Unit – V

Diagnostic Techniques and Bio-Telemetry

Principles of ultrasonic measurement, Ultrasonic Imaging, Ultrasonic Diagnosis, X-ray and Radio-
Isotope Instrumentations, CAT scan, Emission Computerized Tomography,MRI, Introduction to
bio-telemetry system, Components of bio-telemetry system.

Principles of ultrasonic measurement

 An ultrasound scan is a medical test that uses high-frequency sound waves to capture live
images from the inside of your body.
 The technology is similar to that used by sonar and radar, which help the military detect
planes and ships. An ultrasound allows your doctor to see problems with organs, vessels,
and tissues—without needing to make an incision.
 Unlike other imaging techniques, ultrasound uses no radiation, so it is the preferred method
for viewing a developing fetus during pregnancy.Ultrasound is also known as sonography.
 Ultrasound exist as a sequence of alternate compressions and rarefactions
 Medium for these waves are,

• Air

• Water

• Bone

• Tissue

 The ultrasonic source produces the sound waves which hit the obstacle and reflect back to
the source.
 Reflected energy is dependent on difference of densities between the two media and angle
at which the transmitted beam hits the medium.
 The distance to the object and back is given by
distance=speed x time
As this is the total distance that the sound has travelled to the object and back, we must
divide by 2 to find the one-way distance.
 If difference is more i.e., tissue and bone or tissues and gas most of the energy will be
reflected.
 The ultrasound machine transmits high-frequency (1 to 15 megahertz) sound pulses into
your body using a probe. The sound waves travel into your body and hit a boundary
between tissues (e.g. between fluid and soft tissue, soft tissue and bone).Some of the sound
waves get reflected back to the probe, while some travel on further until they reach another
boundary and get reflected.
 Airless contact like water bag or aqueous gel is used between transducer and skin for
application of ultrasound.
 The reflected waves are picked up by the probe and relayed to the machine.
 The machine calculates the distance from the probe to the tissue or organ (boundaries)
using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of the each echo's
return (usually on the order of millionths of a second).
 The machine displays the distances and intensities of the echoes on the screen, forming a
two dimensional image
 Ultrasonic Characteristics:
  The velocity of body fluids is generally around 1550 m/sec
 Velocity of sound propagation through medium is dependent on the elastic properties and
temperature.
 The depth of penetration at which ultrasound energy is attenuated to half the applied
amount is called half-value layer

Material Frequency Half-value Layer

Blood 1.0 35.0

Muscle 0.8 2.1

Fat 0.8 3.3

Bone 0.8 0.23

How is the ultrasound used in medical Instruments

  The frequencies of ultrasound required for medical imaging are in the range 1 - 20 MHz.
These frequencies can be obtained by using piezoelectric materials. When an electric field
is placed across a slice of one of these materials, the material contracts or expands. If the
electric field is reversed, the effect on the material is also reversed. If the electric field
keeps reversing, the crystal alternately contracts and expands. So a rapidly alternating
electric field causes the crystal to vibrate.
 The vibration is largest when the electric field stimulates a natural frequency of the crystal
- this is an example of resonance. The vibrations are then passed through any adjacent
materials, or into the air as a longitudinal wave i.e. a sound wave is produced.
 The piezoelectric effect occurs in a number of natural crystals including quartz, but the
most commonly used substance is a synthetic ceramic, lead zirconate titanate. The crystal
is cut into a slice with a thickness equal to half a wavelength of the desired ultrasound
frequency, as this thickness ensures most of the energy is emitted at the fundamental
frequency.
 Doppler effect, in which the frequency of the reflected ultrasonic energy is increased or
decreased by a moving interface.
 When the object reflecting the ultrasound waves is moving, it changes the frequency of the
echoes, creating a higher frequency if it is moving toward the probe and a lower frequency
if it is moving away from the probe. How much the frequency is changed depends upon
how fast the object is moving. Doppler ultrasound measures the change in frequency of the
echoes to calculate how fast an object is moving. Doppler ultrasound has been used mostly
to measure the rate of blood flow through the heart and major arteries.
 The amount of frequency shift ∆f = 2V/λ
Basic modes of Transmission of ultrasound

Ultrasound is transmitted in various forms and modes as follows

• Pulsed Ultrasound: Short bursts at a repetition rate 1 to 12KHz.Echoes are displayed as a

function of time after transmission, which is proportional to the distance from the source
to the interface.Used in most imaging applications.

• Continuous Doppler : Continuous signal is transmitted while returning echoes are picked
up by a separate receiver transducer. Frequency shifts die to moving interfaces are
 detected and recorded and the average velocity of the targets is usually determined as a
function of time. It requires two transducer crystals. Used for blood flow measurements.

• Pulsed Doppler : Same as pulsed ultrasound. Frequency shifts due to movement of the
reflected interfaces can be measured in order to determine their velocities. Both the
velocity and distance of a moving target can be measured.3MHz.

• Range-gated Doppler : Is a refinement of pulsed doppler ultrasound, in which a gating

circuit permits measurement of the velocity of targets at specific distance form the
transducer. Velocity as a function of time, also as a function of the distance from the
vessel wall.

Ultrasonic Imaging

 Need of Ultrasonic Imaging : Ultrasonic imaging is useful for imaging the internal organs
or structures of the body called as non-invasive technique. Imaging provides information
regarding the size, location, displacement, or velocity of a given structure without the
necessity of surgery. Tumors and other regions of an organ that differ in density from
surrounding tissues can be detected.
 Instrumentation includes electrical signal source, transmitter and receiver. After
amplification, the received information is displayed in one of the several display modes.

Display Modes

 Imaging systems are comprised of pulsed ultrasound or pulsed doppler mode which are as
follows
1. A-scan display

2. M-scan display

3. B-scan display

A-scan Display

 Each layer of tissue in the body produces a separate reflection of the ultrasound signal. In
the original type of scanner, these reflections were simply displayed on the screen of a
 cathode ray oscilloscope. This results in a trace just like the Sonar trace below, where the
x-axis represents time, and the y-axis represents the amplitude of the reflection i.e. how
strongly the sound is reflected.

 Each layer producing a reflection shows up as a peak on the trace. This gives rise to the
name of the technique, an amplitude-scan or A-scan. The diagram below shows an A-
scan which could result from the layers in the eye (this should be familiar to all
ophthalmologist ever performs biometry). The amplitude of the peaks depends on the
difference in acoustic impedance between the tissues on each side of each boundary. It also
depends on how much of the sound is absorbed as it travels through each layer, an effect
which complicates the interpretation of the scan.
 This is used for diagnostic test of optometry which gives data on length of eye

M-scan display

 This M-scan is the motion mode ultrasound

 This uses a single transducer to scan along the body
 This is used to identify the motion of internal organs like the heart dysfunction
 Stationary target can be scanned for its self movement with the M-scan
 This is accomplished with recording the amplitude and rate of motion in real time.

B-scan Display

 In this method the amplitude of each returning signal is not simply displayed on a graph or
CRO screen. Instead the amplitude controls the brightness of the spot which represents this
 reflection, the b for brightness giving rise to the name B-scan. So a single pulse of
ultrasound passing into a series of tissues will give rise to a series of spots, with the
brightness of the spots corresponding to the amplitude of the reflection from different
layers.
 The largest amplitude gives rise to a spot with the greatest brightness, here shown almost
white. The smallest amplitude gives rise to a spot which is almost black. Intermediate
amplitudes give various shades of gray. The area that does not give rise to any spike for
example the aqueous and the vitreous will appear black.

 This is a brightness scan mode of ultrasound. This It is Useful to image stationary organ or
body structure
 The brightness of oscilloscope is controlled by returning echoes.

Ultrasonic Diagnosis

 The ultrasonic diagnosis is used in

• Cardiology

• Abdominal imaging

• Brain studies

• Eye analysis

• Obstetrics

• Gynecology
  This ultrasonic diagnosis is useful for the imaging the organ from several positions (for
example all four chambers of heart)
TYPES :

• Echocardiogram __ ultrasonic measurement of heart

• Echoencephalogram __ ultrasonic of brain

• Ultra sonogram __ analysis of eye

Ultrasonic system

The ultrasonic systems has the following functional units

1. Generator for electrical signal

2. Transducer

3. Amplifiers

4. Electronic processing unit

5. Display devices
Echocardiography

• Echocardiography is useful in diagnosis with m-scan technique

• Movement of valves and other parts of heart are displayed as a function of time

• The mobility of heart is given as the displacement of echo per unit time

• Echocardiogram is helpful in finding the presence of the fluids surrounding the heart

Echoencephalogram

• This uses the A-scan mode

• This is used to display and determine the location of midline of the brain

• Transducer is held against the head to measure the distance to the midline of the brain

• Midline echoes from both sides of head are compared

Advantages compared with other techniques

1. Ultrasound examinations are non-invasive i.e. they do not require the body to be opened up,
or anything to be inserted into the body. This is a major advantage compared to fibre-
optic endoscopy, for example, which may involve much more patient discomfort as the
probe is inserted.
2. Ultrasound methods are relatively inexpensive, quick and convenient, compared to
techniques such as X-rays or MRI scans. The equipment can be made portable, and the
images can be stored electronically.
3. No harmful effects have been detected, at the intensity levels used for examinations and
imaging. This contrasts with methods based on X-rays or on radioactive isotopes, which
have known risks associated with them, and ultrasound methods are preferred whenever
possible. This is particularly relevant to examination of expectant mothers.
4. Ultrasound is particularly suited to imaging soft tissues such as the eye, heart and other
internal organs, and examining blood vessels.
Disadvantages of ultrasound compared with other techniques
1. The major disadvantage is that the resolution of images is often limited. This is being
overcome as time passes, but there are still many situations where X-rays produce a much
higher resolution.
2. Ultrasound is reflected very strongly on passing from tissue to gas, or vice versa. This
means that ultrasound cannot be used for examinations of areas of the body containing
gas, such as the lung and the digestive system.
3. Ultrasound also does not pass well through bone, so that the method is of limited use in
diagnosing fractures. It is possible to obtain quite good ultrasound scans of the brain, but
much greater detail is obtained by an MRI scan.

TYPES AND USES OF X-RAY

• X-ray machines are devices that generate exceedingly high frequency, high energy EM
waves that penetrate the body during medical procedures.

• These machines serve diagnostic (measurement) and therapeutic (treatment) purposes.

Produce pictures of tumors and skeletal fractures or deformations.

• X-rays are high energy waves that pass through the body and indicate relative tissue density
on a photosensitive plate.

• Essentially, bones are dense and pass less x-rays than soft tissues.

• The x-ray that does not pass through is absorbed and stored within the body in
accumulating doses. High accumulated doses over the ling term represent a health hazard.

CATEGORIES

1. Diagnostic still picture: broken bones and tissues.

2. Diagnostic continuous picture: to examine organ as they are functioning to identify tumors
and blockages (less energy is used).

3. Diagnostic motion picture: to examine circulatory systems as they are functioning

(angiography). X-ray still picture exposures are taken, one every 5 seconds or faster, and
played back on a motion picture machine.
 4. Diagnostic still picture: (tomography)used to examine bones, organs and tissues from many
different angles.

5. Therapeutic: same as diagnostic x-ray except that the aim is to eradicate and destroy
cancerous tissues and tumors.

Origin and nature of x-rays

• X-rays are actually EM waves, as are light and radio waves.

• The principal difference is a matter of frequency or wavelength.

• X-rays range of frequency 1017 to 1019 Hz .( X-Rays in electromagnetic spectrum shown

below)

• Higher frequencies possess greater energy than lower frequencies but require higher
voltages to produce.

Energy, E=hf

h= 6.624 × 10-34 J-s

Properties of EM waves:

1. They obey the relationship V=Fλ

2. They propagate in a straight line.

3. They obey the inverse square law (1/d2 ).

4. They produce interference and diffraction patterns.

 5. They are not deflected by magnetic fields.

THREE TYPES OF RADIATION

1. Alpha rays: positively charged particles of He nuclei whose velocity is moderate and whose
penetration depth is small.

2. Beta rays: negatively charged electrons of widely varying velocity and whose penetration
depth is small.

3. Gamma rays & x-rays: EM waves that travel at the speed of light and have high penetration.

GENERATION OF X-RAYS

• When fast moving electrons are suddenly decelerated by impinging on a target X-rays are
generated.

• X-rays are generated by a high vaccum x-ray diode tube in which electrons are accelerated
to high velocities (100KV).

• Radiation intensity is obtained by varying the high voltage, current and time of exposure.

• The radiation is filtered and formed to produce optimal contrast relative to the patient dose.
• The x-ray tube operates by emitting electrons from a heated cathode tungsten filament
toward a rotating high voltage anode disc.

• X-rays arise from the target disc at right angles and are focused by the collimator.

• Images are received and viewed on an imaging device (photographic film).

• Light and dark areas on the film represent high and low tissue penetration, respectively.

• Two methods are used to overcome the heat problem in x-ray tubes:

1. To construct the target anode of tungsten alloy. Forming a “bevel” on the anode
contributes greatly to good heat dissipation and high resolution.

2. To use the rotating anode by replacing the spot anode.

Coefficients of thermal expansion of the glass case become important as the tube heats up.
Too much heat on these tubes will burn them out quickly.

• Special microcomputers have been used to warn the operator of excessive anode heat.

• Stationary anodes are used mostly in low-energy level x-ray machines, while the more
common rotating anodes are used in higher energy machines.

• The housing used for the x-ray tube must provide 3 types of protection in addition to the
physical and mechanical protection.

1. High voltage
 2. Heat dissipation

3. Radiation shielding

X-Ray interaction with body,Film construction and instrumentation

• Bones, metallic parts, air-filled cavities have different densities from surrounding tissues

• X-ray machines will show the high density parts i.e., bones, metallic parts, air-filled
cavities.

• When X-rays penetrate a body part , internal parts absorb varying amount of radiation.

• The radiation that leaves the body has varying intensity of images.

X-ray film Processing

• X-rays have shorter wavelength than visible light

• X-rays react with photographic emulsions and a film which is exposed to X-rays
shows image of X-ray intensity

• Most commonly used material for film is calcium tungsten

• After development film is gripped & lifted with forceps for 3sec to drop excess
developer
Block diagram and operation of an x-ray machine

• X-ray machines have the following major sections:

• Multitap ac line autotransform, which allows selection of taps to compensate for incoming
line variations. These also permit the operator to choose voltages for specific applications.

• X-ray machine has high mA current for heating element

• Low exposure time

• High Kv potential difference between anode and cathode.

• x-ray tube high-voltage circuit, transformer and bridge rectifier, which transforms the ac
line to supply the high dc voltage for accelerating electrons from cathode to anode.

• Timing circuit, which controls turn-on, turn-off and length of x-ray exposure delivered to
the patient.

X-Ray imaging Techniques

• Fluoroscopy(radiation effects of certain metal salts)

 • Photographic emulsion(X-Ray effects of some films)

• Image Intensifiers(Fluroscopic image brigther)

• TV camera

• Monitor

• Tape Recorders

• Mobile X-Ray machines

Special Techniques

• Grids- scattered X-rays are absorbed.

• Contrast media - filling of ventricles of brain with air.

• Cardiac Catherization – Catherer insertion through an artery or vein to diagnose vaine

defects of the heart.

• 3-D Visualization

Radioisotope Instrumentation

• Radioisotope technique is based on counting the number of nuclear disintegrations that

occur in a radioactive sample.

• Nuclear radiation detectors used for medical applications use light flashes caused by
radiations in suitable medium.
 • Scintillation detectors are used for gamma rays.

• The amplitude of radiation is proportional to the energy of radiation .

CAT or CT Scan

• Computerized Axial Tomography (CAT) or computerized tomography (CT) scanning

combines X-ray imaging with computer techniques

• The X-ray images are taken from different directions.

• X rays hide the internal organs one behind the others.

 •

• CAT allows visualization of internal organs with more clarity

• Present day CAT scanners use X-ray sources which provide fan beams and multiple
detectors which simultaneously measure density in various positions

• Synchronizing scans with ECG helps to reconstruct slices of the heart in various phases

• This process simply gives the cross section of the human body using X-ray

• X-ray source and detector are placed opposite to each other.

• When patient is placed between these two X-rays are passed through the body and sensed
by detector.
 • The source or detector or both are made to move across the body.

Electron-beam CT scanner

Block diagram of CT scanner

• X ray source and detector placed opposite each other.

• The radiation transmitted from the body detected by the detectors.

• Measurements are made at regular intervals.

MRI :

Magnetic resonance based on nuclear properties of hydrogen atoms in the body. The MRI images
are accurate for tumors, inflammatory, and vascular abnormalities.
MRI scan is radiology technique combining magnetism, radio waves and computers to produce
images of organs.