BIOMEDICAL INSTRUMENTATION

Subject Code:100818
MODULE-2.1

Faculty: Miss Richa Rani

Assistant Professor, ECE

TOPICS COVERED: [Link] MONITORING SYSTEMS AND AUDIOMETERS

2. CARDIAC MONITOR, BEDSIDE PATIENT MONITOR
3. MEASUREMENT OF HEART RATE, BLOOD PRESSURE,
TEMPERATURE, RESPIRATION RATE
Contents 2

 1. Introduction
 [Link]
 3. Bedside Monitoring System
 4. Cardiac Monitor
 5. Measurement of Heart Rate
 6. Measurement of Blood Pressure
 7. Measurement of Temperature
 8. Measurement of Respiration Rate
Introduction 3

 Objective of patient monitoring is to have a quantitative

assessment of the important physiological variables of the
patients during critical periods of their biological functions.
 For diagnostic and research purposes, it is necessary to know
their actual value or trend of change.
 Patient monitoring systems are used for measuring
continuously or at regular intervals, automatically, the values
of the patient’s important physiological parameters.
Objectives 4

 The long-term objective of patient monitoring is

generally to decrease mortality and morbidity by:
 (i) organizing and displaying information in a form
meaningful for improved patient care,
 (ii) correlating multiple parameters for clear
demonstration of clinical problems,
 (iii) processing the data to set alarms on the
development of abnormal conditions,
 (iv) providing information, based on automated data,
regarding therapy and
 (v) ensuring better care with fewer staff members.
Block diagram of bedside patient 5

monitoring system

Fig 1: Block Diagram of

patient monitoring
system
Bedside patient monitoring system 6
 The system basically consists of three circuit blocks: Preamplifier section, Logic boards
and Display part.
 The preamplifiers incorporate patient isolation circuits based on optical couplers. The
ECG waveform has facilities for lead-off detection, ‘pacer’ detection and quick recovery
circuit for overload signals.
 Various amplified signals are carried to a multiplexer and then to an analog-to-digital
converter, included in the logic board.
 The central processing unit along with memory gives X and Y output for the CRT
display.
 The character generator output is mixed with the Y output for numeric display on the
CRT.
 The alarm settings, selection switches for different parameters and the defibrillator
synchronization system communicate with the CPU.
 The alarm signals are also initiated under its control. The memory comprises 5 K bytes
ROM and 3.25 K bytes RAM with 256 samples of ECG. Eight seconds delayed ECG is
available for recording purposes.
Bedside patient monitoring system …contd. 7
 It basically consists of the modular parts for measurement of the following:
 • ECG and respiration measuring electronics
 • Blood pressure (non-invasive) measuring electronics, pump and tubing
 • Blood pressure (invasive)
 • Temperature measuring electronics
 • Pulse probe and SpO2 (pulse oximetry)
 • Microprocessor board including analog signal multiplexer, A–D converter and real
time
 clock
 • Video control board to convert the CPU commands into video signal
 • Video display module
 • Transformer and power supply board to generate necessary voltages
 • Mother board including signal buses and analog input signal buffers
 • Keyboard
Cardiac Monitor 8
 A cardiac monitor is specifically useful for monitoring patients
with cardiac problems and the special areas in the hospitals where
they are generally used are known as cardiac care units or
coronary care units (CCU).
 These instruments are also called ‘Cardioscopes’ and comprise of:
 Disposable type pre-gelled electrodes to pick up the ECG signal.
• Amplifier and a cathode ray tube (CRT) for the amplification
and display the ECG which enable direct observation of the
ECG waveform.
• A heart rate meter to indicate average heart rate with audible
beep or flashing light or both with each beat.
• An alarm system to produce signal in the event of
abnormalities occurring in the heart rate.
Cardiac Monitor …Contd. 9

Fig 2: Block schematic of an oscilloscope display system incorporating digital storage

Cardiac Monitor …Contd. 10
 The cardioscope is basically similar to the conventional oscilloscope
used for the display of waveforms in electronic laboratories.
 They have the usual circuit blocks like vertical and horizontal
amplifiers, the time base and the EHT (extra high tension) for the
cathode ray tube.
 However, they differ in two important aspects as compared to the
conventional instrument.
 These are slower sweep speeds and a long persistence screen. The slow
sweep is an outcome of the low frequency character of the ECG signal.
 The slow sweep speed necessitates the use of a long persistence screen
so as to enable a convenient observation of the waveform.
Cardiac Monitor …Contd. 11

Fig 3: A human heart Fig 4: A cardiac monitor display

Cardiac Monitor …Contd. 12
 Selection of system parameters:
 1. Sampling Rate: Signals with high bandwidth require sampling to be
carried out at a high rate to faithfully obtain all its features. A high
sampling rate, however, necessitates a large memory to store all the
data. Therefore, a compromise must be worked out. For ECG, AHA
(American Heart Association) recommends a sampling rate of 500
samples per second for computer analysis.
 2. Word Length: The ECG signals, before they are coded in the digital
form, are amplified in a preamplifier and brought to a level of 0–1 V.
The accuracy of conversion of analog signals depends on the number of
bits used in the conversion. The greater the number of bits per word, the
greater will be the resolution, as a greater number of levels will be
available to accurately define the value of the sampled signal.
Cardiac Monitor …Contd. 13
 Selection of system parameters:
 3. Memory Capacity: The contents of each channel memory
are displayed with each sweep across the CRT screen.
Therefore, the stored signal must roll on the screen with a
time interval, which must be convenient for viewing.
 For example, a display of 5 s of data (on a 13 cm CRT screen),
with the spot moving at a rate of 25 mm/s and at a sampling
rate of 200 samples/s, would require a 1000 word memory.
Increasing either the sampling rate or the display time
interval will increase the memory size proportionately.
Measurement of Heart Rate 14

 Heart rate is derived by the amplification of the ECG signal

and by measuring either the average or instantaneous time
intervals between two successive R peaks.
 Techniques used to calculate heart rate include:
 • Average calculation This is the oldest and most popular
technique. An average rate (beats/ min) is calculated by
counting the number of pulses in a given time. The average
method of calculation does not show changes in the time
between beats and thus does not represent the true picture of
the heart’s response to exercise, stress and environment.
Measurement of Heart Rate …Contd. 15

 • Beat-to-beat calculation This is done by measuring the

time (T), in seconds, between two consecutive pulses,
and converting this time into beats/min., using the
formula beats/ min. = 60/T. This technique accurately
represents the true picture of the heart rate.
 • Combination of beat-to-beat calculation with averaging
This is based on a four or six beats average. The
advantage of this technique over the averaging
techniques is its similarity with the beat-to-beat
monitoring system.
Measurement of Heart Rate …Contd. 16

 1. Average Heart Rate Meters: They work on the basis of

converting each R wave of the ECG into a pulse of fixed
amplitude and duration and then determining the average
current from these pulses.
 They incorporate specially designed frequency to a voltage
converter circuit to display the average heart rate in terms of
beats per minute.
 2. Instantanenous Heart Rate Meters: Instantaneous heart
rate facilitates detection of arrhythmias and permits the timely
observation of incipient cardiac emergencies. Calculation of
heart rate from a patient’s ECG is based upon the reliable
detection of the QRS complex.
Measurement of Heart Rate …Contd. 17

Fig 5 : Block diagram of the cardiotachometer based on matched QRS filter

Measurement of Heart Rate …Contd. 18
 The ECG is sampled every 2 ms.
 Fast transition and high amplitude components are attenuated by a slew rate limiter
which reduces the amplitude of pacemaker artefacts and the probability of counting
these artefacts as beats.
 Two adjacent 2 ms samples are averaged and the result is a train of 4 ms samples.
 In order to remove unnecessary high frequency components of the signal, a 30 Hz,
infinite-impulse-response, Butterworth filter is employed.
 This produces 8 ms samples in the process. Any dc offset with the signal is removed by
a 1.25 Hz high-pass filter. The clamped and filtered ECG waveform is finally passed
through a QRS matched filter.
 The beat detector recognizes QRS complexes in the processed ECG waveform value
that has occurred since the last heart beat.
 If this value exceeds a threshold value, a heart beat is counted. The beat interval
averaged over several beats is used to calculate the heart rate for display, alarm limit
comparison, trending and recorder annotation.
Measurement of Pulse Rate 19

 Each time the heart muscle contracts, blood is ejected from the ventricles and a
pulse of pressure is transmitted through the circulatory system.
 This pressure pulse when travelling through the vessels, causes vessel-wall
displacement, which is measurable at various points of the peripheral
circulatory system.
 The pulse can be felt by placing the finger tip over the radial artery in the wrist
or some other location where an artery seems just below the skin.
 The pulse pressure and waveform are indicators for blood pressure and flow.
 Instruments used to detect the arterial pulse and pulse pressure waveforms in
the extremities are called plethysmographs.
 Most plethysmograph techniques respond to a change in the volume of blood
as a measure of blood pressure.
Measurement of Pulse Rate 20

 The pulse gives a measure of pulse wave velocity and can be

recorded and compared with the ECG signal.
 The methods used for the detection of volume (pulse) changes
due to blood flow are:
 • Electrical impedance changes
 • Strain gauge or microphone (mechanical)
 • Optical changes (changes in density)
Measurement of Blood Pressure 21

 The determination of only B.P.s maximum and minimum levels during

each cardiac cycle supplemented by information about other
physiological parameters is an invaluable diagnostic aid to assess the
vascular condition and certain other aspects of cardiac performance.
 Pressure measurements are a vital indication in the successful treatment
and management of critically ill patients in an intensive cardiac care or of
patients undergoing cardiac catheterization.
 Blood is pumped by the left side of the heart into the aorta, which
supplies it to the arterial circuit. Due to the load resistance of the
arterioles and pre capillaries, it loses most of its pressure and returns to
the heart at a low pressure via highly distensible veins. The right side of
the heart pumps it to the pulmonary circuit, which operates at a lower
pressure.
Measurement of Blood Pressure …Contd. 22

 The heart supplies blood to both circuits as simultaneous intermittent

flow pulses of variable rate and volume.
 The maximum pressure reached during cardiac ejection is called systolic
pressure and the minimum pressure occurring at the end of a ventricular
relaxation is termed as diastolic pressure.
 The mean arterial pressure over one cardiac cycle is approximated by
adding one-third of the pulse pressure (difference between systolic and
diastolic values) to the diastolic pressure.
 All blood pressure measurements are made with reference to the
atmospheric pressure.
Measurement of Blood Pressure …Contd. 23

Fig 6 : Typical
haemodynamic pressure
values present in the basic
circulatory System
(Courtesy:Hewlett
Packard, USA)
Measurement of Blood Pressure …Contd. 24

 There are two basic methods for measuring blood pressure—direct and
indirect.
 1. Direct Method: The direct methods provide continuous and much
more reliable information about the absolute vascular pressure from
probes or transducers inserted directly into the blood stream. But the
additional information is obtained at the cost of increased disturbance to
the patient and complexity of the equipment.
 2. Indirect Method: The indirect methods consist of simple equipment
and cause very little discomfort to the subject but they are intermittent
and less informative. They are based on the adjustment of a known
external pressure equal to the vascular pressure so that the vessel just
collapses.
Measurement of Blood Pressure …Contd. 25

Fig 7 : Typical set up

of a pressure
measuring system by
direct method
Measurement of Blood Pressure …Contd. 26

Fig 8 : Rheographic method of indirect blood pressure

measurement
Measurement of Temperature 27
 The transducer normally used for temperature measurement in a
patient monitoring system is a thermistor. Changes in resistance
of the thermistor with changes in temperature are measured in a
bridge circuit and indicated on a calibrated meter. The
measuring range is 30–42°C.
 In a patient monitoring system, provision for two channel
temperature measurements are usually made.
 Similar to ECG monitoring, the output circuits are isolated
through opto-couplers.
 Provision for in operate conditions are also included in such type
of monitoring equipment.
Measurement of Respiration Rate …Contd.
28
 The primary functions of the respiratory system are to supply oxygen and
remove carbon dioxide from the tissues.
 The action of breathing is controlled by a muscular action causing the volume
of the lung to increase and decrease to effect a precise and sensitive control of
the tension of carbon dioxide in the arterial blood.
 Under normal circumstances, this is rhythmic action with the result that the
respiration rate provides a fairly good idea about the relative respiratory
activity.
 Methods used to Measure Respiration Rate:
 1. Displacement Method
 2. Thermistor Method
 3. Impedance Pneumography
 4. CO2 Method
Measurement of Respiration Rate …Contd.
29
 Displacement Method:
 The respiratory cycle is accompanied by changes in the thoracic volume. These changes can be
sensed by means of a displacement transducer incorporating a strain gauge or a variable
resistance element.
 The transducer is held by an elastic band, which goes around the chest. The respiratory
movements result in resistance changes of the strain gauge element connected as one arm of a
Wheatstone bridge circuit.
 Bridge output varies with chest expansion and yields signals corresponding to respiratory
activity.
 Changes in the chest circumference can also be detected by a rubber tube filled with mercury.
 The tube is fastened firmly around the chest. With the expansion of the chest during an
inspiratory phase, the rubber tube increases in length and thus the resistance of the mercury
from one end of this tube to the other changes.
 Resistance changes can be measured by sending a constant current through it and by
measuring the changes in voltage developed with the respiratory cycle.
Measurement of Respiration Rate …Contd.
30
 Thermistor Method:
 Since air is warmed during its passage through the lungs and the respiratory
tract, there is a detectable difference of temperature between inspired and
expired air.
 This difference of temperature can be best sensed by using a thermistor placed
in front of the nostrils by means of a suitable holding device.
 In case the difference in temperature of the outside air and that of the expired
air is small, the thermistor can even be initially heated to an appropriate
temperature and the variation of its resistance in synchronism with the
respiration rate, as a result of the cooling effect of the air stream, can be
detected. This can be achieved with thermistor dissipations of about 5 to 25
mW.
Measurement of Respiration Rate …Contd.
31
 Impedance Pneumograph Method:
 Impedance method for measuring respiration rate consists in passing a high
frequency current through the appropriately placed electrodes on the surface
of the body and detecting the modulated signal.
 The signal is modulated by changes in the body impedance, accompanying
the respiratory cycle. The electrode used for impedance pneumograph are of
the self-adhesive type.
 Contact with the skin is made through the electrode cream layer for
minimizing motion artefacts.
 The electrodes, when the skin is properly prepared, offer an impedance of 150
to 200 ohms.
 The change in impedance corresponding to each respiratory cycle is of the
order of 1% of the base impedance.
Measurement of Respiration Rate …Contd.
32
 Impedance Pneumograph Method:

This is an
indirect
technique for
the
measurement
of respiration
rate.

Fig 9 : Principle of impedance pneumograph (two electrode method)

 Measurement of Respiration Rate …Contd.
33
 CO2 Method:
 The measurement is based on the absorption property of infrared rays by certain gases. Suitable filters are
required to determine the concentration of specific gases (like CO2, CO, and NO2) constituting the expired
air. Rare gases and diatomic gases do not absorb infrared rays.
 When infrared rays are passed through the expired air containing a certain amount of CO2, some of the
radiations are absorbed by it. There is a proportional loss of heat energy associated with the rays. The
detector changes the loss in heating effect of the rays into an electrical signal. This signal is used to obtain
the average respiration rate.
 Two beams of equal intensity of infrared radiations from the hot-wire spirals fall on one half of each of the
condenser microphone assembly. The detector has two identical portions separated by a thin, flexible metal
diaphragm. The detector is filled with a sample of pure CO2. Because of the absorption of CO2 in the
analysis cell, the beam falling on the test side of the detector is weaker than that falling on the reference
side. The gas in the reference side would, therefore, be heated more than that on the analysis side. As a
result, the diaphragm is pushed slightly to the analysis side of the detector. The diaphragm forms one plate
of a capacitor. The infrared beams are chopped at 25 Hz and the alternating signal which appears across the
detector is amplified, shaped and suitably integrated to give the respiration rate.
Measurement of Respiration Rate …Contd.
34
 CO2 Method:

Fig 10 : Schematic diagram for detection of CO2 in the expired air for
continuous monitoring of respiration rate
 35

Thank You
 BIOMEDICAL INSTRUMENTATION
Subject Code:100818
MODULE-2.1

Faculty: Miss Richa Rani

Assistant Professor, ECE

TOPICS COVERED: [Link] MONITOR

2. METHODS OF MONITORING FATAL HEART RATE
3. MONITORING LABOR ACTIVITY
Contents 2

 1. Cardiac Arrhythmia
 2. Arrhythmia Monitor
 3. Methods Of Monitoring Fatal Heart Rate
 4. Monitoring Labor Activity
 5. Methods of Monitoring Foetal Heart Rate
Cardiac Arrhythmia 3
 Any disturbance in the heart’s normal rhythmic contraction is called an
arrhythmia.
 Patients undergoing a seemingly uneventful recovery from myocardial
infarction may develop cardiac arrest as a direct and immediate result of
ventricular fibrillation.
 Detailed and extensive examination of ECG records has shown that
abnormalities in the functioning of the heart invariably manifest themselves
in ECG waveform. Diagnostic statements as observed from the ECG records
are classified into two classes:
 (i) morphological statements— primarily based on ECG waveshapes that
attempt to describe the state of the working muscle masses and
 (ii) rhythm statements—concerned with the site and rate of the cardiac
pacemaker and the propagation of impulses through the conduction
system.
Cardiac Arrhythmia 4

Fig 1: A typical
ECG waveform
Arrhythmia Monitor 5
 An arrhythmia monitor is basically a sophisticated alarm system.
 It is not an ECG interpretation system. It constantly scans ECG rhythm patterns and issues alarms to
events that may be premonitory or life threatening.
 The arrhythmias, which the instruments are designed to detect, are premature QRS complexes,
widened QRS complexes and runs of widened complexes. Because each patient’s ECG may differ, the
instruments generally base their determination of abnormal or ectopic beats upon a reference obtained
from the patient himself. Therefore, any arrhythmia monitoring instrument will operate in the
following sequence:
 Stores a normal QRSfor reference, particularly QRSwidth and R–R interval. An external ECG recorder
is automatically activated during the store normal mode so that the reference heart beats may be
visually examined and determined as to whether they are truly representative.
 • Initiates an alarm automatically, when ectopic beats are detected—either the ventricular prematured
or widened varieties.
 • Gives alarm light signals whenever the prematured or widened ectopic beats exist up to the rate of
6/min or 12/min.
 • Detects and triggers alarm when artifacts are present at the source, e.g. muscle tremor due to patient
movement, base line shift and improperly connected electrodes.
Arrhythmia Monitor …Contd. 6

 Therefore, any arrhythmia monitoring instrument will operate in the

following sequence:
 • Stores a normal QRSfor reference, particularly QRSwidth and R–R
interval. An external ECG recorder is automatically activated during the
store normal mode so that the reference heart beats may be visually
examined and determined as to whether they are truly representative.
 • Initiates an alarm automatically, when ectopic beats are detected—either
the ventricular prematured or widened varieties.
 • Gives alarm light signals whenever the prematured or widened ectopic
beats exist up to the rate of 6/min or 12/min.
 • Detects and triggers alarm when artifacts are present at the source, e.g.
muscle tremor due to patient movement, base line shift and improperly
connected electrodes.
Arrhythmia Monitor …Contd. 7

Fig 2 : Block
diagram of
basic
arrhythmia
monitoring
system
Methods Of Monitoring Fatal Heart 8

Rate
 1. ST/AR (ST and Arrhythmia) algorithm
 The algorithm processes the ECG signals for both paced and non-
paced patients and performs several actions on the incoming ECG
waveform, including filtering the signal, detecting and classifying
the QRS, generating heart rate, identifying ectopic events and
rhythms and generating alarms, when necessary.
 The contribution from each ECG lead to the QRS detection signal
is propotional to its measured quality based on the waveform
amplitude, and the amount of muscle and baseline noise. The
weighting factors are updated atleast every 200 ms to allow for
quick adaptation to signal quality changes (Fig 3).
Methods Of Monitoring Fatal Heart 9

Rate …Contd.
 1. ST/AR (ST and Arrhythmia) algorithm

Fig 3 : Generating
the QRS detection
signal in ST/AR
system
Methods Of Monitoring Fatal Heart 10

Rate …Contd.
 2. Exercise Stress Testing:
 Stress test or exercise electrocardiography is used when the
diagnosis of coronary arterial disease is suspected or to determine
the physical performance characteristics of a patient.
 The test involves the recording of the electrocardiogram during
dynamic or occasionally isometric exercise.
 The diagnostic value of exercise testing primarily concerns either
depression or elevation of the ST segment present in myocardial
ischemia.
Methods Of Monitoring Fatal Heart 11

Rate …Contd.
 [Link] Stress Testing:
 i) Treadmill Test:
 There are two basic kinds of exercise protocols used in treadmill tests:
 • The Balke-Ware Protocol: It uses a constant speed of 3.3 miles/hour (5.3 km/hour),
with progressive increments in the load every 2 minutes.
 This is achieved by increasing the grade or incline of the motor-driven treadmill.
The exercising subject therefore walks “uphill” and his own body weight serves as
the load.
 • The Bruce Protocol: It uses simultaneous increments in both speed and treadmill
grade at intervals of 3 minutes.
Methods Of Monitoring Fatal Heart 12

Rate …Contd.
 2. Exercise Stress Testing:
 ii) Bicycle Test:
 In this test, the speed is usually kept constant and incremental resistance is applied
either mechanically (friction belt or brake pads) or electrically.
 The work load can be precisely measured in terms of kilograms per metre per minute.
In bicycle ergometry, physiological measurements are more easily obtained with the
subject comfortably seated and the torso relatively immobile.
 The stress test laboratory is equipped with an exercise device, a PC-based ECG display
and recording system, a blood pressure measuring instrument (sphygmomanometer)
and a defibrillator.
 Sophisticated algorithms (digital filters and programs for the morphologic recognition)
have been developed in order to obtain stabilized artifact-free ECG tracings.
Methods Of Monitoring Fatal Heart 13

Rate …Contd.

Fig 4: ST segment measurement Fig 5: ST segment slope

Monitoring Labor Activity 14
 The condition of the foetus is assessed by studying the blood flow in the foetal heart
and its heart rate.
 The foetal heart rate (FHR) yields important information about the status of the foetus.
 Cardiotocograph: An assessment of the condition of the foetus can be made during
labour from the foetal heart action.
 The instrument which carries out a continuous and simultaneous recording of the
instantaneous foetal heart rate and labour activity is called cardiotocograph.
 Cardiotocographs are designed to measure and record foetal heart rate on a beat-to-
beat basis rather than on an average basis.
 Normally, an accuracy of measurement may be 2–3% for classification of responses.
 Sensitivity of 20 bpm/cm of recording chart allows adequate reading of the recorded
FHR.
 Labour activity and FHR traces are usually recorded simultaneously on the same time
scale.
Monitoring Labor Activity …Contd. 15

Fig 6: Foetal Ultrasound

photograph
Monitoring Labor Activity …Contd. 16
 The following methods are commonly employed in most of the cardiotocographic monitoring
during labour:
Method Foetal Heart Rate Uterine Contraction
Indirect (external) 1. Abdominal foetal Tocodynamometry (using
electrocardiogram tocotonometer to sense
changes in uterine tension Table 1:
transmitted to the
abdominal skin surface)
2. Foetal phonocardiogram
3. Ultrasound techniques
(narrow beam and wide-
angle transducer)
Direct (internal) Foetal ECG with scalp Intrauterine pressure
electrode (spiral, clip or measure-ment (using a fluid-
suction electrode attached filled
to the intracervical catheter with
presenting part of the foetus) strain gauge transducer)
Monitoring Labor Activity 17

Fig 7: Block diagram of of labour activity monitor (external method)

Monitoring Labor Activity …Contd. 18
 During labor, the uterus muscle starts contractions of increasing intensity in a bid to expel
out the child.
 The intrauterine pressure can reach values of 150 mmHg or more during the expulsion
period.
 The transducer output is amplified in an ac amplifier.
 The low frequency labor activity signal is obtained from the synchronous detector and is
further amplified by a dc amplifier.
 The activity can be either displayed on a meter or on a direct writing chart recorder.
 The labor activity can be recorded either in terms of the intra-uterine pressure measured
directly by means of a catheter or a relative indication of the labour intensity measured
through an external transducer.
 A plot of the tension of the uterine wall is obtained by means of a spring loaded
displacement transducer.
 The transducer performs a quasi-isometric measurement of the tension of the uterus.
Methods of Monitoring Foetal Heart 19

Rate
 1. Abdominal Foetal Electrocardiogram:
 Foetal electrocardiogram is recorded by suitably placing the electrodes on the
mother’s abdomen and recording the combined maternal and foetal ECG.
 The maximum amplitude of FECG (R wave) recorded during pregnancy is about
100 to 300 mV. This magnitude is much smaller than in the typical adult ECG
which is about 1 mV in the standard lead connection.

Fig 8: Abdominal recording of foetal

electrocardiogram. Bandwidth
(a) 0.2 – 200 Hz
(b) 15-40 Hz
Methods of Monitoring Foetal Heart 20

Rate …Contd.

Fig 9: Block diagram of the abdominal foetal electrocardiogram processing circuit

Methods of Monitoring Foetal Heart 21

Rate …Contd.
 2. Foetal Phonocardiogram:
 Foetal heart sounds can be picked up from the maternal abdomen by a sensitive
microphone.
 The heart sounds in the form of mechanical vibrations have to pass through tissue
structure and the signals picked up are rather weak because of distance effects and the
small size of foetal heart valves.
 To pick up the heart sounds, it is essential that the transducer be properly placed and
its impedance carefully matched. A crystal microphone is used for picking up phono
signals.
 The phono transducer signals are amplified by a low noise preamplifier and fed to a
bandpass filter which rejects all frequencies outside the 70 to 110 Hz range.
 The preamplifier is incorporated in the transducer housing to minimize interference
signals being picked up.
Methods of Monitoring Foetal Heart 22

Rate …Contd.
 2. Foetal Phonocardiogram:

Fig 10: Block diagram of the circuit arrangement used for obtaining variable pulse
duration to inhibit triggering by second heart sound
Methods of Monitoring Foetal Heart 23

Rate …Contd.
 3. Doppler-shift based ultrasound foetal blood flow detectors:
 The technique is extended to derive an integrated rate of the foetus heart from blood flow
signals and to display it on a suitable display system.
 In obstetric applications, the site of investigation varies from 5 to 20 cm below the surface of the
abdomen.
 The Doppler-shift based ultrasound foetal blood flow detectors use hand-held probes which
may be either pencil-shaped or flat and contain two piezo-electric crystals.
 The probe is coupled to the patient’s skin by means of an acoustic gel. This is done to exclude
any air from the interface.
 The presence of air severely attenuates the ultrasound, the problem being more acute during
early pregnancy.
 The transmitting crystal emits ultrasound (2 – 2.5 MHz) and the back-scattered ultrasound is
detected by the receiving crystal.
Methods of Monitoring Foetal Heart 24

Rate …Contd.

Fig 11: Ultrasonic blood Fig 12: Ultrasonic foetal heart beat detector
flow detector in use
Methods of Monitoring Foetal Heart 25

Rate …Contd.

Fig 13: Ultrasonic

Doppler-shift based
FHR measuring
circuit
 26

Thank You
 BIOMEDICAL INSTRUMENTATION
Subject Code:100818
MODULE-2.3

Faculty: Miss Richa Rani

Assistant Professor, ECE

TOPICS COVERED: [Link]

2. OXIMETERS
3. BLOOD CELL COUNTERS, FLOW METER, GAS ANALYZERS
4. CARDIAC OUTPUT MEASUREMENT
Contents 2

 1. Audiometers
 2. Oximeters
 3. Blood Flowmeters
 4. Cardiac Output Mwasurement
Audiometers 3

 Audiometry is a technique used to measure the ability to hear sounds.

 The process of audiometry is quite simple, consisting of three parts:
• Mechanical sound transmission (middle ear function)
• Neural sound transmission (cochlear function)
• Speech discrimination ability (central integration)

Fig 1: A wireless audiometer

 An audiometer is referred to a complex instrument which helps to measure a

person's ability to hear. Various audiometric techniques and procedures are used
to identify the hearing ability of a person.

Types of Audiometers 4
 [Link]-tone Audiometry
 Pure-tone audiometry is considered to be the gold standard in the evaluation of
auditory sensitivity.
 The extent of hearing loss and the cause is determined using pure-tone audiometry.
 It helps in finding out the hearing thresholds at different frequencies.
 The range of pure-tone audiometers vary from simple inexpensive devices to
elaborate and expensive diagnostic audiometers.
 In this test, a pure tone is presented to the ear through an earphone, and the lowest
intensity at which the tone is perceived 50% of the time is measured in decibels
(dB).
 This measurement is termed as ‘threshold’. The output is plotted as a graph known
as audiogram. Testing procedure is performed at specific frequencies ranging from
250 to 8000 Hz.
Types of Audiometers …Contd. 5

 2. Speech Audiometry
 The objective of the speech audiometry is to assess the integrity of the entire
auditory system by evaluating the hearing ability.
 Neural type of hearing loss can be identified with the help of speech
audiometry.
 Speech audiometric test is further categorized into speech discrimination test
and speech reception threshold test.
 Both the tests aim to identify the lowest decibel intensity at which a patient
can repeat 50% of the words correctly.
 While speech discrimination test uses monosyllable test words, speech
reception threshold test utilizes two syllable words with equal stress (also
referred to as “spondees”).
Types of Audiometers …Contd. 6

 [Link] Audiometry
 Recruitment is referred to the condition where patients having different
degrees of hearing loss in both ears experience enhancement in
perceived loudness in response to small increase in the intensity.
 Recruitment detection tests are known as the suprathreshold
audiometry. At a typical conversational speech level, it helps detecting
whether the listener can accurately recognize the speech or not.
 Benefits to a patient due to the use of a hearing aid can also be
determined by this test.
Types of Audiometers …Contd. 7

 [Link]-recording Audiometry
 Self-recording audiometry is also referred to as Bekesy audiometry. In 1947,
George von Bekesy first introduced this test.
 In this procedure, intensity and frequency are automatically changed with the
help of a motor.
 The frequency can be changed in a forward or backward manner.
 This hearing test is performed using a recording attenuator.
 At a fixed rate of so many decibels per second, the attenuator can either
increase or decrease the signal intensity.
 The attenuator action can be controlled by the listener.
Types of Audiometers …Contd. 8
 5. Impedance Audiometry
 The mobility and air pressure of the middle ear system and middle ear reflexes are measured in
impedance audiometry.
 6. Computer-administered (Microprocessor) Audiometry
 The first commercial microprocessor audiometer was introduced in 1975. The typical
microprocessor audiometer instrument contains a multifunctional keypad. Compared to the
manual and self-recording audiometers, microprocessor audiometers offer significant
advantages.
 7. Subjective Audiometry
 In this test, the subjects are asked to respond when they hear the presented sound. This
audiometric test can present systematically varying acoustic stimuli to the subjects and record
their responses.
 8. Objective Audiometry
 Unlike subjective audiometry, this test is not dependent on responses from the patients.
However, the subjects are asked to co-operate during the attachment of the measuring
electrodes or probes for carrying out the objective test.
Oximeters 9
 Oximetry refers to the determination of the percentage of oxygen saturation of the
circulating arterial blood.
 By definition:

 where [HbO2] is the concentration of oxygenated Haemoglobin

 [Hb] is the concentration of deoxygenated Haemoglobin
 The main application areas of oximetry are the diagnosis of cardiac and vascular
anomalies;
 The treatment of post-operative anoxia and the treatment of anoxia resulting from
pulmonary affections.
 The total quantity of oxygen bound with haemoglobin in the normal arterial blood is
approximately 19.4 ml percent at a pO2 of 95 mmHg.
 On passing through the tissue capillaries this amount is reduced to 14.4 ml per cent at a
pO2 of 40 mmHg.
Types of Oximeters 10

 1. In Vitro Oximetry:
 When blood is withdrawn from the subject under anaerobic conditions and
measurement for oxygen saturation is made at a later time in the laboratory, the
procedure is referred to as in vitro oximetry.
 For discrete blood samples, a spectrophotometric measurement of oxygen
saturation can be made by either a transmission method or a reflection method.

Fig 2 : Principle of transmission

oximetry

Where, I= the intensity of transmitted light ,

IO= the intensity incident light,
C= concentration of the light absorbing medium,
b= thickness of the medium
k= is known as the extinction coefficient and varies as a function of the substance and the
wavelength of light
Types of Oximeters …Contd. 11

 2. In Vivo Oximetry:
 In vivo oximetry measures the oxygen saturation of blood while the blood is flowing
through the vascular system or it may be flowing through a cuvette directly connected with
the circulatory system by means of a catheter. The blood in this case is unhaemolyzed.
 Both techniques, reflection and transmission, are utilized for in vivo oximetry.

Fig 3 : Schematic
arrangement of reflection
oximeter
Types of Oximeters …Contd. 12

 3. Ear Oximeters:
 Ear oximeters usually make use of the transmission principle to
measure the arterial oxygen saturation.
 In this case, the pinna of the ear acts as a cuvette. Blood in the ear must
be made similar to arterial blood in composition.
 This is done by increasing the flow through the ear without appreciably
increasing the metabolism.
 Maximum vasodilatation is achieved by keeping the ear warm. It takes
about 5 or 10 min for the ear to become fully dilated after the ear unit
has been put up in place and the lamp turned on.
Types of Oximeters …Contd. 13

 3. Ear Oximeters:

Fig 4 : Block diagram of

ear oximeter Model
47201A H.P. (Courtesy:
Hewlett
Packard, USA)
Types of Oximeters …Contd. 14

 4. Pulse Oximetry:
 Pulse oximetry is based on the concept that arterial oxygen saturation determinations
can be made using two wavelengths, provided the measurements are made on the
pulsatile part of the waveform.
 The two wavelengths assume that only two absorbers are present; namely
oxyhaemoglobin (HbO2) and reduced haemoglobin (Hb).
 These observations, proven by clinical experience, are based on the following:
 (i) Light passing through the ear or finger will be absorbed by skin pigments, tissue,
cartilage, bone, arterial blood, venous blood.
 (ii) The absorbances are additive and obey the Beer-Lambert law:

where Io and I are incident and transmitted light intensities, e is the extinction
coefficient, D is the depth of the absorbing layer and C is concentration.
Types of Oximeters …Contd. 15

 4. Pulse Oximetry:
• This has two LEDs (light emitting diodes), one that
transmits infrared light at a wavelength of
approximately 940 nm and the other transmitting light
at approximately 660 nm.
• The absorption of these select wavelengths of light
through living tissues is significantly different for
oxygenated haemoglobin (HbO2) and reduced
haemoglobin (Hb).
• The absorption of these selected wavelengths of light
passing through living tissue is measured with a
photosensor.
Fig 5: (a) A typical finger tip pulse
oximeter probe in use
(b) Components of a pulse oximeter
probe
Types of Oximeters …Contd. 16

 5. Skin Reflectance Oximeter:

 For the measurement of oxygen saturation level of blood in
localized areas of oxygen deprived tissues on the limbs, head
and torso, a skin reflectance oximeter can be employed.
 The instrument basically depends on monitoring
backscattered light from living tissue in two wavelengths.
 The backscattered light data is then used for the in vivo
determination of the blood’s relative oxygen saturation.
Types of Oximeters …Contd. 17

 5. Skin Reflectance Oximeter: Working Principle:

• A pair of red and infrared
light emitting diodes are
used for the light source,
with peak emission
wavelengths of 665 nm (red)
and 935 nm (infrared).
• The reflected light from the
skin at these two
wavelengths is detected by a
silicon diode.
• These detected signals are
processed in the form of
Fig 6 : Schematic diagram of the
photo-plethysmographs to
reflectance oximeter sensor
determine So2.
Types of Oximeters …Contd. 18

 6. Intravascular Oximetry:
 For intravascular oximetry, modern instruments make use of optical fibres to
guide the light signal inside the vessel and the reflected light from the red blood
cells back to the light detector.
 For estimating SO2, usually the reflectance at two wavelengths, one in the red
and the other in the near infrared regions, are used.
 The relationship is given by:
Where, A and B are the constants that
depend upon the fiber geometry and
physiological parameters
of blood

Fig 7 : A catheter – tip hybrid circuit

oximeter for intravascular measurement
Blood Flowmeter 19

 1. Electromagnetic Blood Flowmeter:

 The operating principle underlying all electromagnetic type flowmeters is based upon Faraday’s
law of electromagnetic induction which 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. • In the flowmeter, an electromagnetic assembly
provides the magnetic field placed at right angles to
the blood vessel in which the flow is to be measured.
• The blood stream, which is a conductor, cuts the
magnetic field and voltage is induced in the blood
stream.
• This 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 blood
flow.
Fig 8 : Principle of electromagnetic
flowmeter
Blood Flowmeter …Contd. 20
 [Link] Blood Flowmeters:
 Two types of ultrasonic blood flow-velocity meters:
 i). Transit time velocity meter and
 ii) Doppler-shift type.
 Mostly Doppler shift type blood flowmeters are used.

Fig 9: Principle of
ultrasonic Doppler-shift
flow velocity meter
Blood Flowmeter …Contd. 21
 Doppler Shift Type Blood Flowmeters :
 It is a non-invasive technique to measure blood velocity in a particular vessel from the
surface of the body.
 It is based on the analysis of echo signals from the erythrocytes in the vascular
structures.
 Because of the Doppler effect, the frequency of these echo signals changes relative to the
frequency which the probe transmits.
 The Doppler frequency shift is a measure of the size and direction of the flow velocity.
 The incident ultrasound is scattered by the blood cells and the scattered wave is received
by the second transducer.
 The frequency shift due to the moving scatterers is proportional to the velocity of the
scatterers. Alteration in frequency occurs first as the ultrasound arrives at the ‘scatterer’
and second as it leaves the scatterer.
 If the blood is moving towards the transmitter, the apparent frequency f1 is given by
Blood Flowmeter …Contd. 22
 Doppler Shift Type Blood Flowmeters :

given above:

Fig 10 :
Calculation of
blood flow
velocity
Blood Flowmeter …Contd. 23
 Doppler Shift Type Blood Flowmeters :

Fig 11 : Block diagram of Doppler shift blood flowmeter

Blood Flowmeter …Contd. 24
 3. NMR Blood Flowmeters:
 Nuclear magnetic resonance principle offers yet another non-invasive method for the measurement of
peripheral blood flow or blood flow in various organs.
 The method pertains to a quantum mechanical phenomenon related to the magnetic energy levels of
the nucleus of some elements and their isotopes.
 For blood flow measurement work, behaviour of the two hydrogen atoms of water is studied, since
blood is approximately 83% water.
 Due to the magnetic moment of the hydrogen atom, the nucleus behaves as a microminiature magnet
which can be affected by externally applied magnetic fields.
 The hydrogen nuclei orient themselves to produce a net parallel alignment to a steady magnetic field.
 The nuclear magnets precess around the magnetic field lines until they become aligned. The angular
frequency (Larmor frequency) of this precession is given by:
Where, r is the ratio of the magnetic moment to the angular
momentum (the magnetic gyro ratio) and
Bo is the density of the steady magnetic field and v is the
frequency of radiation.
Blood Flowmeter …Contd. 25
 3. NMR Blood Flowmeters:

Fig 12 : Arrangement for

measurement of arterial
blood flow using NMR
principle. Hydrogen nuclei in
the blood are magnetised by
the magnetiser Bo. The nulcei
are detected downstream by
the receiver coil
Blood Flowmeter …Contd. 26

 4. Laser Doppler Blood Flow meter:

 When a laser beam is directed towards the tissue under study,
absorption and scattering takes place.
 Radiation scattered in movable structures, such as red cells, is shifted
in frequency due to the Doppler effect, while radiation scattered in
nonmoving soft tissue is unshifted in frequency.
 A part of the total scattered radiation is brought to fall on the surface of
a photodetector.
 The effective radiation penetration depth is approximately 1 mm in soft
tissue and scattering and absorption take place mostly in the papilla
region and the underlying corium—two dermal layers containing the
capillary network of the skin.
Blood Flowmeter …Contd. 27

 4. Laser Doppler Blood Flow meter:

Fig 13 : Block diagram

of a laser Doppler
system for blood flow
measurement
in skin
Cardiac Output Measurement 28

 Cardiac output is the quantity of blood delivered by the heart

to the aorta per minute.
 Problems occur when the supply of blood from the heart is
unable to meet the demand. A fall in cardiac output may
result in low blood pressure, reduced tissue oxygenation,
acidosis, poor renal function and shock.
 It is a reflection of the myocardial function and when taken
with other measurements such as blood pressure and central
venous pressure, the rational treatment of cardiac disorders
becomes clearer.
Cardiac Output Measurement 29

…Contd.
 1. Indicator Dilution Method:
 Indicator dilution principle states that if one can introduce into or remove from a stream of fluid
a known amount of indicator and measure the concentration difference upstream and
downstream of the injection (or withdrawal) site, one can estimate the volume flow of the fluid.
 Two methods are generally employed for introducing the indicator in the blood stream, viz: it
may be injected at a constant rate or as a bolus.

 2. Dye Dilution Method:

 The most commonly used indicator substance is a dye.
 Fox and Wood (1957) suggested the use of Indocyanine green (cardiogreen) dye which is usually
employed for recording the dilution curve.
 This dye is preferred because of its property of absorbing light in the 800 nm region of the
spectrum where both reduced and oxygenated haemoglobin have the same optical absorption
Cardiac Output Measurement 30

…Contd.
 2. Dye Dilution Method:
 The procedure consists in injecting the dye into the right atrium by means of a venous catheter.
 Usually 5 mg of cardiogreen dye is injected in a 1 ml volume. The quantity used may be 2.5 mg
in the case of children. A motor driven syringe constantly draws blood from the radial or
femoral artery through a cuvette. The curve is traced by a recorder attached to the densitometer.
After the curve is drawn, an injection of saline is given to flush out the dye from the circulating
blood.

Fig 14 : Diagrammatic
representation of a densitometer
for quantitative measurement
of dye concentration
Cardiac Output Measurement 31
…Contd.
 [Link] Dilution Technique:
 A thermal indicator of known volume introduced into either
the right or left atrium will produce a resultant temperature
change in the pulmonary artery or in the aorta respectively,
the integral of which is inversely proportional to the cardiac
output.
Cardiac Output Measurement 32
…Contd.
 [Link] Dilution Technique:

Fig 15 : Cardiac output thermal-dilution

set-up
Cardiac Output Measurement 33

…Contd.
 [Link] Technique:

Fig 16: Technique

of measuring
cardiac output by
impedance changes
Cardiac Output Measurement 34

…Contd.
 [Link] Technique:
 The technique used for the measurement of cardiac output by the impedance
method is illustratein Fig. given above.
 If p is the resistivity, the resistance of the thorax between two sensing electrodes (2
and 3) is given by

 Where, L is the separation between the electrodes and A is the cross-sectional area
of the thorax.
The value of p is related to the patient’s haematocrit and for
normal values, a blood resistivity of 150 Ω cm can be
assumed.
Cardiac Output Measurement 35

…Contd.
 5. Ultrasound Method:
 Ultrasound can be used to measure the velocity of blood flow in the ascending aorta
by the application of the Doppler principle.
 Blood velocity in the ascending aorta can be measured by a probe that is held in the
operator’s hand and positioned just above the sternal notch.
 Blood velocity in the descending aorta can be measured (Mark et al, 1986) by a probe
attached to an esophageal stethoscope.
 When compared to standard thermodilution measurement of cardiac output, the
correlation coefficients range from 0.63 to 0.91 (Wong et al, 1990).
Cardiac Output Measurement 36

…Contd.
 5. Ultrasound Method:

Fig 17 : Cardio Q – Doppler shift

based cardiac output and aortic
volume
measurement and display system
 37

Thank You