A prespektitive on medical instrumentation

1.

definition of a medical instrumentation The physical forms taken by most examples of medical device, such as instrument, tools, and machine, are illustrated by the block diagram in figure 1.1 each switch position sets the instrument up in one of the physical forms as instrument of measurement, for monitoring, for diagnostic of disease, for therapy for patients or for surgery. Most medical instruments fall into one these categories. A medical instrument performs a specific function on a biological system. The function may be the exact measurement of physiological parameter-pressure, flow voltage, current, chemical ph, volume, weight, temperature-and rates of change of these parameter. in physiological system , because the parameter often have small magnitudes or are other wise to or difficult to process, a transducer (illustrated in figure 1.1). is necessary to transform the physiological signal into a form that can be read by the signal processor. The transducer may, for examples , amplify voltages or pressures, select an appropriate parameter for measurement, provide a transitional medium, or effect an impedance match of the biological system for the signal processor. In physiological systems, measurement parameter cover a wide range, voltages range from 1 microvolt (V) to several millivolt (mV) and up to thousands of volt (V) of static charge. Frequencies of d.c. to 20 kilohertz (kHz). The dynamic range of sound amplitude is 100 decibel (dB) and above. Pressure range from .1 millimeter of mercury (mmHg) to approximately 1000 mmHg . fluid flow rates rise to 25 liters per minute (liter /min) and air flow up to 600liter/minute. The need to maintain physiological stability and control feedback is illustrated by the relativity narrow temperature range in the human body, 90 to 104 degrees Fahrenheit (F). The output of transducer should be a signal compatible with the signal processor illustrated in the figure . this output maybe a force or flow rate sufficient to move a gauge, a voltage or current that can deflect a meter needle, a sound capable of being amplified above ambient noise so it can be measured, or an ionic concentration requiring further processing. For many signal is binary, typically either +5 or 0 V. only upon appropriately processed signals can the arithmetic and logical functions of microprocessor and digital circuit be performed. The type of signal processing depends upon the function of the instrument measurement , monitoring, diagnostic, therapy, or surgery. The function is selected by the switch in the figure. A common example of a measuring instrument is the thermometer, the transducer is glass bulb and scale; the signal processor and monitor are the observed who records the measurement . other example of the measuring device are sphygmomanometer, elctroenchephalographs, and elcroradiograpf. A monitoring instrument represents a higher level of complexity in that it include a memory, which can take the form of a paper strip recorder, a storage oscilloscope, or a computer memory, which hold information for later use.

An even hingger level of sophistication is usually required for machine diagnostic. The diagnostic function may be performed by an instrument as simple as an alaram that warms of an excessive heart rate, or as complex as a mainframe computer that processes symptorms and prescribe a health care program . In order for a medical instrument to be used in the performance of therapy, it must feed back a signal or force to the biological system, as indicated by the position of the feedback transfor in figure 1.1 therapy is applied by a crutch, for example, allowing a leg to heal while the patient remain ambulatory. More complex therapy may be applied by a biofeedback instrument such as a speech therapy device capable of deriving the information bearing elements from speech and applying them to another sense such as sight or touch. Other therapeutic instrumentation may operate independently of physiological parameter in the system to which the therapy is applied. An example is an ultrasonic massager operated by a physical therapist. This is closely related to another category of instrument used in surgery and surgical procedure, namely invasive units, which penetrste the skin of patient. These include electrosurgical knives, hypodermic needles, and lasers. The medical instruments illustrated in figure 1.1 are those that may be used in conection with the patient. Another category is assigned to laboratory instruments used to investigate and assess biologicl fluids and tissue. The measurement of ph is fundamental to the operation of many of these instruments, as are technique to investigation particles in fluids. 1.2 historical considerations the fundamental purpose of tools is to enhance the capability of human beings by helping them to lift more weight, to move faster and more comfortably, to communicate over greater distance, and to use to the five sense more effectively. Throughout history, as technology was developed , the number of human function extended even our ability to thinking. Particular in calculation, analyzing and storing large amounts of information. Consider, for example, the sense of touch. The ancient Greeks used the technique of laying on of hand to determine the size of organs, the nature of wounds, and the extent of bodily growth ; the technique is still used to day. Medoren instrument that extend the sense of touch include devices for massage, such as electrical current stimulator, automatic vibration , and ultrasonic therapy equipment. In the tadoma method of speech therapy, the therapist places a hand on the speakers face during speech training to feel where the sound are placed. An electronic tactile vocoder can be used to extend the therapist ability to locate these placement by amplifying these acoustic cues and transferring them to other, more convenient cutaneous body sites. On specific bit of information obtained by the sense of touch is a relative measure of body temperature in this function, the thermometer extended the sense of touch, serving to quantify a measurement that had previously been only approximate. The invention of the thermometer

in 1603, the Italian scientist Galileo showed that a closed glass tube inserted in a container of water could be arrange so that the height of the water sucked into the tube by a partial vacuum varied with the temperature. In 1625, santorio santonio, a Slavic physician, constructive the similar device, which he used to measure the temperature in the human body. The problem with the instrument (figure1.2a) was that the height of the water was also affected by the atmospheric pressure. This problem was solved a quarter of century later when ferdinand II, grnd duke of Tuscany, sealed the water in a closed vessel to eliminate the effect of atmospheric pressure. This problem was solved a quarter of century later when Ferdinand II , grand duke of Tuscany, sealed the water in a close vessel to eliminate the effect of atmosfer ic pressure, the essentially modern thermometer show in figure 1.2 was introduce by the dutch instrument maker Gabriel D. farenheit, who in the eighteen century replaced the water with mercury and improve the instrument accuracy. This thermometer is still widely used, although more recently liquid crystal thermometer have been adopted for special applications.

The stethoscope and hearing enhancement From the time of the ancient Greeks. Physician have used their hearing for diagnosis, such as in placing the ear against the chest or back to listen for.

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Nuclear medicine images is illustrated in figure 1.10 the exercise is used to induce stress reactions in the patient. clinical application of electrical heart defibrillation began in 1956 when P.M Zoll led a group of investigator who succeeded in reversing a heart fibrillation, a form of heart attack, by application of a.c. currents thought the chest wall. The reliability of the defibrillator was significantly improved when B Lown introduced the d.c. defibrillator in 1962. This device applied a d.c. current from a discharging capacitor thought the chest wall into the heart fibrillation. This type the defibrillator is illustrated in figure 1.11. in 1957, C Walton lillehei paced a heart during surgery by attaching wires to it and applying pulses of current spaced at a normal heart rate. This external pace maker could be applied only during surgery. A most significant breakthrough in heart pacing was made by William chardack and Wilson greadback in 1960, whwn developed the implantable pacemaker. A pacemaker of this type is illustrated in figure 1.12.

figure 1.10 a gamma camera for recording nuclear medicine images. The rotary-pedal exerciser is used to induce stress reactions in the patient. Figure 1.11 A d.c defibrillator with a diagnostic ecg monitor. Figure 1.12 An implantable pacemaker.

Another type of prosthesis, artificial tubes for replacing sections of arteries, was introduced in 1954, and its development led to the artificial kidney. Although hemodialisis, process for removing impurities from blood, was first achieved in 19944, a clinically useful device was not developed until 1960, when B. H. scribner led a group who developed a technique for continuous hemodialysis the equipment used in this technique is called the artificial kidney because in compensates for a failed kidney. In 1970, the technique for measuring the blood pressure, temperature and flow rate in the heart and lungs was significantly advanced with the inpacitors Hal 15-16

Eled in the same direction is zero. In figure 1.19(b) applying KVL as current travels in the clockwise direction thought the closed loop implies that

The plus (+) sign before V1 thought V5 indicates that they are voltages drops. The minus (-) sign on Vsindicates that voltages rises occur as current travels though the branch going in clockwise direction.

Figure 1.19 (a) an illustration of KCL (b) an illustration of KVL example 1.1 applying kirchoff current law to figure 1.20 and derive an equation for the node voltage drop V3 to the reference ground in terms of the given quantities v1,v2,I1,I2, and I3

solution the current I1,I2, and I3 are defined as leaving node 3 KCL then gives

ohms law applied to the branch containing Z1 gives

likewise and

putting the tree preceding equations into the first equation yields this equation can be solved for v3, yielding each of the quatities in this euation is a complex number, which in polar form has magnitude and phase.

Example 1.2 applying ohms law and KCL to figure 1.21 and obtain equations for the node voltages v1 and v2.

Solution KCL is applied to node 1 by defining three currents leaving it. In each case, ohms law is used to write the currents in terms of node voltages as

A second equation is obtained by defining three differen current leaving node 2 and applying ohms law to each barnce. KCL then gives

If Vin , Vout , and all of the circuit impedances are known quantities, the previous two equations can be solved simultaneously to find the node voltages v1 and V2. This would then be sufficient information to compute all branch currents by application of ohms law.

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Voltage division Ohms law and kirchoff s law current and voltage laws are sufficient to enable one to compute the voltage and current in any R,L,C circuit. However, it is often convenient to use the voltage division principle as derived from figure 1.22 applying KVL then gives

Then , ohms law applied to Z2 gives

This current substitute into the first equation yields

Solving this for Vout gives

Quation 1.6 is an expression of the voltage division principle for impedance connected in series. An easy way to remember this widely used formula

Figure 1.22 a voltage divider For voltage division is to think of the output voltage as being proportional to the load impedance over the sum of impedance in series.

Current division Current division principle is derived in figure 1.23. here

And

Eliminating the voltage V betwin these two equations gives

Rearranging this gives the expression for the division of current between two impedance in parallel : 1.23

Current divider

Figure 1.24

An easy way to remember this widely used formula is to think of the current as being proportional to the opposite over the sum of the impedance parallel.

Gain function analysis The gain function for voltage or current are definite from figure 1.24 the voltage gain Av equals the ratio of aut put voltage Vout to input voltage Vin computed as a function or Rs, Ls,Ls and frequency f:

Likewise, the current gain A1 is defened as the ratio of the output current to the input current, or

Calculation of either gain function, Av or A1, is accomplished by application of circhoffs laws and ohms law to the circuit network Example1.3 compute the voltage gain fungtion Av for the circuit of figure 1.24 as a function of frequency f. consider R,L, and C values to be gives numbers. Solution applying the voltage division principle to figure 1.24 yields Therefore

Or

It is clear that Av is a function of f, R, C alone

Example 1.4 take the value C=1 F and R=100 k and plot Av versus frequenty. Solution putting these values in equation (1.8) yields

Putting this in polar form, we have

Where =tan-1 (1.59/f). thus, the magnitude |Av| and angle may be computed to form the plot in figure 1.25. Hal 31 Figure 1.25 The calculation for example1.4 BJT equivalent circuit In additional to R, L, and C element, electronic circuit contain various pn-junction semiconductor devices, including semiconductor diodes, bipolar junction transistor (BJTs), and integrate circuit. For use in electronic circuit analysis, the BJT can be represented as an equipment circuit , consisting of R, L, and C elements and an ideal current or voltage source. Bipolar junction transistor consist of three layers of semiconductor material doped with impurities that make them either p -type or n-type. The circuit symbol for the BJT (figure 1.26) represent two type : the PNP and NPN transistor . in figure 1.26(a) , Ib is the base current entering the base node B, Ic is the collector current entering the collector node C, and Ie is the emitter current leaving the emitter node E of the NPN transistor. The characteristic of the transistor are describe by the collector to-emitter voltage, Vce versus Ic. The curve plotting this voltage is shown in figure 1.27. each of the family of curves is measured at different value of base current: Ib, labeled Ibo, Ib1, Ib2, and so on. Ln d.c. analysis of the transistor element, an important parameter usually specified by the manufacture is the d.c. current gain, dc, defined as

Applying kirchoffs current law to figure 1.26(a) yields Figure 2.4 Ionic currents due to drift and diffusion forces. a 10-molar potassium chloride (KCl) solution outside a membrance and 1-molar solution inside. The x-y plane is shown. The y-z plane is perpendicular to the paper. The membrane separating the two KCl solution is in the y-z plane. A high concentration of ions of [K+] and [Cl-] appears on the outside of the cell, while a low concentration appears on the inside. This means that the slope of the ionic concentrations is negative, since in both cases the concentration decreases as x increases. According to ficks law, the negative chlorine ions *Cl-] flow from outside to inside, causing a diffusion

current flowing to the left, shown by the arrow in the figure; the arrow points in the direction of conventional positive-charge current flow. Likewise, the positive potassium ions [K+] diffuse from outside to inside, causing a conventional diffusion current following to the right, shown by the arrow pointing right in the figure. These positive ions collect on the inside of the membrane, thereby causing a voltage that is positive on the right and negative on the left. This voltage has a positive slope; it increase as x increases. In accordance with the drift equation, this voltage produces drift currents. The positive voltage repels the positive [K+] ions, causing a drift current indicated by the arrow pointing left, labeled [K+]drift. This voltage also attracts negative [Cl-] ions, moving them to the right across the membrane, producing a conventional current to the left, as indicated by the arrow pointing left, labeled [Cl-]drift. Vm, in this case, is assumed positive in the direction indicated in the figure. If Vm were predominantly determined by the negative ions in the electrolyte, it would be a negative number. At equilibrium, which is the condition of a shell membrane at rest, the total current across the membrane must be zero. Otherwise the regions, no matter how large, would eventually fill, since ions are matter. Therefore, the total current is zero. That is,

This condition leads to goldmans equation, state here as

Where the subscript i indicates inside the cell, o designates outside, and K T q Pk P cl [K+] [Cl+] = boltzmans constanta = absolute temperature (K) = the charger on a proton = the permeability of potassium = the permeability of chlorine = the concentration of potassium ions = the concentration of chlorine ions

Permeability is a measure of the ease with which ion pass though the cell membrane

Resting potensial in a cell In a similar argument we can extend the preceding equation for tree ions as follows: Goldmans equation specifies the cell membrane voltages for actual concentrations of potassium, chlorine, sodium. It shows that membrane potential depends strongly on temperature. Since the

permeabilities of different cell types vary the corresponding membrane potentials vary as well. This relationship is the basic for understanding many aspects of transducer behavior, including surface electrodes , discussed in chapter 4. It also explain the behavior of chemical electrodes used in clinical instrumentation. In a living cell, when the approximations Pna 0 and Pcl0 hold, goldmans equation reduced to a simple form as

This is called the Nernst equation, and it is often valid as an approximation to the goldman equation. A direct derivation of the nernst equation from the basic laws governing biopotentials is given as exercise 12. Example 2.1 suppose a flog skeletal muscle has the following ion concentrations and permeabilities of the membrane :

Compute the membrane voltage from inside to outside the cell at 37C(310 K). Solution boltmanns costant k = 1.38 x 10-23J/K An electronic charger q = 1.602 x 10-19 C The temperature T= 310 K Then Considering potassium, [K+] in this equation yields These two results verify the resting potential in a cell is caused primarily by potassium flow. We see that if potassium is considered alone, The result is -94.5 mV, whereas if we also take into account Cl and Na, the result is -86.5 mV. The accuracy is improve by 9.2 % when all ions are accounted for. Under certainly circumstances, the approximation given by the Nernst equation is better than this. Action potential and muscle contration Living cells are encased in a high-resistance membrane, which, at rest, has a potential caused by the flow of sodium and chlorine ions into the cell and potassium ions out of it the resting potential, Vm, as computed by the goldman equation (equation 2.4) normally has values between -50 mV and -100 mV. If the potential is raised across the membrane by about 20%, then a stimulus threshold is exceeded and the cell membrane resistance changes, causing a change in the membrane potential . this new membrane potential called the action potential, is shown in figure 2.5 as long as the action potential exits, the cell is said to be depolarize. In a tissue, the depolarization disturbance of the cell is propagated

to the next until the entire tissue depolarizes. In muscle, where cells are situated in an orderly arrangement, the tissue contracts and becomes shorter in length after some delay following a depolarization. A typical delay of 10 ms between the action potential depolarization and subsequent muscle twitch is indicate in the figure. A stimulus voltages generally does not affect a cell while it is changing its polarization. During the relative refractory period, a higher stimulus is required to reinitiate an action potential and the subsequent contraction of muscle.

Biopotentials in the heart

The electrical