas. It is also being studied in clinical trials (research studies) to treat
some types of brain tumors and
pelvic HYPERLINK
"http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=sarco
ma&version=Patient&language=English" sarcomas in adults.
Prophylactic cranial irradiation (PCI) is external radiation given to

the brain when the primary cancer (for example, small cell lung cancer) has
a high risk of spreading to the brain.
Internal radiation therapy (also called brachytherapy) uses radiation that
is placed very close to or inside the tumor. The radiation source is usually sealed
in a small holder called an implant. Implants may be in the form of thin wires,
plastic tubes called catheters, ribbons, capsules, or seeds. The implant is put
directly into the body. Internal radiation therapy may require a hospital stay.
THERMOGRAPH:
Need for the Thermography:
Thermograph has a number of distinct advantages over other imaging systems. It is
completely non- invasive, there is no contact between the patient and system as with
echography, and there is no radiation hazard as with x-rays. A thermograph is a real-time
system, changes can be followed as fast as at a rate if one study per second.
Classification of thermography:
Based on detection of the thermal radiation from the skin sreas, we can classify the
thermograph into three methods. They are
Infrared thermograph
73
MEDICAL ELECTRONICS
Liquid crystal thermograph

Microwave themograph.
Thermo gram:
Thermo gram is a record of the infrared heat waves that are emitted by the body. it gives a
visual display of the hot and cold areas of the whole body. The technique of obtaining a
thermo gram is known as thermograph.
Thermographic equipment:
Thermographic equipment incorporate scanning systems which enable the infrared radiation
emitted from the surface of the skin with in the field of view to be focused on to an infrared
detector. The equipment used in the thermography basically consists of two units. A special
infrared camera that scans the object and a display unit for displaying the thermal picture on
the screen.
NETD:
NETD is nothing but Noise Equivalent Temperature Difference (NETD). It is the
figure of merit for the thermographic imaging system. This is usually called minimum
resolution.
Resolution of the thermographic system:
The thermal and spatial resolution of a thermographic system is determined by the optical
parameters, detector performance. Preamplifiers noise, the signal processing system, the
picture
presentation and evaluation systems. Thermo gram:

Problem of medical thermography:
For comparing the results of successive thermo graphic examinations, it is essential
that the results are standardized and quantified. In the earlier thermographic equipment the
thermograph was recorded on a photographic film from which it was limited by the long
scanning time. a practical solution to this problem is the use of isotherms. Differences
between the various gray tones are determined accurately by means of a thermal band or
isotherm. In modern thermographic equipment, temperature measurement is improved by
providing two simultaneous isotherm functions.
Analog analysis medicalThermo graphy:
With thermo vision 780M, there are many possibilities of analog analysis of the gray tone
images including the following (i) isotherm function (ii) lever analysis (iii) sample are a
selector and thermal profile analysis.
Digital analysis of medical Thermography:
74
MEDICAL ELECTRONICS
In medical fields where complex image patterns are regular occurrence, computers offer new
opportunities for more efficient and objective reasons. First, it can be used to determine
numerous parameters from the image itself, highest and average temperature or differences
between none region and another or area as various temperature contours or geometric
centroids or skewness and so on.
SOFIA
SOFIA is a general image processing program which can be used in nearly all
applications written in FORTRAN IV, it is specially designed to operate with digital data in
OSCAR (Off-line: system for computer Access and Recording)
Laser
The light emitted from an ordinary light source is incoherent, because the
radiation emitted from different atoms do not have definite phase relationship with each
other. For interference of light coherent sources are required. Two independent sources
cannot act as coherent sources. For experimental purposes, from a single source, two coherent
sources are obtained. In recent years certain highly coherent sources were developed namely
LASER. The word LASER is an acronym for Light Amplification by Stimulated Emission of
Radiation. The difference between ordinary light and LASER beam is pictorially depicted as
follows:
Characteristics of LASER:
The LASER beam is
1. Monochromatic
2. Highly coherent with waves exactly in phase with each other.
3. Doesnt diverge.
4. Extremely intense.
Spontaneous and Stimulated radiation:
An atom may undergo transition between two energy states E1 and E2 if it
emits or absorbs a photon of the appropriate energy E1-E2 =h .
In a system of thermal equilibrium the number of atoms in the ground
state(N1) is greater than the number of atoms in the excited state(N2).This is called Normal
population.
Consider a sample of free atoms, some of which are in the ground state with energy E 1 and some
in the excited state with energy E2. If the photons of energy E1-E2 =h are incident on the
sample,
the photons can interact with the atoms in the ground state and are taken to excited state. This
is called Stimulated or Induced absorption. The process by which the atoms in the ground
state are
taken to the excited state is known as pumping. If the atoms are taken to the higher energy
levels with the help of light it is called Optical pumping. If the atoms in the ground state are
pumped to the excited state by means of external agency, the number of atoms in the excited
state(N2) becomes greater than the number of atoms in the ground state(N1) then this
condition is called population inversion. The lifetime of the atoms in the excited state is
75
MEDICAL ELECTRONICS
-8
normally 10 seconds. Some of the excited energy levels have greater life times for atoms
-3
(10 seconds). These levels are called as Metastable state.
If the excited energy level is an ordinary level the excited atoms return to a lower or
ground energy state immediately without the help off any external energy. During this transition a
photon of energy E1-E2 =h is emitted. This is called spontaneous emission. If the excited state
is a metastable state, the atoms stray for some time in these level and then are brought to a lower
level by the help of the photons of energy E 1-E2 =h . During this process a photon of energy
E1-E2 =h is emitted. This is known as Stimulated radiation and the photon produced is
called as
stimulated photon or secondary photon. The secondary photon is always in phase with the
stimulating photon. These photons in turn stimulate further emission of photons and hence
this results in a chain reaction. This is called laser action and by this action all the emitted
photons having same energy and same frequency and also in phase with each other. Hence a
highly monochromatic and perfectly coherent intense radiation is obtained.
to achieve LASER action:
There must be inverted population.
The excited state must be a metastable state.
The emitted photon must stimulate further emission. This is achieved by

the use of the reflecting mirrors at the ends of the system.
Conditions
Absorbing Energy
Consider the illustration from the previous page. Although more modern views of the atom
do not depict discrete orbits for the electrons, it can be useful to think of these orbits as the
different energy levels of the atom. In other words, if we apply some heat to an atom, we
might expect that some of the electrons in the lower-energy orbitals would transition to
higher-energy orbitals farther away from the nucleus.
Absorption
of
energy:
An atom absorbs energy in the form of heat, light, orelectricity.
Electrons may move from a lower-energy orbit to a higher-energy
orbit.
This is a highly simplified view of things, but it actually reflects the core idea of how atoms
work in terms of lasers.
76
MEDICAL ELECTRONICS
Once an electron moves to a higher-energy orbit, it eventually wants to return to the ground
state. When it does, it releases its energy as a photon -- a particle of light. You see atoms
releasing energy as photons all the time. For example, when the heating element in a toaster
turns bright red, the red color is caused by atoms, excited by heat, releasing red photons.
When you see a picture on a TV screen, what you are seeing is phosphor atoms, excited by
high-speed electrons, emitting different colors of light. Anything that produces light -fluorescent lights, gas lanterns, incandescent bulbs -- does it through the action of electrons
changing orbits and releasing photons.
The Basics of an Atom
There are only about 100 different kinds of atoms in the entire universe. Everything
we see is made up of these 100 atoms in an unlimited number of combinations. How these
atoms are arranged and bonded together determines whether the atoms make up a cup of
water, a piece of metal, or the fizz that comes out of your soda can!
Atoms are constantly in motion. They continuously vibrate, move and rotate. Even the atoms
that make up the chairs that we sit in are moving around. Solids are actually in motion!
Atoms can be in different states of excitation. In other words, they can have different
energies. If we apply a lot of energy to an atom, it can leave what is called the ground-state
energy level and go to an excited level. The level of excitation depends on the amount of
energy that is applied to the atom via heat, light, or electricity.
The Laser/Atom Connection

A laser is a device that controls the way that energized atoms release photons. "Laser" is an
acronym for light amplification by stimulated emission of radiation, which describes very
succinctly how a laser works.
Although there are many types of lasers, all have certain essential features. In a laser, the
lasing medium is pumped to get the atoms into an excited state. Typically, very intense
flashes of
light or electrical discharges pump the lasing medium and create a large collection of excitedstate atoms (atoms with higher-energy electrons). It is necessary to have a large collection of
atoms in the excited state for the laser to work efficiently. In general, the atoms are excited to
a level that is two or three levels above the ground state. This increases the degree of
population inversion. The population inversion is the number of atoms in the excited state
versus the number in ground state.
Once the lasing medium is pumped, it contains a collection of atoms with some electrons
sitting in excited levels. The excited electrons have energies greater than the more relaxed
electrons.
Just as the electron absorbed some amount of energy to reach this excited level, it can also
release this energy. As the figure below illustrates, the electron can simply relax, and in turn
rid itself of some energy. This emitted energy comes in the form of photons (light energy).
The photon emitted has a very specific wavelength (color) that depends on the state of the
electron's energy when the photon is released. Two identical atoms with electrons in identical
states will release photons with
77
MEDICAL ELECTRONICS
Ruby LASER:
The Ruby laser was first developed by T.Maiman in 1960. It consists of a
single crystal of ruby rod of dimensions 10cm and 0.8cm. A ruby is a crystal of aluminium
3+
3+
oxide Al2O3 in which some of aluminium ions (Al ) are replaced by chromium ions (Cr ).
The opposite ends of the ruby rod are made flat and parallel, one end is fully silvered and the
other end is partially silvered. The ruby rod is surrounded by a helical Xenon flash tube
which provides the pumping light to raise the chromium ions to upper energy level. In the
Xenon flash tube each flash lasts several milliseconds and in each flash a few thousand joules
of energy is consumed.
In normal state most of the chromium ions are in the ground state E1. When the ruby rod is
irradiated by a flash of light 5500 radiation (green colour) photons are absorbed by the
chromium ions which are pumped to the excited state E3. The excited ion gives up part of its
energy to the crystal lattice and decay without giving any radiation to the metastable state E 2.
-3
Since the state E2 has a much longer lifetime (10 seconds) the number of ions on this state
goes on increasing. Thus population inversion is achieved between the states
E2 and E1. When the excited ion from the metastable state E2 drops down spontaneously to
the ground state E1 it emits a photon of wavelength 6943.
This photon travels through the ruby rod and is reflected back and forth by the silvered ends
until it stimulates other excited ion and causes it to emit a fresh photon in phase with
stimulating photon. Thus the reflections will amount to the additional stimulated emission,
the so-called Amplification by Stimulated emission. This stimulated emission is the LASER
transition. Finally a pulse of red light of wavelength 6943 emerges through the partially
silvered end of the crystal.
78
MEDICAL ELECTRONICS
Ruby Lasers
A ruby laser consists of a flash tube (like you would have on a camera), a ruby rod and two
mirrors (one half-silvered). The ruby rod is the lasing medium and the flash tube pumps it.
The laser in its non-lasing state
79
MEDICAL ELECTRONICS
2. The flash tube fires and injects light into the ruby rod.
The light excites atoms in the ruby.
3. Some of these atoms emit photons.
4. Some of these photons run in a direction parallel to

the ruby's axis, so they bounce back and forth off the
mirrors. As they pass through the crystal, they
stimulate emission in other atoms.
5. Monochromatic, single-phase, columnated light

leaves the ruby through the half-silvered mirror -laser light!
Helium Neon LASER:
A continuous and intense laser beam can be produced with the help of gas
80
MEDICAL ELECTRONICS
lasers. A simplified diagram showing basic features of a He-Ne gas laser is as follows:
He-Ne laser system consists of a quartz discharge tube containing helium and
neon in the ratio of 1:4 at a total pressure about 1mm of Hg. One end of the tube is fitted with
a perfectly reflecting mirror and the other end with partially reflecting mirror. A powerful
radio frequency generator is used to produce discharge in the gas, so that the helium atoms
are excited to a higher energy level.
When an electric discharge passes through the gas, the electron in the discharge tube
collide with He and Ne atoms and excite them to metastable states of energy 20.61eV and
20.66eV respectively above the ground level. Some of the excited helium atoms transfer their
energy to unexcited Ne atoms by collision. Thus He atom helps in achieving a population
inversion in Ne atoms. When an excited Ne atom drops down spontaneously from the
metastable state at 20.66eV to lower energy state at 18.7eV it emits a 6328
Photon in the visible region. This photon traveling through the mixture of the gas is reflected
back and forth by the reflector ends, until it stimulates an excited neon atom and causes it to
emit a fresh 6328 photon I phase with the stimulating photon. This stimulated transition
from 20.66eV to 18.7eV is the laser transition. The o/p radiation atoms drop down from the
1837eV to lower state E1 through spontaneous emission emitting incoherent light. From this
level E1 the Ne atoms are brought to the ground state through collision with the walls of the
tube. Hence the final transition is radiationless.
Laser Light
Laser light is very different from normal light. Laser light has the following properties:
The light released is monochromatic. It contains one specific wavelength of light

(one specific color). The wavelength of light is determined by the amount of energy
released when the electron drops to a lower orbit.
The light released is coherent. It is organized -- each photon moves in step with
the others. This means that all of the photons have wave fronts that launch in unison.
The light is very directional. A laser light has a very tight beam and is very strong
and concentrated. A flashlight, on the other hand, releases light in many directions,
and the light is very weak and diffuse.
To make these three properties occur takes something called stimulated emission. This does
not occur in your ordinary flashlight -- in a flashlight, all of the atoms release their photons
randomly. In stimulated emission, photon emission is organized.
The photon that any atom releases has a certain wavelength that is dependent on the energy
difference between the excited state and the ground state. If this photon (possessing a certain
energy and phase) should encounter another atom that has an electron in the same excited
state, stimulated emission can occur. The first photon can stimulate or induce atomic
emission such that the subsequent emitted photon (from the second atom) vibrates with the
same frequency and direction as the incoming photon.
The other key to a laser is a pair of mirrors, one at each end of the lasing medium. Photons,
with a very specific wavelength and phase, reflect off the mirrors to travel back and forth
through the lasing medium. In the process, they stimulate other electrons to make the
81
MEDICAL ELECTRONICS
downward energy jump and can cause the emission of more photons of the same wavelength
and phase. A cascade effect occurs, and soon we have propagated many, many photons of the
same wavelength and phase. The mirror at one end of the laser is "half-silvered," meaning it
reflects some light and lets some light through. The light that makes it through is the laser
light.
You can see all of these components in the figures on the following page, which illustrate
how a simple ruby laser works.
Types of Lasers
There are many different types of lasers. The laser medium can be a solid, gas, liquid or
semiconductor. Lasers are commonly designated by the type of lasing material employed:
Solid-state lasers have lasing material distributed in a solid matrix (such as the
ruby or neodymium:yttrium-aluminum garnet "Yag" lasers). The neodymium-Yag
-9
laser emits infrared light at 1,064 nanometers (nm). A nanometer is 1x10 meters.
Gas lasers (helium and helium-neon, HeNe, are the most common gas lasers)
have a primary output of visible red light. CO2 lasers emit energy in the farinfrared, and are used for cutting hard materials.
Excimer lasers (the name is derived from the terms excited and dimers) use reactive
gases, such as chlorine and fluorine, mixed with inert gases such as argon, krypton or
xenon. When electrically stimulated, a pseudo molecule (dimer) is produced. When
lased, the dimer produces light in the ultraviolet range.
Dye lasers use complex organic dyes, such as rhodamine 6G, in liquid solution
or suspension as lasing media. They are tunable over a broad range of
wavelengths.
Semiconductor lasers, sometimes called diode lasers, are not solid-state lasers.
These electronic devices are generally very small and use low power. They may
be built into larger arrays, such as the writing source in some laser printers or CD
players.
A ruby laser (depicted earlier) is a solid-state laser and emits at a wavelength of 694 nm.
Other lasing mediums can be selected based on the desired emission wavelength (see table
below), power needed, and pulse duration. Some lasers are very powerful, such as the CO2
laser, which can cut through steel. The reason that the CO2 laser is so dangerous is because it
emits laser light in the infrared and microwave region of the spectrum. Infrared radiation is
heat, and this laser basically melts through whatever it is focused upon.
Other lasers, such as diode lasers, are very weak and are used in todays pocket laser
pointers.
These lasers typically emit a red beam of light that has a wavelength between 630 nm and
680 nm. Lasers are utilized in industry and research to do many things, including using
intense laser light to excite other molecules to observe what happens to them.
Here are some typical lasers and their emission wavelengths:

Laser Type
Wavelength (nm)
82
MEDICAL ELECTRONICS
Argon fluoride (UV)

Krypton fluoride (UV)
193
248
Xenon chloride (UV)
308
Nitrogen (UV)
337
Argon (blue)
488
Argon (green)
514
Helium neon (green)
543
Helium neon (red)
633
Rhodamine 6G dye (tunable)
570-650
Ruby (CrAlO3) (red)
694
Nd:Yag (NIR)
Carbon dioxide (FIR)
1064
10600
Applications of LASER:
Micro surgery has become possible due to narrow spread angle of the laser beam.
It can be used in the treatment of kidney stone, tumour, cutting and sealing small blood
vessels in brain surgery and retina detachment.
The laser beam is used in endoscopy.
It can also be used for the treatment of human and animal cancer.
MASER:
The term MASER stands for Microwave Amplification by Stimulated
Emission of Radiation. The working of maser is similar to that of laser. The maser action is
based on the principle of Population Inversion followed by Stimulated emission. In maser the
emitted photon during the transition from the metastable state belongs to the microwave
frequencies. The paramagnetic ions are used as maser materials. Practical maser materials are
often chromium or gadolium ions doped as impurities in ionic crystals. Ammonia gas is also
a maser material. Maser provides a very strong tool for analysis in molecular spectroscopy.
LASER SURGERY
Laser surgery, pioneered by Russia, is surgery using a laser (instead of a
scalpel)
to cut tissue.
Examples include the use of a laser scalpel in otherwise conventional surgery, and
soft tissue laser surgery, in which the laser beam vaporizes soft tissues with high
water content. Laser resurfacing is a technique in which molecular bonds of a material
are dissolved by a laser. Laser surgery is commonly used on the eye. Techniques used
include LASIK, which is used to correct near and far-sightedness in vision, and
83
MEDICAL ELECTRONICS
phorefractive keratectomy, a procedure which permanently reshapes the cornea using

an excimer laser to remove a small amount of tissue.
Types of surgical lasers include carbon-dioxide, argon, Nd:YAG, and KTP.
Eye surgery
Various types of laser surgery are used to treat refractive error:
LASIK,in which a knife is used to cut a flap in the cornea, and a laser is used to
reshape
the layers underneath, to treat refractive error
INTRALASIK, a variant in which
the flap is also cut with a laser
Photorefractive keratectomy(PRK, LASEK), in which the cornea is reshaped without
first cutting a flap Laser thermal keratoplasty, in which a ring of concentric burns is
made in the cornea, which cause its surface to steepen, allowing better near vision
Laproscopic surgery
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid

surgery,
or keyhole surgery, is a modern surgical technique in which operations in the
abdomen are performed through small incisions (usually 0.51.5 cm) as opposed to
the larger incisions needed in laparotomy.Keyhole surgery makes use of images
displayed on TV monitors to magnify the surgical elements. Laparoscopic surgery
includes operations within the abdominal or pelvic cavities, whereas keyhole surgery
performed on the thoracic or chest cavity is called thoracoscopic surgery.
Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
The key element in laparoscopic surgery is the use of a laparoscope. There are two
types: (1) a telescopic rod lens system, that is usually connected to a video camera
(single chip or three chip), or
(2) a digital laparoscope where the charge coupled device is placed at the end of the
laparoscope, eliminating the rod lens system.
DIATHERMY:
Diathermy therapy is generally contra-indicated for pacemaker patients.the operation
of a pulse generator subject to the intense fields of energy involved in diathermy cannot be
predicted; reversion to fixed rate pacing is likely, to copmplete inhibition is possible.
Although damage to either pulse generator circuitry or cardiac tissue is highly improbable, it
cannot be positively ruled out. If diathermy therapy must be used, it should be applied away
from the immediate vicinity of the pulse generator/ lead system.
INTRODUCTION:
Operation theatre equipment are very useful both diagnostically and therapeutically.
they are mainly useful for monitoring and treatment purposes. during operation or intensive
care or intensive treatment, the patient's condition is followed carefully by repeated
measurement of many variables, like blood flow velocvity, cardiac output, blood pressure.
PH value and so on.The above variables are also measured and monitored by operation
theatre equipment.
PRINCIPLE OF SURGICAL DIATHERMY:
84
MEDICAL ELECTRONICS
High frequency currents apart from their usefulness for therapeutic applications can
also be used in the operating rooms for surgical purposes involving cutting and coagulation.
The frequency of currents used in surgical diathermy units is in the range of 1-3MHz in
contrast with much higher frequencies employed in shortwave therapeutic diathermy
machines.The evolving steam bubbles in the tissues at the cutting action is obtained.
Similarly during the passage of the high frequency current through the tissue, the tissue is
heated locally. so that the tissue is melted instantaneously and sealing of the capillary and
other blood vessels is taking place. Then the coagulation of the tissues takes place. The use of
high frequency current is to avoid the intense muscle activity and the electrocution hazard
occurs if low frequencies are used.
Surgical diathermy machines depend for their action, the heating effect of electric
current. When high frequency current flows through the sharp edge of a wire loop or point of
a needle into the tissue. There is a high contraction of current at this point. The tissue is
heated to such an extent that cells immediately under the electrode are torn apart by the
boiling of the cell fluid. The indifferent electrode establishes a large area contact with the
patient and the RF current is therefore dispersed so that very little cheat is developed at this
electrode. This type of tissue separation forms the basis of electrosurgical cutting.
Honig (1975) worked out detailed derivation of the significant parameters affecting
the distribution of electro surgical RF power in tissue. He analyzed how electrosurgical RF
power is localized in the vicinity of the cutting electrode. It was shown that the combination
of fine wire electrodes high RF voltage and high cutting speeds are necessary for the
confinement of tissue destruction in electro surgery. These parameters are of great value in
micro surgery since localization of electrosurgical effects would also be accompanied by
coagulation and homeostasis. His analysis supported the supposition that evolving steam
bubbles in the tissues at the surgical tip continuously rupture the tissue and are responsible
for cutting mechanism.
Coagulation:
Electrosurgical coagulation of the tissue is caused by the high frequency current
flowing through the tissue and heating it locally so that it coagulates from inside. The
coagulation process is accompanied by a grayish-white discoloration of the tissue that the
edge of the electrode. In contrast to a thermocauter, better coagulation can be achieved by
high frequency currents because it does not cause superficial burning.
Fulguration:
The term fulguration refers to a superficial tissue destruction without affecting deep-seated
tissues. This is obtained by passing sparks from the needle or ball electrode of small diameter
to the tissue. When electrode is held near the tissue without toughing it, spark is produced.
This spark is capable of burning the unwanted portions.
Desiccation:
The needle point electrodes are stack into the tissue and kept steadily while passing
electric current. This creates a high local increase in heat and drying of tissues is taking
place. This is called desiccation.
85
MEDICAL ELECTRONICS
Blending:
When the electrode is kept above the skin, an electrical arc is sent. The developed
heat produces wedge shaped narrow cutting of the tissue on the surface. By increasing the
current level, deeper level cutting of the tissues takes place. Normally continuous RF current
is used for cutting.
Hemostasis:
The concurrent use of continuous RF current for cutting and a RF wave burst for
coagulation is called Hemostasis mode.
Electrical Shock
Electric shock hazards:

It is a common experience that the hazards due to electric shock are also
associated with equipment other than that used in hospitals. However, the equipments
used in
medical practice have to operate in special environments. Which differ I certain respects from
others. Some such special situations are as follows:
A patient may not be usually able to react in the normal way. He/she is either ill,
unconscious anaesthetized or strapped on the operating table. He/she may not be able
to withdraw him/herself from the electrified object, when feeling tingling in his/her
skin,
The patient or the operator may not realize that a potential hazard exists. This is
because potential differences are small and high frequency and ionizing radiations are
not directly
catheter in his/her heart or an large blood vessels.
Electro medical equipment, example : pacemakers may be used either temporarily or

permanently to support or replace functions of some organs of the human body. The
interruption in the power supply or failure of the permanent injuries or even prove
fatal
indicated.
Considerable neutral protection and barrier to electric current is provided by human

skin. In certain applications of electro medical equipment, the natural resistance of the
skin may be passed. Such situations arise when the tests are carried out on the subject
with a
before any danger of electrocution occurs.
for the patient.
dangerous when used in conjunction with others.
Medical instruments are quite often used in conjunction with several other
instruments
and equipment. These combinations of high power equipment and extremely sensitive
low signal equipment. Each of these devices may be safe in itself, but can become
Environmental conditions in the hospitals particularly in the operating theatres cause
explosion or fire hazards due to the presence of anesthetic agents, humidity and
cleaning agents etc.
86
MEDICAL ELECTRONICS
Effects due to 50 Hz current passage:

This electric shock can cause unwanted cellular depolarization. This is associated with
muscular contraction, or it may cause cell vaporization and tissue injury. The effect of
commercial frequency currents on the human body should be considered. This assists in
establishing allowable leakage currents for electrical appliances and electric hand tools. Most
of the electrical accidents involve a current pathway through victim from one upper limb to
the feet or to the opposite upper limb. At commercial frequencies, the body acts as a volume
conductor. For commercial frequencies (50 Hz 60 Hz) specific physiological effects due to
passage of current through the body are listed below:
Type of current range (mA)
Physiological effect
Threshold1-5
Let go 8-20
Tingling sensation5-8
Intense or painful sensation
Threshold of involuntary muscle contraction paralysis >20.

Respiratory paralysis and heart fibrillation 80-1000, ventricular and heart defibrillation 1,000
to 10,000 sustained myocardial contraction, temporary respiratory paralysis and possible
tissue burns.
Let-go current is the minimum current to produce muscular contraction. For men it
is about 16 mA and for women it is about 10.5 mA.
Microshock and Macroshock:

Macroshock:
A physiological response to a current applied to the surface of the body that produces
unwanted or unnecessary stimulation like muscle contractions or tissue injury is called
macro shock. All hospital patients and medical attendants are exposed from defective
electric devices and bio-medical equipment.
Microshock:
A physiological response to a current applied to a surface of the heart that results in
unwanted stimulation like muscle contractions or tissue injury is called microshock. Micro
shock is most often caused when currents in excess of 10 microamperes, flow through an
insulated catheter to the heart. The catheter may be an insulated, conductive-fluid filled tube,
or a solid wire pacemaker cable. The micro shock results because the current density at the
heart become high in the situation depicted there, in which the catheter touches the heart.
87
MEDICAL ELECTRONICS
UNIT V
RECENT TRENDS IN MEDICAL INSTRUMENTATION
THERMOGRAPH:
Need for the Thermography:
Thermograph has a number of distinct advantages over other imaging systems. It is
completely non- invasive, there is no contact between the patient and system as with
echography, and there is no radiation hazard as with x-rays. A thermograph is a real-time
system, changes can be followed as fast as at a rate if one study per second.
Classification of thermography:
Based on detection of the thermal radiation from the skin sreas, we can classify the
thermograph into three methods. They are
Infrared thermograph
Liquid crystal thermograph
Microwave themograph.
Thermo gram:
Thermo gram is a record of the infrared heat waves that are emitted by the body. it gives a
visual display of the hot and cold areas of the whole body. The technique of obtaining a
thermo gram is known as thermograph.
Thermographic equipment:
Thermographic equipment incorporate scanning systems which enable the infrared radiation
emitted from the surface of the skin with in the field of view to be focused on to an infrared
detector. The equipment used in the thermography basically consists of two units. A special
infrared camera that scans the object and a display unit for displaying the thermal picture on
the screen.
NETD:
NETD is nothing but Noise Equivalent Temperature Difference (NETD). It is the
figure of merit for the thermographic imaging system. This is usually called minimum
resolution.
Resolution of the thermographic system:
The thermal and spatial resolution of a thermographic system is determined by the optical
parameters, detector performance. Preamplifiers noise, the signal processing system, the
picture
presentation and evaluation systems. Thermo gram:

88
MEDICAL ELECTRONICS
Problem of medical thermography:

For comparing the results of successive thermo graphic examinations, it is essential
that the results are standardized and quantified. In the earlier thermographic equipment the
thermograph was recorded on a photographic film from which it was limited by the long
scanning time. a practical solution to this problem is the use of isotherms. Differences
between the various gray tones are determined accurately by means of a thermal band or
isotherm. In modern thermographic equipment, temperature measurement is improved by
providing two simultaneous isotherm functions.
Analog analysis medicalThermo graphy:
With thermo vision 780M, there are many possibilities of analog analysis of the gray tone
images including the following (i) isotherm function (ii) lever analysis (iii) sample are a
selector and thermal profile analysis.
Digital analysis of medical Thermography:
In medical fields where complex image patterns are regular occurrence, computers offer new
opportunities for more efficient and objective reasons. First, it can be used to determine
numerous parameters from the image itself, highest and average temperature or differences
between none region and another or area as various temperature contours or geometric
centroids or skewness and so on.
SOFIA
SOFIA is a general image processing program which can be used in nearly all
applications written in FORTRAN IV, it is specially designed to operate with digital data in
OSCAR (Off-line: system for computer Access and Recording)
Laser
The light emitted from an ordinary light source is incoherent, because the
radiation emitted from different atoms do not have definite phase relationship with each
other. For interference of light coherent sources are required. Two independent sources
cannot act as coherent sources. For experimental purposes, from a single source, two coherent
sources are obtained. In recent years certain highly coherent sources were developed namely
LASER. The word LASER is an acronym for Light Amplification by Stimulated Emission of
Radiation. The difference between ordinary light and LASER beam is pictorially depicted as
follows:
Characteristics of LASER:
The LASER beam is
5. Monochromatic
6. Highly coherent with waves exactly in phase with each other.
7. Doesnt diverge.
8. Extremely intense.
89
MEDICAL ELECTRONICS
Spontaneous and Stimulated radiation:

An atom may undergo transition between two energy states E1 and E2 if it
emits or absorbs a photon of the appropriate energy E1-E2 =h .
In a system of thermal equilibrium the number of atoms in the ground
state(N1) is greater than the number of atoms in the excited state(N2).This is called Normal
population.
Consider a sample of free atoms, some of which are in the ground state with energy E 1 and some
in the excited state with energy E2. If the photons of energy E1-E2 =h are incident on the
sample,
the photons can interact with the atoms in the ground state and are taken to excited state. This
is called Stimulated or Induced absorption. The process by which the atoms in the ground
state are
taken to the excited state is known as pumping. If the atoms are taken to the higher energy
levels with the help of light it is called Optical pumping. If the atoms in the ground state are
pumped to the excited state by means of external agency, the number of atoms in the excited
state(N2) becomes greater than the number of atoms in the ground state(N1) then this
condition is called population inversion. The lifetime of the atoms in the excited state is
-8
normally 10 seconds. Some of the excited energy levels have greater life times for atoms
-3
(10 seconds). These levels are called as Metastable state.
If the excited energy level is an ordinary level the excited atoms return to a lower or
ground energy state immediately without the help off any external energy. During this transition a
photon of energy E1-E2 =h is emitted. This is called spontaneous emission. If the excited state
is a metastable state, the atoms stray for some time in these level and then are brought to a lower
level by the help of the photons of energy E 1-E2 =h . During this process a photon of energy
E1-E2 =h is emitted. This is known as Stimulated radiation and the photon produced is
called as
stimulated photon or secondary photon. The secondary photon is always in phase with the
stimulating photon. These photons in turn stimulate further emission of photons and hence
this results in a chain reaction. This is called laser action and by this action all the emitted
photons having same energy and same frequency and also in phase with each other. Hence a
highly monochromatic and perfectly coherent intense radiation is obtained.
to achieve LASER action:
There must be inverted population.
The excited state must be a metastable state.
The emitted photon must stimulate further emission. This is achieved by

the use of the reflecting mirrors at the ends of the system.
Conditions
Absorbing Energy
Consider the illustration from the previous page. Although more modern views of the atom
do not depict discrete orbits for the electrons, it can be useful to think of these orbits as the
different energy levels of the atom. In other words, if we apply some heat to an atom, we
90
MEDICAL ELECTRONICS
might expect that some of the electrons in the lower-energy orbitals would transition to
higher-energy orbitals farther away from the nucleus.
Absorption
of
energy:
An atom absorbs energy in the form of heat, light, orelectricity. Electrons may move
from a lower-energy orbit to a higher-energy orbit.
This is a highly simplified view of things, but it actually reflects the core idea of how atoms
work in terms of lasers.
Once an electron moves to a higher-energy orbit, it eventually wants to return to the ground
state. When it does, it releases its energy as a photon -- a particle of light. You see atoms
releasing energy as photons all the time. For example, when the heating element in a toaster
turns bright red, the red color is caused by atoms, excited by heat, releasing red photons.
When you see a picture on a TV screen, what you are seeing is phosphor atoms, excited by
high-speed electrons, emitting different colors of light. Anything that produces light -fluorescent lights, gas lanterns, incandescent bulbs -- does it through the action of electrons
changing orbits and releasing photons.
The Basics of an Atom
There are only about 100 different kinds of atoms in the entire universe. Everything
we see is made up of these 100 atoms in an unlimited number of combinations. How these
atoms are arranged and bonded together determines whether the atoms make up a cup of
water, a piece of metal, or the fizz that comes out of your soda can!
Atoms are constantly in motion. They continuously vibrate, move and rotate. Even the atoms
that make up the chairs that we sit in are moving around. Solids are actually in motion!
Atoms can be in different states of excitation. In other words, they can have different
energies. If we apply a lot of energy to an atom, it can leave what is called the ground-state
energy level and go to an excited level. The level of excitation depends on the amount of
energy that is applied to the atom via heat, light, or electricity.
The Laser/Atom Connection
A laser is a device that controls the way that energized atoms release photons. "Laser" is an
acronym for light amplification by stimulated emission of radiation, which describes very
succinctly how a laser works.
Although there are many types of lasers, all have certain essential features. In a laser, the
lasing medium is pumped to get the atoms into an excited state. Typically, very intense
91
MEDICAL ELECTRONICS
flashes of
light or electrical discharges pump the lasing medium and create a large collection of excitedstate atoms (atoms with higher-energy electrons). It is necessary to have a large collection of
atoms in the excited state for the laser to work efficiently. In general, the atoms are excited to
a level that is two or three levels above the ground state. This increases the degree of
population inversion. The population inversion is the number of atoms in the excited state
versus the number in ground state.
Once the lasing medium is pumped, it contains a collection of atoms with some electrons
sitting in excited levels. The excited electrons have energies greater than the more relaxed
electrons.
Just as the electron absorbed some amount of energy to reach this excited level, it can also
release this energy. As the figure below illustrates, the electron can simply relax, and in turn
rid itself of some energy. This emitted energy comes in the form of photons (light energy).
The photon emitted has a very specific wavelength (color) that depends on the state of the
electron's energy when the photon is released. Two identical atoms with electrons in identical
states will release photons with
Ruby LASER:
The Ruby laser was first developed by T.Maiman in 1960. It consists of a
single crystal of ruby rod of dimensions 10cm and 0.8cm. A ruby is a crystal of aluminium
3+
3+
oxide Al2O3 in which some of aluminium ions (Al ) are replaced by chromium ions (Cr ).
The opposite ends of the ruby rod are made flat and parallel, one end is fully silvered and the
other end is partially silvered. The ruby rod is surrounded by a helical Xenon flash tube
which provides the pumping light to raise the chromium ions to upper energy level. In the
Xenon flash tube each flash lasts several milliseconds and in each flash a few thousand joules
of energy is consumed.
In normal state most of the chromium ions are in the ground state E1. When the ruby rod is
irradiated by a flash of light 5500 radiation (green colour) photons are absorbed by the
chromium ions which are pumped to the excited state E3. The excited ion gives up part of its
energy to the crystal lattice and decay without giving any radiation to the metastable state E 2.
-3
Since the state E2 has a much longer lifetime (10 seconds) the number of ions on this state
goes on increasing. Thus population inversion is achieved between the states
E2 and E1. When the excited ion from the metastable state E2 drops down spontaneously to
the ground state E1 it emits a photon of wavelength 6943.
This photon travels through the ruby rod and is reflected back and forth by the silvered ends
until it stimulates other excited ion and causes it to emit a fresh photon in phase with
stimulating photon. Thus the reflections will amount to the additional stimulated emission,
the so-called Amplification by Stimulated emission. This stimulated emission is the LASER
transition. Finally a pulse of red light of wavelength 6943 emerges through the partially
silvered end of the crystal.
92
MEDICAL ELECTRONICS
Ruby Lasers
A ruby laser consists of a flash tube (like you would have on a camera), a ruby rod and two
mirrors (one half-silvered). The ruby rod is the lasing medium and the flash tube pumps it.
The laser in its non-lasing state
2. The flash tube fires and injects light into the ruby rod.
The light excites atoms in the ruby.
3. Some of these atoms emit photons.
93
MEDICAL ELECTRONICS
4. Some of these photons run in a direction parallel to

the ruby's axis, so they bounce back and forth off the
mirrors. As they pass through the crystal, they
stimulate emission in other atoms.
5. Monochromatic, single-phase, columnated light

leaves the ruby through the half-silvered mirror -laser light!
Helium Neon LASER:
A continuous and intense laser beam can be produced with the help of gas
lasers. A simplified diagram showing basic features of a He-Ne gas laser is as follows:
He-Ne laser system consists of a quartz discharge tube containing helium and
neon in the ratio of 1:4 at a total pressure about 1mm of Hg. One end of the tube is fitted with
a perfectly reflecting mirror and the other end with partially reflecting mirror. A powerful
radio frequency generator is used to produce discharge in the gas, so that the helium atoms
are excited to a higher energy level.
When an electric discharge passes through the gas, the electron in the discharge tube
collide with He and Ne atoms and excite them to metastable states of energy 20.61eV and
20.66eV respectively above the ground level. Some of the excited helium atoms transfer their
energy to unexcited Ne atoms by collision. Thus He atom helps in achieving a population
inversion in Ne atoms. When an excited Ne atom drops down spontaneously from the
metastable state at 20.66eV to lower energy state at 18.7eV it emits a 6328
Photon in the visible region. This photon traveling through the mixture of the gas is reflected
back and forth by the reflector ends, until it stimulates an excited neon atom and causes it to
emit a fresh 6328 photon I phase with the stimulating photon. This stimulated transition
from 20.66eV to 18.7eV is the laser transition. The o/p radiation atoms drop down from the
1837eV to lower state E1 through spontaneous emission emitting incoherent light. From this
level E1 the Ne atoms are brought to the ground state through collision with the walls of the
tube. Hence the final transition is radiationless.
94
MEDICAL ELECTRONICS
LASER SURGERY
Laser surgery, pioneered by Russia, is surgery using a laser (instead of a scalpel) to
cut tissue.
Examples include the use of a laser scalpel in otherwise conventional surgery, and
soft tissue laser surgery, in which the laser beam vaporizes soft tissues with high
water content. Laser resurfacing is a technique in which molecular bonds of a material
are dissolved by a laser. Laser surgery is commonly used on the eye. Techniques used
include LASIK, which is used to correct near and far-sightedness in vision, and
phorefractive keratectomy, a procedure which permanently reshapes the cornea using
an excimer laser to remove a small amount of tissue.
Types of surgical lasers include carbon-dioxide, argon, Nd:YAG, and KTP.
Eye surgery
Various types of laser surgery are used to treat refractive error:
LASIK,in which a knife is used to cut a flap in the cornea, and a laser is used to
reshape
the layers underneath, to treat refractive error
INTRALASIK, a variant in which
the flap is also cut with a laser
Photorefractive keratectomy(PRK, LASEK), in which the cornea is reshaped without
first cutting a flap Laser thermal keratoplasty, in which a ring of concentric burns is
made in the cornea, which cause its surface to steepen, allowing better near vision
Laproscopic surgery
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid

surgery,
or keyhole surgery, is a modern surgical technique in which operations in the
abdomen are performed through small incisions (usually 0.51.5 cm) as opposed to
the larger incisions needed in laparotomy.Keyhole surgery makes use of images
displayed on TV monitors to magnify the surgical elements. Laparoscopic surgery
includes operations within the abdominal or pelvic cavities, whereas keyhole surgery
performed on the thoracic or chest cavity is called thoracoscopic surgery.
Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
The key element in laparoscopic surgery is the use of a laparoscope. There are two
types: (1) a telescopic rod lens system, that is usually connected to a video camera
(single chip or three chip), or
(2) a digital laparoscope where the charge coupled device is placed at the end of the
laparoscope, eliminating the rod lens system.
DIATHERMY:
Diathermy therapy is generally contra-indicated for pacemaker patients.the operation
of a pulse generator subject to the intense fields of energy involved in diathermy cannot be
predicted; reversion to fixed rate pacing is likely, to copmplete inhibition is possible.
Although damage to either pulse generator circuitry or cardiac tissue is highly improbable, it
cannot be positively ruled out. If diathermy therapy must be used, it should be applied away
from the immediate vicinity of the pulse generator/ lead system.
95
MEDICAL ELECTRONICS
INTRODUCTION:
Operation theatre equipment are very useful both diagnostically and therapeutically.
they are mainly useful for monitoring and treatment purposes. during operation or intensive
care or intensive treatment, the patient's condition is followed carefully by repeated
measurement of many variables, like blood flow velocvity, cardiac output, blood pressure.
PH value and so on.The above variables are also measured and monitored by operation
theatre equipment.
PRINCIPLE OF SURGICAL DIATHERMY:
High frequency currents apart from their usefulness for therapeutic applications can
also be used in the operating rooms for surgical purposes involving cutting and coagulation.
The frequency of currents used in surgical diathermy units is in the range of 1-3MHz in
contrast with much higher frequencies employed in shortwave therapeutic diathermy
machines.The evolving steam bubbles in the tissues at the cutting action is obtained.
Similarly during the passage of the high frequency current through the tissue, the tissue is
heated locally. so that the tissue is melted instantaneously and sealing of the capillary and
other blood vessels is taking place. Then the coagulation of the tissues takes place. The use of
high frequency current is to avoid the intense muscle activity and the electrocution hazard
occurs if low frequencies are used.
Surgical diathermy machines depend for their action, the heating effect of electric
current. When high frequency current flows through the sharp edge of a wire loop or point of
a needle into the tissue. There is a high contraction of current at this point. The tissue is
heated to such an extent that cells immediately under the electrode are torn apart by the
boiling of the cell fluid. The indifferent electrode establishes a large area contact with the
patient and the RF current is therefore dispersed so that very little cheat is developed at this
electrode. This type of tissue separation forms the basis of electrosurgical cutting.
Honig (1975) worked out detailed derivation of the significant parameters affecting
the distribution of electro surgical RF power in tissue. He analyzed how electrosurgical RF
power is localized in the vicinity of the cutting electrode. It was shown that the combination
of fine wire electrodes high RF voltage and high cutting speeds are necessary for the
confinement of tissue destruction in electro surgery. These parameters are of great value in
micro surgery since localization of electrosurgical effects would also be accompanied by
coagulation and homeostasis. His analysis supported the supposition that evolving steam
bubbles in the tissues at the surgical tip continuously rupture the tissue and are responsible
for cutting mechanism.
Coagulation:
Electrosurgical coagulation of the tissue is caused by the high frequency current
flowing through the tissue and heating it locally so that it coagulates from inside. The
coagulation process is accompanied by a grayish-white discoloration of the tissue that the
edge of the electrode. In contrast to a thermocauter, better coagulation can be achieved by
high frequency currents because it does not cause superficial burning.
Fulguration:
96
MEDICAL ELECTRONICS
The term fulguration refers to a superficial tissue destruction without affecting deep-seated
tissues. This is obtained by passing sparks from the needle or ball electrode of small diameter
to the tissue. When electrode is held near the tissue without toughing it, spark is produced.
This spark is capable of burning the unwanted portions.
Desiccation:
The needle point electrodes are stack into the tissue and kept steadily while passing
electric current. This creates a high local increase in heat and drying of tissues is taking
place. This is called desiccation.
Blending:
When the electrode is kept above the skin, an electrical arc is sent. The developed
heat produces wedge shaped narrow cutting of the tissue on the surface. By increasing the
current level, deeper level cutting of the tissues takes place. Normally continuous RF current
is used for cutting.
Hemostasis:
The concurrent use of continuous RF current for cutting and a RF wave burst for
coagulation is called Hemostasis mode.
Electrical Shock
Electric shock hazards:

It is a common experience that the hazards due to electric shock are also
associated with equipment other than that used in hospitals. However, the equipments used in
medical practice have to operate in special environments. Which differ I certain respects from
others. Some such special situations are as follows:
before any danger of electrocution occurs.
The patient or the operator may not realize that a potential hazard exists. This is
because potential differences are small and high frequency and ionizing radiations are
not directly
A patient may not be usually able to react in the normal way. He/she is either ill,
unconscious anaesthetized or strapped on the operating table. He/she may not be able
to withdraw him/herself from the electrified object, when feeling tingling in his/her
skin,
indicated.
Considerable neutral protection and barrier to electric current is provided by human

skin. In certain applications of electro medical equipment, the natural resistance of the
skin may be passed. Such situations arise when the tests are carried out on the subject
with a
catheter in his/her heart or an large blood vessels.
Electro medical equipment, example : pacemakers may be used either temporarily or

permanently to support or replace functions of some organs of the human body. The
interruption in the power supply or failure of the permanent injuries or even prove
fatal
97
MEDICAL ELECTRONICS
for the patient.
Medical instruments are quite often used in conjunction with several other
instruments
and equipment. These combinations of high power equipment and extremely sensitive
low signal equipment. Each of these devices may be safe in itself, but can become
dangerous when used in conjunction with others.
Environmental conditions in the hospitals particularly in the operating theatres cause

explosion or fire hazards due to the presence of anesthetic agents, humidity and
cleaning agents etc.
Effects due to 50 Hz current passage:
This electric shock can cause unwanted cellular depolarization. This is associated with
muscular contraction, or it may cause cell vaporization and tissue injury. The effect of
commercial frequency currents on the human body should be considered. This assists in
establishing allowable leakage currents for electrical appliances and electric hand tools. Most
of the electrical accidents involve a current pathway through victim from one upper limb to
the feet or to the opposite upper limb. At commercial frequencies, the body acts as a volume
conductor. For commercial frequencies (50 Hz 60 Hz) specific physiological effects due to
passage of current through the body are listed below:
Type of current range (mA)
Physiological effect
Threshold1-5
Tingling sensation5-8
Intense or painful sensation
Let go 8-20
Threshold of involuntary muscle contraction paralysis >20.

Respiratory paralysis and heart fibrillation 80-1000, ventricular and heart defibrillation 1,000
to 10,000 sustained myocardial contraction, temporary respiratory paralysis and possible
tissue burns.
Let-go current is the minimum current to produce muscular contraction. For men it
is about 16 mA and for women it is about 10.5 mA.
98

Medical Electronics

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Medical Electronics

Transféré par

Droits d'auteur :

Formats disponibles

MEDICAL ELECTRONICS

Components of blood plasma

Blood and Blood Vessels

chloride ions is 4 x 10-6 cm/s

gas constant(8.315 x 10 ergs/mole/degree Kelvin)

absolute Temperature, degrees Kelvin

ISOLATED POWER SUPPLY:

It is the gold standard for the evaluation of cardiac arrhythmias .

ECG lead configurations

Bipolar limb leads

Left arm Cardiac vector

The closed path RA to LA to LL and back to RA is called Einthoven triangle.

Augmented unipolar limb leads

Unipolar limb lead system is introduced by Wilson.

terminal.The central terminal has a potential corresponding to the center of the

Unipolar chest leads

Color codes for ECG leads

Frank lead system

ANALYSIS OF ECG SIGNALS

If PQ segment has prolonged condition I.e. extended f normal condition

If ST segment is elevated means Result : Myocardial infraction.

If train of pulses occurs instead of PQRST waves means Result : Ventricular

Block diagram of a ECG recording system:

Block diagram of a EEG recording system:

The level of anesthesia can be indicated by characteristic eye movements.

Measurement of respiration rate by measuring changes in thoracic impedance during

Measurement of respiration rate by measuring changes, which are produced by thoracic

Thoracic or transducer impedance change amplitude-modulates a high frequency carrier

Procedure for measurement of blood pressure:

IMPLANTING THE PACEMAKER

It should be negatively going pulses to avoid the ionization of the muscles.

It does not necessitate open heart surgery

The pacemaker is surgically implanted

Ventricular asynchronous pacemaker ( Fixed rate pacemaker)

Ventricular synchronous pacemaker

Ventricular asynchronous pacemaker

To arrest the ventricular fibrillation, this circuit can be used.

Working of Ventricular Synchronous Pacemaker

of ventricular synchronous pacemaker:

Disadvantages of ventricular synchronous pacemaker:

Atrial and ventricular are not synchronized.

The EKG complex.

Under normal conditions, electrical activity is spontaneously generated by the SA

As the electrical activity is spreading throughout the atria,

The AV node functions as a critical delay in the conduction system.

The distal portion of the AV node is known as the Bundle of His .

Purkinje fibers/ventricular myocardium: QRS complex

Bundle branch block (when wide), ventricular origin of tachycardia, ventricular

The ST segment connects the QRS complex and the T wave.

Ventricular repolarization: T wave

The last event of the cycle is the repolarization of the Ventricles.

These conditions are not necessarily bad symptoms, however.

ECG waveforms Lead III

It is the gold standard for the evaluation of cardiac arrhythmias .

The baseline voltage of the electrocardiogram is known as the isoelectric line.

ECG lead configurations

Bipolar limb leads

Left arm Cardiac vector

The closed path RA to LA to LL and back to RA is called Einthoven triangle.

Augmented unipolar limb leads

Unipolar limb lead system is introduced by Wilson.

Unipolar chest leads

Color codes for ECG leads

Frank lead system