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1 Contents Preface xin OkCeasuring, (Recerding and omönitering Instruments Fundamentals of Medical Instrumentation Anatomy and Physiology Physiological Systems of the Body Sources of Biomedical Signals Basic Medical Instrumentation System Performance Requirements of Medical Instrumentation Systems Intelligent Medical Instrumentation Systems General Constraints in Design of Medical Instrumentation Systems Regulation of Medical Devices 28 Bioelectric Signals and Electrodes Origin of Bioelectric Signals Recording Electrodes Silver-silver Chloride Electrodes Electrodes for ECG Electrodes for EEG Electrodes for EMG Electrkal Conductivity of Electrode Jellies and Creams Microelectrodes 63

2 vi Contents 3. Physiological Transducers Introduction Classification of Transducers Performance Characteristics of Transducers Displacement, Position and Motion Transducers Pressure Transducers Transducers for Body Temperature Measurement Photoelectric Transducers Optical Fibre Sensors Biosensors Smart Sensors Recording Systems m 4.1 Basic Recording System General Considerations for Signal Conditioners Preamplifiers Sources of Noise in Low Level Measurements Biomedical Signal Analysis Techniques Signal Processing Techniques The Main Amplifier and Driver Stage Writing Systems Direct Writing Recorders The InkJet Recorder Potentiometrie Recorder Digital Recorders Instrumentation Tape Recorders Biomedical Recorders Electrocardiograph Vectorcardiograph (VCG) Phonocardiograph (PCG) Electroencephalograph (EEG) Electromyograph (EMG) Other Biomedical Recorders Biofeedback Instrumentation Patient Monitoring Systems System Concepts Cardiac Monitor Bedside Patient Monitoring Systems Central Monitors Measurement of Heart Rate Measurement of Pulse Rate 204

3 Contents 6.7 Blood Pressure Measurement Measurement of Temperature Measurement of Respiration Rate Catheterization Laboratory Instrumentation Ärrhythmia and Ambulatory Monitoring Instruments Cardiac Arrhythmias Ärrhythmia Monitor 244 : 7.3 QRSDetectionTechniques 247 7A Exercise Stress Testing Ambulatory Monitoring Instruments Foetal Monitoring Instruments Cardiotocograph Methods of Monitoring Foetal Heart Rate Monitoring Labour Activity Recording System Biomedical Telemetry and Telemedicine Wireless Telemetry Single Channel Telemetry Systems Multi-channel Wireless Telemetry Systems Multi-patient Telemetry Implantable Telemetry Systems Transmission of Analog Physiological Signals Over Telephone Telemedicine Oximeters Oximetry EarOximeter Pulse Oximeter Skin Reflectance Oximeters Intravascular Oximeter Blood Flowmeters Electromagnetic Blood Flowmeter Types of Electromagnetic Flowmeters Ultrasonic Blood Flowmeters 331 IIA NMR Blood Flowmeter Laser Doppler Blood Flowmeter Cardiac Output Measurement Indicator Dilution Method Dye Dilution Method 346

4 viii Contents 12.3 Thermal Dilution Techniques Measurement of Continuous Cardiac Output Derived rom the Aortic Pressure Waveform Impedance Technique UJtrasound Method Pulmonary Function Analysers 13.1 Pulmonary Function Measurements 358 to.2 bpirometry Pneumotachometers Measurement of Volume Pulmonary Function Analyzers Respiratory Gas Analyzers ClinicalLaboratory Instruments 14.1 Medical Diagnosis with Chemical Tests Z bpectrophotometry Spectrophotometer Type Instruments 390 t4.4 Colonmeters Spectrophotometers Automated Biochemical Analysis Systems Chmcal Flame Photometers Selective-ion Electrodes Based Electrolytes Analyzer 415 ' 15. Blood Gas Analyzers 15.1 Acid-base Balance BloodpHMeasurement Measurement of Blood PC Blood p0 2 Measurement Intra-arterial Blood Gas Monitoring AComplete Blood Gas Analyzer Blood Cell Counters 16.1 Typesof Blood Cells MethodsofCellCounting Coulter Counters Automatic Recognition and Differential Countingof Cells Audiometers and Hearing Aids 17.1 Mechanismof Hearing Measurement of Sound 467 V7 3 ^a&c kmäflonvört SS 387

5 Contents ix 17.4 Pure Tone Audiometer Speech Audiometer Audiometer System Bekesy Evoked Response Audiometry System Calibration of Audiometers Hearing Aids Patient Safety Electric Shock Hazards Leakage Currents Safety Codes for Electromedical Equipment Electrical Safety Analyzer Testing of Biomedical Equipment 500 QMödern ma$in$ Q&pstems 19. X-ray Machines and Digital Radiography Basis of Diagnostic Radiology Nature of X-rays Production of X-rays X-ray Machine Visualization of X-rays Dental X-ray Machines Portable and Mobile X-ray Units Physical Parameters for X-ray Detectors Digital Radiography X-ray Computed Tomography Computed Tomography System Components Gantry Geometry Patient Dose in CT Scanners NuclearMedicallmaging Systems Radio-isotopes in Medical Diagnosis Physics of Radioactivity Radiation Detectors Pulse Height Analyser Uptake Monitoring Equipment Radio-isotope Rectilinear Scanner The Gamma Camera Multi-crystal Gamma Cameras 576

6 X Contents 21.9 Emission Computed Tomography (ECT) Single-photon Emission Computed Tomography (SPECT) Positron Emission Tomography (PET Scanner) Magnetic Resonance Imaging System 22.1 Principlesof NMR Imaging Systems Image Reconstruction Techniques Basic NMR Components Biological Effects of NMR Imaging Advantagesof NMR Imaging System Ultrasonic Imaging Systems 23.1 Diagnostic Ultrasound Physics of Ultrasonic Waves Medical Ultrasound Basic Pulse-echo Apparatus A-Scan Echocardiograph (M-mode) B-Scanner Real-time Ultrasonic Imaging Systems Multi-element Linear Array Scanners Digital Scan Converter Biological Effects of Ultrasound Thermal Imaging Systems 24.1 Medical Thermography Physics of Thermography Infrared Detectors Thermographic Equipment Quantitative Medical Thermography Pyroelectric Vidicon Camera Thermal Camera Based on IR Sensor with Digital Focal Plane Array Cardiac Pacemakers 'Ukerapeutic (SLquipment 25.1 Need for Cardiac Pacemaker Externa! Pacemakers Implantable Pacemakers Recent Developments in Implantable Pacemakers Pacing System Analyser 713

7 Contents xi»6. Cardiac Defibrillators 26.1 Need for a Defibrillator DC Defibrillator Implantable Defibrillators Pacer cardioverter defibrillator Defibrillator Analysers Instruments for Surgery 27.1 Principle of Surgical Diathermy Surgical Diathermy Machine Safety Aspects in Electro-surgical Units '.4 Surgical Diathermy Analysers Laser Applications in Biomedical Field 28.1 The Laser Pulsed Ruby Laser Nd-YAG Laser Helium-Neon Laser Argon Laser C0 2 Laser Excimer Lasers Semiconductor Lasers Laser Safety Physiotherapy and Electrotherapy Equipment 29.1 High Frequency Heat Therapy Short-wave Diathermy Microwave Diathermy Ultrasonic Therapy Unit Electrodiagnostic/Therapeutic Apparatus Pain Relief Through Electrical Stimulation Diaphragm Pacing by Radio-frequency for the Treatment of Chronic Ventilatory Insufficiency Bladder Stimulators Cerebellar Stimulators Haemodialysis Machines 30.1 Function of the Kidneys Artificial Kidney Dialyzers Membranes for Haemodialysis Haemodialysis Machine Portable Kidney Machines 807

8 Xll Contents 31. Lithotriptors 31.1 The Stone Disease Problem First Lithotriptor Machine Modern Lithotriptor Systems Extra-corporeal Shock-wave Therapy Anaesthesia Machine 32.1 Need for Anaesthesia Anaesthesia Machine Electronics in the Anaesthetic Machine Ventilators 33.1 Mechanics of Respiration Artificial Ventilation Ventilators Types of Ventilators Ventilator Terms Classification of Ventilators Pressure-volume-flow Diagrams Modern Ventilators High Frequency Ventilators Humidifiers, Nebulizers and Aspirators Radiotherapy Equipment 34.1 Use of High Voltage X-ray Machines Development of Betatron Cobalt-60 Machine Medical Linear Accelerator Machine Automated Drug Delivery Systems 35.1 Infusion Pumps Components of Drugs Infusion Systems Implantable Infusion Systems Closed-loop Control in Infusion Systems Examples of Typical Infusion Pumps 877 References Index

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