EC2021-Medical Electronics Notes For All Five Units-Libre

EC2021- Medical Electronics Study Materials for all
5 units
UNIT I
ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING
UNIT I PART A
1.1)Define a) Resting Potential
b) Action Potential
May/June 2009, Nov/Dec 2008
1.2)Define Conduction Velocity Apr/May 2008, Nov/Dec 2008, May/June 2007
1.3)State all or none law in respect of cell bio potential.
Apr/May 2008
1.4)Name the electrodes used for recording EMG and ECG. Nov/Dec 2012
1.5)List the lead systems used in ECG recording.
Apr/May 2010
1.6)What is PCG?
May/June- 2012, Nov/Dec 2012
1.7)Compare the signal characteristics of ECG and PCG. Nov/Dec 2011
1.8)What is EOG?
Nov/Dec 2011
1.9)Draw typical ECG waveform. Nov/Dec 2009, May/June 2007
1.10What are the peak amplitude and frequency response for ECG, EEG and EMG.
1.11) Write down the Nernst equation ? (Nov/Dec 07 )
1.12) What is Phonocardiogram ? (Nov/Dec 07 )
1.1)What is the specific usage of a SIGNAL AVERAGER ? (May/ June 2006)

1.14)What is EARLY RECEPTOR POTENTIAL (ERP) ? (May/ June 2006)
1.15)Write down the Nernst Equation ? (APRIL/MAY 2005)
1.16)What are the factors that influence the flow of ions across the membrane ? (APR/MAY 2005)
1.17).Draw an action potential waveform and label the amplitude and give the time scale for nerve
cells and heart muscle.( April /May 2004)
1.18). What is PCG ? What is its diagnostic use ? ( April /May 2004)
1.19)Mention the important bands of frequencies in EEG and their importance. ( Nov.Dec.2003)
1.20)What are the electrodes used for recording EMG ? ( Nov.Dec.2003)
UNIT I-PART B
1.1) Discuss in detail the origin of bioelectric potentials with necessary diagrams. (Nov/Dec 07 )
1.2)Draw an Electrocardiogram, labeling the critical features. Include typical amplitudes and
time intervals for a normal person(Nov/Dec 07 )
1.3)With neat diagrams explain the 12 lead system in ECG measurement (Nov/Dec 07 )
1.4). Draw the waveform of the ACTION POTENTIAL and explain
: (i) Depolarization
(ii) Repolarization
Prepared by A.Devasena., Asso. Prof.,

Dept/ECE
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1
(iii) Resting Potential
(iv) Absolute Refractory period
(v) Relative Refractory Period (vi) Propagation Rate

(vii) all-or-nothing law and
(viii) net height of the action. (May/ June 2006)
1.5) Draw the waveform of the ACTION POTENTIAL and describe Resting Potential ,
Depolarization, Repolarization, action potential, Absolute Refractory period and
Relative Refractory Period (APR/MAY 2005)
1.6)Write down Goldman Equation and write the constants indicate. (APR/MAY 2005)
1.7)Draw a typical single channel ECG machine and give justification for the inclusion of each
circuit block of the machine. ( Nov.Dec.2003)
1.8)Write about standard lead system for ECG recording. Also draw a typical ECG waveform and
mark the various complexes of ECG and give their durations. ( April /May 2004)
1.9)Write briefly about the recording devices for EMG. ( April /May 2004)
1.10) Draw the equivalent circuit of a pair of electrodes in electrolytic contact with a human being
to measure bio-potential. Name the components. (4)
1.11).Draw a typical 8 channel EEG machine and discuss about its function. (12)
UNIT I - ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING

THE ORIGIN OF BIO-POTENTIALS
1. Define
c) Resting Potential
d) Action Potential
2008
May/June 2009, Nov/Dec
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
Action potential is defined as the change in electrical potential associated with the passage of
an impulse along the membrane of a cell.
2. Define Conduction Velocity

2007
Apr/May 2008, Nov/Dec 2008, May/June
Conduction velocity is defined as the rate at which an action potential mo ves down a fiber or
is propagated from cell to cell. It is also called as Nerve conduction rate.
3. Write down the Nernst equation of action potential.
An equation relating the potential across the membrane and the two concentrations of the ion
is called Nernst equation.
RT
C1 f1
E
ln

Where,
nF
C2 f 2
7
R
gas constant(8.315 x 10 ergs/mole/degree Kelvin)
T
absolute Temperature, degrees Kelvin
n
valence of the ion (the number of electrons added or removed to ionize the atom)
F
Faraday constant (96,500 coulombs)
C1, C2 two concentrations of the ion on the two sides of the membrane
f1, f2 respective activity coefficients of the ion on the two sides of the membrane
4. What is meant by sodium pump?
Sodium pump is an active process in which sodium ions are quickly transported to the outside
of the cell and the cell again becomes polarized and assumes its resting potential.
5. State all or none law in respect of cell bio potential.
Apr/May 2008
Regardless of the method by which a cell is excited or the intensit y of the stimulus, the
action potential is always the same for any given cell.
6. List the types of bioelectric potentials.
Bio electric potential related to
Heart
ElectroCardioGram (ECG)
ElectroEncephaloGram (EEG)
Brain
Muscle
ElectroMyoGram (EMG)
ElectroRetinoGram (ERG)
Eye (Retina)
Eye (Cornea - Retina)
ElectroOculoGram (EOG)
BIO
BIO-POTENTIAL ELE
ELECTRODES
7. Define electrode and list its types.

The devices that convert ionic potential into electronic potential are called as
electrode. The types of electrode are
a) Micro electrode
b) Depth and needle electrode
c) Surface electrode
8. What are perfectly polarized and perfectly non polarized electrodes?
Electrodes in which no net transfer of charge occurs across the metal electrolyte interface
is called perfectly polarized electrode.
Electrodes in which unhindered exchange of charge occurs across the metal electrolyte
interface is called perfectly non polarized electrode.
9. What are the types of electrodes used in bipolar measurement? May/June- 2012
The types of electrodes used in bipolar measurement
are a) Limb electrodes
b) Floating Electrodes
c) Skin electrodes
10. Name the electrodes used for recording EMG and ECG.
Electrodes used for recording EMG are
a) Needle electrodes
b) Surface electrodes
Electrodes used for recording ECG are
d) Limb electrodes
e) Floating Electrodes
f) Pregelled disposable electrodes
g) Pasteless electrodes
Nov/Dec-2012
BIO
BIOLOGICAL AMPLIFIERS
11. State the importance of biological amplifiers.
Apr/May 2010
Bio signals such as ECG, EMG, EEG, EOG have low amplitude and low frequency.
So, amplifier is used to boost the amplitude level of bio signals.
12. What are the requirements for bio-amplifiers?
Bio amplifiers must have
a) High input impedance
b) Isolation and protection
circuit c) High voltage gain
d) Constant gain throughout required
bandwidth e) Low output impedance
f) High CMRR
ECG, EEG, EMG, PCG, EOG LEAD SYSTEMS AND
AND RECORDING METH
ETHODS,
TYPICAL WAVEFORMS AND SIGNAL CHARACTERISTICS.
Dept/ECE
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13. What are the basic components of biomedical systems?

The basic components are
a) Patient
b) Transducer
c) Signal processing equipment
d) Display
e) Control unit
f) Stimulus
14. List the lead systems used in ECG recording.
The lead systems used in ECG recording are
a) Bipolar Limb leads or Standard leads
b) Augmented unipolar limb leads
c) Chest leads or precordial leads
Apr/May 2010
15. What is evoked potential?

The external stimuli are detected by the sense organs which cause changes in the electrical
activity of the brain. Due to this, potential is developed in the brain as the response to
external stimului like light, sound etc. It is called as evoked potential.
16. What is PCG?
May/June- 2012, Nov/Dec -2012
A Phonocardiogram or PCG is a graphic display of the sounds generated by the heart and
picked up by a microphone at the surface of the body. Frequency response required is 5 to 2000
Hz. It
is measured by special transducer or microphone.
17. Compare the signal characteristics of ECG and PCG. Nov/Dec-2011
ECG wave occurrence

QRS Complex
End of T wave
Beginning of P wave
PCG wave occurrence

1 heart sound
nd
2 heart sound
rd
3 heart sound
st
18. What is EOG?

Nov/Dec-2011
Electrooculogram is the measure of the variations in the corneal retinal potential as affected by
the position and movement of eye. The EOG potentials are picked up by small surface
electrodes
placed on the skin near the eye.
Page
Dept/ECE
5
19. State the importance of PCG signals.

May/June 2009
The importance of PCG signals are
a) Different types of heart sounds are measured.
b) Additional sounds are heard between normal heart sound due to vibration
setup in the blood inside the heart by sudden closure of valves.
c) The presence of higher frequencies (mumurs) in the phonocardiogram indicates
a possible hear disorder such as Aortic stenosis, Mitral regurgitation, mitral
stenosis etc.
20. Define latency as related to EMG.
Nov/Dec 2008
Latency is defined as the elapsed time between the stimulating impulse and the muscle
action potential. In other words it is the time delay between stimulus and response
21. Draw typical ECG waveform.
Wave
Nov/Dec 2009, May/June 2007
Amplitude (mV)
0.25
1.06
0.1 0.5
-
P
R
T
QRS Complex
Duration (sec)
0.12 0.22 (P R interval)
0.07 0.1
0.05 0.15 (S T segment)
0.09
22. What are the important bands of frequencies in EEG and state their importance.
Nov/Dec 2004
Waves
Frequency (Hz)
Observation
Delta()
0.5 4
These wave occur in deep sleep in premature babies and

in very serious organic brain disease.
Theta()
48
These wave occurs during emotional stress in some

adults particularly during disappointment and frustration

Dept/ECE
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Alpha()
8 13
Beta()
13- 22
They found in the normal persons when they are awake

in a quiet, resting state. During sleep they disappear.
It is observed when the person is alert active, busy, or
anxious thinking, active concentration
23. What are the peak amplitude and frequency response for ECG, EEG and EMG.
Bioelectric potential
Function
Peak
amplitude
0.1 to 4mV
ElectroCardioGram
(ECG)
Records
electrical
activity of heart
ElectroEncephaloGram
(EEG)
Records
electrical
activity of
brain
2 to 200V
ElectroMyoGram
(EMG)
Records
muscle
potential
50V to
1mV
Observation
Frequency
response
0.05 to
Used to measure
120 Hz
heart rate,
arrhythmia and
abnormalities
0.1 to 100 Used to analysis
Hz
evoked potential,
certain patterns,
frequency
response
5 to 2000
Used as indicator
Hz
of muscle action
for measuring
fatigue
UNIT II
BIO-CHEMICAL AND NON ELECTRICAL PARAMETER MEASUREMENTS

UNIT II PART A
2.1) What are the typical values of blood pressure and pulse rate of an adult? (Nov/Dec.2012)
2.2) What are systolic and diastolic pressures?
( Nov/Dec 2011)
2.3) What is the reason for decrease of cardiac output?
2.4) Define Cardiac Output.
2.5) State the principle behind the indicator dilution method.
2.6)What is residual volume?
( May /June 2007)
2.7) What is electrophoresis?
(April / May 2010)
2.8) What are the applications of flame photometer?
( Nov/Dec2009)
2.9) How is auto analyzer useful in medical field?
( April /May 2010)
2.10)What are korotkoff sounds?
( Nov/Dec 2008)
2.11) Name the four physical principles based on which blood flow meters are constructed?
(Nov/Dec 07 )
2.12) Define Mean Arterial Pressure ? (Nov/Dec 07)
.1) What is a BRANCHO SPIROMETER ? (May/ June 2006)

2.14) Name two types of electronic temperature-sensing devices used in biomedical applications.
(May/ June 2006)
2.15) Write down the demerits of indirect method of blood pressure measurement . (APRIL/MAY 2005)
2.16) What are Cardiac output and phonocardiogram ? (APRIL/MAY 2005)
2.17) What are the demerits of electromagnetic blood flow meter ? ( April /May 2004)
2.18) Name any two methods of respiration rate measurement . ( April /May 2004)
2.19) What is flame photometer? ( Nov.Dec.2003)
2.20) What is Cardiac output? Mention the methods of measurement of cardiac output.( Nov.Dec.2003)
2.21)What are the two methods of pulse measurement?

UNIT II PART B
2.1) What is a coulter counter ? Explain its operation. Mention the drawbacks of the
system. ( Nov.Dec.2003)
2.2) Explain how the pH of blood is measured. ( Nov.Dec.2003)
.)Define the term Cardiac Output . How is cardiac output measured by dye dilution technique?
Explain. ( April /May 2004)
2.4).Describe , with neat diagrams, the operation of a blood cell counter working on the principle
of conductivity. list the drawbacks of the system. ( April /May 2004)
2.5) Give a pictorial representation of Long Volumes and capacities indicate and explain the following
: i)Tidal Volume (ii) Insipiratory reserve volume (iii) Expiratory Reserve Volume (iv) Residual
Volume (v) Vital Capacity (vi) Total Lung capacity (vii)Inspiratory capacity
(viii)Functional residual capacity. (APR/MAY 2005)
2.6) List out the physical principles based on which blood flow meters are working. (APR/MAY 2005)
2.7)Draw the block diagram of ultrasonic blood flow meters and explain the method of measuring
the velocity of blood flow. (APR/MAY 2005)
2.8) Compare DIRECT measurements and INDIRECT measurements of
BLOOD PRESSURE .( May/ June 2006)
2.9)Name the physical principles based on which the blood flow meters are used.
2.10)Write down the application of ELECTROPHORESIS and explain the BASIC
principles involved .
(May/ June 2006)
2.11)Explain :
(i) ultrasonic Blood flow meter (Doppler type) (May/ June
2006) (ii) Plethysmograph. (May/ June 2006)
2.12) Draw the block diagram of ultrasonic blood flow meter. Explain the method
of measuring the velocity of blood flow using (i) transit time principle (ii) Doppler Effect
(Nov/Dec 07 )
2.13)Describe a procedure for the measurement of pH in blood . (Nov/Dec 07 )
2.14)Explain the principle and the working of Electrophoresis apparatus (Nov/Dec 07 )
1.
2.
3.
4.
5.
6.
7.
8.
UNIT II - BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

MEASUREMENTS
What are the typical values of blood pressure and pulse rate of an adult?
(Nov/Dec.2012)
Systolic (maximum) blood pressure in the normal adult is in the range of 95 to145
mm Hg, with 120 mm Hg being average. Diastolic (lowest pressure between beats)
blood pressure ranges from60 to 90 mm Hg, 80 mm Hg being average.
What are systolic and diastolic pressures?
(
Nov/Dec
2011)
The hearts pumping cycle is divided into two major parts systole and diastole. Systole is
defined as the period of contraction of the heart muscles specifically the
ventricular muscle at which time blood is pumped into the pulmonary artery and the
aorta. Systolic pressure is 120 mm Hg(average value). Diastole is the period of
dilation of the heart
cavities as they fill with blood. Diastolic pressure is 80 mm Hg (average
value).
What is the reason for decrease of cardiac output?
The reason for decrease of cardiac output may be due to low blood pressure,
reduced tissue oxygenation, poor renal function, shock and acidosis.
Define Cardiac Output
Cardiac output is defined as the amount of blood delivered by the heart to the aorta
per minute. In case of adults during each beat, the amount of blood pumped ranges
from 70 to 100 ml. for normal adults the cardiac output is about 4- 6 liters/ minute.
State the principle behind the indicator dilution method.
The indicator dilution method is based on the principle that a known amount of dye
or radio isotope as an indicator is introduced with respect to time at the measurement
site, so the volume flow of blood can be estimated.
What is residual volume?
( May /June
2007)
Residual volume is the volume of gas remaining in the lungs at the end of
maximum expiration.
Define Tidal Volume
Tidal volume is also called as normal depth volume of breathing or is the volume of
gas inspired or expired during each normal quiet respiration cycle.
What is total lung capacity?
The total lung capacity is the amount of gas contained in the lungs at the end of
maximal inspiration.
9. Define Vital Capacity

The vital capacity (VC) is the maximum volume of gas that can be expelled from
the lungs after a maximal inspiration.
10. What is electrophoresis?
(April / May 2010)
Electrophoresis is a method for separating and analyzing macromolecular substances such as
plasma proteins. The method is based on the fact that, the molecules carry electric charges
and therefore migrate in a electric field.
11. How is cardiac output is used?
Using implanted electromagnetic fine probe on the aorta, find the cardiac output per
minute directly can be found by multiplying the stroke volume with the heart beat rate per
minute.
12. What are the uses of gas analyzers?
Gas analyzers are used to determine the quantitative composition of inspired and expired gas
to assess the lung function.
13. What are the uses of blood flow meters?
Blood flow meters are used to monitor the blood flow in various blood vessels and to
measure cardiac output.
14. What are the applications of flame photometer?
( Nov/Dec2009)
Flame photometer is used to analyze urine or blood in order to determine the concentration
of
potassium (K), sodium (Na), calcium (Ca) and lithium
(Li).
15. What are blood cells?
The blood cells have important functions in our body. The red blood cell is used for the
transport
of oxygen and carbon dioxide. The white blood cells are part of the bodys defense against
infections and foreign substances. The platelet is involved in the clotting of
blood.
16. What is the purpose PO2 electrode is used?
PO2 electrode is used to determine the oxygen tension in the blood. It is a piece of platinum
wire embedded in an insulating glass holder with the end of wire exposed to the electrolyte into
which the oxygen from the solution under measurement is allowed to diffuse through the
membrane.
17. How is auto analyzer useful in medical field?
( April /May
2010)
Auto analyzer is used to measure blood chemistry and display that on a graphic recorder.
18. What are korotkoff sounds?
(
Nov/Dec
2008)
In the Blood pressure (BP) measurement, when the systolic pressure exceeds the cuff pressure,
then the doctor can hear some crashing, snapping sounds through the stethoscope. These
Dept/ECE
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10
sounds are called as korotkoff sounds.

19. What is cardiac output? What are the methods of measurement of cardiac output?
( Nov/ Dec
2004).
Cardiac output is the amount of blood delivered by the heart to the aorta per minute. For normal
adult, the cardiac output is 4- 6 litres/min. The cardiac output is measured by using three

Dept/ECE
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10
methods. They are Ficks Method, Indicator dilation method, Measurement of cardiac output by
impedance change.
20. What are the two methods of pulse measurement?
The methods used for measuring pulse are transmittance and reflectance
methods.
1.
2.
3.
4.
5.
6.
7.
8.

MEASUREMENTS
(Nov/Dec.2012)
(
Nov/Dec
2011)
The hearts pumping cycle is divided into two major parts systole and diastole. Systole is
defined as the period of contraction of the heart muscles specifically the
ventricular
muscle at which time blood is pumped into the pulmonary artery and the aorta.
Systolic pressure is 120 mm Hg(average value). Diastole is the period of dilation of
the heart cavities as they fill with blood. Diastolic pressure is 80 mm Hg (average value).
( May /June
2007)
maximum expiration.
Define Tidal Volume

Dept/ECE
Page
13

(April / May 2010)
minute.
( Nov/Dec2009)
of
potassium (K), sodium (Na), calcium (Ca) and lithium
(Li).
transport
blood.
membrane.
( April /May
2010)
(
Nov/Dec
2008)

( Nov/ Dec
2004).
Cardiac output is the amount of blood delivered by the heart to the aorta per minute. For normal
adult, the cardiac output is 4- 6 litres/min. The cardiac output is measured by using three
impedance change.
methods.
1.
2.
3.
4.
5.
6.
7.
8.

MEASUREMENTS
(Nov/Dec.2012)
(
Nov/Dec
2011)
The hearts pumping cycle is divided into two major parts systole and diastole. Systole is defined
as the period of contraction of the heart muscles specifically the ventricular
muscle at which time blood is pumped into the pulmonary artery and the aorta.
Systolic pressure is 120 mm Hg(average value). Diastole is the period of dilation of
the heart cavities as they fill with blood. Diastolic pressure is 80 mm Hg (average value).
( May /June 2007)
maximum expiration.
Define Tidal Volume

(April / May 2010)
minute.
( Nov/Dec2009)
of potassium (K), sodium (Na), calcium (Ca) and lithium (Li).
transport
blood.
membrane.
April /May 2010)
( Nov/Dec 2008)
( Nov/ Dec 2004).

Cardiac output is the amount of blood delivered by the heart to the aorta per minute. For
normal
adult, the cardiac output is 4- 6 litres/min. The cardiac output is measured by using
three
impedance change.
methods.
UNIT III
UNIT III ASSIST DEVICES AND BIO TELEMETRY

UNIT III PART A
3.1) Distinguish between Internal and External pacemakers.

[M/J 2007], [N/D 2008]
3.2)What are the batteries used for implantable pacemaker?
[N/D 2012]
3.3)What is meant by fibrillation?
[M/J 2009][A/M 2010]
3.4)Calculate the energy stored in 16F capacitor of a DC defibrillator that is charged to a
potential of 5000 Vdc.
3.5)Draw the defibrillator output waveform and indicate the output energy level. [M/J 2012]
3.6)Draw the block diagram of a Bio-Telemetry system. [N/D 2008]
3.7)What are the advantages of biotelemetry system? [M/J 2007] [M/J 2009]
3.8)Specify the frequencies used for biotelemetry.[N/D 2012]
3.9)What is a radio-pill? [N/D 2009][A/M 2010][M/J 2012]
3.10)What is principle of telestimulation? [A/M 2008]
3.11)Classify Pacing modes. (Nov/Dec 07 )
3.12)What is Defibrillator ? State its use. (Nov/Dec 07 )
.1)Why should a patient susceptible to Ventricular fibrillation be watched continuously ?
(May/ June 2006)
3.14) Name three types of Exchangers used in HEMODIALYSIS system. (May/ June 2006)
3.15) Give two important features that demand internal pacemaker usage. (APRIL/MAY 2005)
3.16) Write down the advantage of (a) double modulation (b) Pulse Width Modulation in wireless
telemetry system. (APRIL/MAY 2005).
3.17) List the parameters to be monitored during dialysis. ( April /May 2004)
3.18) Define threshold of hearing. ( April /May 2004).
3.19) List the parameters to be monitored when the heart lung machine is connected to a patient.
( Nov.Dec.2003)
3.20Name the different hearing losses. Which of these effects is being minimized by hearing aid.
( Nov.Dec.2003)
UNIT III PART B
3.1) With respect to the Defibrillator draw the following waveform :(Nov/Dec 07 )
(1) DC fibrillator discharge waveform

(2) Dual peak monophasic defibrillator discharge waveform
(3) Truncated defibrillator discharge waveform .
3.2) Draw the basic circuit diagram of a capacitive discharge type of cardiac
defibrillator and explain the working principle
(Nov/Dec 07 )
3.3)What is Bio Telemetry ? Explain the working of single channel ECG telemetry system.
(Nov/Dec 07 )
3.4) W.r.t. DEFIBRILLATOR draw the following waveforms : (May/ June 2006)
(1) DC fibrillator discharge waveform
(2) Dual peak monophasic defibrillator discharge waveform
(3) Truncated defibrillator discharge waveform
(4) Write the technical properties of Electrodes used in Defibrillator.
3.5) (i) What are the basic requirements to be taken care for any implantable circuit
? (ii) W.r.t Dialyser Perforamance what are CLEARANCE, PRIMING VOLUME,
RESIDUAL BLOOD VOLUME , ULTRAFILTRATION RATE ?.
(May/ June 2006)
3.6 i) Draw the basic circuit diagram of a capacitive discharge type of cardiac defibrillator and
explain the working principle. (APR/MAY 2005)
ii) List out the advantages of Rectangular Wave Defibrillators. (APR/MAY 2005)
3.7) Explain in detail about Pacing modes and pulse generators. (APR/MAY 2005)
3.8) What is Fibrillation ? With a neat diagram, discuss about the equipment used to correct this. What
are the precautions to be followed when such an equipment is used in the hospital? ( Nov.Dec.2003)
3.9) What is a Triggred type pacemaker ? Expalin .Also discuss about its merits and demerits compared
to other types of pacemakers. ( Nov.Dec.2003)
3.10). Write briefly about the power sources used for implantable tykpe of pacemaker . ( Nov.Dec.2003)
3.11).What is meant by Demand Pacemaker ? How is it different from other types of pacemakers ?
State the merits and demerits of this pacemaker.. ( April /May 2004)
3.12). How is atrial defibrillation arrested? Explain with neat diagrams of the setup
used. ( April /May 2004)
3.13)What is meant by Demand Pacemaker ? How is it different from other types of pacemakers ?
State the merits and demerits of this pacemaker.. ( April /May 2004)
3.14)How is atrial defibrillation arrested? Explain with neat diagrams of the setup
used. ( April /May 2004)
UNIT III ASSIST DEVICES AND BIO TELEMETRY

CARD
ARDIAC PACEMAK
MAKERS
1
Give two important factors that demand internal pace makers usage. [A/M2005]
The two important factors that demand internal pace makers usage are
(i). Type and nature of the electrode used
(ii). Nature of the cardiac problems.
(iii). Mode of operation of the pacemaker system.
Distinguish between Internal and External pacemakers. [M/J 2007]

S.No
[N/D 2008]
Internal Pacemakers
External Pacemakers
The pacemaker is a surgically

implanted when if the skin near the
chest or abdomen, with its outputs
leads is connected directly to the heart
muscle.
The pacemaker is placed outside the

body. It may be in the form of wrist
watch or in the pocket, from that one
terminal will go in the heart through the
vein
It requires open chest minor surgery It does not require open chest surgery
to place the pacemaker
It is used for
regularity
There is no safety for the pacemaker, There is 100% safety for circuit from
particularly in case of child carrying the external disturbances.
the pacemaker
temporary heart It is used for permanent heart regularity
3 Classify Pacing modes[N/D 2007]

Based on the modes of operation of the pacemakers, they can be classified into five
types. They are:
i) Ventricular asynchronous pacemaker(fixed rate pacemaker)
ii) Ventricular synchronous pacemaker.
iii) Ventri defibrillator inhibited pacemaker (demand pacemaker)
iv) Atrial synchronous pacemaker.
v) Atrial sequential ventricular inhibited pacemaker.
4
What are the batteries used for implantable pacemaker?[N/D

2012]
The batteries used for implantable pacemakers are
(i).Mercury cell, (ii).Lithium cells, (iii). Nuclear cell
DC DEFIBRILL
ILLATOR
5
What types of electrodes are used in a defibrillator? [A/M 2005]

The electrodes used in a defibrillator are
(i)Internal electrodes - Spoon shaped
(ii)External electrodes Paddle shapped
What are the three types of exchangers used in HEMODIALYSIS system? [M/J
2005]
The three types of exchangers used in HEMODIALYSIS systems
are i)Parallel Flow dialyzer,
(ii).Coil Hemodialyser,
(iii). Hollow Fiber Hemodialyser
What is meant by fibrillation?[M/J 2009][A/M 2010]
The condition at which this necessary synchronism is lost is known as

fibrillation. During fibrillation the normal rhythmic contractions of either atria or the
ventricles are replaced by rapid irregular twitching of the muscular wall
8
Calculate the energy stored in 16F capacitor of a DC defibrillator that is charged

to a potential of 5000 Vdc.
Given Data:
C = 16F
V= 5000
2
E= (1/2) CV
-6
=(1/2) 16 10
=200 Joules
9
25
10
Draw the defibrillator output waveform and indicate the output energy level. [M/J
2012]
FREQUENCY SELEC
LECTION AND BIO-TELEM
LEMETRY
10 What is the modulation techniques used for biotelemetry? Mention the reason for
adopting that modulation scheme.[N/D 2004]
The two different modulation techniques used for biotelemetry are
i)Double Modulation
ii)Pulse Width Modulation
The reason for adopting such a scheme
i)Double modulation gives
a) better
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 sub modulators can be a FM (frequency modulation) system,
or a PWM
(pulse width modulation) system or a final modulator is practically always an FM

system.
11 Draw the block diagram of a Bio-Telemetry system. [N/D 2008]
Electrodes
Biological
signal(ECG,EEG)
Transducer
Amplifier &
Filter(Conditioner)
Transmisssion
channel
12 What are the advantages of biotelemetry system? [M/J 2007] [M/J 2009]
Output unit
The advantages of biotelemetry systems are (Video recorder
Tape recorder,
(i). It is used to record the biosignals over long
periods and while the
C.R.O)
ies.
Patient is engaged in his normal
activit
(ii). The medical attendant or computer can easily diagonise the nature
of Disease by seeing the telemeter biosignals without attending
patient Room
(iii). Patient is not disturbed during recording.
(iv). For recording on animals, particularly for research, the biotelemetry
is greatly used.
13 Specify the frequencies used for biotelemetry.[N/D 2012]
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.
RADI
ADIO-PILL
ILL AND TELE-STIM
TIMULATION
14 What is a radio-pill? [N/D 2009][A/M 2010][M/J 2012]
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.
15 What is principle of telestimulation? [A/M 2008]
Telestimulation is the measurement of bio logical signals over long distance.
UNIT IV
RADIOLOGICAL EQUIPMENTS
UNIT IV- PART A

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4.1)State different types of radiation generated from radio isotopes.

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May/June 2012
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19
4.2)What is meant by ionizing radiation?
Nov/Dec 2012, Nov/Dec 2011
4.3)In what way X-ray equipments are useful for diagnostic purpose?
4.4)Distinguish between hard X-ray and soft X-ray.
4.5)What is angiography?
Apr/May 2010
Nov/Dec 2009
Nov/Dec 2008
4.6)State few radio isotopes used for diagnostic purpose. Apr/May 2010, May/June 2009, Nov/Dec 2011
4.7)Differentiate between radiography and fluoroscopy. May/June 2007, Nov/Dec 2008
4.8)List out safety precaution to be taken while handling radio isotopes.
Nov/Dec 2009, Apr/May 2008
4.9)Name two equipments used in radiation therapy.
4.10)What is radiation therapy?
May/June 2007
Apr/May 2008
4.11) What is Angiography ? (Nov/Dec 07 )

4.12)State
the principle
by which body organs could be visualized by radioisotope
methods(Nov/Dec
07 )
4.1)Define let go current level. (May/ June 2006)
4.14) What is the basic difference between coherent fiber bundles and non-coherent bundles? (May/
June 2006)
4.15) Name the types of scanning modes used in modern instrumentation. (APRIL/MAY 2005)
4.16) What are the types of Lasers used for therapeutic purposes. (APRIL/MAY 2005)
4.17) Define Micro shock and Macro shock.
( April /May 2004)
4.18) What is the principle of Cryogenic technique? Give any two medical applications of the
same. ( April /May 2004)
4.19)Mention the scheme of modulation techniques used for biotelemetry. Also mention the reason
for such scheme ( Nov.Dec.2003)
4.20)What is the frequency of operation of ultrasound diathermy ?What is the reason for this
frequency selection ? ( Nov.Dec.2003)
UNIT IV- PART B
4.1) Explain in detail an X-ray Image Intensifier with appropriate diagram (Nov/Dec 07 )
4.2)Discuss in detail the Scintillation detectors for gamma radiations with necessary diagrams
(Nov/Dec 07 )
4.3)With a neat block diagram explain the instrumentation system for radioisotope procedures.
(Nov/Dec 07 )
4.4)Write short notes on Fluroscopy. (Nov/Dec 07 )
4.5) Write down the salient features of Frequency Selection with respect to Biotelemetry.

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(May/ June 2006)

4.6) Draw the block diagram of a single channel telemetry system suitable for
ECG Transmission (May/ June 2006)
4.7) Write down the salient features of Microwave Diathermy . (May/ June 2006)
4.8) With the help of a suitable figure, explain Phrinic Nerve stimulator. (May/ June 2006)
4.9) List out the needs for Biotelemetry system. (APR/MAY 2005)
4.10) Draw the block diagram of a typical biotelemetry transmitter and a receiver. (APR/MAY 2005)
4.11) What are the advantages of Diathermy? (APR/MAY 2005)
4.12) Explain the Microwave Diathermy with a block diagram Representation. (APR/MAY 2005)
4.13)Write in detail about short wave diathermy. What are its applications. ? ( Nov.Dec.2003)
4.14)What is a Radio Pill ?Describe briefly. ( Nov.Dec.2003)
4.15)Discuss about intensity duration curve What is its use.? ( Nov.Dec.2003)
UNIT IV - RADIOLOGICAL EQUIPMENTS

IONIZING RADIATIO
TION
1. State the different types of radiation generated from radio isotopes. May/June
2012
Different types of radiation generated from radio isotopes
are i.Alpha Emission
ii. Beta Emission
iii. Gamma Emission
2. What is meant by ionizing radiation?
Nov/Dec 2012, Nov/Dec
2011
The rays coming out from x rays or radioactive materials has the characteristics of ionizing the
gases through which it travels. This is known as ionizing radiation.
3. What is the need for ionizing radiation?
May/June 2009
The ability of ionizing radiation to penetrate materials that are opaque to visible light is
utilized in numerous techniques in medical diagnosis. The ionizing effects of radiation are also
used for the treatment of certain diseases, such as cancer. It is used in imaging as an aid to
diagnose or as a screening tool.
DIAGNOST
OSTIC X-RAY EQUIPMENTS
4. List the characteristics of X-ray.
2012
Characteristics of X-ray are
i.
They travel in a straight line with the speed of light in
vacuum.
ii. They expose photographic films.
iii. They ionize gases
May/June
iv.
They penetrate matter.
v. They cause emissions of electron from metals

vi. They are not deviated by electric or magnetic fields.
5. In what way X-ray equipments are useful for diagnostic purpose? (Apr/May 2010)
X-ray equipments are useful for diagnostic purpose such
as, i. For detecting fractures in bones.
ii. In Angiography X-ray is mainly used, to study blockage in blood
vessel. iii.
In fluoroscopy, it creates a moving x-ray image.
iv. It is used to study the digestive and endocrine systems with the help
of contrast medium.
6. Distinguish between hard X-ray and soft X-ray.
Nov/Dec 2009
S. no
Soft X-rays
Hard X-rays
1
Low penetrating power
High penetrating power
2
They have long wavelength
They have short wavelength
3
Low frequency
High frequency
Mainly used for diagnostic purpose, such Mainly used for therapeutic purpose,
4
as detecting fractures and the presence of such as treating certain types of skin
foreign matter like bullet in human body. disease and cancer.
7. What is angiography?
Nov/Dec 2008
Angiography is a medical imaging technique in which an X ray picture is taken to visualize the
inner opening of blood filled structures, including arteries, veins and the heart chambers. An
X- ray contrast medium is injected into the blood vessel and an X-ray called an angiogram is
taken.
USE OF RADIO ISOT
SOTOPE IN DIAGNOSIS
8. What is a betatron? What is its application?
Nov/Dec 2012
Betatron is a device which produces high energy X-ray beams and electron beams of
varying energies. It is a circular induction accelerator used for electron acceleration. The
energy produced by it is as high as 45 MeV.
Applications of betatron are
i. It is used in treating tumors in trunk and pelvis.
ii. It is used in radio therapy for cancer treatment.
9. List few radio isotopes used for diagnostic purpose.
Apr/May 2010, May/June 2009, Nov/Dec 2011
Radio isotopes used for diagnostic purpose are
i.
Iodine - 123
: Used for diagnosis of thyroid function
ii.
Bismuth - 213
: Used for targeted alpha therapy especially cancers
iii.
Cobalt
: Used for external beam radio therapy
iv.
Copper - 64
: Used for genetic disease
10. List out safety precaution to be taken while handling radio isotopes.
Nov/Dec 2009, Apr/May 2008
Safety precaution to be taken while handling radio isotopes are
i. Radioactive materials should be kept in thick walled lead containers so that
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radiation cannot penetrate them.

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ii.
iii.
Lead aprons and lead gloves should be worn.

All radioactive samples should be handled by a special remote control
process using robots.
11. How radio isotopes are used for therapy?
Apr/May 2011
Radio isotopes are used to identify the tumor location, detect any urinary tract obstruction, in
diagnosis of coronary heart disease and for giving external beam therapy.
RADI
ADIATION THERAPY
12. What is radiation therapy?
Apr/May 2008
Certain diseases and tumors can be treated by ionizing effect of x-rays. The use of radiation for
the treatment of disease is called as radiation therapy. In dermatology soft x-rays are used for
the
treatment of skin diseases. Hard x-rays are used in treatment of deep seated tumors.
13. Name two equipments used in radiation therapy.
Equipments used in radiation therapy
are i.Cobalt 60 machine
ii. Medical linear accelerator machine
May/June 2007
14. Distinguish between radiography and fluoroscopy.May/June 2007, Nov/Dec 2008

S.No
Radiography
Fluroscopy
X-ray
image
is
developed
by
X-ray
image
is
developed by
1
photosensitive film
photoelectric effect and fluoresence.
Patient is not exposed to x-rays
Patient is exposed to x-ray during the
2
during examination of the x-ray
examination of the x-ray image
image.
The image can be obtained for
Immediately image can be seen and
developing the film and the
3
exqamination can be finished with a
examination cannot be made before
short time.
developing the film
Movement of organs cannot be
4
Movement of organs can be observed
observed
UNIT V
RECENT TRENDS IN MEDICAL INSTRUMENTATION

UNIT V PART A
5.1)Define Micro Shock. [M/J 2007]
5.2)What are the advantages of performing surgery using LASER? [A/M 2008][N/D 2009]
5.3) Define Macro Shock. [N/D 2009]
5.4)What are the applications of laser in medicine?
5.5)What is meant by diathermy? [A/M 2010]
5.6)List the applications of Endoscope.
5.7)What is the use of laparoscope?

5.8)What is the purpose of using resuscitation unit?
5.9)What are the two methods of shortwave diathermy?
5.10)What are the devices used to protect against electrical hazards?
5.11) Distinguish between Micro shock and macro shock . (Nov/Dec 07 )
5.12) What is Diathermy? List its types (Nov/Dec 07 )
5.1) Define let go current level. (May/ June 2006), [A/M 2008]
5.14). Draw the waveforms generated in a medical stimulator. ( April /May 2004)
5.15).What is a Radio pill ? ( April /May 2004)
5.14).What is the basic difference between coherent fiber bundles and non-coherent bundles
(May/ June 2006)
5.15) Name the types of scanning modes used in modern instrumentation. (APRIL/MAY 2005)
5.16) What are the types of Lasers used for therapeutic purposes . (APRIL/MAY 2005)
5.19.) What is medical thermography ? Mention its applications. ( Nov.Dec.2003)
5.20) Mention the types of Lasers used in medical field . ( Nov.Dec.2003).
UNIT V PART B
5.1) Discuss in detail the different applications of Lasers in medicine (Nov/Dec 07 )
5.2) Explain the physiological effects of current at 50Hz (Nov/Dec 07 )

5.3)With reference to Electrical safety explain (Nov/Dec 07 )
1) Ground Fault Circuit Interpreter
2) Protection by low voltage
5.4) (a) Explain : .
(May/ June 2006)
(i) Macro shock Hazards and

(ii) Micro shock Hazards
5.5) Write down the typical applications of bio-telemetry. (May/ June 2006)
5.6) Explain the basic concepts (including the modulation types )of radio transmission used
in
Bio-telemetry.
5.7)With reference to Electrical safety explain : (APR/MAY 2005)
i) Physiological effects of electricity.
ii) Ventricular fibrillation
iii) Isolated power systems
iv) Macro shock hazards.

5.8)List out the characteristics of different types of LASERS used in Biomedical field with
particular reference to types of beam and the fields of applications. (APR/MAY 2005)
5.9) What is Cryogenic Technique ?How is it useful in the hospital ? Expalin. What are
the precautions to be followed during application ? ( Nov.Dec.2003)
5.10) What are the methods by which the electrical safety of the patient in the hospital is ensured ?
Discuss in detail. ( Nov.Dec.2003)
5.11) Discuss about the applications of high frequency generator as a surgical knife. What are
the hazards associated with this. (April/ May 2004)
UNIT-V RECENT TRENDS IN MEDICAL INSTRUMENTATION

1. What is medical thermography? Mention its applications. [N/D 2004] [N/D 2005]
Thermography is the process of recording true thermal image of the surfaces of objects under
study. It displays images representing the thermal radiation of skin areas. Thermogram
contain both qualitative and quantitative information relevant to the image itself and to
temperature.
Medical applications of thermography
i)Tumors
ii) Inflammation
iii) Diseases of peripheral vessels
iv) Orthopedic diseases
2. List the types of lasers used in medical field [N/D 2004]
The types of lasers used in medical fields are
i). Pulsed Nd-YaG laser
ii). Continuous laser. Co 2 laser
iii). Continuous wave organ ion laser
3. Define - Let-go current [M/J 2006] [A/M 2008]
Let go current is the minimum current to produce muscular
contraction. For menabout 16mA
For Womenabout 10.5 mA
4. Define Micro Shock[M/J 2007]
A physiological response to a current alied to the surface of the heart that
results in unnecessary stimulation like muscle contractions or tissue injury is
called as microshock.
5. What are the advantages of performing surgery using LASER? [A/M 2008][N/D
2009]
The advantages of performing surgery using LASER are
i)Highly sterile
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34
ii) Non-contact surgery

iii)Highly localized and precise
iv)prompt surgery
v)short period of surgical time
6. Define Macro Shock [N/D 2009]
A physiological response to a current applied to the surface of the body
that produces unwanted stimulation like tissue injury or muscle contractions is
called as macro shock.
7. What are the applications of laser in medicine?
Laser is used in ophthalmology (eye problem), Gynecology (fertility), Plastic
surgery, skin cancer etc.
8. What is meant by diathermy? [A/M 2010]
Diathermy is the treatment process by which, cutting coagulation of tissues
are obtained.
9. List the types of diathermy.
The types of diathermy are
i)Short wave diathermy
ii)Microwave diathermy
iii)Ultrasonic diathermy
iv)Surgical diathermy
10. What are the types of thermography?
The types of thermography are
i). Infrared thermography
ii) Liquid crystal thermography
iii). Microwave thermography
11. What are the different types of current that are used for medical applications?
The different types of current are Threshold current, pain current, let -go current,
paralysis current, fibrillation and defibrillation current.
12. Define - Endoscopes and mention some of its types.
Endoscope is a tubular optical instrument to inspect or view the body cavities which
are not visible to the naked eye normally.
Types of endoscopes are cardioscope, bronchoscope, laparoscope, otoscope, gastroscope
etc.
13. What are the devices used to protect against electrical hazards?
i).Ground fault interrupt
ii). Isolation transformer
14. What are the two methods of shortwave diathermy?

The two methods of shortwave diathermy
are i)Capacitive method
ii) Inductive method
15. What is the purpose of using resuscitation unit?
Resuscitation unit is generally used in intensive care unit (ICU). In modern hospitals
the resuscitation units are in the form of a mobile trolley.
16. List the applications of Endoscope.
Endoscopes are used in hospitals for examination, treatment of disease and surgery.
17. What is the use of laparoscope?
The laparoscope is used for analyzing abdominal related diseases and to
perform operations in the abdominal region.
Introduction
Introduction:
The human body is the most deeply studied and frequently portrayed object in the
history. Despite its familiarity, it is instinctively absorbing and eternally fascinating.
The number of humans in the world is racing towards seven billion. More than
5 babies are born every minute, while 150,000 people die daily. With the population increasing
by almost three humans per second. Each of these people lives, thinks, worries, and day
dreams with and within the most complex and marvelous of possessions- a human body. An
enduring feature of this body and its behavior is self-curiosity. We continually look inside
ourselves in enormous and ever-increasing detail in order to comprehend the action within.
Levels of organization:
The body is viewed to be a series of integrated systems. Each system carries out one
major role or task. In the cardiovascular system, for example the heart pumps blood
through
vessels, to supply every body part with essential oxygen and nutrients. The systems are in
turn composed of main parts known as organs. The stomach, intestines and liver are the
organs of digestive system. Moving through further levels in the hierarchy the organs consist of
tissues and tissues made up of cells.
Cells are often called the microscopic building blocks of the body. However they
are active and dynamic, they continually grow and specialize function die and replenish
themselves by the millions every second. The whole body contains 200 different kinds.
Science in increasingly able to deliver deeper than cells to the organelles within them and
onwards and inwards to the ultimate components of ordinary matter molecules and atoms.
Anatomy:
The study of the bodys structure and how it cells, tissues and organs are assembled is
known as human anatomy. In reality, the inside of the body is a crowded place. Tissues
and organs push and press against one another. There is no free space, and no stillness either.
Body parts shift continually in relation to each other. We move about, breathe, pump
blood shift digestive matter and eat. For example, swallowed food does not simply fall
down inside the gullet {oesophagus}. The gullet is normally pressed flat by internal chest
pressure so that food must be forced down into the stomach by waves of muscular contraction.
Physiology:
The anatomical drawing of a large factory or orifice would show the arrangement of
rooms, location of machinery and furniture, and service ducts for electricity water and
service
ducts for electricity, water and air-conditioning. For a rounded understanding we need to see
the premises in action, with people goods and information on the move. Similarly human
anatomy is combined with its twin; physiology focuses on the dynamic chemical minutiae at
atomic ionic and molecular level. It investigates the working of such processes as enzyme
action, hormone stimulation, DNA synthesis and how the body stores and uses energy from
food. As researchers stare harder and more physiological secrets are unlocked. Much of
this work is directed at preventing, treating or alleviating disease and allows us to appreciate
the latest wonder drug or take a meditation
Health and illness:

Medical
amasses
of evidence
everyinheritance
year for which
the best
stay healthy
andscience
avoid disease.
At mountains
present an individuals
genetic
is aways
mattertoof
chance in the given starting point for maintaining healthy and wellbeing. In coming
years treatments such as pre-implantation genetic diagnosis {PGN} carried out as part of
assisted reproductive techniques such as In vitro-fertilization {IVF} and gene therapy could
remove or negate some of these elements. Many aspects of upbringing have a major impact
on health. Factors such as diet, whether it is rich, bringing with it the risk of obesity or too
poor leading to malnutrition particularly affect children as their bodies are still developing.
The body can be affected by different types of disorder such as infection by a virus or
bacteria. Injuries resulting from an accident or long-term repetitive activities, inherited faulty
genes or exposure to toxins in the environment.
Body Cell:
Everyone is made up of Billions of cells, which are the basic structural units of the body.
Bones, muscles, nerves, skin, blood and all other tissues are formed from different types of
cells.
Each cell has a specific function but works with other types of cells. Each cell has a
specific function but works with other types of cells to perform the enormous number of tasks
needed to sustain life. Most body cells have a similar basic structure. Each cell has an outer
layer (called cell membrane) and contains a fluid material (cytoplasm). Within the
cytoplasm are many specialized structures(organelles). The most important organelle is the
nucleus which contains
vital generic material and acts as the cells control centre.
The structure of DNAs is like spiral ladder DNA contains all the vital generic
information and instruction codes necessary for the maintenance and continuation of
life.
Skeleton:
The skeleton is a mobile frame work made up of 201 bones, approximately half of which
are in the hands and feet. Although individual bones are rigid, the skeleton as a whole
is remarkably flexible and allows the human body a huge range of movement. The Skelton
serves
as an anchorage for the skeletal muscles and as protective cage for the bodys internal organs.
Female bones are usually smaller and higher than male bones, and the female pelvis is
shallower and has wider cavity.
Head:
In a new born body, the head accounts for one quarter of total body length, by adulthood,
the proportion has reduced to one eighth contained in the head are the bodys main sense organs,
eyes, ears, olfactory nerves that defect smells, and the taste buds of the tongue. Signal from
these
organs pass to the bodys great coordination centre. The brain housed in the protective bony
dome of the skull. Hair on the head insulates against heat loss, and adult males also grow
thick facial hair. The face has three important openings two nostrils through which air passes
and the mouth which takes in the nourishment and helps from speech. Although all heads are
basically similar, differences in the size, shape and color of features produce an infinite
variety of appearances.
Body organs:
All the body organs except for the brain are enclosed within the trunk or torso(the body
apart from the head and limbs). The trunk also contains two large cavities separated by
a muscular sheet called the diaphragm. The upper cavity contains the st omach, intestines, liver
and pancreas which all play a role in digesting the food. Also within the trunk are the
kidneys and bleeder, which are part of the urinary system, and the reproductive organism
which hold the seeds of new human life. Modern imaging techniques such as contrast X-rays
and different types of scans make it possible to see and study body organs without eh need
to cut through their protective covering of skin, fat, muscle and bone
Bones and joints:

Bones form the bodys hard, strong skeletal framework. Each bone has a held compact
exterior surrounding a spongy, lighter interior. The long bones of the arms and legs, such as
the femur (thick bone) hale a central cavity containing bone marrow,. Bones are composed
chiefly of calcium, phosphorous and a fibrous substance known as collagen. Bones must at
joints, which are of several different types. For example, the hip is ball and socket joint that
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allows the femur a wide range of movement, whereas finger joints are simple hinge joints that
allow only bending

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and straightening. Joints are held in place by bands of tissue called ligaments. Movement of
joint is facilitated b the smooth hyaline cartilage that covers the bone ends and by the
synovial membrane that lines and lubricates the joint.
Muscles:
There are three main types of muscles skeletal muscle (also called voluntary muscle
because it can be consciously controlled); smooth muscle (also called involuntary
muscle because it is not under voluntary control) and specialized muscle tissue of the heart.
Humans have more than 600 skeletal muscles which differ in size and shape according to the
jobs they do. Skeletal muscles are attached directly or indirectly (via tendons) to bones and
work in opposing pairs (one muscle in the pair contracts while the other relaxes) to produce
body movements as diverse as making threading a needle and an array of facial expression.
Smooth muscles occur in the wall of internal body organs and perform actions such as forcing
food through the intestines, contracting the uterus (womb) In child birth and pumping blood
through blood vessels some other muscle in the body.
Iris:
The muscle fibers contract and dilate (expand) to alter pupil size.
Tongue:
Interacting layer of muscle allow great mobility
Ileum:
Opposing muscle layers transport semi-digested food.
Movement of the forearm:

Controlled movement of the limbs relies on coordinated relaxation and contraction of
opposing muscles. To raise the forearm, the biceps (two-rooted muscle) contracts and shortens
while the triceps (three-rooted muscle) relaxes, the reverse occurs when the forearm is lowered.
Muscles 2:
Muscles of facial expression:
A single expression is the result of movement of many muscles.
H a nds :
The human hand is an extremely versatile root, capable of delicate manipulation as well
as powerful gripping actions. The arrangement of its 27 small bones, moved by 37
skeletal
muscles that are connected to the bones by tendons, allows a wide range of movements.
Out ability to bring the tips of out thumbs and fingers together combined with the extra
ordinary sensitivity of our fingertips due to their rich supply of nerve endings, makes out
hands uniquely dextrous.
Feet:
The feet and toes are essential elements in body movement. They bear and propel the
weight of the body during walking and running and also help to maintain balance during
changes
of body position. Each foot has 26 bones, more than 100 ligaments and 33 muscles some
of which are attached to the lower leg. The heel pad and the arch of the foot act as shock
absorbers, providing and cushion against the joints that occur with every step.

5 units
Physiological system
2.1.Information Processing
The human body is alive with information. Being a complex, dynamic mechanism, its
interacting and interdependent parts require control and co-ordination. This is done by passing
information
between them. Two body systems are responsible for command-control and data management
The nervous and the endocrine

systems.
Information processing involves inputs evaluation and decision making followed by
outputs. The body has inputs from the various senses such as sight and hearing. Its brain is
CPU (Central Processing Unit) whose outputs control the physical action of muscles and c
hemical responses of glands. Both nerves and hormones are involved in data management.
2.1.1.Electrical and chemical pathways
The language of the nervous system is tiny electrical impulses. They are small and fast each
just one-tenth of a volt in strength and lasting hardly one-thousandth of a second and
numerous. Every second millions pass through the networks of long pale, string like
pathways called nerves. Informations from the senses flow to the brain as electrical impulse. Here it is
shifted,
analyzed and evaluated causing millions more signals to pass around and within the
brain between numerous, complex areas. Decisions are reached and command messages are
produced
in the form of electrical impulses. The brains electrical output travels along motor nerves to the
muscles to stimulate and co-ordinate their contraction for movements. Different
information carriers-hormones-instruct the endocrine glands on the timing and quantity of
secretion required for the desired effect. More than 50 hormones circulate in the blood
stream. The specific molecular structure of each hormone stimulates only cells with
suitable receptors on their
surface, instructing the cells to carry out certain procedures. In general nerves work fast
within
fraction of a second. Most hormones function over longer times within minutes, days or
even
months. Long-lasting effects as in growth of hormones are continuously secreted over
many years, as individual dose would last only few days.
2.2.Body Clock Input

The body has built-in rhythms of activity. People in experimental timeless surroundings
(of constant light, temperature food availability and other conditions) still tend to sleep, wake
,
eat , become alert and move about in a roughly 24 hours style. A small part of the brain known
as the suprachiasmat ic nucleus located just above the place where the visual or optic nerves
meet, is the body clock. It is continually adjusted by external cues such as light levels and
temperature fluctuations and our mental acknowledgement of clock times. In turn, it feeds
information to many brain parts that deal with cyclical activities such as hormone release,
tissue repair, body temperature control, urine production and digestive matter. In this way,
the natural rhythms of the body are co-ordinate.
2.2.1.The Importance of Input

5 units
As can be seen by the workings of the body clock, feeding information into the brains
processing center relies on more than the five senses. The continuing environmental adjustment
of the body
clock is one example of more subtle and complex sensory input within the body, There
are
thousands of micro receptors that continually monitor variables, for example oxygen,
waste carbon dioxide and blood glucose. These data feed to automatic or subconscious parts
of the brain, which make decision that, do not register in the conscious mind. In this way
a huge amount of information processing occurs, of which we are hardly ever aware.
2.3.Nerves and Neurons

The brain has over 100 billion nerve cells or neurons, and the body co ntains
millions
more. Bundle of nerve fibers projecting from the neurons from body-wide networks of
nerves. Neurons are highly specialized in their structure, function and the way they link
together to communicate.
Like all other cells, typical neurons have a main cell body with a nucleus. But a neuron
also has a long wire. Process that read out to transmit messages to other neurons at
junction called synapse. These processes are of two kinds. Dendrites receive messages from
other neurons or from nerve-like cells in sense organs and conduct them towards the cell
body of neurons. Axons convey messages away from the cell body to other neurons or to
muscle or gland cells. Dendrite tend to be short and have many branches, while axons are
usually longs and branc hless along their length. Neurons in the brain and spinal cord are
protected and nurtured by supporting nerve cells known as glial cells.
2.3.1.Types of Neurons
The shapes and sizes of the bodies of neuron cells vary greatly as do the type,
number and length of their projections. Neurons are classified according to the number of
process that
extends from the cell body. Bipolar neurons are the original neuronal design in the embryo,
but
adulthood, they are found in only a few locations, such as the eyes ret ina and the olfactory nerve
in the nose. Most neurons in the brain and spinal cord are multipolar, unipolar neurons
are present mainly in the sensory nerves of the peripheral nervous system.
Unipolar Neuron: - A single short process, an axon extends from the cell body and splits
into tow.
Bipolar Neuron: - The cell body is located between two processes-an axon and a
dendrite.
Multipolar Neuron: -These have three or more processes several dendrites and one
axon.
2.4.ORIGIN OF BIOPOTENTIALS:
Nerve cells or neurons are excitable. When stimulated, they undergo chemical changes
that produce tiny traveling waves of electricity.- nerve signals or impulses. These pass to
other neurons, eliciting similar response from them.
Throughout the nervous system, information is conveyed as tiny electrical signals called
nerve impulses or action potentials. These impulses are the same all over the body about
100
milli volts in strength and lasting just 1 millisecond. The information carried depends on
their position in the nervous system, and their frequency from one impulse every few
seconds to several hundreds per second. Typically when a neuron receives enough pulses
from other neurons it fires one of its own as wavelike movements of ions (electrically
changed particles) impulses jump from one neuron to another at junctions known as synapses.
2.4.1.IMPULSE MOVEMENT WITHIN A NERVE CELL:

The nerve impulse is based chiefly on movement of positively charged sodium and
potassium ions through the neurons cell membrane. Impulses travel at speeds between 1 and
120 m/s. depending on the type of nerve. Movement is much faster in sheathed
(myelinated),axons in which the action potential jumps along successively myelincoated sections from one node to the next.

5 units
2.4.1.Nerve Impulse
Nerve
cells or neurons are excitable. When stimulated they undergo chemical changes
that
otherproduce tiny travelling waves of electricity nerve signals or impulses. These pass to
neurons, exciting similar responses from
them.
Throughout
theornervous
system, information
is conveyed
tiny all
electrical
called
nerve
impulses
action potentials.
These impulses
are theassame
over thesignals
body
about 100
millivolts (0.1 volts) in strength and lasting just 1 millisecond. The information carried
depends on their position in the nervous system and their frequency from one impulse every
few seconds to several hundreds from other neurons it fires one of its own, as wave-like
movements of ions
(electrically changed particles) .Impulses jump from one neuron to another at junctions
known
as synapses.
2.4.2.Crossing the gap between neurons
When and electrical impulse arrives at the junction (synapse) it triggers the release of
chemicals
called neurotransmitters. They cross the incredibly thin gap (synaptic cleft) between
the membranes of presynaptic (sending) and postsynaptic neurons (receiving). They either
trigger a new impulse in the receiving neuron or actively inhibit in from firing.
2.4.3.Resting Potential
With no impulse, there are more positively charged ions, particularly sodium ions outside the
cell
membrane and more negative ions inside. This produces an electrical resting potential of
-70
millivolts. The membrane is polarized, with the inside
negative.
2.4.4.Depolarization
During this phase (depolarization) positive sodium ions rush in through ion rush in through
ion
channels in a patch of neuron membrane. The membrane is first depolarized then its polarity
is reversed to become slightly positive, resulting in an action potential of +30 millivolts on
the inside.
2.4.5.Repolarization
Positively charged potassium ions flow in the opposite direction, restoring the charge
membrane and the next and so on. The impulse moves along the membrane as a wave of
depolarization and repolarization.
2.4.6.Excitement and Inhibition

When neurotransmitters on their receptors sites they can either excite or inhibit the
receiving
cell. Both responses are equally valuable in relaying messages through the nervous systems.
To excite a receiving cell, positive sodium ions flow into it, depolarizing the membrane in a
similar way to a nerve impulse. The depolarizing effect spreads through the membrane
for a few milliseconds, fading as it does so. If further signals enter the cell, they may
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5 units
become strong enough to file a new nerve impulse. To inhibit the cell, negatively charged
particles rush into the cell. The negative effect spreads through the cell membrane and prevents
its excitement.
2.4.6.1.Parts of Neurons: - Projection of neurons: collect nerve impulses from other
neurons or sensory nerve endings.
2.4.6.2.Dendrites: - Main part of neuron, containing the nucleus and
cell.
2.4.6.3.Neuron fibril node: - Also called node of ranvier, portion of axon not covered
by
myelin.

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2.4.6.4.Schwann cell: Sheet-like cell that grows around a portion of axon (fiber) to
form the
myelin sheath.
2.4.6.5.Myelin Sheath: Also called neurilemma or Schwann sheath; spiraling structure
of fatty myelin that helps to speed an impulse and prevent it fading or leaking.
2.4.6.6.Axon: Main nerve fiber of the neuron conveys impulses away from the cell body.
2.4.6.7..Neurotubule: Specialized micro tube that works as a conveyer
belt to bring synaptic vesicles from the cell body to the axon terminal.
2.4.6.8.Synaptic Knob: Enlarged end of axon terminal.
2.4.6.9Membrane Channel Protein: Complex protein embedded in cell membrane;
when enough ions flood through the channel they cause a response in the receiving cell.
2.4.6.9.Receptor: - Sits in membrane channel into which neurotransmitter molecules
slot, altering the shape of the channel to admit charged ions.
2.4.6.10.Synaptic Cleft: - Fluid-Filled gap between the sending and receiving neuron just 25
nanometers wide.
2.4.6.11.Microfilament: - Thinnest element of the flexible, supporting scaffolding found
in most cells.
Presynaptic Membrane: Membrane of sending cells axon.
Postsynaptic Membrane: Membrane of receiving cells dendrite.
2.5.Respiratory system
Respiratory system a pneumatic systeman air pump (diaphragm ) alternately creates negative and positive pressures in a
sealed chamber (thoriac cavity) and causes air to be sucked into and forced out of a
pair of
elastic bags (lungs).
The respiratory system supplies the oxygen needed by the body cells and carries off
their carbon dioxide waste.
Inhaled air passes via the trachea (windpipe) through two narrower tubes, the bronchi
to the lungs.
chambers called alveoli
Each lung comprises many fine, branching tubes called bronchioles that end in

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tiny clustered

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Lungs -outside environment through a passage way comprising nasal cavities,

pharynx, larynx, trachea, bronchi, and bronchioles.
Oxygen is taken into the blood from the incoming air and carbon dioxide is
transferred from the blood to the air
Thus, the blood circulation forms link in the supply of oxygen to the tissues and in
the removal of gaseous waste products of metabolism.
Gases cross the thin alveolar walls to and from a network of tiny blood vessels.
Intrercostal (rib) muscles and the muscular diaphragm below the lungs operate the
lungs like bellows, drawing air in and forcing it out at regular intervals.
2.6.Urinary system
The urinary system filters waste products from the blood and removes them from
the body via a system of tubes.
Blood is filtered in the two kidneys which are fist-sized. Bean-shaped organs.
The renal arteries carry blood to the kidneys.
The renal veins remove blood after filtering
Each kidney contains about one million tiny units called nephrons.
Each nephron is made up of tubule and a filtering unit called glomerulus, which consists
of a collection of tiny blood vessels surrounded by the hollow Bowmans capsule.
The filtering process produces a watery fluid that leaves the kidney as urine.
The urine is carried via two tubes called ureters to the bladder where it is stored until
its release from the body through another tube called urethra.
2.7.Nervous system
The nervous system -control and communication network.

Rapid communications between various parts, the effective integrated activity of
different organs and tissues and coordinated contraction of muscle are almost entirely
dependent upon the nervous system.
The brain consists of three parts, namely the cerebrum, cerebellum, and the brain stem.
2.7.1.cerebrum
The cerebrum consists of two hemispheres right and left.
Each hemisphere is sub divided into two lobes.
Frontal lobe and temporal lobe In the left hemisphere
Parietal and occipital lobe in the right hemisphere.
The outer layer of the brain is called the cerebral cortex.
All sensory inputs from various parts of the body eventually reach the cortex.
Various areas are responsible for hearing, sight, touch and control of the
voluntary muscles of the body.
2.7.2.Cerebellum
The cerebellum acts as a physiological microcomputer which intercepts various sensor
y and motor nerves to smooth out the muscle motions which could be otherwise jerky.
It also consists of two hemispheres which regulate the coordination of
muscular movements elicited by the cerebrum.
The cerebellum also enables a person to maintain his balance
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2.7.3.Brain stem
Brain stem- connects the spinal cord to the center of the brain just below the
cerebral cortex.
Essential parts
medulla oblongata
The pons
Midbrain
Diencephalon thalamus, hypothalamus.
2.7.4.spinal cord:
The spinal cord is a downward continuation of medulla oblongata
The cord consists of white matter on the surface and gray matter inside.
The cord containing motor and sensory fibres running between the brain and the
body and reflex action
Billions of specialized cells neurons are functionally active as signal transmitters
Fundamental property of neuron- is the ability to transmit electrical signals,
called nerve impulses in response to the changes in their environment
2.7.4.5.Neuron
A typical neuron consists of a nucleated cell body and has several processes or branches.
The size and distribution of these branches vary greatly at different sites in cells
with different functions, but two main kinds are the axon and the dendrite.
2.8.Endocrine system
The endocrine system works by using harmones which are carried through
circulatory system.
The harmones are generated in the endocrine glands.
The principal endocrine gland is PITUTIARY which governs several other
endocrine glands.
The pitutiary is controlled by hypothalamus.
The thyroid gland secretes thyroxin which increases the metabolism in the body.
The deficiency of thyroid gland secretes thyroxin which increases the metabolism
of the body.
The adrenal gland secretes corticoids and they regulates the metabolism of glucose.
A deficiency of insulin results in increase glucose in the blood which leads
the condition called diabetes.
2.9.Ear
The ear is the organ of hearing and balance.

The outer ear consists of a flap called the auricle or pinna and the auditory canal.
The main functional parts-the middle and inner ears are enclosed within the skull.
The middle ear consist of three tiny bones known as auditory ossicles and the
eustachian tube, which links the ear to the back of the nose.
The inner ear consist of the spiral-shaped cochlea and also the semicircular canals and
the vestibule which are the organs of balance.
Sound waves entering the ear travel through the auditory canal to the
tympanic membrane (ear drum) where they are converted to vibrations that are
transmitted via the ossicles to the cochlea.
Here the vibrations are converted by millions of microscopic hairs into electrical
nerve signal to be interpreted by the brain.
2.10.Eye
The eye is the organ of sight.

Two eyeballs, protected within bony sockets called orbits and on the outside by
the eyelids, eyebrows, and tear film are directly connected to the brain by the
optic
nerves.
Each eye is moved by six muscles.
Which are attached around the eyeball.
Light rays entering the eye through the pupil are focused by the cornea and lens
to form the image on the retina.
The retina contains millions of light-sensitive cells, called rods and cones
which convert image into a pattern of nerve impulses These impulses are
transmitted along the optic nerve to the brain.
Information from the two optic nerves is processed in the brain to produce a
single coordinated image.
2.11.Body cells
Every one is made up of billions of cellsWhich are the structural units of the
body.bones, muscles, nerves, skin blood, and all other body tissues are formed from
different types of cells.Each cell has
an outer layer
(cell membrane)
and contains
fluid material(cytoplasm)Within the
cytoplasm
many specialized structures
called organelles.The
most important is the nucleus which contains vital genetic material.The structure of
DNA is like a spiral ladder.DNA contains genetic information and instruction codes
necessary for maintenance and continuation of life.In DNA we have four basic
materials.
They are - adenine, guanine, thymine and cytocine.Nucleus is centrally located.It
is separated from surrounding fluids by cell membrane.Protoplasm is present in
the cell.This
protoplasm
is composed
by
water,
electrolytes, protein,
lipids
and carbohydrates.
The principal fluid medium of the cell is water.Its concentration is about 7085 percent.Water serves as solvent for various chemicals to produce chemical
reactions.The inorganic chemicals for chemical reactions are provided by electrolytes.In
the electrolytes we have sodium ions, potassium ions, phosphate ions, sulphate ions,
bicarbonate ions and a small quantity of proteins.Proteins- structural proteins,
globular proteins.Lipids are composed of different types of phospho lipids and

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cholesterol.Carbohydrates play a major role in the nutrition of the cell. They are stored
in the cells in the form of glycogen

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which supplies energy needs for the cells. Ribosomes are also present in
the cystol.Lysosomes are vesicular organelles.
They provide an intracellular digestive system that allows the cell to digest and
thereby remove unwanted substances and damaged foreign structures such as
bacteria. The mitochondria organelles are called power house of the cell. The cell
extract significant amounts of energy from the nutrients and oxygen by means of
mitochondria. Nucleolus is present inside the nucleus. The size of the cell is in the range
of 5-10 micrometer.
2.11.1.Transport of ions through cell membrane
Fluid is present inside the cell and outside the cell. This fluid is called intracellular
fluid and extra cellular fluid respectively. The extra cellular fluids contain large
amount of sodium ions and small amount of potassium ions. But in the intra cellular
fluid it is vice versa.
The concentration of phosphates and proteins are more in intracellular fluid.
Concentration of chloride ions are more in extra cellular fluid. a lipid bilayer is present in
the cell membrane. This consists of large number of protein molecules are present in
the cell membrane.
The cell membrane constitutes a barrier for the movement of the water soluble su
bstances between the extra cellular and intracellular fluid organs. With the help of
diffusion process transport of substances take place. This type of transport is
called passive transport. Ions like sodium potassium, calcium, chloride and most
amino acids are actively transported through cell membrane..
The active transport can be subdivided into two types according to the source of energy used
to cause the transport. They are primary active transport and secondary active transport.
Blood and its types

3.1.Fluid Body
rd
Roughly (2/3) of the body is composed of water and the various essential
substances dissolved within it. These fluids have innumerable vital roles within many body
systems. They
are found in cells, around the bodys tissue and most obviously in blood and lymph.
Most body parts are largely composed of water. Tissues are 70-80% fluid which means
that organs such as the brain and intestines are typically three quarters water. Blood plasma is
over
90% water while bones contain almost 25%. Fat has 10-50% water composition.
3.2.Fluid Compartments
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The bodys different fluids can be grouped into physiological categories that are known
as compartments. There are two major fluid compartments intracellular and extra cellular.
Intracellular fluid (also known as cytoplasm) is found within the bodys cells. Extracellular fluid

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accounts for all other fluids in the body. Its sub compartments are interstit ial fluid,
which occupies the spaces between cells and tissues; blood plasma and lymph. The fluids
found in
bones, joints and dense connective tissue; and Trans cellular fluid which includes saliva and
other digestive juices, mucus, sweat and urine.
3.3.Function of fluids
Water is excellent solvent. Thousands of substances that are dissolved in it are used in the
bodys biochemical reactions. These reactions are the very basis of life. Water is also an
effective transport system. It moves around the body distributing nutrients and collecting
and delivering waste materials. Fluids spread heat from active parts of the body, such as
exercising muscles, to cooler areas and in doing so they aid I thermoregulation. The body
uses fluid as shock absorbers to cushion sensitive areas such as brains, the eyes and the spinal
cord. Fluid also works as lubricants within the body, so that tissues and organs slip past each
other with minimal friction. Small amount of specific fluids that specialize in this role
include the pleural fluid around the lungs, the pericardial fluid around the heart and the
synovial fluids inside joints.
3.4.Blood and Lymph

The blood and lymph circulatory system are closely linked because they are constantly
swapping
fluids. Blood plasma, the fluid in which blood cells are suspended, transports red blood
cells
(which carry oxygen and remove carbon dioxide) around the body. Blood plasma leaks
from capillaries into the tissues around them, becoming interstitial fluid. Most of this leaked
fluid is reabsorbed into the blood, but some of it is drawn into the capillaries of the
lymphatic system where it is used as lymph fluid. This transports white blood cells (which
produce antibodies to fight infect ion and disease) around the body. After flowing through the
lymphatic system, lymph drains back into the blood system, once again to be used as blood
plasma.

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Blood Plasma: The pressure

produced by the hearts
pumping squeezes blood
plasma through capillary walls
Lymph: Lymph vessels collect

and circulate the fluid then
route it back into the blood
circulation
Blood plasma
and lymph
cycle:Blood plasma
leaks out from
capillaries to
become
interstitial fluid.
Interstitial Fluid: The fluid now

under little pressure flows
randomly and slowly around
cells and tissues.
Some of this drains into lymph

vessels and becomes lymph fluid.
Eventually this fluid is returned to
blood circulation as lymphatic
vessels empty into large veins.

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3.5.Balance and Recycling

The average adult body consists about 40 liters 170 pints of water. Every day water is lost
form
the body in the form of urine, sweat, water vapor from the lungs and in feces. Water is used
up and also produced by the body in biochemical reactions, for example glands producing
saliva and digestive juices. To maintain a healthy balance of fluids, we need to drink at least 2
liters (3
pints) of water per day. But If were not for the bodys amazing water conservation and
recycling measures (such as recycling blood plasma as lymph and vice versa) we would need
to consume at least 100 times more water than the recommended amount every day
3.6.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.
3.6.1.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.
3.6.2.What is Blood?
th
Blood forms about 1/10 of the body weight of an adult amounting to 5 liters in
volume. Roughly 50-55% of blood plasma consists of the liquid-only portion in
which cellular components are distributed. Plasma is 90% water containing dissolved
substances such as glucose (blood sugar) hormones, enzymes and also waste products such as
urea and lactic acid. Plasma also contains proteins such as albumins, fibrinogens (important
in blood clotting) and globular proteins or globulins. Alpha and beta globulins help to
transport lipids, which are fatty substances such as cholesterol. Gamma globulins are mostly
the disease fighting substances known as antibodies. The remaining 45-50% of blood is
made up of three types of specialized
cells. Red cells or erythrocytes carry oxygen; various white cells known as leucocytes are part
of the defense system; and cellular fragments (platelets or thrombocytes) are involved in
the process of clotting.
3.6.3.Parts of Blood
Blood is made up of liquid portion (plasma) red blood cells, a small band of platelets and white
blood cells.
Red Blood Cell Structure:
A biconcave disc with no nucleus or discrete nibble inner structure, each red blood cell
contains 300 millions hemoglobin molecules.
Role of Hemoglobin:
Hemoglobin is composed of hem, an iron-rich pigment and globins, ribbon-like
protein chains. Oxygen in the lungs latches onto hem to make oxyhemoglobin. In this
conjoined form, oxygen travels through the blood stream to all parts of the body.
3.7.Blood Groups
Every individual belongs to one of four blood groups which are determined by markers or
red blood cells known as antigens (agglut inogens). The antigens may be either A, B, both
(AB)
or neither (O) and blood groups are named correspondingly. Plasma contains different
ant ibodies (isohemoagglustinins). For example, a person with blood group A has plasma
containing B antibodies. If mixed with type B blood with A antibodies in its plasma) A
antibodies clump
(agglutinate) with A antigens. This is the reason why blood types must be matched to transfuse
blood safely from donor to
recipient.
Blood Group A
A Antigen; B - Antibody
Blood Group B
A - Antibody; B - Antigen
Blood Group AB
A & B Antigen with neither
A or B in Plasma
Blood Group O
Lack of A & B antigen but plasma
contains both A & B antibodies.
3.7.1Arteries
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.
3.7.2.Veins
A vein is more flexible than an artery and its walls are considerably thinner. The blood
inside
a vein veins
is under
relativelythe
lowlong
pressure
as alegs
result,
it flows
slowly
Many
particularly
veinsand
in the
contain
valves
thatand
aresmoothly.
formed from
pouch larger
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.
3.7.4.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).
3.8.Cellular Respiration
Glucose (blood sugar) is the bodys main energy source. Cellular respiration occurs in
every body cell when oxygen reacts with glucose to free its energy in chemical fo rm. The
end products are carbon dioxide and water, which is known as metabo lic water and amounts to
about
300ml daily throughout the body. The whole process is called aerobic (oxygen requiring)
cellular or internal respiration.
3.8.Respiration Reaction
Cells take up oxygen to drive the key respiration reaction that release energy from glucose.
3.8.1.Gas Exchange in Blood

The body cannot store oxygen and needs continuing supplies. It also constantly produces carbon
dioxide as a waste product. Gas exchange swaps oxygen and carbon dioxide in the lungs
and tissues.
Oxygen gas is physically drawn into the body by expanding lungs (above right) when it
reaches the microscopic blind ends of the lungs airways, the gas dissolves into the fluid
thing the air
spaces (alveoli, top, left). It then passes into blood stream, which distributes oxygen to each
body cell. Inside cells, the chemical changes known as cellular respirat ion use oxygen to
break apart
glucose for energy. Toxic carbon dioxide is a by product of the process, but gas
exchange discharges it into the air. In both lungs and body tissues, gases pass by diffusion (the
process of
flowing from region of high to low
density). Step1:
Oxygen in air dissolves into fluid lining the alveolus and diffuses through alveolar
wall and blood capillary wall.
Step2:
Step3: Step4:
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Oxyge inside capillary.

n
enters Oxygen quickly bonds to hemoglobin in red blood cells.
blood
plasma Carbon dioxide diffuses out of blood plasma and enters air in the alveolus (air-space).

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Step5: Bright red, oxygenated blood leaves heart along the aorta (the bodys main artery) and
circulates through a network of arteries to the bodys tissues.
Step6:
Oxygenated blood is carried through the tissues in capillaries thinner than hair.
Step7:
Arriving red blood cells are rich in oxygen, which is bound to hemoglobin in the
body of
e
a
c
h
c
e
ll
.
S
t
e
p
8
:
Oxygen leaves the hemoglobin within the red blood cells, diffuses across
the blood
capillary walls and into
tissue cells. Step9:
Carbon dioxide diffuses out of tissue cell, across wall of blood capillary and
into blood plasma.
3.8.3. Exchange in the Lungs

When fresh, oxygen-rich air reaches the alveoli the tiny dead end air spaces in the lungs
it must
pass through several layers to reach the red cells in the blood. But these layers are so
thin that the
total distance is 0.001mm.
3.8.4.Exchange in the Body Tissues

Oxygen levels are higher in the blood than in surrounding tissues. The difference in
levels forces
oxygen to break its bonds to the hemoglobin in red blood cells and diffuse out of the
blood into
the adjacent cells. The reverse applies to carbon dioxide, which diffuse from the tissue
into blood plasma.
3.9.Blood Pressure
The heart is a dynamic, untiring, precisely adjustable double-pump that forces blood
around the bodys immense network of blood vessels, perhaps more than three billion times
during lifetime. The hearts power comes from its two lower chambers (ventricles) which have
thick muscular
walls. That contact to squeeze blood out into the arteries. The upper chamber
(arter
ial)
have
thinn
er
walls
and
functi
on
partly
as
passi
ve
reser
voirs
for
blood
oozin
g in
from
the
main
veins.
Each
heart
beat
has
two
phase
s. In
the
first
phase
(diast
ole)
the
heart
relax
es
and
refills
with
blood
;
durin
g the
secon
d
stage
(syst
ole)
it contracts, forcing the blood out. The whole cycle takes on average less than second.
During vigorous activity or stress, both beating rate and the volume of blood pumped
out of the heart increases greatly.
3.9.1.Relaxation
Diastole)
(Late
During this phase of the heart beat sequence, the muscular walls of the heart
relax the
arteri
al
cham
bers
ballo
on
slight
ly as
they
fill
with
blood
comi
ng
under
quite
low
press
ure
from
the
main
veins.
Deox
ygena
ted
blood
from
the
body
enter
s the
right
atriu
m,
while
oxyg
enate
d
blood from the lungs enters the left atrium. Some of the blood in the atria flows down into
the ventricles. By the end of this phase, the ventricles are filled to 80% of capacity.
3.9.2.Contraction of the Atria (Atrial Systole)

The hearts natural pacemaker, known as the sinoatrial node, is located in the upper part of
the right atrium. It fires electrical impulses, much like those generated by nerves, which set
off
the contraction phase. Some impulse spread through the atrial walls and stimulate their
cardiac muscle to contract. This squeezes blood inside the atrioventricular (tricuspid and
mitral) valves into the ventricles whose walls remain relaxed.
3.9.3.Contraction
Systole)
of
the
ventricles
(Ventricular
During this most active and powerful stage of the heartbeat, the thick cardiac muscle in
the ventricle walls contracts stimulated by electrical impulses relayed by the atrio
-ventricular node, this cause a rise in ventricular pressure, which opens the aortic and
pulmonary valves at the exits of the ventricles. Blood is force out into the main arteries,
making the atrio -ventricular valves snap shut.
3.9.4.Relaxation (Early Diastole)

The walls of the ventricle begin to relax, causing ventricular pressure to reduce. The pressure
of
the recently ejected blood in the main arteries is now high. So both the aortic and
pulmonary valves close. This prevents back-flow into the ventricles as ventricular pressure
on the atrio ventricular valves relaxes, the valves open. This reduces pressure in the atria,
allowing blood to enter once again from the main veins.
3.9.5.Control of heart rate

Without control, the heart would beat at its natural intrinsic rate of about 100 times per
minute. However, a region known as the cardio regulatory center in the medulla of the brain
stem
sends electrical impulses along nerves (especially the cranial vagus nerve) to set an
average resting rate of about 70 beats per minute. During activity or stress, the sympathetic
cardiac nerve signals, controlled by the hypothalamus, convey over riding signals to speed up
the heart rate. The rate is also influenced by hormones such as adrenaline.
Sino Atrial Node

The Sino atrial node is inactive during most of the diastole. As systole approaches, it
begins to send out a wave of electrical impulses which will co-ordinate the
heartbeat.
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Electrical Impulses
Electrical impulses spread over surface of both atria, stimulating them to
contract.

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Electrical Impulses spread

Impulses travelling through atrial muscles make them contract within 0.1 seconds. Some signals
pass faster along conducting fibers to the atrio-ventricular node.
Atrio-ventricular Signals Fire

The Atrio-ventricular node fast-tracks impulses along conducting fibers within the septum
(dividing wall) to the lower ventricles and up through ventricle muscle.
Electrical Impulse Fade

Impulses spread through the ventricular walls back towards the atria within 0.2 seconds of
leaving the sinoatrial node which then fires again to continue the cycle.
Blood cell counters

4.1.Introduction:
Changes in the normal functioning of an organism are often accompanied by changes
in
the blood cell count. The determination of the number and size of blood cells per
unit volume provides valuable information for accurate diagnosis. Blood
consists of corpuscles suspended in a fluid called plasma in the proportion of 45 parts
of corpuscles (cells) of plasma.
The percentage of cells in the blood is called the haematocrit value or
packed cell volume (PCV). The majority of the corpuscles in blood are red
blood cells (erythrocytes) others being white blood cells (leucocytes) and platelets
(thrombocytes)
Erythrocytes (RBC) have no nucleus. But it has a membrane and is filled with
a solution containing an iron-containing protein hemoglobin. They are responsible
for carrying oxygen from the lungs to the tissues and carbondioxide from the tissues
to the lungs. Anaemia (reduction in the oxygen carrying capacity of the blood) can
develop from a change in the number caused by bone marrow dysfunction resulting in
the poor production rate of RBCs.
Leucocytes (WBC) are spherical cells having nucleus. There are normally 5000 10,000 white cells per cubic mm of blood. But their number varies during the day.
They
alive for seven to fourteen days and there is a rapid turnovers with constant
destruction and replacement.
Thrombocytes (platelets) are usually tiny, round oblong or irregularly

shaped cells of the blood with an average diameter of approximately 2 microns. They
play a n
important role in the blood coagulation process. There are usually 250,000 750,000
platelets in every cubic mm of blood. They are colorless and have no nucleus.
By spinning blood in a centrifuge, the blood cells can be sedimented. The
blood plasma with the blood cells removed is a slightly viscous, yellowish liquid that
contains large amounts of dissolved proteins. One of the proteins fibrinogen,
participates in the process of blood clotting and forms thin fibers called fibrin. The
plasma from which the fibrinogen has been removed by precipitation is called blood
serum.
Blood clotting can be inhibited by the injection of
natural anticoagulant extracted from the liver and lungs of cattle.
heparin,
A count of the blood cells, an inspection of the size and shape, or a

chemical analysis of the blood serum can, therefore provide important
information for the diagnosis of diseases similarly other body fluids, smears and small
samplesof live tissue, obtained by a biopsy are studied through the techniques of
bacteriology, serology and histology to obtain clues for diagnosis of diseases.
Mean cell volume(MCV):
It is calculated from the packed cell volume (PCV) and the number of red
-15
cells present per litre of blood. It is indicated in f/l (femolitres 1 f/l = 10 )
Mean cell haemoglobin (MCH):
It is calculated from the HB and red cell count (it is expressed in picograms)
Mean cell haemoglobin concentration(MCHC):
It can be calculated if PCV Hb per dl are known.
Mean platelet volume(MPV):
It is the ratio of the integrated platelet volume to the platelet count and is
expressed in femolitres.
Plateletcrit:
It is the percentage of the total specimen volume occupied by the platelets.
Red cell distribution width (RDW):
It is a numerical expression of the width of the size distribution of red cells.
Platelet distribution width (PDW):
This index is related to the size range covered by those platelets lying between the
sixteenth and eighty fourth percentile.
4.2.Tests on blood cell:

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When whole blood is centrifuged, the blood cells sediment and form a
packed volume at the bottom of the test tube. Most of this column consists of the red
blood cells, with the other cells forming a thin buffy layer on the top of the red cells.
The volume of the packed red cells is called the hematocrit. This is expressed as a
percentage of the total blood volume.
The hematocrit can be determined by aspirating a blood sample into a
capillary tube and closing one end of the tube with a plastic sealing material. The tube is
then spun for 3 to 5 minutes in a special high-speed centrifuge to separate the blood
cells from the plasma. Because the capillary tube has a uniform diameter, the blood
and cell volumes can be compared by measuring the lengths of the columns. This is
usually done with a simple nomogram.
The red blood cells have a much higher electrical resistivity than the blood plasma
in which they are suspended and so the resistivity of the blood shows a high correlation
with the hematocrit.
Manual blood cell counts are performed by using microscope. For this, the blood is
first diluted 1 :100 or 1:200 for counting of red blood cells (RBC) and 1:10 or 1:20 for
white blood cell count (WBC). For counting WBC, a diluents is used that dissolves the
RBCs, whereas for counting RBCs, an isotonic diluent preserves these cells. The diluted
blood is then brought into a counting chamber of 0.1mm deep, which is divided by
marking lines into a number of squares, when magnified about 500 times, the cells in a
certain number of squares can be counted.
Today simple RBC and WBC counts are normally performed by automatic or
semiautomatic blood cell counters. The most commonly used devices of this kind
are based on the conductivity(coulter) method, which makes use of the fact that blood
cells have a much lower electrical conductivity than the solution in which they are
suspended. Such a counter contains a beaker with the diluted blood. A closed glass tube
that contains a very small orifice is placed inside the diluted blood. The
conductance between the solution in the glass tube and the solution in the beaker is
measured with two electrodes. The result is a pulse at the output of the conductance
meter, the amplitude of which is proportional to the volume of the cell.
1. First Contact
2. Second Contact
3. Suction Pump
4. Electrodes
( Platinum)
Conductivity
meter
Threshold unit
2
1
Pulse gate
BLOCK gives
start stop signal to
counter
counter
Conductivity Method (Coulter Method)
A threshold circuit lets only those pulses pass that exceed a certain amplitude
gate. The first contact and closes when it reaches the second contact. Thus counting
the number of cells contained in a given volume, of the solution passing through the
orifice. A count is completed in less than 20 seconds. With counts of upto 100,000 the
result is statistically accurate. Care must be taken to keep the aperture from clogging.
From these measurements, the mean cell volume, the mean cell hematocrit and mean
cell hematocrit concentration are calculated and the corresponding results are taken out
on a preprinted report form.
Blood cell counter (Dark field microscope method):

The diluted blood flows through a thin cuvette. The cuvette is illuminated by
a cone-shaped light beam obtained from a lamp, through a ring aperture. And an
optical system. The cuvette is imaged on the cathode of a phototube by means of
lens and an aperture. normally no light reaches the photo tube until a blood cell
passes through the cuvette and reflects a flash of light on the phototube.
4.2.BLOOD GAS ANALYZERS

4.2.1Introduction:
H
Blood gas analyzers are used to measure the p , partial pressure of carbon dioxide
(pCO2) and partial pressure of oxygen (pO2) of the body fluids with special reference to
H
the human blood. A sudden change in the p and pCO2 could result in cardiac arrhythmias
, ventricular hypotension and even death.
4.2.2.Acid- base balance:
H
The normal p of the extra cellular fluid lies in the range of 7.35 to 7.45 indicating
H
that the body fluid is slightly alkaline. When the p below 7.35, it indicates acidosis. When
H
the p
exceeds 7.45, the body is considered to be alkalosis. With the help of three physiological
mechanisms as
Respiration
Excretion into urine by kidneys
Buffering by chemical means
H
it is possible for us to analyze the deviation of p of the blood.
The blood and tissue fluids contain chemical buffers, which react with added acids
and bases and minimize the resultant change in hydrogen ions.
The respiratory system can adjust sudden changes in carbon dioxide, tension back
to normal levels in just a few minutes. Carbon dioxide can be removed by increased breathing
and therefore hydrogen concentration of the blood can be effectively modified. The kidney
requires many hours to readjust hydrogen ion concentration by excreting highly acidic or
alkaline urine to enable body conditions to return towards normal condition.
Arterial blood has a pH of approximately 7.40. Venous blood acquires carbon
H
dioxide forms carbonic acid and hydrogen ions, the venous blood p falls to approximately
7.36. this pH drop of 0.04 units occurs when the CO2 enters the tissue capillaries. When CO2
diffuses from pulmonary capillaries into the alveoli, the blood pH rises 0.04 units to bring
the normal atrial
value of 7.40. it is difficult to measure the pH of fluids inside the tissue cells, but from
estimates based on CO2 and HCO3 ion concentration, intracellular pH probably ranges from 7.0
to 7.2.
The three important chemical factors regulating alveolar ventilation are the
+
arterial concentration of CO2, H and O2. Carbon dioxide tension in the blood stream and
cerebrospinal fluid (CSF) is the major chemical factor regulating alveolar ventilation.
4.2.3.Gas exchange and distribution:
Once air is in the lungs, oxygen and carbon dioxide must be exchanged between the air
and the blood in the lungs and between the blood and the cells in the body tissues. These
gases must be transported between the lungs and the tissue by the blood.
The mixing of gases within the lungs ventilation of the alveoli and the exchange
of oxygen and carbon dioxide between air and blood in the lungs takes place through a
process
called diffusion. Diffusion is the movement of gas molecules from a point of higher pressure
to a point of lower pressure to equalize the pressure difference. This process can occur when
the gas is unequally distributed in a chamber on two sides of membrane permeable to that gas.
Measurements required for determining the amount of diffusion involve the
partial pressures of oxygen and carbon dioxide, pO2, pCO2, respectively.
Methods for analyzing pO2, pCO2
Chemical analysis method
Diffusing capacity using CO infrared analyzer
Gas chromatograph.
4.2.4.Chemical analysis methods

These analyzers are developed by Haldane and modified by Scholander.
In this analyzer, a gas sample of approximately 0.5ml is introduced into a
reaction chamber by use of a transfer pipet at the upper end of the reaction chamber
capillary. An indicator droplet in this capillary allows the sample to be balanced against a
trapped volume of air in the thermo-barometer. Absorbing fluids for CO2 and O2 can be
transferred in from side arms without causing any change in the total volume of the system.
The micrometer is adjusted so as to put mercury into the system in place of the gases being
absorbed. The volume of the absorbed gases is read from the micropipette barrel calibration.
4.2.4.1.Gas Chromatograph:
The quantities of various gases in the expired air can also be determined by means of
a gas chromatograph, an instrument in which the gases are separated as the air passes
through a
column containing various substances that interact with the gases. The reactions cause
different gases to pass through the column at different times. The quantity of each gas is
measured as it
emerges. To identify the gases in the expired air other than oxygen nitrogen or CO 2, a
mass spectrometer is used in conjunction with the gas chromatograph. The mass
spectrometer identifies the ions according to their mass/charge ratio.
4.2.4.2.Diffusion capacity using CO infrared analyzer:
With the help of this analyzer, it is possible to measure O 2,CO2,p and bicarbonate
in arterial blood. If we try to measure the diffusion of oxygen from the aleovli, into the blood,
it is
usually assumed that all alveoli have an equal concentration of oxygen. Actually this
condition does not exist because of the unequal distribution of ventilation in the lung,
hence the terms
diffusing capacity or transfer factor (rather than diffusion) is used to describe the transfer
of oxygen from the alveoli into the pulmonary capillary blood.
Carbon mono oxide (CO) resembles oxygen in its solubility and molecular weight
and also combines with hemoglobin reversibly. Its affinity for hemoglobin is about 200 to 300
times that of oxygen. Carbonmonooxide can thus be used as a tracer gas in measuring the
diffusion capacity of the lung. It passes from the alveo lar gas into the alveolar walls, then into
the plasma from which it enters the red blood cells where it combines with hemoglobin
1 / TF = 1/ Dm + 1/Vc
Where TF = diffusing capacity for the lung for CO.
Dm = diffusing capacity for alveolar membrane
Vc = volume of blood in the capillaries.
= reaction rate of CO with oxyhemoglobin.
TF, the diffusing capacity for the whole lung in normal adults ranges from 20 to 38 ml/min/mm
HG during exercise, and decreases with anemia or low hemoglobin.
In the single-breath method, the last 75 to 100 ml of the expired air is collected so
that enough end-tidal air containing CO is available for the measurement. CO in the
blood is negligible, for it combines with the hemoglobin I the red blood cells and exerts no
significant back pressure. The commonly used carbon mono oxide analyzer utilizes an
infrared energy source, a beam chopper, sample and reference cells, plus a detector and
amplifier. A milli ammeter or a digital meter may be used for display. Two infrared beams are
each measured by a differential infrared detector. The output signal is proportional to the
amount of monitored gas in the sample cell. The signal is amplified and presented to the
output display meter or to a recorder.
Study of the Lungs, Temperature, pulse, Cardiac

output, Blood flow meters
4.3.Respiratory system
The respiratory system in close conjunction with circulatory system is responsible for
supplying all blood cells with essential oxygen and removing potentially harmful carbo n
dioxide from the body. The mouth and nose channel air from outside the body through a
system of tubes of diminishing size that eventually reach the two lungs situated on either side
of the heart within chest cavity.
Air enters the body mainly through the nostrils (but sometimes through the mouth) .
the nostrils lead into the nasal cavity which opens up within the skull and joins with the
pharynx
(part of the throat) towards the rear. The pharynx is a short-funnel shaped tube that
extends
partway down the neck. The first part of the pharynx conveys only air, but lower down, food
and liquids also travel through. The larynx, home to vocal cords, joins the pharynx to the wind
pipe. (trachea). A loose flap of cartilage the epiglottis, lies just above the lar ynx and
blocks it off during swallowing to prevent food and liquids entering the trachea. The trachea
splits into two air ways called primary bronchi, one of which enters the right lung and the
other the left lung. Each brounchus divides further into secondary and teritiary bronchi and
eventually into tiny bronchioles. The continuous branching is referred to as the bronchial tree.
Deep within the paired cone-shaped lungs exchange of gases takes place.
4.3.1.Parts of Lung :
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:
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
with lubricated double layer of pleural membranes.
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:
Has only two lobes, to make room for heart (right lung is tri-lobed)
Bronchioles:
ends.
Miniscule terminals of the bronchi; gas exchange occurs in tiny sacs (alveoli) at their
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.
4.3.2.Breathing:
The physical movement of air into and out of the lungs is generated by differences in
pressure within the lungs compared to the surrounding atmospheric pressure. The
pressure differences are produced by forcefully expanding the chest and lungs by muscular
action and then passively allowing them to return to their former size. The rate and depth of
breathing can be consciously modified. However the underlying need to breathe is controlled by
ares within the brain stem, where responses to regulate the breathing muscles (of which we
are usually not aware) occur according to the levels of carbon dioxide and oxygen in the blood.
4.3.2.1.Diaphragm movement:
The abdominal contents are flattened by the diaphragm muscle during inhalation and then
rise up during exhalation.
4.3.2.2 Inhalation:
The chief muscles used in respiration at rest are the diaphragm at the base of the chest
and the external intercostal between the ribs. For forceful inhalation, additional muscles assist
in
moving the ribs and sternum to expand the chest further and stretch the lungs even more.
4.3.2.3.Volume and pressure:
Breathing alters the volume of the chest (thoracic activity). The lungs suck onto the inner
chest wall, so that as the cavity expands, they also become larger. The main expanding forces
are provided by the diaphragm and intercostal muscles. At rest, the diaphragm carries out
most of
the work. 0.5 liters of air the tidal volume-shifts in and out with each breath 912 to 1
times
every minute) rate and volume increases automatically if the body needs more oxygen as
during
exercise. Then forced inspiration can suck in an extra liters and forced expiration expels
almost as much leading to a total air shift or vital capacity, of more than .5 liters in a large
healthy adult. The breathing rate can be ripple producing a total air exchange more than times
greater than at rest.
4.3.2.4.Breathing in:
The diaphragm contracts to become less dome like while the ribs swing upward and
outward with a bucket handle action to raise the sternum.
4.3.2..5Breathing out:
The diaphragm relaxes and the elastic stretched lungs recoil to become smaller again,
allowing the sternum and ribs to move down and inward.s
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Negative pressure:

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As lung volume increases, air pressure within decreases. Atmospheric pressure

outside
effect airtheis body is now higher and air is drawn down the airways and into the lungs in
sucked in.
Positive pressure:
As lung volume diminishes, when exhaling, the air is compressed, raising its
pressure within the lungs. So the air is pushed back along the airways and out of the mouth.
Respiratory Reflexes:
The two important respiratory reflexes are coughing and sneezing. Both aim to
blow out excess mucus, dust irritants and obstructions- coughing from lower pharynx, larynx,
trachea and lung air ways and sneezing from nasal chambers and naso-pharynx. In both
cases, a deep inhalation is followed by sudden contraction of the muscles involved in forceful
exhalation. For a cough, the lower pharynx, epiglottis and larynx close so that air pressure
builds up in the lungs and is released explosively, rattling the vocal cords. In a sneeze, the
tongue closes off the mouth to force air up and out through the nose.
4.4.Spirometry:
Flow-Volume loop showing successful FVC maneuver. Positive Values represent
expiration, negative values represent inspiration. The trace moves clockwise for
expiration followed by inspiration. (Note the FEV1, FEV1/2 and FEV3 values are arbitrary
in this graph and just shown for illustrative purposes, they must be recorded as part of the
experiment).
Spirometry (meaning the measuring of breath) is the most common of the

Pulmonary Function Tests (PFTs), measuring lung function, specifically the measurement of
the a mount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is
an important tool used for generating pneumotachograph to assessing conditions such as
asthma, pulmonary fibrosis, and COPD.
4.4.1.Spirometry testing
The spirometry test is performed using a device called a spirometer, which comes in several
different varieties. Most spirometers display the following graphs:
a volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the
Xaxis
a flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total
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volume inspired or expired on the X-axis

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The most commonly used guidelines for spirometric testing and interpretation are set by
the
American Thoracic Society (ATS) and the European Respiratory Society
(ERS).
Procedure
The basic FVC test varies slightly depending on the equipment
used.
Generally, the patient is asked to take the deepest breath they can, and then exhale into the
sensor as hard as possible, for as long as possible. It is sometimes directly followed by
a rapid inhalation (inspiration), in particular when assessing possible upper airway
obstruction. Sometimes, the test will be preceded by a period of quiet breathing in and out
from the sensor (tidal volume), or the rapid breath in (forced inspiratory part) will come
before the forced exhalation.
During the test, soft nose clips may be used to prevent air escaping through the nose.
Filter mouthpieces may be used to prevent the spread of microorganisms, particularly for
inspiratory maneuvers.
Limitations of test
The maneuver is highly dependent on patient cooperation and effort, and is normally repeated
at least three times to ensure reproducibility. Since results are dependent on patient
cooperation, FEV1 and FVC can only be underestimated, never overestimated.
Due to the patient cooperation required, spirometry can only be used on children old enough
to comprehend and follow the instructions given (typically about 4-5 years old), and only
on patients who are able to understand and follow instructions - thus, this test is not
suitable for patients who are unconscious, heavily sedated, or have limitations that would
interfere with vigorous respiratory efforts. Other types of lung function tests are available
for infants and unconscious persons.
Related tests
Spirometer can also be part of a bronchial challenge test, used to determine bronchial
hyper responsiveness to either rigorous exercise, inhalation of cold/dry air, or with a
pharmaceutical agent such as methacholine or histamine.
Sometimes, to assess the reversibility of a particular condition, a bronchodilator is
administered before performing another round of tests for comparison. This is commonly
referred to as a reversibility test, or a post bronchodilator test (Post BD), and is an important
part in diagnosing asthma versus COPD.
Explanation of common test values in FVC tests Abbreviation
Name Description
FVC Forced Vital Capacity This is the total amount of air that you can forcibly blow out
after
full inspiration, measured in
liters.
FEV1 Forced Expiratory Volume in 1 Second

This is the amount of air that you can
forcibly blow out in one second, measured in litres. Along with FVC it is considered one of
the primary indicators of lung function.
FEV1 / FVC FEV1%
This is the ratio of FEV 1 to FVC. In healthy adults this should
be
approximately 75 - 80%.
PEF Peak Expiratory Flow This is the speed of the air moving out of your lungs at
the
beginning of the expiration, measured in liters per
second.
FEF 25-75% or 25-50%
Forced Expiratory Flow 25-75% or 25-50% this is the average
flow (or speed) of air coming out of the lung during the middle portion of the expiration
(also sometimes referred to as the MMEF, for maximal mid-expiratory flow).
FIF 25-75% or 25-50%
Forced Inspiratory Flow 25%-75% or 25%-50% this is similar
to FEF 25%-75% or 25%-50% except the measurement is taken during inspiration.
FET
Forced Expiratory Time
This measures the length of the expiration in seconds.
SVC Slow Vital capacity
TV
Tidal Volume During the respiratory cycle, a specific volume of air is drawn into
and then expired out of the lungs. This volume is tidal volume.
MVV Maximum Voluntary Ventilation
a measure of the maximum amount of air that
can
be inhaled and exhaled in one minute, measured in
liters/minute.
Note that functional residual capacity (FRC) cannot be measured via spirometry, but it can
be measured with a plethysmograph.
Results are usually given in both raw data (liters, liters per second) and percent predicted the test result as a percent of the "predicted values" for the patients of similar characteristics
(height, age, sex, and sometimes race and weight). The interpretation of the results can vary
depending on the physician and the source of the predicted values. Generally speaking,
results nearest to
100% predicted are the most normal, and results over 80% are often considered
normal. However, review by a doctor is necessary for accurate diagnosis of any individual
situation.
4.5.Temperature Measurements:
Body temperature is one of the oldest known indicators of the general well being of a
person. Techniques and instruments for the measurement of temperature have been
common
place in home. Two basic types of temperature measurements can be obtained from the
human body. Systematic and skin surface measurements. Both provides valuable diagnostic
information although the systematic temperature measurement is much more commonly used.
4.5.1.Temperature Regulation:
One of the skins functions is to contribute to thermo regulation maintenance of a
constant body temperature. It does this in three main ways: Widening and narrowing of
blood
vessels, sweating and hair adjustments, if the body becomes hot, blood vessels in the
dermis widen (vasodilate) to allow extra blood flow so more warmth can be lost from the
surface. The skin may look flushed, and sweat oozes from sweat glands and evaporates ,
drawing away body heat. If the body is cold, the peripheral blood vessels (vasoconstrict) to
minimize heat loss and
sweating is reduced. Tiny body hairs are pulled upright by the erector pili muscles to trap air
as an insulating.
Feeling cold ( Hair stands more upright)
Tiny body hairs, raised by the contraction of the erector pili muscles, create small
mounds known as goose pimples at their bases, the peripheral blood vessels constrict and
sweat reduce their activity.
Feeling Hot (Hair Lies Flatter)
Tiny body hairs lie flatter as the erector pili muscles relax, and the small mounds at their
bases disappear. Dermal blood vessels dilate , increasing blood flow and the sweat glands
raise their o/p.
Ultraviolet Defences:
The suns rays include a spectrum of colour wavelength including infra red or IR rays (
the warming component) and ultraviolet, UV rays. Both UV-A and UV-B wavelengths
are invisible to human eyes, but exposure to the latter in particular is linked to forms of skin
cancer.
Skins self-defence is its dark colouring substance or pigment, melanin. This forms a screen in
the upper epidermis that shields the actively multiplying cells in the base of the epidermis.
Melanin Production:
Melanocytes are melanin- producing cells in the base of the epidermis, They make parcels of
melanin granules melanosomes which pass inti surrounding cells.
Skin Pigmentation:
Skin colour depends on the type and quantity of two main melanin pigmentsreddish
pheomelanin and brown-black eumelanin. Darker skin has layer melanocytes with
more melanosomes which break down to give even pigmentation through skin cells. Lighter
skin has smaller melanocytes and grouped melanosomes. Exposure to UV light stimulates
melanocytes so the skin becomes darker or tanned.
4.6.Systematic Temperature:
It is the temperature of the internal regions of the body. This temperature is maintained through
a
carefully controlled balace between the heat generated by the active tissues of the body
mainly
the muscles and the liver and the heat lost by the body to the environment. Measurement
of systemic temperature is accomplished by temperature sensing devices placed in the mouth,
under the arm pits or in the rectum. The normal oral (mouth) temperature of a healthy person
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is about
31 C . The under arm temperature is about 1 degree lower, whereas the rectal temperature
is about 1 degree higher than the oral reading.

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Systemic temperature is not affected by the ambient temperature, even if the latter
drops to as low as - 18 C(0 F ) or rises to over 38 C(100 F ) . This balance is upset only
when the metabolism of the body cannot produce heat as rapidly as it is lost or when the
metabolism of the body cannot produce heat as it is lost or when the body cannot rid itself of
heat fast enough.
The temperature control center for the body is located deep within the brain . Here the
temperature of the blood is monitored and its control functions are coordinated. In
warm, ambient temperatures cooling of the body is aided by production of perspiration due to
secretion of the sweat glands and by increased circulation of the blood near the surface. In this
manner, the body acts as a radiator. If the external temperature becomes too low, the body
conserves heat by reducing blood flow near the surface to the minimum required for
maintenance of the cells. At the same time metabolism is increased. If these measures are
insufficient , additional heat is produced by increasing the tone of skeletal muscles and
sometimes by involuntary contraction of skeletal muscles(shivering) and of the arrector muscles
in the skin (gooseflesh).
In addition to the central thermostat for the body, temperature sensors at the surface
of the skin permit some degree of local control in the event a certain part of the body is
exposed to local heat or cold. Cooling or heating is accomplished by control of the surface
blood flow in the region affected.
Derivation from the temperature control is a rise in temperature. This is known as fever,.
This fever can be experienced with cerrain types of infection. If the heat elimination
mechanism gets affected means, we will get fever. The body temperature increases due to the
thermostat in the brain were suddenly turned up. Because of this, additional metabolism
occurred, this will accelerate the chemical reactions of the body. The increase in
temperature can be analysed through the skin. The skin is often pale and dry shivering
usually takes place and the skin muscles react to coolness. Finally as the body
temperature is lowered to normal increased sweating (breaking of the fever) is observed as
the means by which the additional body heat is eliminated. Surface or skin temperature is
also a result of balance. The skin temperature is a function of the surface circulation in a
local area and the cooling of that area by conduction, radiation convection and evaporation.
4.6.1.Measurement of systemic Body Temperature:

The internal or systemic body temperature is a good indicator of the health of a person,
measurement of this temperature is considered one of the vital signs of medicine. It is
not necessary to get an accurate measurement for temperature analysis , but the method
which we
adopt for measuring temperature must be easy to
perform.
Mercury thermometer is the device which is used for measuring temperature, this the
standard method of measurement. This type of thermometer is inexpensive, an
accurate measurement can be obtained from this thermometer. Electronic thermometers are
available as replacement for mercury thermometers with disposable tips, these electronic
thermometers require much less time for a reading and are much easier to read than
the conventional thermometer.
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For obtaining continuous recording of the temperature or whenever greater accuracy is

needed then, this can be obtained with the help of electronic
thermometers.

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Thermocouple and thermistor are the two types of electronic temperature sensing
devices used in thermocouple, a junction of two dissimilar metals that produce an o/p
voltage nearly proportional to the temperature at that junction with respect to a reference
junction.
Thermistor a semiconductor element whose resistance varies with temperature.
Thermistors are used more frequently than thermocouples. This preference is primarily
because of the greater sensitivity of the thermistor in the temperature range of interest
and the requirement for a reference junction for the thermocouple.
Thermistors are variable resistance devices formed into disks, beads , rods or other
desired shapes. They are manufactured from mixtures of oxides (sometimes sulphates
or silicates) of various elements such as nickel, copper, magnesium, manganese, cobalt,titanium
and aluminium. After the mixture is compressed into shape, it is sintered at a high temperature
into a solid mass. The result is a resistor with large temperature coefficient. The relationship
betwee n
resistance change and temperature change is nonlinear. The
Rt1 of a thermistor at a
resistance,
1
1
given temperature T1 can be determined by Rt1 Rt 0e the non linear characteristics of
T1 T0
the thermistor can be overcome by the instrumentation circuit in which the resistance
is measured often incorporates special linearizing circuits. Some of the other problems occur
when we use
thermistors, as the danger of error due to self heating, the possibility of hysterisis and
the
changing of characteristics because of aging. If the power dissipation of the thermistor can
be kept to about a milliwatt, the error should not be excessive, even when temperature
differences as small as 0.01 C are sought. Self heating effect can be reduced by limiting
the amount of
current used in measuring the resistance of the
thermistor.
Skin Temperature Measurements:
The systemic temperature remains constant throughout the body, skin temperatures can
vary several degrees from one point to another. The range is usually from about 30
to
35 C(85to95 c) . The purpose of using skin temperature measurements is to detect or
locate defects in the circulatory system by showing differences in the pattern from one side of
the body to the other.
Skin temperature measurements from specific locations on the body are frequently made
by using small flat thermistor probes taped in the skin. The simultaneous readings from a
number of these probes provide a means of measuring changes in the spatial
characteristics of the circulatory pattern over a time interval or with a given stimulus.
The human skin also emits infrared radiation. With the help of infrared thermometer, it
is
possible to measure the infrared radiation. For measuring this infrared radiation, the patient
has to be allowed to remain in a room at about 21 C(70 F ) without clothing over the area
to be measured. Infrared thermometers can be used to detect the areas of poor circulation a
nd other sources of coolness. They can also be used to locate breast cancer other unseen sources
of heat.
An extension of this method of skin temperature measurement is the thermograph. A
thermograph is a device in which an infrared thermometer is incorporated into a scanner so
that the entire surface of a body or some portions of the body is scanned in much the same way
that a television camera scans an image, but the process is little bit slower. The scanner scans
the body
the infrared energy is measured and used to modulate the intensity of a light beam that
produces a map of the infrared energy on photographic paper. This presentation is known as
thermogram. The advantage of this method is that relatively warm and cool areas are
immediately evident.
4.7.Measurement of pulse:
When the heart muscles contracts, blood is ejected from the ventricles and a pulse of
pressured is transmitted through the circulatory system. A vessel-wall displacement is caused
by
vessels when the pressure pulse is traveling. The pulse can be measured at various points of
the peripheral circulatory system. We can analyze the pulse rate if we keep the finger tip
over the radial artery in the wrist or some other location where an artery seems just below the
skin. The timing and wave shape of the pressure pulse are diagnostically important because
they provide correct information.
The pulse gives the measure of pulse wave velocity and can be reduced and
compared with the ECG signal. The pulse wave travels at 5 to 15 m/s depending on the size
and rigidity of
the arterial walls, the larger and more rigid the artery walls, the greater the velocity. The
velocity is 10-15 times faster than blood flow and is relatively independent of it.
The methods used for the detection of volume(pulse) changes due to blood flow
are: (i) optical changes (changes in density)
(ii)
Electrical impedence changes
(iii)
Strain gauge or microphone (mechanical)
The most common used method to measure plusatile blood volume changes is by
the
photoelectric method . Two methods are common : Reflectance method and
transmittance method.
In the transmittance method, a light emitting diode (LED) and photoresistor are
mounted in an enclosure that fits over the tip of the patients finger. Light is transmitted through
the finger
tips of the subjects finger and the resistance of the photoresistor is determined by the amount of
light reaching it. With each contraction of the heat, blood is forced to the extremities and
the
amount of blood in the finger increases. This alters the optical density with the result that
the light transmissions through the finger reduce and the resistance of the photo resistor
increases accordingly. The photo resistor is connected as part of the voltage divider circuit and
produces a voltage that varies with the amount of blood in the finger. This voltage that
closely follows the pressure pulse and its waveshape can be displayed on an oscilloscope or
recorded on a strip chart.
An electric impedance method measures the impedance change between two
electrodes caused by the changes in blood volume between them. The change in impedance
(0.1 ohm) may be small as compared to the total impedance (several hundred ohms) . An
alternating current is applied between electrodes that are attached to the body. With this set
the impedance can be measured. An alternating signal (10- 100khz) is used (rather than dc) in
order to polarization of the electrodes.
The mechanical method involves the use of a strain gauge connected to a rubberband placed around a limb or finger. Expansion in the band due to change in blood volume
causes a
change in resistance of the strain gauge. In some other technique, a sensitive crystal microphone
is placed on the skins surface to puck-up the pulsation.
A piezo electric crystal can also be used to detect the pulse wave at certain places of
the peripheral system, where considerable displacement of the tissue layer above the
artery is involved. A piezo electric crystal is clamped in a hermetically sealed capsule
subject to displacement stresses. The displacement can be transmitted to the crystal through a
soft rubber diaphragm. The crystal can be connected to an ECG recorder for recording the
pressure pulse measurement.
4.8.Cardiac output:
The blood flow at any point in the circulatory system is the volume of blood that passes
that point during a unit of time. It is normally measured in millimeters per minute or liters
per minute. Blood flow is highest in the pulmonary artery and the aorta, where these blood
vessels leave the heart. The flow at these points called cardiac output is between 3.5 and 5
litres/min in a normal adult at rest. On the other hand in the capillaries blood flow can be slow
, that the travel of individual blood cells can be observed under a microscope.
With the help of cardiac output or the blood flow in a given vessel, it is possible for us to
calculate so many other variables. The cardiac output divided by the number of heart beats
per minute gives the amount of blood that is ejected during each heart beat, it is known as
stroke volume. If the total amount of blood circulation is known and this stroke volume is
divided by the cardiac output, the mean circulation time is obtained. From the blood flow
through a vessel , divided by the cross sectional area of the vessel, the mean velocity of the
blood at the point of measurement can be calculated.
In the arteries, blood flow is pulsatile. In fact, in some blood vessels, a reversal of
the flow can occur during certain parts of the heart beat cycle. Because of the elasticity of their
walls the blood vessels tend to smooth out the pulsations of blood flow and blood
pressure. Both pressure and flow are greatest in the aorta where the blood serves the heart.
Blood flow is a function of the blood pressure and flow resistance of the blood vessels
in the same way as electrical current flow depends on voltage and resistance. The flow
resistance of the capillary bed can vary ever a wide range. The body reduces the blood flow
through the skin by means of vasoconstriction (narrowing) of the capillaries . This symptoms
occur whenever a body is exposed to low temperatures or under the influence of certain drugs
(eg: nicotine)
Vasodilation (widening) of the capillaries occur when heat excitement or
local inflammation among other things, this increases the blood flow locally. Wide variations
that are possible in the flow resistance, the determination of blood pressure along is not
sufficient to access the status of the circulatory system.
The velocity of blood flowing through a vessel is not constant throughout the
cross section of the vessel but is a function of the distances from the wall surface. A thin layer
of blood actually adheres to the wall, resulting in zero velocity at this place, whereas the
highest velocity occurs at the centre of the vessel. Some blood flow meters do not actually
measure the blood flow but measures the mean velocity of the blood.
The laminar flow of blood has been changed to turbulent flow pattern , when the local
blood velocity exceeds a certain limit, it is difficult to determine the flow
rate.
Based on the flow of blood to all parts of the organs, the body has to be
functioned properly. If there is a reduction of blood occurs by a narrowing of the blood vessels,
the function of that organ can be severely limited. When the blood flow in a certain vessel
is completely obstructed (by a blood clot or thrombus) the tissue in the area supplied by this
vessel may die. Such an obstruction in a blood vessel of the brain is one of the causes of a
cerebrovascular accident (CVA) or stroke. An obstruction of part of the coronary arteries that
supply blood for the heart muscle is called a myocardial ( or coronary) infarct or heart attack,
whereas merely a reduced flow in the coronary vessels can cause a severe chest pain called
angina pectoris . A blood clot in a vessel in the lung is called an lubolism. Blood clots can also
afflict the circulation in the lower extremities (Thrombosis)
4.9.Blood Flow Meter:

An adequate blood supply is necessary for all organs of the body infact an impaired
supply of blood is the cause of various diseases. The ability to measure blood flow in the
vessel that supplies a particular organ would therefore be of great help in diagnosing such
diseases. The rate of flow of a liquid or gas in a pipe is expressed as the volume of the
substance that passes through the pipe in a given unit of a time. Flow rate are therefore usually
3
expressed in liters per minute or millimeters per minute. (cm / min)
Methods used in industry for flow measurements of other liquids, like the
turbine flowmeter and the rotatometer are not very suitable for the measurement of blood flow
because they require cutting the blood vessel. These methods also expose the blood to sharp
edges, which are conductive to blood clot formation. Practically all blood flow meters
currently used in clinical and research applications are based on one of the following physical
principles:
(i)
Electromagnetic induction.
(ii)
Ultrasound transmission or reflection
(iii)
Thermal convection
(iv)
Radiographic principles
(v)
Indicator (dye or thermal) dilution.
Commonly used flowmeters such as orifile or turbine flowmeters are unsuitable for
measuring blood flow because hey require cutting the vessel and can cause formation of clots.
4.9.1.Magnetic and ultras onic blood flow meters:

Velocity of the blood stream. These techniques measure the require that a transducer
surround, an excised blood vessel, they are mainly used during surgery. When compare
to indicator-dilution methods, this electromagnetic flow meter has a greater capability. It is
possible for us to use electromagnetic flow meters for any conductive liquid such as saline or
blood.
Plethysmograph actually indicates volume changes in body segments, can be used to
measure the flow of blood in the
limbs.
Electromagnetic Blood flow meters:

The most commonly used instrument for the measurement of blood flow is of
the electromagnetic type. The blood flow can be measured in intact blood vessels
without cannulation. The blood vessel has to be exposed so that the electromagnetic flow meter
measures instantaneous pulsatile flow of blood.
Principle:
The operating principle underlying all electromagnetic type flowmeters is based on
Faradays Law of Electromagnetic induction The law of electromagnetic induction states that
when a conductor is moved at right angles through a magnetic field in a direction at right
angles both to the magnetic field and its length, an emf is induced in the conductor.
The electric generator generates electricity by induction. Here copper wire move
through a magnetic field, cutting the lines of magnetic flux and inducing an emf in the wire.
In the flow meters an electromagnetic assembly provides the magnetic field placed
at right angles to the blood vessel in which the blood flow is measured. The flow meter
depends on
the movement of blood, which has a conductance similar to that of saline. The blood
stream which is a conductor cuts the magnetic field and voltage is induced in the blood
stream. The
induced voltage is picked up by two electrodes incorporated in the magnetic assembly.
The magnitude of the voltage picked up is
directly proportional to the strength of the magnetic field, the diameter of the blood vessel
and the velocity of the blood flow i.e., e = CHVd
Where e = induced voltage
H=strength of the magnetic field
V= velocity of blood flow
d=diameter of blood vessel
C=constant of proportionality
If the strength of the magnetic field and the diameter of the blood vessel
remain unchanged, then the induced voltage will be a linear function of the blood flow
velocity. Therefore, e = C1 V where C1 is a constant and equal to CHd
Flow rate Q through the tube Q = VA
Therefore V = Q/A
A is the cross sectional area of the tube.
Q
e C1 C2 Q
A
The induced voltage picked up by the electrodes is amplified and displayed/recorded on
a suitable system. The system is calibrated in terms of volume flow as a function of the
induced voltage. The diameter of the blood vessel is held constant by the circumference of the
hole in the probe that surrounds it.
Flowmeter, consists of a generator of alternating current a probe assembly,

a demodulator, a dc amplifier and a suitable recording device. The shape of the energizing
current waveform for the electromagnet may be sinusoidal or square.
Factors that cause error in electromagnetic flow meter:
1. Regions of high velocity generate higher incremental emfs than regions of low velocity.
So circulating currents flow in the transverse plane. These currents cause varying
drops in resistance within the conductive blood and surrounding tissues.
2. The ratio of the conductivity of the wall of the blood vessel so that of the blood varies
with the hematocrit (percentage of volume to blood volume). So the shunting
effects of the wall cause the variable error.
3. Fluid outside the wall of the vessel has the greater conductivity than the wall. So
it shunts the flow signal.
The magnetic flux density is not uniform in the transverse plane; this accentuates
the problem of circulating current.
The magnetic flux density is not uniform along the axis, which causes circulating
current to flow in the axial direction.
4.9.2.Ultrasonic Blood Flow meter:

With the help of ultrasonic energy it is possible for us to measure the velocity of flowing
blood.
There are basically two types of ultrasonic blood flow velocity meters. The first type is
the transit time velocity meters and the second is the Doppler-shift
type.
In transit time ultrasonic flow meter, a pulsed beam is directed through a blood vessel at a
shallow angle and its transit time is then measured. The transit time is shortened when the
blood flows in the direction of energy transmission. If the blood flows in the opposite
direction of energy transmission, the transit time is prolonged.
Popularly used ultrasonic blood flow metals are based on the Doppler principle. An
oscillator operating at a frequency of several megahertz, excites a piezoelectric transducer
(made by
barium titanate). This transducer is coupled to the wall of an exposed blood vessel and sends
an ultrasonic beam with a frequency F into the flowing blood. A small part of the
transmitted energy is scattered back and is received by a second transducer arranged opposite
the first one. Scattering occurs mainly as a result of the moving blood cells, the reflected signal
has a different
frequency due to Doppler Effect. Its frequency is either F FD or F FD , depending on the
direction of flow. The Doppler component FD is directly proportional to the velocity of
the flowing blood. A fraction of the transmitted ultrasonic energy however reached the
second transducer directly with the frequency being unchanged. After amplification of t he
composite signal, the Doppler frequency can be obtained at the output of a detector as the
difference between the direct and the scattered signal components. The Doppler frequency is
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typically in the low audio frequency range. Because of the velocity profile of the blood, the
Doppler signal is

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not a pure sinewave, but has more the form of marrow-band noise. Doppler frequency can
be calibrated directly in flow-rate units.
4.9.3. Blood Flow measurement by indicator Dilution Method:

The indicator or dye dilution methods are the only methods of blood flow measurements
that really measure the blood flow and not the blood velocity. Any substance can be used as
a
indicator if it mixes readily with blood and its concentration in the blood can be
easily determined after mixing. The substance must be stable but should not be retained by the
body. It must have no toxic side effects.
An indocyanine dye, cardiogreen used in an isotonic solution was long favored as a
indicator. Its concentration was determined by measuring the light absorption with
a densitometer (calorimeter) . Radio isotopes (Radio iodited serum albumen) have also
been employed for this purpose.
Blood flow measurements by Thermal convection:
A hot object in a colder-flowing medium is cooled by thermal convection. The rate
of cooling is proportional to the rate of the flow of the medium. This principle is used to
measure gas flow has also been applied to the measurement of blood velocity. In one
application, an electric heater is placed between two thermocouples or thermistors that are
located some distance apart along the axis of the vessel. Temperature difference between the
upstream and the down stream sensor is a measure of the blood velocity.
Blood flow determination by Radiographic method:
Blood is not generally visible on an x-ray image because it has about the same
radio density as the surrounding tissue. But with the help of a injection of a contrast medium
into a blood vessel (eg: an iodated organic compound) it is possible for us to make the
blood to be visible by x-ray image (either photographic) or on a videorape recording the
process of the contrast medium can be followed obstructions can be detected and the blood
flow in certain blood vessels can be estimated.
4.10.Colorimeter
Colorimeter :
Introduction:
A colorimeter, an instrument used in colorimetry, measures the absorbance o f

particular wavelengths of light by a specific so lution. This device, invented by Jan
Szczepanik, is most commonly used to determine the concentration of a known solute in a
given solution by the application of the Beer-Lambert law, which states that the
concentration of a solute is proportional to the absorbance.
Composition of blood serum is determined by specialized chemical techniqus.
The different components of biological substances can be determined by measuring how they
either absorb or emit visible light. Colorimeter uses light absorption to determine blood
proteins and irn levels. In order to enhance the color of these substances in blood serum, it is
necessary to mix it with reagents. The basic principle behind these colorimeters is that, many
chemical cmpounds in slution appears coloured with saturation of the color depending on the
concentration of the compund. By analyzing the transmitted light through the sample or
emitted light by the sample. The concentration of the substance can be determined as
TRANSMITTANCE T = I1/ Io
I1 = transmitted light intensity.
Io = incident light intensity.
ABSORBANCE OR OPTICAL DENSITY:
A = - Log (I1/ Io)
Or A = log (1/T)
Thus A = CL.
= absorbitivity which depends on the absorbing substance and optical wavelength at
which measurement is performed.
C= concentration of the absorbing substance
L = path length of the cuvette.
The essential parts of a colorimeter are:
a light source (often an ordinary low-voltage filament lamp)

an adjustable aperture
a set of colored filters
a cuvette to hold the working solution
a detector (usually a photoresistor} to measure the transmitted light
a meter to display the output from the detector
In addition, there may be:
a voltage regulator, to protect the instrument from fluctuations in mains voltage.

a second light path, cuvette and detector. This enables comparison between the working
solution and a "blank", consisting of pure solvent, to improve accuracy.
By measuring the optical density or absorbance A, the concentration of a given substance in

a sample can be determined. Colorimeter can be filter photometer or spectrophotometer. When
an interference filter is used to select a given wavelength, it is called filter photometer.
When a diffraction grating or prism is used as a monochromatic to get different spectral
components or wavelengthsof interest
in
colorimeter, then
it is
called
spectrophotometer.
This spectrophotometer
allows
the
determination of absorption of samples at various wavelengths. Fluorescence is an optical
phenomenon in which the light kof shorter wavelength is incident kon a sample absorbs
and reemits light on a longer wavelength. The concentration of such chemicals can be
determined by fluorometers and spectrofluorometers are used to select the emission
wavelength respectively.
Filter photometer:
Fig shows the schematic diagram of a simple filter photometer which is used to
measure transmittance. Light from a halogen lamp incident on filter F. it transmits
only suitable wavelength range at which the measurement is performed. The divergent of
transmitted light is converted into two parallel beams buy an optical arrangement. One beam
falls on a reference selenium photoelectric cell CR, and other beam falls on a sample selenium
photoelectric cell Cs after passing through sample in the cuvette. Without output from
photoelectric cells are the same. When the sample is placed in the light path, the output of the
sample cell is reduced and hence the potentiometer is adjusted by the full deflection in
the galvanometer G. since the potentiometer is calibrated in terms of transmittance, we
can determine the concentration of a given substance in the sample. Generally potentiometers
are calibrated in terms of concentration of a given substance in the sample. Generally
potentiometers are calibrated in terms of concentration directly using a standard known
concentration.
Filters
Changeable optics filters are used in the colorimeter to select the wavelength of light which
the solute absorbs the most, in order to maximize accuracy. The usual wavelength range is from
400 to 700 nanometres (nm). If it is necessary to operate in the ultraviolet range (below
400 nm) then some modifications to the colorimeter are needed. In modern colorimeters
the filament lamp and filters may be replaced by several light-emitting diodes of different
colors.

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Cuvettes
In a manual colorimeter the cuvettes are inserted and removed by hand. An aut
omated colorimeter (as used in an AutoAnalyzer) is fitted with a flowcell through which
solution flows continuously.
Output
The output from a colorimeter may be displayed by an analogue or digital meter and may
be shown as transmittance (a linear scale from 0-100%) or as absorbance (a logarithmic
scale from zero to infinity). The useful range of the absorbance scale is from 0-2 but it is
desirable to keep within the range 0-1 because, above 1, the results become unreliable due to
scattering of light.
In addition, the output may be sent to a
computer.
chart recorder, data logger, or
Graphic
design
In graphic design, colorimeters are used to generate color profiles for equipment in
the workflow. Accurate color profiles are important to ensure that screen displays match the
final printed products.
Flame photometer:
A flame photometer is used to analyze urine or blood in order to determine
the concentration of potassium (K) sodium (Na) calcium(Ca) lithium (Li). Sometimes lithium is
used as a calibration substance in the analysis of the other three substances. A known
amount of lithium is added to the sample and the emitted light intensity of the sample
under analysis is measured relative to that of the lithium. By this way, any error due to varying
flame temperature is eliminated.
The sample whose concentration is to be analyzed is taken in a beaker. This sample
is sprayed into fine droplets using an atomizer. This fine droplets are passed through oxygen or
air past opening in it.
4.11.Electrophoresis
Electroporesis Introduction:

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Devices based on electrophoresis principles are used in clinical laboratory to

measure quantities of the various types of proteins in plasma, urine and CSF; to separate
enzymes into their component isoenzymes to identify antibodies, and to serve in a variety of
other applications.
Electrophoresis is the most known electrokinetic phenomena. It was discovered
by Reuss in 1809 . He observed that clay particles dispersed in water migrate
under influence of an applied electric field. Generally, electrophoresis is the
motion of dispersed particles relative to a fluid under the influence of an electric
field that is space uniform. Alternatively, similar motion in a space non-uniform
electric field is called dielectrophoresis.
Electrophoresis occurs because particles dispersed in a fluid almost always carry an

electric surface charge. An electric field exerts electrostatic Coulo mb force on the
particles through these charges.
Another force is electrostatic as well. It is known from double layer theory that all
surface charges in fluids are screened with a diffuse layer. T his diffuse layer has the same
absolute charge value, but with opposite sign from the surface charge. The electric field
induces force on the diffuse layer, as well as on the surface charge. The total value of this
force equals to the first mentioned force, but it is oppositely directed. However, only part of
this force is applied to the particle. It is actually applied to the ions in the diffuse layer. These
ions are at some distance from the particle surface. They transfer part of this electrostatic
force to the particle surface through viscous stress. This part of the force that is applied
to the particle body is called electrophoretic retardation force.
Basic Principles:
Electrophoresis may in general be defined as the movement of solid phase with respect
to a liquid movement of solid phase with respect to a liquid (the buffer solution) the main
H
functions of the buffer solution are to carry the current and t keep the P of the solution
constant during migration. The buffer solution is supported by a solid solition called medium.
In th\is technique, the sample is applied to the medium and under the effect of the electric field,
groups of particles that are similar in charge, size and shape migrate at similar rates. This
results in migration of the particles in the field.
Magnitude of charge:
The mobility of the given particle is directly related to the net magnitude of the
particles charge. Mobility is defined as the distance in centimeters a particle moves in unit
time per unit field strength, expressed as voltage drop per centimeter.
Ionic strength of the buffer:
The more concentrated the buffer, the slower the rate of migration of the particles. This
is because the greater the properties of buffer ions present,the greater the proportion of the
current they carry. It is also due to interaction between the buffer ions and the particles.
Time:
The distance of migration is directly related to the time the electrophresis takes. Other
factors that influence migration include electrophoresis chromatography,particle shape.
Applications
There are many applications of electrophoresis for measurements and various operations
with particulates
Measurement
Electrophoresis is used for studying properties of dispersed particles.
Gel electrophoresis
Gel
electromacromolecules
phoresis is an application
in molecular
Biological
usually proof
teinelectrophoresis
s, DNA, or RNA
are loadedbiology.
on a gel and
separated on
the
basis of their electrophoretic mobility. (The gel greatly retards the mobility of all
molecules present.)
Electrophoretic displays
Electrophoretic displays (EPD's) are a class of information display that form images
by electrophoretic motion of charged, colored pigment particles.
Electrophoretic fingerprinting:
Electrophoresis is also used in the process of DNA fingerprinting. Certain DNA segments
that vary vastly among humans are cut at recognition sites by restriction enzymes (
restriction endonuclease). After the resulting DNA fragments are run through electrophoresis,
the distance between bands are measured and recorded as the DNA "fingerprint."
Electrophoretic deposition:
Coatings, such as paint or ceramics, can be applied by electrophoretic deposition.
The technique can even be used for 3-D printing.
4.12. pCO2 (Partial Pressure of Carbon Dioxide) reflects the amount of carbon
dioxide gas dissolved in the blood.
Indirectly, the pCO2 reflects the exchange of this gas through the lungs to the outside
air. Two factors each have a significant impact on the pCO2. The first is how rapidly
and deeply the individual is breathing:
Someone who is hyperventilating will "blow off" more CO2, leading to lower
pCO2 levels
Someone who is holding their breath will retain CO2, leading to increased
pCO2 levels
The second is the lungs capacity for freely exchanging CO2 across the alveolar
membrane:
With pulmonary edema, there is an extra layer of fluid in the alveoli that
interferes with the lungs' ability to get rid of CO2. This leads to a rise in pCO2.
With an acute asthmatic attack, even though the alveoli are functioning
normally, there may be enough upper and middle airway obstruction to block
alveolar ventilation, leading to CO2 retention.
Increased pCO2 is caused by:
Pulmonary edema
Obstructive lung disease
Decreased pCO2 is caused by:
Hyperventilation
Hypoxia
Anxiety
Pregnancy
Pulmonary Embolism (This leads to hyperventilation, a more important
consideration than the embolized/infarcted areas of the lung that do not
function properly. In cases of massive pulmonary embolism, the infarcted or
non-functioning areas of the lung assume greater significance and the pCO2
may increase.)
4.12.1.Measurement of PCO2
The measurement of PCO2 is based on the fact that the relationship between log PCO2 and pH is
linear over the range of 10 to 90 mm Hg which includes essentially all the values of clinical
interest. This result can be established by examining some fundamental chemical
+
relationships among H , H2CO3, and PCO2. The first three quantities are related by the
equilibrium equation
H2O + CO2
H2CO3
+
H + HCO3 - ------------
In addition, the relationship between PCO2 and the concentration of the CO2 dissolved in the
blood, [CO2] is given by
[CO2] = a(PCO2) ------------------------------------------(2)
Where a = 0.0301 mmol/liter per mm Hg PCO2. The mass relationship corresponding to eq(1)
k' =
---------------------------------------------------------(3)
Next we use the fact that [H2CO3] is proportional to [CO2] to obtain the result
k=
--------------------------------------------------------------(4)
where k represents the combined values of k' and the proportionality constant between [H2CO3]
and [CO2] using eq(2) we obtain the following result
k=
----------------------------------------------------------------(5)
next taking
the base-10
logarithm of eq(5) and rearranging, we obtain
+
log[H ] + log[HCO3 ] log k log a log PCO2 = 0 ---------------------(6)
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using the definition of pH

yields
pH = log[HCO3 ] - log a log PCO2 --------------------------------------(7)
this shows that pH has a linear dependence on the negative of log PCO 2. The assembly
includes two chambers, one for the specimen and a second containing a pH electrode. In
contrast to the
basic pH measurement device in which the pH electrode is placed in the specimen. In this
case the pH electrode is bathed by a buffer solution of bicarbonate and NaCl.
The two chambers are separated by a semi permeable membrane, usually made of Teflon
or silicone rubber. This membrane allows dissolvedCO2 to pass through but blocks the
passage of charged particles, in particular H+ HCO3 . When the specimen is placed in its
chamber, Co2 diffuses across the membrane to establish the same concentration in both
chambers. If there is a net movement of CO2 into (or out of) the chamber containing the
+
buffer,[H ] increases (or decreases), and the pH meter detects this change, because the
relationship between pH and the negative log PCO2 is only a proportional one, it is necessary
to calibrate the instrument before each use with two gases of known PCO2. Fig.1. shows PCO2
electrode
Fig. 1.PCO2 Electrode

Semipermeable
Exit
H +
Glass
Voltmeter
HCO3 +
AgCl Ag
H2CO3
k
For blood
Or calibrating
Entrance
CO2
H2CO3
k
CO2
(Dissolve
Sample Chamber
Buffer
Reference
Fig. 1.PO2 Electrode

Semipermeable
Glass
Exit
e
For blood
Or calibrating
Cathode
Voltmeter
O2
Anode
O2
AgCl Ag
(Dissolve
Entrance
Sample Chamber
Reference
Base Excess or Base Deficit

Whenever there is an accumulation of metabolically-produced acids, the body
attempts to neutralize those acids to maintain a constant acid-base balance.
This neutralizing is achieved by using up various "buffering" compounds in the blood
stream, to bind the acids, disallowing them from contributing to more acidity.
About half of these buffering compounds come from HCO3, and the other half from
plasma and red blood cell proteins and phosphates.
The words "base deficit" and "base excess" are equivalent and are generally used
interchangeably. The only difference is that base deficit is expressed as a positive
number and base excess is expressed as a negative number.
A "Base Deficit" of 10 means that 10 mEqu/L of buffer has been used up to neutralize
metabolic acids (like lactic acid). Another way to say the same thing would be the
"Base Excess is minus 10."
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More Negative Values of Base Excess may Indicate:
Lactic Acidosis
Ketoacidosis
Ingestion of acids
Cardiopulmonary collapse
Shock
More Positive Values of Base Excess may Indicate:
Loss of buffer base

Hemorrhage
Diarrhea
Ingestion of alkali
4.13. 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 halfcell 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 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
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resting potential state to the action potential state is called

depolarization.

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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.
RT
C1 f1
E
ln

Where,
nF
C2 f 2
7
R
gas constant(8.315 x 10 ergs/mole/degree Kelvin)
T
absolute Temperature, degrees Kelvin
n
valence of the ion (the number of electrons added or removed to ionize the
atom) F
Faraday constant (96,500 coulombs)
C1, C2 two concentrations of the ion on the two sides of the membrane
f1, f2 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.

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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
Heart
Brain
Muscle
Eye (Retina)
Eye (Cornea - Retina)
ElectroCardioGram (ECG)
ElectroEncephaloGram (EEG)
ElectroMyoGram (EMG)
ElectroRetinoGram (ERG)
ElectroOculoGram (EOG)
Bioelectric potential
Function
ElectroCardioGram
(ECG)
Records
electrical
activity of heart
ElectroEncephaloGram
(EEG)
Records
electrical
activity
brain
ElectroMyoGram
(EMG)
Records
muscle
potential
Peak
amplitude
0.1 to 4mV
2 to 200V
of
50V
1mV
to
Frequency Observation
response
0.05 to
Used to measure
120 Hz
heart
rate,
arrhythmia
and
abnormalities
0.1 to 100 Used to analysis
Hz
evoked potential,
certain patterns,
frequency
response
5 to 2000 Used as indicator
Hz
of muscle action
for
measuring
fatigue
4.14. Pacemaker
Inroduction
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 .
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
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 prima ry 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 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 at rium 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 non- contracting 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
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pacing modes for individual patients. Some combine a pacemaker and

single implantable device. Others

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defibrillator in a
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have multiple electrodes stimulating differing positions within the heart to

improve synchronization of the lower chambers (ventricles) of the heart.
Pacemaker Pulses
These Pulses should have the pulse to space ratio 1:10000.
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.
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Comparision between external pacemaker and internal

pacemaker.

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External pacemaker
It does not necessitate open heart surgery
The skin near the chest or abdomen with its
output leads are connected directly to he
heart muscle
These are used for temporary heart
irregularities. There is no safety or
pacemaker.
Internal pacemaker
The pacemaker is surgically implanted
beneath
It requires open chest minor surgery to
place the circuit
These are used for permanent heart
damages. There is cent percent safety for
circuit from external disturbances
Electrodes for Stimulation

Bipolar and unipolar electrodes are used.
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.
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Disadvantages:

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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 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
to natural
pace the
heart. The
leadthe
used
to detect the
R wave
now used
tosostimulate
theturned
heart. on
If the
contraction
occurs,
asynchronous
pacers
timingiscircuit
is reset
that it
will time its next pulse to detect the heart beat
Advantages 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.
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, 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
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the multivibrator is given to the amplifier which produces the desired stimulus to be applied
to the heart

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5 units
Heart
5.1.Electrical conduction system of the heart
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.
5.2.SA node:
5.2.1P 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.
5.2.2.INTERNODAL TRACTS,
As the electrical activity is spreading throughout the atria,
it travels via specialized pathways, known as inter nodal 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.
5.2.3.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.
5.3.Bundle of His

5 units
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.
5.4.Purkinje fibers/ventricular myocardium: QRS complex
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

5 units
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
5.5.R and S wave

The R and S waves indicate the spread of the action potential along the ventricular
myocardium itself.
5.6.ST Segment
The ST segment connects the QRS complex and the T wave.

ST segment elevation or ST segment depr ession) may indicate coronar y ischemia
or
myocardial infraction.
5.7.Ventricular repolarization: T wa ve
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.
These conditions are not necessarily bad symptoms, however.
Trained athletes, for example, usually show heart rates slower than 60bpm when not
exercising
5.8.ECG waveforms Lead III

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5.9.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).
5.10.Normal ECG
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 wa ve is normally visible in 50 to 75% of ECGs.
5.10.1.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.
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four types of electrode systems are there. They are:

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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 wa ve is normally visible in 50 to 75% of ECGs.
5.10.2.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

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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
5.10.3.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)
5.10.4.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.
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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
5.10.4.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.
5.11.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.
5.12.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.
5.13.Heart Transplantation
5.13.1.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).
5.13.2.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
5.13.3.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
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considered or attempted prior to recommendation.

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5.14.Causes of heart failure
Cardiomyopathy
Congential heart disease
Coronary artery disease
Heart valve disease
Life-threatening arrhythmias.
5.15.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 protect ion 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.
5.15.1.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.
5.15.2.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 bioamplifier.
5.15.3.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 R 2 and is used to position the output stylus pen. Gain adjustment is provided with
the resistance Ro.
5.15.4.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.
5.15.5.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.
5.15.6.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.
5.15.7.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
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switch must be placed in the RUN position. In the off position, the ECG unit is in switched
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5.16.Echocardiogr
ap h y
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.
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
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regurgitation), and calculation of the cardiac output as well as the ejection fraction.

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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
sonographers
is
usually
performed
by
cardiologists
or
cardiac
5.16.1.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.
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.
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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,
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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.
6.Study of the brain

6.1.Fields of study
Neuroscience seeks to understand the nervous system, including the brain, from a biological
and computational perspective. Psychology seeks to understand behavior and the brain. The
terms neurology and psychiatry usually refer to medical applications of neuroscience and
psychology respectively. Cognitive science seeks to unify neuroscience and psychology with
other fields that concern themselves with the brain, such as computer science (artificial
intelligence and similar fields) and philosophy.
6.1.1.Methods of observation
6.1.2.Electrophysiology
Each method for observing activity in the
drawbacks. Electrophysiology allows scientists to
individual neurons or groups of neurons.
brain has its advantages and

record the electrical activity of
6.1.3.EEG
By placing electrodes on the scalp one can record the summed electrical activity of the cortex
in a technique known as electroencephalography (EEG). EEG measures the mass changes
in electrical current from the cerebral cortex, but can only detect changes over large areas of
the brain with very little sub-cortical activity.The abbreviation of electroencephalograph is
called EEG. It deals with the recording and study of electrical activity of the brain. EEGs are
recorded by means of electrode attracted to the skull of a patient the brain waves can be
picked up and recorded. Graded potentials are variations around the average value of the resting
potential. Thus the EEG potentials originate within the dendrite.
.6.1.4.MEG
Apart from measuring the electric field around the skull it is possible to measure the
magnetic field directly in a technique known as magnetoencephalography (MEG). This
technique has the same temporal resolution as EEG but much better spatial resolution,
although admitedly not as good as fMRI. The main advantage over fMRI is a direct
relationship between neural activation and measurement.
6.1.5.fMRI and PET

Functional magnetic resonance imaging (fMRI) measures changes in blood flow in the brain,
but the activity of neurons is not directly measured, nor can it be distinguished whether this
activity is inhibitory or excitatory. fMRI is a noninvasive, indirect method for measuring
neural activity that is based on BOLD; Blood Oxygen Level Dependent changes. The
changes in blood flow that occurs in capillary beds in specific regions of the brain are
thought to represent various neuronal activities. Similarly, a positron emission tomography
(PET), is able to monitor glucose metabolism in different areas within the brain which can be
correlated to the level of activity in that region.
6.1.6.Other methods
Attempts have also been made to directly "read" the brain, which has been accomplished in
a
rudimentary manner through a brain-computer interface. Brain activity can be detected
by implanted electrodes, raising the possibility of direct mind-computer interface. The
reverse method has been successfully demonstrated.
6.1.7.Other matters
Computer scientists have produced simulated neural networks loosely based on
the structure of neuron connections in the brain. Artificial intelligence seeks to replicate
brain
functionalthough not necessarily brain mechanismsbut as yet has been met with
limited
success.
Creating algorithms to mimic a biological brain is very difficult because the brain is not a
static arrangement of circuits, but a network of vastly interconnected neurons that are
constantly changing their connectivity and sensitivity. More recent work in both neuroscience
and artificial intelligence models the brain using the mathematical tools of chaos theory
and dynamical systems. Current research has also focused on recreating the neural structure of
the brain with the aim of producing human-like cognition and artificial intelligence.
6.2.ElectroEncephaloGraphy (EEG)
The recorded representation of bioelectric potential generated by

neuronal activity of the brain is called electroencephalogram(EEG). With the help of
electrodes attached to the skull of a patient, the brain waves can be picked up and recorded.
EEG wave form has a very complex pattern, which is much more difficult to recognize
than the ECG. The brain waves are the summation of neuronal depolarization in the brain.
Due to stimuli from the five senses as well as from the thought process on the surface of
the brain, these voltages are about 10 mV. Due to propagation through skull bone, they
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are attenuated to levels from 1v to 100 v,which are picked up by EEG electrodes. They
are in the frequency range from 0.5 to 3000hz.. These potentials vary with respect to
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surface of skull. The waveform varies greatly with the location of the measuring
electrodes on the surface of the scalp. EEG potentials measured at the surface of the
scalp, actually represent the combined effect of potentials from a fairly wide region of the
cerebral cortex and from the various points beneath. During recording the electrodes are
placed around the frontal, parietal, temporal and occipital lobe of the lobes, the EEG
waveforms is generally affected by the mental activity of a person.
Evoked potentials are the potentials developed in the brain as the responses to external
stimuli like light, sound etc. the external stimuli is detected by the sense organs, which cause
changes in the electrical activity of the brain. Nowadays the term event related potential
has been used instead of evoked potential.
6.2.1.Brain Waves:
Wide variation among individuals and the lack of repeatability in a given
person from one person to another make the establishment of specific relationships.
But some
characteristics EEG waveforms can be related to epileptic seizures and sleep. The
EEG waveforms obtained with the help of intensity and patterns of this electrical activity
due to overall level of excitation of the brain. This includes various activities of a person
when in alert condition, sleepy condition, tension condition etc.
Normally the brain waves are irregular, no general patterns can be discerned in the
EEG. But during abnormal conditions we can obtain the specific wave
form.
The normal Brain waves that occur in the human being can be classified into Alpha,
Beta, delta and theta waves.
Brain waves
Delta wave
Theta wave
Alpha wave
Beta wave
Frequency
below 3 hz
from 3 hz to about 8hz .
from about 8hz to about 13hz .
above 13hz .
Activity types
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Historically four major types of continuous rhythmic sinusoidal EEG activity are
recognized (alpha, beta, delta and theta). There is no precise agreement on the frequency
ranges for each type.
Delta is the frequency range up to 4 Hz and is often associated with the very young
and certain encephalopathies and underlying lesions. It is seen in stage 3 and 4 sleep.
Delta waves.
Theta is the frequency range from 4 Hz to 8 Hz and is associated with

drowsiness, childhood, adolescence and young adulthood. This EEG frequency can
sometimes be produced by hyperventilation. Theta waves can be seen during
hypnagogic states such as trances, hypnosis, deep day dreams, lucid dreaming and light
sleep and the preconscious state just upon waking, and just before falling asleep.
Theta waves.
Alpha (Berger's wave) is the frequency range from 8 Hz to 12 Hz. It is characteristic

of a relaxed, alert state of consciousness. Alpha rhythms are best detected with the
eyes closed. Alpha attenuates with drowsiness and open eyes, and is best seen
over the occipital (visual) cortex. An alpha-like normal variant called mu is sometimes
seen over the motor cortex (central scalp) and attenuates with movement, or
rather with the intention to move.
Alpha waves.
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sensorimotor rhythm (SMR) is a middle frequency (about 1216 Hz) associated with
physical stillness and body presence.
Beta is the frequency range above 12 Hz. Low amplitude beta with multiple and
varying frequencies is often associated with active, busy or anxious thinking
and active concentration. Rhythmic beta with a dominant set of frequencies is
associated with various pathologies and drug effects, especially benzodiazepines.
Beta waves.
Gamma is the frequency range approximately 26100 Hz. Gamma rhythms appear to
be involved in higher mental activity, including perception, problem solving, fear,
and consciousness.
Gamma waves.
Rhythmic slow activity in wakefulness is common in young children, but is abnormal
in adults. In addition to the above types of rhythmic activity, individual transient waveforms
such as sharp waves, spikes, spike-and-wave complexes occur in epilepsy, and other
types of transients occur during sleep.
In the transition from wakefulness, through Stage I sleep (drowsiness), Stage II (light) sleep,
to Stage III and IV (deep) sleep, first the alpha becomes intermittent and attenuated,
then disappears. Stage II sleep is marked by brief bursts of highly rhythmic beta activity
(sleep spindles) and K complexes (transient slow waves associated with spindles, often
triggered by an auditory stimulus). Stage III and IV are characterized by slow wave activity.
After a period of deep sleep, the sleeper cycles back to stage II sleep and/or rapid eye
movement (REM) sleep, associated with dreaming. These cycles may occur many times during
the night.
EEG under general anesthesia depends on the type of anesthetic employed. With
halogenated anesthetics and intravenous agents such as propofol, a rapid (alpha or low
beta), nonreactive EEG pattern is seen over most of the scalp, especially anteriorly; in some
older terminology this was known as a WAR (widespread anterior rapid) pattern, contrasted
with a WAIS (widespread slow) pattern associated with high doses of opiates. Anesthetic
effects on EEG signals are beginning to be understood at the level of drug actions on
different kinds of synapses and the circuits that allow synchronized neuronal activity
6.3.Co
ma
In medicine, a coma (from the Greek - koma, meaning deep sleep) is a profound state
of unconsciousness. A comatose patient cannot be awakened, fails to respond normally to
pain or light, does not have sleep-wake cycles, and does not take voluntary actions. Coma
may result from a variety of conditions, including intoxication, metabolic abnormalities,
central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia.
It may also be deliberately induced by pharmaceutical agents in order to preserve
higher brain function following another form of brain trauma.
The difference between coma and stupor is that a patient with coma cannot give a
suitable response to either noxious or verbal stimuli, whereas a patient in a stupor can
give a crude response, such as screaming, to an unpleasant stimulus.
Some psychiatric diseases appear similar to coma. Some forms of schizophrenia, catatonia,
and extremely severe major depression are responsible for behaviour that appears comatose.
Coma is also to be distinguished from the persistent vegetative state which may follow it. This
is a condition in which the individual has lost cognitive neurological function and awareness of
the environment but does have noncognitive function and a preserved sleep-wake
cycle. Spontaneous movements may occur and the eyes may open in response to external
stimuli, but the patient does not speak or obey commands. Patients in a vegetative state
may appear somewhat normal and may occasionally grimace, cry, or laugh.
Likewise, coma is not the same as brain death, which is the irreversible cessation of all
brain activity. One can be in a coma but still exhibit spontaneous respiration; one who is
brain-dead, by definition, cannot.
Coma is different from sleep; sleep is always
reversible.
6.4.Distinctive phases of coma

Within coma itself, there are several categories that describe the severity of
impairment. Contrary to popular belief, a patient in a comatose state does not always lay still
and quiet. They may talk, walk, and perform other functions that may sometimes appear to be
conscious acts, yet are not.
Two scales of measurement frequently used in TBI diagnosis to determine the phase
of coma are the Glasgow Coma Scale and the Ranchos Los Amigos Scale. The GCS is a simple
15- point scale used by medical professionals to assess severity of neurologic trauma, and
establish a prognosis. The RLAS is a more complex scale that describes up to eight separate
levels of coma, and is often used in the first few weeks or months of coma while the
patient is under closer observation, and when shifts between levels are more frequent.
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There are several levels of coma, through which patients may or may not progress.
As coma deepens, responsiveness of the brain lessens, normal reflexes are lost, and the
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longer responds to pain. The chances of recovery depend on the severity of the underlying
cause. A deeper coma alone does not necessarily mean a slimmer chance of recovery,
because some people in deep coma recover well while others in a so-called milder coma
sometimes fail to improve.
The outcome for coma and vegetative state depends on the cause, location, severity
and extent of neurological damage: outcomes range from recovery to death. People may emerge
from a coma with a combination of physical, intellectual and psychological difficulties
that need special attention. Recovery usually occurs gradually, with patients acquiring more
and more ability to respond. Some patients never progress beyond very basic responses, but
many recover full awareness. Gaining consciousness again is not instant: in the first days,
patients are only awake for a few minutes, and duration of time awake gradually increases.
Comas generally last a few days to a few weeks, and rarely last more than 2 to 5
weeks. After this time, some patients gradually come out of the coma, some progress to a
vegetative state, and others die. Many patients who have gone into a vegetative state go on
to regain a degree of awareness. Others may remain in a vegetative state for years or
even decades. Predicted chances of recovery are variable due to different techniques used to
measure the extent of neurological damage. All the predictions are statistical rates with some
level of chance for recovery present: a person with a low chance of recovery may still
awaken. Time is the best general predictor of a chance for recovery, with the chances for
recovery after 4 months of brain damage induced coma being low (less than 15%), and full
recovery being very low.
The most common cause of death for a person in a vegetative state is secondary infection such
as pneumonia which can occur in patients who lie still for extended periods.
6.5.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
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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.
Oscilloscope
Tape recorder
Input
EMG
amplifier
Speaker
A.F.Amplifier
Block diagram of typical set up for EMG recording
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
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
ra nge 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.
6.6.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.
Electroretinogram waveform
B
D
Action
potential
1 Sec
1 mV
Light on
Time
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
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contact lens. Rotations of the eye cause induced voltages of few millivolts, which can give
information about the eye potential.

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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.
TELEMEDICINE
7.1 Introduction :
7.1.1 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
gastrointestinal pressure, blood flow and temperatures.
blood pressure,
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
signal for transmission.
7.1.2 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
Subject
Amplifier
Processor
Transducer
Modulator
Exciter
Carrier
Block Diagram of a Biotelemetry transmitter
Tuner
Demodulator
Chart Recorder
or Oscilloscope
Tape Recorder
Receiver Storage Display units
7.2 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.
7.2 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.
7.2.1 Pulse width Modulation (PWM):
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
of the modulating
e m . the other zero
side of
capacitor
to amplitude
the base voltage
of Q2 dropsvoltage
from approximately
to this
em.
transistor is
Q2connected
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.
7.2.2 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. 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
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quality

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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 L 1, C1, C2 as the tank
circuit.
Transmitter circuit diagram:
Inductor
A capacitive divider circuit is plced in the collector circuit, that is formed with the
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 subcarrier input. Thus the transmitter,s output consists of an RF signal, tuned in the FM broad
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cast band and frequency modulated by the sub-carrier oscillator (SCO), which in turn is
frequency modulated by the physiological signals of interest.

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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 submodulator 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.
7.3.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 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.
7.4.NERVE AND MUSCLE STIMULATORS:

Stimulators are the devices which are used to stimulate innervated muscles denervated
muscles and nerves. further these are used for the treatment of paralysis with totally or
partially denervated muscles, for the treatment of pain. muscular spasm and peripheral
circulatory disturbances. this technique is called electrotherapy which uses low volt, low
frequency impulse currents.
7.4.1.STIMULATION OF NERVES:
There is normally a potential difference of about 100mv across a nerve membrane. if this
potential is reversed for more than about 20 milliseconds, the nerves will be stimulated and
an action potential will be propagated along the nerve fiber.
the nervous system is the body's internal, electrochemical, communication network.
its main poarts are the brain and spinal cord from the central nervous system (CNS) the body's
chief
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controlling and coordinating centres. Billions of long neurons, many grouped as nerves, make
up the peripheral nervous system, transmitting nerve impulses between the CNS and other
regions
of the body. Each neurons has threee parts: a cell body, branching dendrites that receive
chemical signals from other neurons, and a tube -like axon that conveys these signals
as
electrical impulses.

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Types of neurons:
Three types of neurons are there. they are Multipolar, unipolar, bipolar.
Types of nerve ending:
free nerve ending, Meissner's corpuscle. Merkel's disc. Ruffini corpuscle, Pacinian
corpuscle.
7.4.2.ACCUPUNCTURE:
Accu-means needle, puncture- means making a highly concentrated presssure over the
skin, in order to relief the pain over the partiular area of the skin. This kind of treatment
is
popular in CHINA from 2600B.C. onwards. in accupuncture, care should be taken for
the patient, not for the diseases. iin our body electric energy is there. It is possible for us to
adjust the electric energy in proper way. 12 paths are there in our body. in these 12 paths 900
needle points are there. in these points, with the help of stainless steel needle we are
puncturing our body. by doing like this we can increase or decrease the electric energy in our
body. In olden days people had used this acupuncture in place of anasthesia. With the help of
these acupunctre we can stop the poain information, which passes to our brain. In our heart
there are no nerves. so if we are acupuncturing our heart means, we dont feel no pain. With the
help of this accupunctur , we can stimulate our nerves. nowadays with the help of electric
current these nerves are stimulated.
7.4.3.DIFFERENT
TYPES
OPF
STIMULATOR(ELECTROTHERAPY)
WAVEFORMS
USED
IN
Various types of waveforms are used for stimulation of nerves and muscles to carry
out
treatment of various diseases.
(i) Galvanic current:
galvanic current is a constant or direct current. the maximum amount of current passed
through the body is about 0.3 to 0.5 mA/cm2 of electrode surface. the duration of the passage
of current is about 10 to 20 minutes. The passage of current creates the movement of ions. it is
used for the preliminary treatment of atonic paralysis and for the disturbance of blood flow
in the arteries.
(ii) Interrupted galvanic current:
Interrupted galvanic current pulses are a series of negative going rectangular pulses.
the pulse duration is about 100 milliseconds with a repetition rate is between 12 per minute
and 70
per minute. A silghtly different form of interrupted galvanic pulses is the triangular
wavepulses.
fig shows the unidirectional interrupted galvanic pulses which create ionization of the skin of
the patient and produce discomfort and inflammation. it is overcome by the application of a
positive current in between the negative pulses proportional to the time interval.
(iii) Faradic current:

Faradic current pulses are usually between 50 per second in duration with a triangular
waveform as shown in fig (b). The repetition rate is invariably 50 per second. Faradic current
can produce muscular contractions. There is no ion movement due to the passage of faradic
current. This is used primarily for the treatment of muscle weakness. There are two types
of faradic current pulses , plain faddism is a train of faradic pulses of unvarying amplitude.
These are rarely used. Surged faradism is a series of surges of pulses shown in fig (c). Thus the
amplitude of the pulses applied to the patient increases in a slow manner and the number of
surges per minute is known as contraction rate. these faradic pulses are mainly used in the
treatment of functional paralysis and spasm. the muscular contraction occurs for each surge
which gradually increases in intensity from zero to maximum at the desired rate for muscular
contraction, and relaxation of muscles occurs when the surge ceases. Each surge has duration of
1500ms and approximately 70 impulses. its repetition rate is about 2 to 3 seconds.
(iv) Exponential current:
Fig(d) shows the exponential pulses used for the treatment of severe paralysis. By this
kind of pulses, the surrounding healthy muscles even in the immediate neighborhood of
the
diseases be varied to provide selective
stimulation.
Radiation therapy
Radiation therapy:
Radiation therapy (also called radiotherapy, x-ray therapy, or irradiat ion) 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 genet ic 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 so lid 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 lympho ma (cancers of the blood-forming cells and lymphat ic 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 radioact ive
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
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 co lorectal cancers,
gynecological cancers, cancer of the small intest ine, and cancer of the
pancreas. It is also being studied in clinical trials (research studies) to treat
some types of brain tumors and pelvic sarco mas 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.
Internal radiation is usually delivered in one of two ways, each of which is

described below. Both methods use sealed implants.
Interstitial radiation therapy is inserted into tissue at or near the
tumor site. It is used to treat tumors of the head and neck, prostate, cervix,
ovary, breast, and perianal and pelvic regions. Some women treated with
external
radiation for breast cancer receive a booster dose of radiation that may use
interstitial
radiation
or
external
radiation.
Intracavitary or intraluminal radiation therapy is inserted into the

body with an applicator. It is commonly used in the treatment of uterine
cancer. Researchers are also studying these types of internal radiation therapy
for other cancers, including breast, bronchial, cervical, gallbladder, oral,
rectal, tracheal, uterine, and vaginal.
Systemic radiation therapy uses radioactive materials such as iodine 131

and strontium 89. The materials may be taken by mouth or injected into the
body. Systemic radiation therapy is sometimes used to treat cancer of the thyroid
and adult non-Hodgkin lympho ma. Researchers are investigating agents to treat
other types of cancer.
Cancer patients receiving radiation therapy are often concerned that the treatment
will make them radioactive. The answer to this question depends on the type of
radiation therapy being given.
External radiation therapy will not make the patient radioactive. Patients do not need
to avoid being around other people because of the treatment.
Internal radiation therapy (interstitial, intracavitary, or intraluminal) that involves
sealed implants emits radioactivity, so a stay in the hospital may be needed. Certain
precautions are taken to protect hospital staff and visitors. The sealed sources deliver
most of their radiation mainly around the area of the implant, so while the area around
the implant is
radioactive, the patients whole body is not radioactive.
Systemic radiation therapy uses unsealed radioactive materials that travel throughout
the body. Some of this radioactive material will leave the body through saliva,
sweat, and urine before the radioactivity decays, making these fluids radioactive.
Therefore, certain precautions are sometimes used for people who come in close
contact with the patient.
The patients doctor or nurse will provide information if these special precautions are
needed.
Dosage of radiation:
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The amount of radiation absorbed by the tissues is called the radiation dose (or
dosage). Before 1985, dose was measured in a unit called a rad (radiation absorbed

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dose). Now the unit is called a gray (abbreviated as Gy). One Gy is equal to 100 rads;
one centigray (abbreviated as cGy) is the same as 1 rad.
Different tissues can tolerate various amounts of radiation (measured in centigrays).
For example, the liver can receive a total dose of 3,000 cGy, while the kidneys can
tolerate only 1,800 cGy. The total dose of radiation is usually divided into smaller
doses (called fractions) that are given daily over a specific time period. This maximizes
the destruction of cancer cells while minimizing the damage to healthy tissue.
The doctor works with a figure called the therapeutic ratio. This ratio compares
the damage to the cancer cells with the damage to healthy cells. Techniques are
available to increase the damage to cancer cells without doing greater harm to healthy
tissues.
Sources of energy for external radiation therapy:

The energy (source of radiation) used in external radiation therapy may come from the
following:
X-rays or gamma rays, which are both forms of electromagnet ic
radiation.
Although they are produced in different ways, both use photons (packets of
energy).
X-rays are created by machines called linear accelerators. Depending

on
the amount of energy the x-rays have, they can be used to destroy cancer
cells on the surface of the body (lower energy) or deeper into tissues and
organs (higher energy). Compared with other types of radiation, x-rays can
deliver radiation to a relatively large area.
Gamma rays are produced when isotopes of certain elements (such as

iridium and cobalt 60) release radiation energy as they break down.
Each element breaks down at a specific rate and each gives off a different
amount of energy, which affects how deeply it can penetrate into the body.
(Gamma rays produced by the breakdown of cobalt 60 are used in the
treatment called the
gamma knife,)
Particle beams use fast-moving subatomic particles instead of

photons.
This type of radiation may be called particle beam radiation therapy
or
particulate radiation. Particle beams are created by linear

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accelerators, synchrotrons, and cyclotrons, which produce and accelerate

the particles required for this type of radiation therapy. Particle beam
therapy uses electrons, which are produced by an x-ray tube (this
may be called electron-beam radiation); neutrons, which are
produced by radioactive elements and special equipment; heavy ions
(such as protons and helium); and pi-mesons (also called pions), which
are small, negatively charged particles produced by an accelerator and a
system of magnets. Unlike x-

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rays and gamma rays, some particle beams can penetrate only a
short distance into tissue. Therefore, they are often used to treat cancers
located on the surface of or just below the skin.
Proton beam therapy is a type of particle beam radiation therapy.

Protons deposit their energy over a very small area, which is called the
Bragg peak. The Bragg peak can be used to target high doses of proton beam
therapy to a tumor while doing less damage to normal tissues in front of and
behind the tumor. Proton beam therapy is available at only a few facilities in
the United States. Its use is generally reserved for cancers that are difficult or
dangerous to treat with surgery (such as a chondrosarcoma at the base of the
skull), or it is combined with other types of radiation. Proton beam therapy is
also being used in clinical trials for intraocular melano ma (melanoma that
begins in the eye), retinoblastoma (an eye cancer that most often occurs in
children under age 5), rhabdo myosarco ma (a tumor of the muscle tissue),
some cancers of the head and neck, and cancers of the prostate, brain, and
lung.
The sources of energy for internal radiation.

The energy (source of radiation) used in internal radiation comes from the
radioactive
isotope in radioact ive iodine (iodine 125 or iodine 131), and from strontium
89,
phosphorous, palladium, cesium, iridium, phosphate, or cobalt. Other sources are
being investigated.
Stereotactic radiosurgery and stereotactic radiotherapy
Stereotactic (or stereotaxic) radiosurgery uses a large dose of radiation
to destroy tumor tissue in the brain. The procedure does not involve actual surgery.
The
patients head is placed in a special frame, which is attached to the patient skull. The
frame is used to aim high-dose radiation beams directly at the tumor inside the
patients
head. The dose and area receiving the radiation are coordinated very precisely.
Most nearby tissues are not damaged by this procedure.
Stereotactic radiosurgery can be done in one of three ways. The most common
technique uses a linear accelerator to administer high-energy photon radiation to the
tumor (called
linac-based stereotactic radiosurgery). The gamma knife, the second most common
technique, uses cobalt 60 to deliver radiation. The third technique uses heavy
charged particle beams (such as protons and helium ions) to deliver stereotactic
radiation to the tumor.
Stereotactic radiosurgery is mostly used in the treatment of small benign and
malignant brain tumors (including meningio mas, acoustic neuromas, and pituitary
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cancer). It can also be used to treat other conditions (for example, Parkinson disease
and epilepsy). In addition, stereotactic radiosurgery can be used to treat metastatic
brain tumors (cancer that has spread to the brain from another part of the body)
either alone or along with whole-brain radiation therapy. (Whole-brain radiation
therapy is a form of external radiation therapy that treats the entire brain with
radiation).

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Stereotactic radiotherapy uses essentially the same approach as stereotactic

radiosurgery to deliver radiation to the target tissue. However, stereotactic
radiotherapy uses multiple small fractions of radiation as opposed to one large dose.
Giving multiple smaller
doses may
improve
outcomes and minimize
side effects. Stereotactic radiotherapy is used to treat tumors in the brain as
well as other parts of the body.
Clinical trials are under way to study the effectiveness of stereotactic radiosurgery
and stereotactic radiotherapy alone and in combination with other types of radiation
therapy.
Three-dimensional (3D) conformal radiation therapy.

Traditionally, the planning of radiation treatments has been done in
two dimensions
(width and height). Three-dimensional (3D) conformal radiation
therapy
uses computer technology to allow doctors to more precisely target
a
tumor
with radiation beams (using width, height, and depth).
Many
can beradiat ion onco logists use this technique. A 3D image of a tumor
obtained using computed tomography (CT), magnet ic resonance
imaging (MRI), positron emission tomography (PET), or single photon
emission computed tomography (SPECT). Using information from
the image,
special computer programs design radiation beams that conform to the
shape of the tumor. Because the healthy tissue surrounding the tumor
is largely spared by this technique, higher doses of radiation can be used
to
treat the cancer. Improved outcomes with 3D conformal radiation
therapy
have been reported for nasopharyngeal, prostate, lung, liver, and
brain
cancers.
Intensity-modulated radiation therapy (IMRT). IMRT is a new type of 3D

conformal radiation therapy that uses radiation beams (usually x-rays) of
varying intensities to deliver different doses of radiation to small areas of tissue at
the same time. The technology allows for the delivery of higher doses of radiation
within the tumor and lower doses to nearby healthy tissue. Some techniques
deliver a higher dose of radiation to the patient each day, potentially shortening the
overall treatment time and improving the success of the treatment. IMRT may also
lead to fewer side effects during treatment.
The radiation is delivered by a linear accelerator that is equipped with a
multileaf collimator (a collimator helps to shape or sculpt the beams of
radiation). The equipment can be rotated around the patient so that radiation beams
can be sent from the best angles. The beams conform as closely as possible to the
shape of the tumor. Because IMRT equipment is highly specialized, not every
radiation onco logy center uses IMRT.

This new technology has been used to treat tumors in the brain, head and
neck, nasopharynx, breast, liver, lung, prostate, and uterus. However, IMRT
is not appropriate or necessary for every patient or tumor type. Long-term
results following treatment with IMRT are becoming available.
Low-LET and high-LET radiation.

Linear energy transfer (LET) describes the rate at which a type of radiation
deposits
energy as it passes through tissue. Higher levels of deposited energy cause more cells
to be killed by a given dose of radiation therapy. Different types of radiation have
different levels of LET. For example, x-rays, gamma rays, and electrons are known as
low-LET radiation. Neutrons, heavy ions, and pions are classified as high-LET radiation.
Most high-LET radiation is invest igat ional treatment. The cost of the equipment and
the amount of specialized training needed to perform high-LET radiation therapy
restrict its use to only a few facilities in the United States.
Radiation treatment for the patient:

Many health care providers help to plan and deliver radiation treatment to the
patient.
The radiation therapy team includes the radiation oncologist , a doctor who specializes
in using radiation to treat cancer; the dosimetrist , who determines the proper radiation
dose; the radiat ion physicist , who makes sure that the machine delivers the right
amount of radiation to the correct site in the body; and the radiat ion therapist ,
who gives the
radiation treatment. Often, radiation treatment is only one part of t he patients total
therapy. Combined modalit y therapy, the use of radiation with drug therapy, is
commonly
used.
The radiation oncologist also works with the medical or pediatric oncologist,
surgeon, radio logist (a doctor who specializes in creating and interpreting pictures of
areas inside the body), pathologist (a doctor who identifies diseases by studying
cells and tissues
under a microscope), and others to plan the patients total course of therapy. A close
working relationship between the radiation oncologist, medical or pediatric
oncologist, surgeon, radiologist, and pathologist is important in planning the total
therapy.
Importance of treatment planning.
Because there are so many types of radiation and many ways to deliver
it, treatment planning is a very important first step for every patient who will have
radiation
therapy. Before radiation therapy is given, the patients radiation therapy team determines
the amount and type of radiation the patient will
receive.
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If the patient will have external radiation, the radiation oncologist uses a process
called simulation to define where to aim the radiation. During simulation, the patient
lies very still on an examining table while the radiation therapist uses a special x-ray
machine to
define the treatment port or fieldthe exact place on the body where the radiation will
be
aimed. Most patients have more than one treatment port. Simulation may also involve
CT
scans or other imaging studies to help the radiation therapist plan how to direct
the

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radiation. The simulation may result in some changes to the treatment plan so that
the greatest possible amount of healthy tissue can be spared from receiving radiation.
The areas to receive radiation are marked with either a temporary or permanent
marker,
tiny dots or a tattoo showing where the radiation should be aimed. These marks are also
used to determine the exact site of the initial treatments if the patient should
need radiation treatment later.
Depending on the type of radiation treatment, the radiation therapist may make
body molds or other devices that keep the patient from moving during treatment.
These are usually made from foam, plastic, or plaster. In some cases, the therapist will
also make shields that cannot be penetrated by radiation to protect organs and
tissues near the treatment field.
When the simulation is complete, the radiation therapy team meets to decide how
much radiation is needed (the dose of radiation), how it should be delivered, and
how many treatments the patient should have.
Radiosensitizers and Radioprotectors
Radiosensitizers and radioprotectors are chemicals that modify a cells response to
radiation. Radiosensitizers are drugs that make cancer cells more sensitive to the
effects of radiation therapy. Several compounds are under study as radio sensitizers.
In addition, some anticancer drugs, such as 5-fluorouracil and cisplat in, make cancer
cells more sensitive to radiation therapy.
Radioprotectors (also called radioprotectants) are drugs that protect normal
(noncancerous) cells from the damage caused by radiation therapy. These agents
promote the repair of normal cells that are exposed to radiation. Amifost ine (trade name
Ethyol) is the only drug approved by the U.S. Food and Drug Administration
(FDA) as a radioprotector. It helps to reduce the dry mouth that can occur if the
parotid glands (which help to produce saliva and are located near the ear) receive
a large dose of radiation. Additional studies are under way to determine whether
amifostine is effective when used with radiation therapy to treat other types of cancer.
Other compounds are also under study as radioprotectors.
Uses of radio pharmaceuticals:

Radiopharmaceuticals, also known as radionucleotides, are radioactive drugs used
to treat cancer, including thyroid cancer, cancer that recurs in the chest walls and
pain
caused by the spread of cancer to the bone (bone metastases). The most commonly
used
radiopharmaceuticals are samarium 15 (Quadramet) and strontium 89 (Metastron).
These drugs are approved by the FDA to relieve pain caused by bone metastases.
Both agents are given intravenously (by injection into a vein), usually on an outpatient
basis; sometimes they are given in addition to external beam radiation. Other
types of
radiopharmaceuticals, such as phosphorous 32, rhodium 186, and gallium nitrate, are
not used as frequently. Still other radiopharmaceuticals are under investigation.
New approaches to radiation therapy:

Hyperthermia, the use of heat, is being studied in conjunction with radiation
therapy. Researchers have found that the combination of heat and radiation can
increase
the response of some tumors.
Researchers are also studying the use of radio labeled bodies to deliver doses of
radiation directly to the cancer site (radio-immunotherapy). Antibodies are highly
specific proteins that are made by the body in response to the presence of ant igens
(substances recognized as foreign by the immune system). Some tumor cells contain
specific antigens that trigger the production of tumor-specific antibodies. Large
quantities of these antibodies can be made in the laboratory and attached to
radioactive substances (a process known as radiolabeling). Once injected into the
body, the antibodies seek out cancer cells, which are destroyed by the radiation. This
approach can minimize the risk of radiation damage to healthy cells.
The success of this technique depends on identifying appropriate radioactive
substances and determining the safe and effective dose of radiation that can be delivered
in this way. Two radioimmunotherapy treatments, ibritumomab tiuxetan (Zevalin) and
tositumomab and iodine 131 tositumomab (Bexxar), have been approved for
advanced adult nonHodgkins lymphoma (NHL). Clinical trials of radioimmunotherapy are under way with a
number of cancers, including leukemia, NHL, colorectal cancer, and cancers of the
liver, lung, brain, prostate, thyroid, breast, ovary, and pancreas.
THERMOGRAPH:
Need for the Thermography:
Thermograph has a number of distinct advantages over other imaging systems. It
is completely noninvasive, 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
system:
of
the
thermographic
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 equip
ment 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
graphy:
analysis
medicalThermo
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
Thermography:
of
medical
In medical fields where complex image patterns are

new opportunities for more efficient and objective
determine numerous parameters from the image itself,
differences between none region and another or area
geometric centroids or skewness and so on.
regular occurrence, computers offer

reasons. First, it can be used to
highest and average temperature or
as various temperature contours or
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)
Lasers
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
radiation:
and
Stimulated
An atom may undergo transition between two energy states E 1 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(N 1)
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 E 2. If the photons of energy E 1-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(N 2) becomes greater than the number of atoms in the ground state(N 1) then this
condition is called
-8
population inversion. The lifetime of the atoms in the excited state is normally 10
seconds.
-3
Some of the excited energy levels have greater life times for atoms (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.
Conditions 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.
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.

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Absorption
of
energy:
An atom absorbs energy in the form of heat, light, or

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electricity. 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 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 oxide
3+
3+
Al 2O3 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 E 1. 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 E 3. The excited ion gives up part
of its energy to the crystal lattice and decay without giving any radiation to the metastable
-3
state E 2. 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 E 2 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 socalled
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.
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.

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1. 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.
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 E 1 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,
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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 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.

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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
semico nductor. 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 laser
-9
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 far-infrared, and
are used for cutting hard materials.
Excimer lasers (the name is derived from the terms excited and dimer s) 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)
Argon fluoride (UV)

Krypton fluoride (UV)
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)
1064
Carbon dioxide (FIR)
10600
Medical 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
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 surger
y, 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:

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 deepseated 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
8.1 Introduction:
Electric shock is a traumatic state caused by the passage o f electric current can
flow through the human body either accidentally or intentionally. The kind and amount of
damage depends on the intensity, type and duration of the current, the point where the
electricity first touched the body and the path it took through the body. Burns may be
superficial or very deep with widespread tissue death. Severe shock may cause muscle
contractions, respiratory paralysis, unconsciousness and cardiac arrest. A high voltage
electric shock may cause sudden muscle spasm that may through the victim away from the
power source with extreme force, resulting in further injuries, such as fracture. Lightening
causes injuries similar to those sustained from a high voltage electric shock. Electrical
currents are administered intentionally in the following case.
For measurement of respiration rate by impedance method, a small current at
high frequency is made to flow between the electrodes applied on the surface of the
body.
High currents are also passed through the body for therapeutic and surgical
purposes.
When recording signals like ECG, and EEG, the amplifiers used in the preamplifier
stage may deliver small currents themselves to the patient. These are due to bias
currents.
Accidental transmission of electrical current takes place because of defect in
the equipment; excessive leakage and simultaneous use of other equipment on the
patient
which may produce potentials on the patient circuit.
8.2 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, 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 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 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.
8.3 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

Dept/ECE
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146
Intense or painful sensation

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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.
8.4 Microshock and Macroshock:

8.4.1 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.
8.4.2 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.

Dept/ECE
Page
147

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EC2021- Medical Electronics Study Materials for all

1.1)What is the specific usage of a SIGNAL AVERAGER ? (May/ June 2006)

Prepared by A.Devasena., Asso. Prof.,

(iii) Resting Potential

(iv) Absolute Refractory period

(v) Relative Refractory Period (vi) Propagation Rate

(viii) net height of the action. (May/ June 2006)

UNIT I - ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING

May/June 2009, Nov/Dec

2. Define Conduction Velocity

Apr/May 2008, Nov/Dec 2008, May/June

5. State all or none law in respect of cell bio potential.

7. Define electrode and list its types.

11. State the importance of biological amplifiers.

13. What are the basic components of biomedical systems?

15. What is evoked potential?

ECG wave occurrence

PCG wave occurrence

18. What is EOG?

19. State the importance of PCG signals.

21. Draw typical ECG waveform.

Nov/Dec 2009, May/June 2007

These wave occur in deep sleep in premature babies and

These wave occurs during emotional stress in some

Prepared by A.Devasena., Asso. Prof.,

They found in the normal persons when they are awake

BIO-CHEMICAL AND NON ELECTRICAL PARAMETER MEASUREMENTS

.1) What is a BRANCHO SPIROMETER ? (May/ June 2006)

2.21)What are the two methods of pulse measurement?

(May/ June 2006)

UNIT II - BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

9. Define Vital Capacity

sounds are called as korotkoff sounds.

Prepared by A.Devasena., Asso. Prof.,

UNIT II - BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

Prepared by A.Devasena., Asso. Prof.,

9. Define Vital Capacity

sounds are called as korotkoff sounds.

UNIT II - BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

9. Define Vital Capacity

( Nov/ Dec 2004).

UNIT III ASSIST DEVICES AND BIO TELEMETRY

3.1) Distinguish between Internal and External pacemakers.

(1) DC fibrillator discharge waveform

UNIT III ASSIST DEVICES AND BIO TELEMETRY

Distinguish between Internal and External pacemakers. [M/J 2007]

The pacemaker is a surgically

The pacemaker is placed outside the

temporary heart It is used for permanent heart regularity

3 Classify Pacing modes[N/D 2007]

What are the batteries used for implantable pacemaker?[N/D

What types of electrodes are used in a defibrillator? [A/M 2005]

What is meant by fibrillation?[M/J 2009][A/M 2010]

The condition at which this necessary synchronism is lost is known as

Calculate the energy stored in 16F capacitor of a DC defibrillator that is charged

(pulse width modulation) system or a final modulator is practically always an FM

Prepared by A.Devasena., Asso. Prof.,

4.1)State different types of radiation generated from radio isotopes.

Prepared by A.Devasena., Asso. Prof.,

4.2)What is meant by ionizing radiation?

Nov/Dec 2012, Nov/Dec 2011

4.11) What is Angiography ? (Nov/Dec 07 )

( April /May 2004)