Principles of Biomedical Instrumentation and Measurement Richard Aston Pennsylvania State University Wilkes-Barre 1 Merrill, an imprint of Macmillan Publishing Company New York Maxwell Macmillan Canada, Inc. Toronto Maxwell Macmillan International Publishing Company New York Oxford Singapore SydneyContents Part! Basics A Perspective on Medical Instrumentation 1.1 Definition of a Medical Instrument 1.2 Historical Considerations The Invention of the Thermometer 6 The Stethoscope and Hearing Enhancement 6 Sight Enhancement 7 Chemical Instrumentation and the Senses 9 Twentieth-Century Developments 10 1.3. The Role of Electronic Circuit Theory a.c. Circuits 21 Voltage Division 28 Current Division 29 Gain Function Analysis 30 BJT Equivalent Circuit 32 References Exercises The Origin of Biopotentials, Electrocardiograms, and Electrical Shock Fundamental Laws for Current in Biological Tissue Fick’s Law 39 Particle Drift 40 Single-Cell Membrane Potential 40 Resting Potential in a Cell 42 Action Potential and Muscle Contraction 44 jopotentials in the Heart [2:3 |The Electrocardiogram [2.4 [Electrical Shock High-Frequency Effects 53 Microshock and Macroshock 55 References Exercises 34 34 37 37 45 49 56 56Hospital Equipment Safety and Organization, and a Logical Approach | to Troubleshooting Jectrical Hazards of Medical Instruments lacroshock Hazards 62 jicroshock Hazards 64 Devices to Protect Against Electrical Hazards Ground Fault Interrupter 68 Isolation Transformer 69 Line Isolation Monitor 70 Receptacle Tester 70 Electrical Safety Analyzer Equipment 72 3.3 An Equipment Safety Program 72 Hospital Regulations 73 Inspections of Equipment 74 Emergency Power Systems 75 Oxygen Safety 77 Safety in the Operating Room 77 Hazards of Gases 79 Pressure Chambers 81 3.4 Preventive Maintenance 3.5 A Logical Approach to Troubleshooting References Exercises Medical Instrument Transducers and Component-Level Troubleshooting 4.1 Electrode Transducers The Surface Electrode 90 Half-Cell Potential and Equivalent Circuit Elements 94 4.2. Thermal Transducers 4.3 The Wheatstone Bridge Sensitivity of a Wheatstone Bridge 111 7 4.4 Strain Gauges The Strain Gauge in a Wheatstone Bridge 118 Sensitivity of a Strain Gauge 120 4.5 The Differential Capacitive Transducer 4.6 Inductive TransducersContents 4.7 Troubleshooting at the Component Level 127 References 128 Exercises ~ 129 Biopotential Amplifiers 135 5.1 A Transistor Differential Amplifie Inverting and Noninverting Amplifiers 140 5.2. Operational Amplifier Analysis 143 Operational Amplifier Voltage and Current Sources 147 Operational Amplifiers in Tandem 149 High-Input-Impedance Amplifiers with Controlled Gain 152 Differential Amplifier with Controlled Gain 154 Buffer Amplifier for a Diff Amp 157 5.3 Biopotential Measurement Interference 158 Common-Mode Rejection in a Diff Amp 161 5.4 Troubleshooting Medical Instrumentation 137 Amplifiers 163 References 164 Exercises 165 Part Il Patient-Care Equipment The Electrocardiograph and Unit-Level Troubleshooting 177 6.1 The ECG 177 The ECG Block Diagram 180 6.2 ECG Lead Connections 185 Augmented ECG Lead Connections 190 Chest Lead Connection 191 6.3 Common-Mode Voltage Reduction 198 6.4 Push-Pull Power Amplifiers 201 Maximum Power Transfer 206 A Push-Pull Amplifier with Crossover Compensation 209 Power Amplifier with Offset Control 210 6.5 Power Supplies Power Supply Regulation 214 211The Lown Voltage Waveform of a Defibrillator 271 Case | (Underdamped) 273 Case Il (Overdamped) 275 8.4. Troubleshooting Defibrillators References Exercises The Pacemaker — A Digital Pulse Oscillator 9.1 Properties of the Pacemaker Pacemaker Batteries 286 Illustrative Pacemaker Characteristics 288 9.2 Programmable Pacemakers Contents: 6.6 Unit-Level Troubleshooting: ECGs . 2s Circuit-Board Swapping 216 References 217 Exercises 217 The Electroencephalograph and Filtering 223 7.1 The EEG 223 EEG Electrodes 223 ‘An EEG Block Diagram 227 Electroencephalograms 230 EEGs in Diagnosis 231 7.2 Filters 233 First-Order Filters 236 Higher-Order Active Filters 240 Second-Order Low-Pass Filters 241 Second-Order High-Pass Filters 244 Third-Order Low-Pass Filters 247 Band-Reject Filters 251 7.3. Troubleshooting an EEG 254 References 255 Exercises 255 The Defibrillator and Step Response 261 8.1. The Defibrillator 261 Example Defibrillators 264 8.2. Defibrillator Energy Delivery 267 8.3. Analysis of the Defibrillator Voltage Waveform 270 277 278 278 283 284Contents 10 1 9.3 Digital Pulse Oscillators A Comparator Circuit 294 A Threshold Detector Analysis 297 Square-Wave Generator 299 Monostable Multivibrator 304 Positive-Edge Triggered Multivibrator 306 An Illustrative Pacemaker Circuit 307 References Exercises Electrosurgical Units and Laser Surgery 10.1 The Basic ESU Active Electrodes 315 The Active Electrode Resistance 316 The Return Electrode 318 A Block Diagram 321 10.2 Sinusoidal Oscillators 10.3 An ESU Power Amplifier 10.4 Troubleshooting an ESU 10.5 Laser Surgical Devices The CO, Laser 333 The Argon Laser Surgical Unit 335 The Nd:YAG Laser 336 References Exercises Catheters and Blood Pressure Monitoring 11.1 Circulation System Measurements Pumping Action of the Heart 341 Arterial Pressure Measurement 344 Invasive Blood Pressure Measurement Fluid Resistance 347 Instrumentation for Direct Pressure Measurement 348 Pressure Transducer Calibration 349 346 Pressure Measurements in the Heart 351 11.2 Catheter Measurements The Equivalent Circuit of a Catheter Fluid Inertance 356 Compliance 357 356 309 310 313 313 323 327 330 333 EK ps 337 341 341 355ee ce Contents xvi The Fluid-Electrical Analogy 358 . The Catheter Equivalent Circuit 359 ‘The Physical Formulas for Catheter Components 359 Frequency Response of a Catheter with a Diagram 360 Tuning a Catheter 363 Pinches, Bubbles, and Leaks in a Catheter 363 References 368 Exercises 368 12 Respiratory Equipment and Pulmonary Function Monitoring 371 12.1 Therapeutic and Diagnostic Equipment 371 12.2 The Ventilator 374 Ventilator Modes of Operation 374 12.3 A Spirometer 381 12.4 Pheumotachograph Airflow Measurement 383 The Integrator Circuit 385 Pneumotachograph Volume Measurements 386 12.5 The Plethysmograph 389 Measurement of Total Lung Capacity 390 12.6 Troubleshooting Pneumatic Equipment 392 References . 393 Exercises 393 13 The Central Station Monitor, Microprocessor-Based Equipment, and System-Level Troubleshooting 395 13.1 Machine Language 396 13.2 Microprocessor Block Diagram 398 The CPU 399 The Memory Chip 402 Input/Output Units 403 13.3 A Microprocessor-Based Monitor 405 Central Station Monitoring 410 - Troubleshooting Microprocessor-Based Equipment 413 Self-Test 415 ‘A Logical Approach to Troubleshooting 416 References 41Contents xvii Part Ill Specialized Medical Equipment 14 Clinical Laboratory Equipment 423 14.1 Chemical Electrodes 423 The pH Electrode 424 14.2 A Blood Gas Analyzer 425 The CO, Electrode 426 The "0, Electrode 427 Noninvasive Blood Gas Monitoring 429 14,3 Photometers and Colorimeters 431 Diffraction Gratings 431 Flame Photometers 433 14.4 Blood Cell Counter : 437 Optical Methods of Cell Counting 442 References 443 Exercises 443 15 Medical X-Ray Equipment 445 15.1 X-Rays 445 The X-Ray Tube 446 The Nature of X-Rays 449 X-Ray Absorption 452 Tissue Contrast 455 15.2 X-Ray Equipment Block Diagram 456 The X-Ray Tube 458 The Collimator 461 The Bucky Grid 463 The X-Ray Detector 463 The Power Supply 464 15.3 Fluoroscopic System 467 15.4 X-Ray CT Scanners 469 15.5 Nuclear Medicine Imaging 473 Radioisotopes and Radiopharmaceuticals 474 Radiation Detectors 474 The Photomultiplier Tube 478 Gamma-Ray Camera 478 15.6 Radiation Dose ~ 481 References 487 Exercises 487rr xviii Contents 16 Ultrasonic Equipment * 489 16.1 Therapeutic and Diagnostic Equipment 489 ‘Therapeutic Ultrasonic Equipment 489 Piezoelectric Transducers 491 Ultrasonic Imaging Equipment 491 The Display Unit 493 Scanning-Type Displays 493 16.2 Ultrasonic Waves 496 Wave Reflections 500 Analysis of a Typical Ultrasonic Reflection 503 Ultrasonic Power 504 Attenuation in Ultrasonic Waves 505 16.3 Ultrasonic Blood Flow Equipment 506 ‘An Analysis of the Doppler Effect 506 ‘An Analysis of Transit Time 509 References 510 Exercises 510 Appendix A Computer Programs 515 Appendix B_ Laplace Transforms 526 B.1 The Laplace Method 526 The Step Source 526 Laplace Equivalent Impedances 527 Circuit Analysis of Laplace Equivalent Elements 529 Laplace Transform Tables 531 RC Circuit Step Response 532 Appendix C Medical Terminology 537 C.1 Common Prefixes 537 C.2. Common Suffixes 538 C3 The Terminology of General Anatomy 539 C.4 Terminology of Circulation 541 C.5 Terminology of Respiration “542 C.6 Terminology of the Nervous System 542 C.7 Terminology of Sensory Organs 7 543 Index 545. A Perspective on Medical Instrumentation - The Origin of Biopotentials, Electrocardiograms, and Electrical Shock - Hospital Equipment Safety and Organization, and a Logical Approach to Troubleshooting |. Medical Instrument Transducers and Component- Level Troubleshooting - Biopotential AmplifiersA Perspective on Medical Instrumentation 1.1 DEFINITION OF A MEDICAL INSTRUMENT ‘The physical forms taken by most examples of medical devices, such as in- struments, tools, and machines, are illustrated by the block diagram in Fig- tre 1.1, Each switch position sets the instrument up in one of the physical forms as an instrument for measurement, for monitoring, for diagnosis of disease, for therapy of patients, or for surgery. Most medical instruments fall into one of these categories. ‘A medical instrument performs a specific function on a biological sys~ tem. The function may be the exact measurement of physiological param- Ud ‘Measurement Biological |_o} Transducer Signal o-{ Monitoring system processor a Feedback | Surger transform — ‘Therapy Surgical [j— i tool FIGURE 1.1 ‘A block diagram of a generalized medical instrument.ee 4 Chapter 1. | A Perspective on Medical Instrumentation eters—pressure, flow, voltage, current, chemical pH, volume,-weight, temperature —and rates of change of these parameters. In physiologival sys- tems, because the parameters often have small magnitudes or are otherwise 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 sig- nal processor. The transducer may, for example, amplify voltages or pres- sures, select an appropriate parameter for measurement, provide a transitional medium, or effect an impedance match of the biological sys- tem to the signal processor. In physiological systems, measurable parameters cover a wide range. Voltages range from 1 microvolt (uV) to several millivolts (mV) and up to thousands of volts (V) of static charge. Frequencies range from d.c. to 20 kilohertz (kHz). The dynamic range of sound amplitudes is 100 decibels (dB) and above. Pressures range from 0.1 millimeter of mercury (mmHg) to approximately 1000 mmHg. Fluid flow rates rise to 25 liters per min- ute (liters/min) and air flow up to 600 liters/min. The need to maintain physiological stability and control feedback is illustrated by the relatively narrow temperature range in the human body, 90 to 104 degrees Fahren- heit (°F). The output of a transducer should be a signal compatible with the sig- nal processor illustrated in the figure. This output may be 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 processors (for example, those having digital components), the compatible signal is binary, typically either +5 or 0 V. Only upon appro- priately processed signals can the arithmetic and logical functions of micro- processors and digital circuits be performed. The type of signal processing depends upon the function of the instrument — measurement, monitoring, diagnosis, therapy, or surgery. The function is selected by a switch in the figure. A common example of a measuring instrument is the thermometer. The transducer is the glass bulb and scale; the signal processor and mon- itor are the observer who records the measurement. Other examples of measuring devices are sphygmomanometers, electroencephalographs, and electrocardiographs. A monitoring instrument represents a higher level of complexity in that it includes a memory, which can take the form of a‘pa- per strip recorder, a storage oscilloscope, or a computer memory, which holds information for later use. An even higher level gf sophistication is usually required for machine diagnosis. The diagnostic function may be per- formed by an instrument as simple as an alarm that warns of an excessiveSection 1.2 | Historical Considerations 5 heart rate, or as complex as a mainframe computer that processes symp- _ toms and prescribes 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 in- dicated by the position of the feedback transform in Figure 1.1. Therapy is applied by a crutch, for example, allowing a leg to heal while the patient remains ambulatory. More complex therapy may be applied by a biofeed- back 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 parameters in the system to which the ther- apy is applied. An example is an ultrasonic massager operated by a physi- cal therapist. This is closely related to another category of instruments used in surgery and surgical procedures, namely invasive-units, which penetrate the skin of the patient. These include electrosurgical knives, hypodermic needles, and lasers. The medical instruments illustrated in Figure 1.1 are those that may be used in connection with the patient. Another category is assigned to labo- ratory instruments used to investigate and assess biological fluids and tis- sue. The measurement of pH is fundamental to the operation of many of these instruments, as are techniques for investigating particles in fluids. 1.2 HISTORICAL CONSIDERATIONS The fundamental purpose of tools is to enhance the capabilities of human beings by helping them to lift more weight, to move faster and more com- fortably, to communicate over greater distances, and to use the five senses more effectively. Throughout history, as technology was developed, the number of human functions extended by the use of tools increased. Most recently, the introduction of computers has extended even our ability to think, particularly in calculating, analyzing, and storing large amounts of information. Consider, for example, the sense of touch. The ancient Greeks used the technique of “laying on of hands” to determine the size of organs, the na- ture of wounds, and the extent of bodily growths; the technique is still used today. Modern instruments that extend the sense of touch include devices - for massage, such as electrical current stimulators, automatic vibrators, and ultrasonic therapy equipment. In the Tadoma method of speech therapy, the therapist places a hand on the speaker’s face during speech training to feel where the sounds are placed. An electronic tactile vocoder can be used to extend the therapist’s ability to locate these placements by amplifyingEES —CCS 6 Chapter 1 | A Perspective on Medical Instrumentation these acoustic cues and transferring them to other, more convenient cuta- neous body sites. ~ One specific bit of information obtained by the sense of totich is a rel- ative measure of body temperature. In this function, the thermometer ex- tends 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 arranged 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, constructed a similar device, which he used to measure the temperature in the human body. The prob- Jem with the instrument (Figure 1.2a) was that the height of the water was also affected by the atmospheric pressure. This problem was solved a quar- ter of a century later when Ferdinand II, Grand Duke of Tuscany, sealed the water in a closed vessel to eliminate the effect of atmospheric pressure. The essentially modern thermometer shown in Figure 1.2(b) was introduced by the Dutch instrument maker Gabriel D. Fahrenheit, who in the eight- eenth century replaced the water with mercury and improved the instru- ment’s accuracy. This thermometer is still widely used, although more recently liquid crystal thermometers have been adopted for special applicatians. The Stethoscope and Hearing Enhancement From the time of the ancient Greeks, physicians have used their hearing for diagnosis, such as in placing the ear against the chest or back to listen fot Glass Atmospheric tube Sealed glass pressure tube Partial \ vacuum Water Mercury @ ©) FIGURE 1.2 . . ‘Thermometer development.