BIO MEDICAL INSTRUMENTATION
21EI71
Module -1
Fundamentals of Biomedical Instrumentation:
Sources of biomedical signals, Basic Medical
Instrumentation system, Performance requirements of
medical instrumentation systems. PC based medical
instruments, General constraints in design of
biomedical instrumentation systems.
Bioelectric Signals and Electrodes : Origin of
Bioelectric signals, Types of bioelectric signals-ECG,
EEG, EMG, Recording electrodes: Electrode – Tissue
interface, polarization, skin contact- impedance, Silver-
silver chloride electrodes, Electrodes for ECG, EEG,
EMG, Microelectrodes.
Module -2
Electrocardiograph: Physiology of the heart,
Electrical activity of the heart and
Electrocardiogram (ECG), Normal & Abnormal
cardiac Rhythms, Block diagram-description of
an Electrocardiograph, ECG leads, Effects of
artifacts on ECG Recordings, Multi- channel
ECG machine.
Electroencephalograph: Block diagram
description of an Electroencephalograph, 10-20
electrode systems, computerized analysis of
EEG. Electromyograph, Biofeedback
instrumentation.
Module -3
Patient Monitoring System: Bedside patient
monitoring systems, Central monitors, Measurement of
heart rate – Average heart rate meter, Instantaneous
heart rate meter, Measurement of pulse rate, Definition
of oximeter & Pulse oximeter.
Blood Pressure Measurement: Introduction, Indirect
methods of blood pressure measurement: Korotkoff ’s
method, Rheographic method, differential auscultatory
technique, Oscillometric technique.
Measurement of Respiration Rate: Impedance
pneumography, CO2 method of respiration rate
measurement, Apnoea detectors.
Module -4
Blood Flow Measurement: Electromagnetic blood
flow meter- Principle and Square wave
electromagnetic flowmeter. Doppler shift blood flow
velocity meter, Blood flow measurement by Doppler
imaging.
Cardiac Output Measurement: Measurement of
continuous cardiac output derived from the aortic
pressure waveform, ultrasound method.
Cardiac Pacemakers and Defibrillators: Need for
cardiac pacemaker, External pacemaker, Implantable
pacemaker, Types of Implantable pacemakers,
Programmable pacemakers, Power sources for
Implantable pacemaker.
Cardiac Defibrillator: Need for a Defibrillator, DC
defibrillator, Pacer-Cardioverter-Defibrillator
Module -5
Therapeutic Instruments:
Cardiac-assist devices, Pump oxygenators, Total
artificial heart, Hemodialysis, Lithotripsy,
Ventilators,
Infant incubators, Drug infusion pumps,
Ambulatory and Implantable Infusion systems,
Anesthesia
Page 52 of 135
Machines, Electrosurgical unit.
Patient Safety: Electric shock hazards, Leakage
currents, Electrical safety analyzer, Testing of
Biomedical equipment
Text Books:
1. Handbook of Biomedical Instrumentation - [Link], 2nd
Edition, Tata McGraw- Hill, 2003
(Module 1, 2, 3, 4 & Module 5- Patient Safety)
2. Medical Instrumentation: Application and Design – John G
Webster, 3rd Edition, John Wiley &
Sons, 2006. (Module 5- Therapeutic Instruments)
Reference Book:
1. Biomedical Instrumentation & Measurement - Leslie Cromwell,
Fred J Weibell& Erich A
Pfeiffer, 2nd Edition, Prentice Hall of India, 2001.
Module 1
FUNDAMENTALS
➢ Use of electrical and electronic equipment in the medical field
for clinical purposes.
➢ To determine the presence of some physical quantity.
➢ Science of structure of the body- anatomy and its function is-
physiology.
➢ Human body is a source of various bio-potential signals.
➢ These signals can be picked up from surface of the body or
from within the body.
➢ These signals are used as parameters in various bio-medical
studies.
Physiological systems of the body
• Human body is a complex system which contains various types of
systems such as
• electrical,
• mechanical,
• hydraulic,
• pneumatic,
• chemical,
• thermal etc.
➢ The Cardiovascular system.
➢ The Respiratory system.
➢ The Nervous system
➢ Digestive system, excretory system, reproductive system and
biochemical system.
➢ They perform vital functions required to carry out various body
functions
Sources of Biomedical signals
➢ Biomedical signals are those signals which are used
primarily for extracting information on a biological
system under investigation.
➢ Extracting information could be simple or complex.
➢ Biomedical signals originate from a variety of sources
such as:
1. Bioelectric signals: are
▪ Ionic voltages produced due to electrochemical activity of
cells
▪ generated by nerve and muscle cells.
▪ the basic source is the cell membrane potential
▪ electric field generated by many cells constitute bio-electric
signal
▪ eg. ECG, EEG
[Link] Signals
▪ the measurement of acoustic signals created by many biomedical
phenomena provides information about the underlying phenomena.
▪ eg. flow of blood in the heart and flow of air through the upper and lower
airways and in the lungs which generate acoustic signals.
3. Biomechanical signals
▪ originates from some mechanical function.
▪ motion and displacement signals, pressure and flow signals etc.
▪ Eg : movement of chest wall in accordance with the respiratory activity.
[Link] signals
▪ Results due to chemical measurements from living tissue or from samples
analyzed in the laboratory.
▪ Eg. Partial pressure of carbon dioxide, partial pressure of oxygen,
concentration of various ions.
[Link] signals
▪ Weak magnetic fields produced by brain, heart and lungs.
▪ Provides information which is not available in the other types of bioelectric
signals.
▪ Eg. magneto-encephalogram signal from brain.
[Link]-optical signals
▪ Results as a function of optical functions in biological system occurring
naturally or induced by the measurement process.
▪ Eg. Blood oxygenation measured by transmitted/back scattered light from
tissue at different wavelengths.
[Link]-impedance signals
▪ Impedance of the tissue is a source of important information concerning its
composition, blood volume etc.
▪ Eg. measurement of galvanic skin resistance .
BASIC MEDICAL INSTRUMENTATION SYSTEM
Any medical instrument would comprise of the following four basic
functional components.
o Measurand- internal, surface-derived from body
o Transducer/sensor
o Signal conditioner
o Display system-visual, alarm
The processed signal after signal conditioning may be passed on to
o Alarm system
o Data storage
o Data transmission
Measurement in the medical field can be classified into
o In-vivo-within
o In-vitro- outside
Definitions
[Link]
• Energy is given to the patient and the effect it has on the patient is
measured.
stimulus may be a flash of light, direct electrical simulation of some part of
nervous system.
• Eg: recording of evoked response with EEG machine.
[Link]
• Calibration is necessary at regular intervals
• Calibration signal is usually applied to the sensor input or as early in the
signal conditioning.
[Link] DEVICES
• Automatic control of transducer, stimulus, or signal conditioning.
• Achieved by using feedback
• Control and feedback can be automatic or manual.
Performance requirements of medical
instrumentation systems
Sensor/Transducer output- current, intensity,
frequency, voltage level –opamp used to get voltage
output
Input impedance of device > output impedance of
signal source- gives accurate measurement
Frequency response of system should be compatible
with operating range of signal being measured.
System bandpass should contain all frequencies- for better
signal strength
Instrument designed to give high SNR.
PERFORMANCE REQUIREMENTS OF MEDICAL INSTRUMENTATION
SYSTEMS
Digital technology makes hardware and software
more efficient and flexible.
It is not affected by component aging and temperature,
easily changed.
Displays –both analog and digital
LED –small sized 7segment displays used in digital
circuits
LCD-require low current for operation.
Used in high resolution color graphic screens
Displays used to monitor physiological variables.
PC BASED MEDICAL INSTRUMENTS
Personal computers used due to low cost, power
capability etc.
PC software –commercially available, open source
Price, performance and programmability
PCs helpful for data collection, manipulation,
processing, display, storage etc.
Workstation used to manage huge data
Workstation includes sensors/transducers- converts
physical phenomena into measurable signals
Data can be processed, stored in files, plotted or
printed.
GENERAL CONSTRAINTS IN DESIGN OF
MEDICAL INSTRUMENTATION SYSTEMS
Medical equipment used-measure physiological parameters.
Stimulus or some energy applied to human body for diagnosis and treatment
Factors which determine the design of a medical measuring instrument
❑ Measurement range- quiet low, in microvolt range
❑ Frequency range- biomed signals are in audio freq range , low freq
components
Constraints to be considered
❑ Inaccessibility of the signal source-
❑ ex. Measurement of intra cranial pressure in the brain
❑ Physical sensor size is a constraint
❑ Variability of physiological parameters-
❑ are generally time variant
❑ Empirical, statistical methods used to establish relationship among variables.
❑ Interference among physiological systems-
❑ Many feedback loops exists
❑ Interrelationships among physiological parameters
❑ Transducer interface problems-
❑ Physical presence of TSD may cause change in reading
❑ Loading effect of the TSD on the source should be minimal
❑ High possibility of Artifacts-
❑ Refers to undesirable signals extraneous to physiological variables under
measurement
❑ Ex. Due to movement of the subject
❑ 50hz electrical interface
❑ Crosstalk
❑ Noise generated within the measuring instrument
❑ Safe levels of applied energy-
❑ Some energy applied to the living tissue ex. Ultrasonic imaging techniques
use U.S energy
❑ Patient safety considerations-
❑ Instruments are connected to patients
❑ Possibility of electric shock hazards
❑ Non-technical and paramedical staff safety to be considered
❑ Organizations have laid specific guidelines in this regard.
❑ Reliability aspects- causes life threat to patients
❑ Ex. Life saving equipment like Defibrillators-
❑ their failure to operate,
❑ provide undesired output
❑ Equipments should be reliable, simple, capable of withstanding
physical abuse
❑ Human factor considerations-
❑ Due to complexity of medical devices,
❑ huge amount of info exchange between staff and machine,
❑ Lack of experience of staff to handle these increases
❑ Error probability to reduce quality, reliability of clinical procedures.
❑ Desired performance not achieved due to deficiency in man-machine
interactions
❑ Government regulations- to ensure equipment performance,
safety
❑ National and international bodies issue guidelines.
General considerations at initial design and
development of medical instruments
Signal considerations-
SNR,
stability wrt temp, pressure, humidity, reliability
Medical consideration-
invasive or non invasive,
patient discomfort,
radiation,
material toxicity, safety
Economic considerations-
Initial cost,
availability,
compatibility with other equipments
BIOELECRTIC SIGNALS AND ELECTRODES
ORIGIN OF BIOELECTRIC SIGNALS
➢ Physiological processes were accompanied with electrical
changes.
➢ Human body, composed of living tissue is a power station
generating multiple electrical signals.
➢ Signals are of few micro-volts and give rise to complicated
pattern of electrical activity .
➢ Bio electric signals are generated by certain systems of the
body which conveys useful information about the functions
they represents.
➢ Potential differences are generated by electrochemical changes.
➢ Bio electric signals are ionic voltages produced by electrochemical activity of
certain special type of cells-excitable cells. Eg. Nerve, muscles etc
Muscular contraction is associated with migration of ions which
generate potential differences
Potential differences are generated by electrochemical changes and
conduction of signals along the nerves to and from the brain.
➢ Bio electric potential are generated at a cellular level and the
source is ionic.
➢ A cell is a semi permeable membrane which acts as ionic filter.
➢ Human cells vary from 1-100 microns in dia,0.01 micron thick,
1mm to 1m in length.
➢ Cells are surrounded by body fluids which are ionic.
➢ Principle ions are
➢ Sodium (Na+)
➢ potassium (K+) and
➢ chloride(Cl-)
➢ K+ and Cl- are permitted to flow through the cell membrane but
Na+ is not easily allowed.
➢ So, Concentration gradient of sodium across cell membrane is
high outside the cell
▪ Sodium is a positive ion in resting state, a cell has negative
charge along inner surface and positive charge in outer portion.
▪ Potential measured – resting potential.
▪ The cell in such condition is said to be polarized.
▪ So, a cell is a tiny battery!!!!
▪ When cell is excited the outer side of the cell membrane
becomes momentarily negative w.r.t interior- depolarization.
▪ Repolarization is necessary in order to re-establish the resting
potential.
▪ This discharging and recharging of the cell produces voltage
waveforms which can be recorded by using micro-electrodes.
Contraction and excitation is found in skeletal
muscle, heart muscle and smooth muscle.
Electrical activity associated with one contraction in
a muscle .
Stimulus threshold-stimulus of minimum value which should
be applied for depolarization.
Refractory period – time required for the cell to move from
excited state to pre stimulus state
Time required due to metabolic activity of the cell
TYPES OF BIOELECTRIC SIGNALS
❑ Electrocardiography- periodical, rhythmically repeating signal.
❑ Electroencephalography- rhythmical potential originates in
individual neurons of brain.
❑ Electromyography-action potential in individual muscle fibre.
❑ Electroretinography
❑ Electro-oculography.
ELECTRICAL ACTIVITY OF THE HEART
Electrical activity associated with the functioning
of the heart- called ECG
The bio electric events generated and waveforms
are recorded and any deviation reflects
abnormality
In top right atrium- a group of cells called sino-
atrial node(SA node) is present
This initiates electrical activity and is the natural
pacemaker of the heart.
It generates impulses at 72 beats/minute at rest
The generated impulse propagates through the right and left atria
at a velocity of 1m/s
0.1s is required to complete atrial excitation
The atrial pulses contracts the atrial muscles
Impulse reaches the atrio-ventricular node(AV-node) in 0.04s
This is in the lower part of the wall between the two atria
AV node delays the spread of excitation for 0.12s
Due to the presence of fibrous barrier
AV node delay ensures the atrial contraction is complete
Bundle of His then carries pulses to ventricles
From AV node impulse moves through bundle of His, right and left
bundle branches then purkinje fibres
Purkinje fibers are present from the apex and on the walls of
ventricles.
This impulse direction in purkinje is from apex of heart-so
ventricular contraction begins at apex to upwards-results in
ventricular contraction.
HEART CYCLE
Electrical signals from SA node spread through atria and causes
them to depolarize-P wave
This causes atrial contraction- diastole
PQ interval represents the time for the impulse to travel from SA
node to the AV node
QRS complex marks the firing of AV node and causes ventricular
depolarization
Q wave represents depolarization of intra ventricular septum
R wave is the depolarization of the main mass of the ventricles
S wave represents last phase of depolarization at the base of the
heart
Atrial repolarization occurs during this time
ST is the duration when the ventricles contract and pump blood-
systole
T represents ventricular repolarization
Each heart beat is 0.8 sec( ventricular action)
Ventricular systole= 0.3s
Ventricular diastole is 0.5 sec
ELECTRO ENCEPHALOGRAM (EEG)
Brain generates rhythmical potentials-stimulated
as millions of cells discharge synchronously.
This appears as surface waveform called EEG
Neurons are polarized at rest
Inside of neuron is at -70mv wrt to exterior
When neuron is exposed to stimulus, change in
membrane potential generated spreads through
the cell
Depolarization of cell occurs
Repolarization occurs very shortly
EEG picked up from scalp or cerebral cortex
Scalp signal peak to peak voltage is <=100uv and exposed brain is
1mv
Normal EEG frequency range is 0.5 to 50Hz
Based of freq range, EEG signals are classified as
Delta(δ) = 0.5 to 4Hz
Theta(θ) = 4 to 8 Hz
Alpha(α) = 8 to 13Hz
Beta (β) = 13 to 22 Hz
Gamma(γ) =22 to 30 Hz
Alpha –principal component determines the alertness of the brain
It indicates the depth of anasthesia
EEG is commonly used in the diagnosis and monitoring of various
neurological disorders, such as
epilepsy, sleep disorders, and brain injuries.
It can also be used in research to study brain function and
cognitive processes.
Evoked response indicates the disturbance in EEG pattern due to
external stimulus
Stimuls can be flash of light or click of sound
ELECTROMYOGRAM (EMG)
Skeletal muscle contraction results in action potential
This recording is EMG
Activity is similar to skeletal, heart muscle-but repolarization is
very rapid.
AP lasts for few milliseconds only
EMG indicates the activity of group of muscle fibers together
Surface electrodes are used to record this electrical activity
The signal frequency range is 0-500Hz or 50 -150 Hz
Amplitude is 1-10mv range
RECORDING ELECTRODES
❑ Bio electric signals are picked up from surface of the body
before amplification and display.
❑ The process is done using electrodes which make a transfer
from ionic conduction in the tissue to electronic conduction
for making measurements.
There are 2 types:
✓ Surface electrodes: pick up potential difference from tissue
surface when placed over it without damaging live tissue.
eg. ECG,EEG
✓ Deep-seated electrodes: indicate electrical potential difference
arising inside a live tissue.
eg. Needle electrodes.
ELECTRODE-TISSUE INTERFACE
❑ Commonly used electrodes are surface electrodes.
Eg :Used for recording ECG,EEG and respiratory activity by
impedance pneumography.
❑ To avoid movement artefacts and to obtain clear contact an
electrolyte is used.
❑ Characteristic of surface electrode dependent on
❖ metal-electrolyte interface
❖ electrolyte-skin interface
❖ quality of the electrolyte
Metal-electrolyte interface
❑ Tendency for each electrode to discharge ions into the
solution and for ions in electrolyte to combine with
each electrode.
❑ Charge gradient is created at each electrode, the spatial
arrangement is called electrical double layer by
Helmholtz
❑ The voltage developed is called half –cell potential.
❑ The difference in half-cell potential that exists between two electrodes –
offset potential
❑ The Half cell potential E of the electrode-electrolyte interface depends on
type of electrolyte, its concentration, and temp.
❑ Warburg circuit- a single electrode/electrolyte interface can be represented by
a series combination of capacitance C and resistance R
Electrode potentials are measured wrt reference- ex. hydrogen
absorbed in platinum black
❑ Lowest potential is observed in silver-silver chloride
electrode.
❑ Value of C and R depend on----
❑ current density,
❑ temp,
❑ type and
❑ concentration of the electrolyte and type of metal used.
❑ Offset potential----the difference between half-cell
potential that exists between two electrodes.
❑ The differential amplifiers used to measure potential
between 2 electrodes
❑ These cancel electrode offset potential so that signal of
interest are recorded.
Potential between electrolytes in electrodes
Electrode Electrolyte p.d between
electrodes
Stainless steel Saline 10mv
Silver Saline 94mv
Silver-silver chloride Saline 2.5mv
Silver -silver ECG paste 0.47mv
chloride(11mm disc)
Silver -silver ECG paste 0.2mv
chloride(sponge)
Electrolyte-skin interface
❑ Skin acts as a diaphragm arranged between two solutions of
different concentration.
❑ Epidermis acts as semi permeable membrane.
❑ Electrolyte-skin interface is represented as
❑ a voltage source in series with
❑ parallel RC ckt.
❑ Capacitance represents charge developed at the phase
boundary and resistance is the tissue resistance.
❑ Voltage of non physiological origin---contact potential.
❑ The voltage presented to the measuring instrument from the
electrode consists of
❑ Contact potential
❑ Biological signal of interest
❑ .
❑ Contact potential cause interference which may exceed signal of interest
❑ Interference signals are produced by the p.d of metal electrolyte and electrolyte skin
interface.
❑ Factors which are responsible for variation of p.d with time is
❑ temp variation,
❑ displacements and
❑ change in electrolyte concentration
Equivalent ckt of a pair of electrodes
❑ Pair of electrodes is placed in electrolytic contact with the
subject.
❑ Measures bio electric event and are connected to differential
amplifier.
❑ Three potential exists-
❑ one is due to bio-electric event (Eb) and
❑ other two are of non- physiological origin and represents half
cell potential E1 and E2
❑ It is essential to minimize potential drops across the
electrode impedance and achieved by making skin contact
impedance as low as possible.
POLARIZATION
❑ When low voltage is applied to the electrodes placed in
solution. electrical double layer is disturbed.
❑ Depending on the metal of the electrode a steady flow of
current may or may not take place.
❑ Some electrode will not permit the measurement of steady or
slowly varying potential in the tissue- polarized or non
reversible
❑ There are 2 types
[Link] polarizable-offers high resistance
[Link] non- polarizable-these rapidly dissipate
any charge imbalance – used in ICU
Skin –contact impedance
❑ The electrical activity generated by various muscles and
nerve is conducted to the electrode through body tissue,
reaches electrode through skin-electrode transition.
❑ The impedance of electrode-skin junction comes in
overall circuitry.
❑ Skin electrode impedance--- contact impedance.
❑ Skin electrode impedance of the body tissue has high
value than electrical impedance of the body tissue as
measured beneath the skin.
❑ Careful skin preparation is necessary.
❑ Measurement of contact impedance at individual
electrode has been suggested by MILLER.
MEASUREMENT OF SKIN-CONTACT IMPEDANCE- MILLER
The oscillator provides a
constant current of 0.1 -
100Hz through 47k resistor
The voltage drop across 1K
gives the circuit current
SKIN CONTACT IMPEDANCE FOR FOLLOWING ELECTRODES
MEASURED USING MILLER METHOD
Silver-silver chloride electrode
❑ Important characteristic---should not polarize.
❑ Ag-AgCl is a non polarizable electrode.
❑ Preferred over zinc-zinc sulphate
▪ non-toxic,
▪ Highly reproducible parameters, long term
stability
Production of Ag-AgCl electrode
▪ Prepared through electrolysis.
▪ Chemical changes at anode and cathode are:
NaCl = Na+ + cl-
cl- + Ag+ -----→ AgCl
• 2 Ag discs –suspended in saline solution
• +ve of dc supply connected to disc to be chlorided and –
ve pole goes to the other side
• Current at a rate of 1mA/cm2 is passed for several
minutes
• A layer of AgCl is deposited on anode
• Anode and cathode chemical changes are as follow
ELECTRODES FOR ECG
▪ Limb electrodes
▪ Floating electrodes
▪ Pregelled Disposable electrodes
▪ Pasteless electrodes
ELECTRODES FOR EEG
▪ Chlorided silver discs
ELECTRODES FOR EMG
▪ Needle type
LIMB ELECTRODE
• Material used is German silver, nickel silver or nickel
plated steel
• Applied on the limbs surface of the body with jelly
• Can be connected to the four limbs of the body-so the
name limb electrodes
• Used during surgery- where limbs are immovable
• Uncomfortable to use for long term monitoring
FLOATING ELECTRODES
Limb electrodes suffer from motion artefacts
Floating electrodes can be used to solve this.
Here electrodes do not make direct contact with the skin
Electrode has light weight metal screen or plate held away from
the subject using a flat washer connected to skin
They don’t use electrode jelly and ideal for monitoring ECG and for
long term monitoring
Used comfortable in ICU
PREGELLED DISPOSABLE ELECTRODES
Electrodes for stress testing and long term
monitoring present problems due to stress,
perspiration, body movement etc
ECG electrodes should prevent random noise and
skin contact- causing signal loss
Disposable electrodes are used to solve the prolonged
application problems
Above problems are reduced by the use of high
absorbency buffer layer with isotonic electrolyte
This layer neutralizes the effects
Perspiration causes electrode displacement which is
removed by additional porous overlay disc.
PASTELESS ELECTRODES
ECG electrodes are metal plates applied to skin over electrolyte
paste
Could be irritable to patients
Electrodes may be periodically removed for replenishments-further
irritation
Bacterial and fungal growth-by long term usage
Conductive electrodes may shift position – due to motion artefacts
Hence, dry electrode usage is preferred in some cases
CAPACITIVE ELECTRODES
Using high input impedance amplifier- signal can be recorded
through tissue-electrode capacitance
Here the electrodes are capacitive coupled to the subject.
Electrodes are anodized with 1 to 30G ohms
Two such electrodes are applied to the subject without any skin
preparation
ELECTRODES FOR EEG
Commonly used electrodes are chloride silver discs
Scalp contact is made via electrolytic paste
Small needle electrodes are sometimes used for carrying out
special EEG studies
Silver ball electrodes covered with small cloth pad are used when
electrical activity is recorded from exposed cortex
EEG ELECTRODE- APPLIED TO SKIN SURFACE BY AN
ADHESIVE TAPE
ELECTRODES FOR EMG
Usually needle type electrodes are used in clinical EMG,
neurography and other for muscle tissues
Stainless steel material is used even though it adds noise
It is preferred due to its mechanical solidity and low price
They are thoroughly sterilized before use
MICROELECTRODES
❑ To study electrical activity of individual cell.
❑ Size of intracellular microelectrode is dictated by the
size and the ability of its enveloping membrane to
tolerate.
❑ There are two types
➢ Metallic-fine needle of suitable metal
direct contact with tissue and have low resistance and
polarize with small current.
➢ Glass micro capillaries –Pyrex glass of special grade
filled with electrolyte.
Improved stability
Microelectrodes have high impedance compared to
conventional electrodes used for ECG,EEG
High impedance is due to the small metal-
electrolyte interface.
MICROELECTRODES