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Medical Electronics

Dr. Neil Townsend The story so far


Michaelmas Term 2001 The electrocardiogram (ECG) can be acquired to give
information on the electrical activity and rhythm of the
(www.robots.ox.ac.uk/~neil/teaching/med_elec)
www.robots.ox.ac.uk/~neil/teaching/med_elec)
heart.
Impedance Plethysmography can be used to infer the
breathing rate (and possibly lung air volume) of a patient.

Lecture 5

Pulse Oximetry Pulse Oximetry


Oximetry is measuring how much oxygen the blood is Oximetry is measuring how much oxygen the blood is
carrying, the oxygen saturation of the blood. carrying, the oxygen saturation of the blood.
blood.
This is a very useful thing for clinicians to know, This is a very useful thing for clinicians to know,
especially in patients with respiratory disorders: especially in patients with respiratory disorders:
Oxygen is the most acutely necessary substrate for Oxygen is the most acutely necessary substrate for
aerobic life. aerobic life.
Insufficiency of oxygen (hypoxia
(hypoxia)) leads to devastating
neurological handicaps, if not death.

Pulse Oximetry Pulse Oximetry


Ideally, this information should be available on a Ideally, this information should be available on a
continuous basis (rather than every few hours). continuous basis (rather than every few hours).
Pulse Oximetry provides this information non−invasively. Pulse Oximetry provides this information non−invasively.
"The pulse oximeter is arguably the most significant
technological advance ever made in monitoring the
well−being and safety of pateints during anaesthesia,
recovery and critical care"
Severinghaus & Astrup (1986)
Measuring SaO2 Measuring SaO2
Is it possible to measure arterial SaO2 without taking a Is it possible to measure arterial SaO2 without taking a
blood sample? blood sample?
It is the haemoglobin molecule which carries oxygen.
It is the haemoglobin molecule which gives blood its
distinctive colour.

Measuring SaO2 Measuring SaO2


Is it possible to measure arterial SaO2 without taking a There is a window of opportunity here:
blood sample? The wavelength range between 600 and 1,000 nm is also
It is the haemoglobin molecule which carries oxygen. the range for which there is the least attenuation of light
by body tissues.
It is the haemoglobin molecule which gives blood its
distinctive colour.
The two forms of the molecule (Hb and HbO2) have
different absorption spectra.

Measuring SaO2 Optical Sensors


There is a window of opportunity here: Optical sensors offer a number of advantages for
biomedical applications:
The wavelength range between 600 and 1,000 nm is also
the range for which there is the least attenuation of light Inherent safety
by body tissues.
By measuring the light transmission through a body
segment at two wavelengths within that range, the
arterial SaO2 can be determined.

Oximetry is a non−invasive optical technique


Optical Sensors Optical Sensors
Optical sensors offer a number of advantages for Optical sensors offer a number of advantages for
biomedical applications: biomedical applications:
Inherent safety Inherent safety
Immunity to electrical interference Immunity to electrical interference
No reference electrode required

Optical Sensors Optical Sensors


Optical sensors offer a number of advantages for Optical sensors offer a number of advantages for
biomedical applications: biomedical applications:
Inherent safety Inherent safety
Immunity to electrical interference Immunity to electrical interference
No reference electrode required No reference electrode required
Optical sensing techniques can be envisaged for most Optical sensing techniques can be envisaged for most
analytes analytes
Robustness and Ease of sterilisation

A simple model for oximetry A simple model for oximetry


Assume that the transmission of light through the arterial Assume that the transmission of light through the arterial
bed depends only on the path length, the relative bed depends only on the path length, the relative
concentrations of Hb and HbO2 and their absorption at the concentrations of Hb and HbO2 and their absorption at the
two wavelengths λ1 and λ2. two wavelengths λ1 and λ2. Let:

Co = concentration of oxyhaemoglobin (HbO2)


Cr = concentration of reduced haemoglobin (Hb)
αon = absorption coefficient of HbO2 at wavelength λn
αrn = absorption coefficient of Hb and wavelength λn
A brief history of oximetry A brief history of oximetry
Matthes, 1935 Matthes, 1935
Transillumination of the earlobe at two wavelengths.
Transillumination of the earlobe at two wavelengths.
No differentiation between arterial, venous and capillary blood.
No differentiation between arterial, venous and
Goldie, 1942
capillary blood.
Compression of earlobe to obtain "bloodless"
reference.

A brief history of oximetry A brief history of oximetry


Matthes, 1935 Matthes, 1935
Transillumination of the earlobe at two wavelengths. Transillumination of the earlobe at two wavelengths.
No differentiation between arterial, venous and capillary blood. No differentiation between arterial, venous and capillary blood.
Goldie, 1942 Goldie, 1942
Compression of earlobe to obtain "bloodless" reference. Compression of earlobe to obtain "bloodless" reference.
Millikan, 1942
Millikan, 1942
Local heating to arterialize capillary blood.
Local heating to arterialize capillary blood.
Merrick and Hayes, 1976
Hewlett−Packard multi−wavelength oximeter.

Hewlett−Packard Ear Oximeter Hewlett−Packard Ear Oximeter


Basic Principles: Disadvantages:
Multi−component model of ear pinna¹
pinna¹. Complex instrumentation and signal processing.
Each light absorber assumed to act independently of Need for pre−calibration.
the others.
Measurement of light transmission at 8 wavelengths
between 650 and 1050 nm.
Empirical calibration coefficients derived from study
on 22 volunteers (750 data points).

¹ The pinna, or auricle, is the outer projecting portion of the ear.


Hewlett−Packard Ear Oximeter Problems with oximetry
Disadvantages: The need to distinguish between absorption due to arterial
blood (the
(the wanted signal)
signal) and the absorption due to other
Complex instrumentation and signal processing.
components requires either:
Need for pre−calibration.
An unacceptable procedure.
Ear must be heated to 41°
41°C for arterialization of
A complex model and an even more complex
capillary blood.
instrument.
The solution?

Problems with oximetry Pulse Oximetry


The need to distinguish between absorption due to arterial Discovered in Japan in the mid−1970’s (Aoyagi, 1974)
blood (the
(the wanted signal)
signal) and the absorption due to other
components requires either:
Only that part of the signal directly related to the inflow of
An unacceptable procedure.
arterial blood into the body segment is used for the
A complex model and an even more complex calculation of SaO2.
instrument.
The solution?
Pulse oximetry

Pulse Oximetry Pulse Oximetry


Discovered in Japan in the mid−1970’s (Aoyagi, 1974) If R is redefined as follows:


log 10 I dc 

ac
I dc 1
R


Only that part of the signal directly related to the inflow of log10 I dc 

ac
I dc  2

arterial blood into the body segment is used for the


calculation of SaO2:

It is assumed that the increase in attenuation of light is


caused by the inflow of arterial blood.
Pulse Oximetry Photoplethysmograph Signals
If R is redefined as follows: Two signals:


log10 I dc 

ac I dc 1
R


log10 I dc 

ac
I dc  2

Then the oximetry equation we derived earlier still holds:

R αon = absorption coefficient of HbO2 at wavelength λn


r2 r1


SaO2  


r2



o2
R 


r1



o1 αrn = absorption coefficient of Hb at wavelength λn

Pulse Oximetry Calibration


Development of LED/photodiode technology the pulse The first pulse oximeters used the equation we have seen to
oximeter (circa 1980). compute values of arterial SaO 2:
Simple finger or earlobe probes (2 LEDs, 1 photodiode) R
r2 r1


SaO2  

Constant, non−invasive monitoring of SaO2. 


r2



o2
R 


r1



o1

However, the Beer−Lambert law, on which it is based,


does not take account of scattering.

Calibration Any volunteers?


Empirical studies show that the actual relationship between
R and oxygen saturation is as follows: