Chapter 4

Basic physiological parameters for

instrumentation
By
Teshome Ab., Msc In BHI
Lecturer
Chapter outline
• Introduction
• The Eight Areas of Physiological Measurement
1. Audiology:
2. Cardiac Physiology
3. Gastrointestinal (GI) Physiology
4. Neurophysiology
5. Ophthalmic and Vision Science
6. Respiratory Physiology (including Sleep
Physiology)
7. Urodynamics
8. Vascular Technology
……
Introduction
• Generally, human health state is defined by variety of physiological
parameters, which usually are self interdependent
• Medical investigations have proven that the most important
parameters are those that specify the work of heart and respiratory
system.
• In addition to this, body’s temperature is also an important parameter
Basic human physiological parameters

The measured The analyzed physiological The character of the measured

parameter parameters signal
1. ECG Variation of electrical heart Time function,
vector, heart work rate mean numerical value
2. Pulse Heart work rate Mean numerical value
3. Respiratory rate Respiratory rate Numerical value
4. Respiratory volume Minutely respiratory volume mean numerical value
gauge
5. Body temperature Temperature Numerical value
6. Blood pressure Systolic and diastolic blood Time function,
pressure, heart rate numerical value
 Defination
• Medical device : means any instrument, apparatus, appliance, software, material or other

article, whether used alone or in combination, including the software intended by its

manufacturer to be used specifically for diagnostic and/or therapeutic purposes and necessary

for its proper application, intended by the manufacturer to be used for human beings for the

purpose of:

– Diagnosis, prevention, monitoring, treatment or alleviation of disease,

– alleviation of or compensation for an injury or handicap,

– Investigation, replacement or modification of the anatomy or of a physiological process.

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 Defination
• « active medical device » means any medical device relying for its functioning on a source of

electrical energy or any source of power other than that directly generated by the human body or

gravity

• « active implantable medical device » means any active medical device which is intended to be

totally or partially introduced, surgically or medically, into the human body or by medical

intervention into a natural orifice, and which is intended to remain after the procedure

• « accessory » means an article which whilst not being a device is intended specifically by its

manufacturer to be used together with a device to enable it to be used in accordance with the use

of the device intended by the manufacturer of the device

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 Exemples
• Medical devices:
• Bone cements; materials for sealing, approximation or adhesion to tissues; sutures,
intrauterine devices; blood bags; wound dressings; catheters; stents; wheelchairs;
hospital beds; contact lenses;….

• Active medical devices:

• Hearing aids; cryosurgery equipment; lung ventilators; blood warmers; surgical lasers;
lithotriptors; therapeutic cyclotrons; gamma cameras,…

• Active implantable medical devices:

• Implantable pacemaker; implantable defibrillator; neurostimulator; cochlear implants
+ related leads

• Accessories:
• Contact lens care products; disinfectants specifically intended for use with MD;
lubricants specifically intended for use together with MD;…
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The Eight Areas of Physiological
Measurement
1. Audiology:
involves a wide range of hearing and balance assessments.
Following assessment, an appropriate care pathway is selected for
treatment
(e.g. surgery for cochlear implant) and support, but more often for
rehabilitative support strategies
(e.g. programmed digital signal processing (DSP or ‘digital’) hearing
aids, counselling, assistive listening devices) to improve the ability to
participate in daily activities.
1…Where is the service located?

• The majority of audiology tests need to be undertaken in quiet

clinical rooms (background noise <35dBA), sound proofed rooms or
electrically shielded and sound proofed rooms.
1…What services do they provide?
• The major elements of audiology services include:
Assessment of patient needs and selection of appropriate care pathways
Hearing function (including pure tone audiometry
Diagnostic audio vestibular function tests (i.e. balance tests and
electrophysiological tests of hearing and balance)
Assessment for implantable devices that aid hearing and communication
Fitting of digital hearing aids to new and existing patients
2. Cardiac Physiology

• Cardiac physiology services involve the diagnosis and

management of patients with known or suspected
cardiovascular disease
An extensive range of both invasive and non­invasive diagnostic and
interventional procedures are carried out.
cardiology departments, providing both invasive and non-invasive diagnostic
and therapeutic procedures.
What services do they provide?
• Services will usually include:
Echocardiography (Echo);
Electrophysiology studies (EPS);
Electrocardiogram (ECG) and blood pressure recording;
Exercise Stress Testing;
Diagnostic and interventional angiography;
Pacemaker implantation and follow-up;
Implantation of cardioverter defibrillators (ICD) and other devices and
subsequent follow-up
3. Gastrointestinal (GI) Physiology
• Gastrointestinal (GI) diagnostic investigations are carried out to assess the
function of the whole of the GI tract, from the process of swallowing to
evaluation of and therapy for disorders of defaecation in patients with pelvic
floor disorders.
 Some investigations measure muscle activity and sphincter function;

 others investigate the effect of enzymes; and by analyzing the gaseous by-products of bacteria,

 it is possible to establish the cause of food intolerance,

 it is possible to establish the cause of food intolerance,

Where is the service located?
• In endoscopy units and others are part of cardio-respiratory units,or
are combined with urodynamic measurement units for sustainable
approaches to provision.
What services do they provide?
• The most common diagnostic investigations are:
Assessment of gastro-oesophageal,reflux, duodeno-gastro-oesophageal reflux
and laryngo-pharyngeal reflux using invasive naso-gastric sensors to measure
pH and bile and also implantable oesophageal pH capsules;
Non-invasive breath tests for confirmation of small bowel overgrowth,
lactose intolerance, oro­caecal transit disturbance and Helicobacter pylori;
Non-invasive bio-chemical tests to evaluate pancreatic function;
Non-invasive evaluation of gastric electromyographic signals using
electrogastrography for example in patients with diabetic neuropathy;
Invasive neural pathway stimulation of the anal canal;
Radio-opaque marker studies to evaluate colonic transit time;
4. Neurophysiology

• Neurophysiology involves the diagnosis of a wide range of

conditions affecting the central and peripheral nervous
systems.

• It is concerned with testing the electrical function of the brain,

spinal cord and nerves in the limbs and muscles. It is principally
diagnostic.
Where is the service located?

• In Clinical Neurophysiology services Unit

• Investigations are usually carried out in dedicated environments, but

can be performed in clinical areas such as intensive care units and

operating theatres.
What services do they provide?
• Peripheral Neurophysiology: is concerned with the peripheral
nervous system only. The core tests provided by neurophysiology
departments in peripheral neurophysiology are:
Nerve Conduction Studies (NCS);
Electromyography (EMG).
Electroencephalography (EEG);
Evoked Potentials (EP).
Nerve Conduction Studies (NCS) … refer the previous chapter ??
5. Ophthalmic and Vision Science

• Ophthalmic and vision science is primarily concerned with the clinical

assessment of the structure and function of the visual system.

• The information is used by ophthalmologists, optometrists and other

clinical professionals to aid the clinical management process.

Where is the service located?
• in ophthalmology outpatient departments

• Most ophthalmologists work in hospitals rather than in community

practices, but this may change with the current restructuring of the

NHS. There is scope for interventions such as laser, surgery,

prescription of medical treatment, orthoptic treatment to be carried

out in primary care settings.

What services do they provide?
• The parameters that can be measured include:

 Visual acuity, refractive error and the determination of optical requirements;

 Field of vision;

 Ocular motility, binocular vision and stereopsis;

 Anatomical changes, often linked to pathological change;

 Temporal properties of vision and motion perception;

 Colour vision.
6. Respiratory Physiology (including Sleep
Physiology)

• Respiratory Physiology involves a wide range of diagnostic testing and

therapeutic services for patients with suspected respiratory disease or

conditions that affect the functioning of the respiratory system.

• Sleep Physiology investigations are included in this area and conducted to

identify abnormal sleep patterns and pathologies, and to assess and provide

therapeutic intervention.
Where is the service located?

• located in dedicated respiratory or lung function unit;

• Sleep physiology services are predominantly associated with respiratory

laboratories, but there are some dedicated units around the country.

• Provision of therapy for home ventilation and sleep apnoea treatment are

based in secondary care and provide an on-going follow-up service for these

patients.
What services do they provide?

• Lung function services include routine testing of airways (spirometry for COPD,

asthma, screening for lung disease), lung size and gas transfer to classify the

major respiratory disease types (known as “full tests”). Other routine tests

include blood gases; assessment of response to bronchodilator drugs,

• respiratory muscle assessment, skin prick allergy testing

• Sleep investigations
7. Urodynamics
• Urodynamics is a series of measurements, which investigate how
the lower urinary tract functions.
Where is the service located?

• In a urological or gynaecological department within an acute Hospital

Trust. A minority of other specialties may also have some urodynamic

facilities
What services do they provide?

• The lower urinary tract comprises the bladder (a reservoir for the storage and expulsion of

urine) and the urethra (which acts as a valve to contain urine within the bladder during urine

storage and acts as a conduit to convey urine away from the body during voiding) It allows the

clinician to determine what physical factors are involved in bladder

• in the diagnosis of different types of incontinence for which there are different indicated

treatments. This allows the patient to be offered the optimal therapy

8. Vascular Technology

• Vascular Technology involves the investigation and monitoring

of diseases of the arteries and veins.

• It primarily uses ultrasound to image blood vessels and assess

the blood flow within them. Investigations are principally

diagnostic.
Where is the service located?
• in the main radiology department.
• Investigations are usually carried out in dedicated rooms.
• Some investigations are carried out at the patient’s bedside, or in
intensive care units and coronary care units.
What services do they provide?

• The majority of vascular investigations are performed using colour duplex ultrasonography.

• This combines conventional ultrasound imaging with Doppler ultrasound, allowing simultaneous

visualisation of blood vessels and of the way blood is flowing.

• Carotid scans for patients suspected of having a TIA or stroke;

• Peripheral arterial scans for patients with conditions such as intermittent claudication or critical

limb ischaemia;

• Peripheral venous scans for patients with suspected DVT or varicose veins.
Thanks for this end But,..