MEDICAL INSTRUMENTATION

Application and Design

FOURTH EDITION John G. Webster, Editor Contributing Authors
John W. Clark, Jr. Rice University Michael R. Neuman Michigan Technological University Walter H. Olson Medtronic, Inc. Robert A. Peura Worcester Polytechnic Institute Frank P. Primiano, Jr. Consultant Melvin P. Siedband University of Wisconsin-Madison John G. Webster University of Wisconsin-Madison Lawrence A. Wheeler Nutritional Computing Concepts |

JOHN WILEY & SONS, INC.

CONTENTS
Preface v List of Symbols ix

BASIC CONCEPTS OF MEDICAL INSTRUMENTATION

Walter H. Olson

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13

Terminology of Medicine and Medical Devices 4 Generalized Medical Instrumentation System 5 Alternative Operational Modes 7 Medical Measurement Constraints 9 Classifications of Biomedical Instruments 12 Interfering and Modifying Inputs 12 Compensation Techniques 13 Biostatistics 16 Generalized Static Characteristics 19 Generalized Dynamic Characteristics 25 Design Criteria 35 Commercial Medical Instrumentation Development Process Regulation of Medical Devices 39 Problems 42 References 43

37

BASIC SENSORS A N D PRINCIPLES

Robert A. Peura and John G. Webster

45

2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8

Displacement Measurements 45 Resistive Sensors 46 Bridge Circuits 53 Inductive Sensors 53 Capacitive Sensors 56 Piezoelectric Sensors 58 Temperature Measurements 62 Thermocouples 63

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2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17

Thermistors 66 Radiation Thermometry 69 Fiber-Optic Temperature Sensors 74 Optical Measurements 74 Radiation Sources 75 Geometrical and Fiber Optics 79 Optical Filters 82 Radiation Sensors 83 Optical Combinations 86 Problems 87 References 88

AMPUFIERS A N D SIGNAL PROCESSING

John c. Webster

91

3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17

Ideal Op Amps 91 Inverting Amplifiers 93 Noninverting Amplifiers 96 Differential Amplifiers 97 Comparators 100 Rectifiers 102 Logarithmic Amplifiers 103 Integrators 104 Differentiators 107 Active Filters 108 Frequency Response 110 Offset Voltage 112 Bias Current 114 Input and Output Resistance 115 Phase-Sensitive Demodulators 117 Timers 120 Microcomputers in Medical Instrumentation 122 Problems 123 References 125

THE ORIGIN OF BIOPOTENTIALS

John w. Clark, Jr.

126

4.1 4.2 4.3 4.4

Electrical Activity of Excitable Cells 126 Volume-Conductor Fields 135 Functional Organization of the Peripheral Nervous System 138 The Electroneurogram 140

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4.5 4.6 4.7 4.8 4.9

The Electromyogram 144 The Electrocardiogram 147 The Electroretinogram 158 The Electroencephalogram 163 The Magnetoencephalogram 181 Problems 182 References 186

5
5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11

BIOPOTENTIAL ELECTRODES
Michael R. Neuman The Electrode-Electrolyte Interface 189 Polarization 192 Polarizable and Nonpolarizable Electrodes 196 Electrode Behavior and Circuit Models 202 The ElectrodeSkin Interface and Motion Artifact 205 Body-Surface Recording Electrodes 209 Internal Electrodes 215 Electrode Arrays 220 Microelectrodes 222 Electrodes for Electric Stimulation of Tissue 231 Practical Hints in Using Electrodes 233 Problems 235 References 239

6
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10

BIOPOTENTIAL AMPLIFIERS
Michael R. Neuman Basic Requirements 241 The Electrocardiograph 243 Problems Frequently Encountered 254 Transient Protection 264 Common-Mode and Other Interference-Reduction Circuits 266 Ampliners for Other Biopotential Signals 269 Example of a Biopotential Preamplifier 274 Other Biopotential Signal Processors 275 Cardiac Monitors 282 Biotelemetry 287 Problems 288 References 291

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7
7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14

BLOOD PRESSURE AND SOUND

Robert A. Peura Direct Measurements 295 Harmonie Analysis of Blood-Pressure Waveforms 300 Dynamic Properties of Pressure-Measurement Systems 301 Measurement of System Response 308 Effects of System Parameters on Response 310 Bandwidth Requirements for Measuring Blood Pressure 311 Typical Pressure-Waveform Distortion 311 Systems for Measuring Venous Pressure 313 Heart Sounds 314 Phonocardiography 318 Cardiac Catheterization 318 Effects of Potential and Kinetic Energy on Pressure Measurements 323 Indirect Measurements of Blood Pressure 325 Tonometry 330 Problems 335 References 336

MEASUREMENT OF FLOW AND VOLUME

OF BLOOD John C. Webster 338

8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8

Indicator-Dilution Method That Uses Continuous Infusion 338 Indicator-Dilution Method That Uses Rapid Injection 341 Electromagnetic Flowmeters 344 Ultrasonic Flowmeters 350 Thermal-Convection Velocity Sensors 361 Chamber Plethysmography 364 Electrical-Impedance Plethysmography 366 Photoplethysmography 372 Problems 374 References 375

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MEASUREMENTS OF THE RESPIRATORY SYSTEM Frank P. Primiano, Jr.

377

9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8

Modeling the Respiratory System 378 Measurement of Pressure 385 Measurement of Gas-Flow 388 Lung Volume 396 Respiratory Plethysmography 404 Some Tests of Respiratory Mechanics 411 Measurement of Gas Concentration 425 Some Tests of Gas Transport 436 Problems 443 References 446

10
10.1 10.2 10.3 10.4 10.5

CHEMICAL BIOSENSORS Robert A. Peura

449

Blood-Gas and Acid-Base Physiology 451 Electrochemical Sensors 453 Chemical Fibrosensors 461 , Ion-Selective Field-Effect Transistor 475 Immunologically Sensitive Field-Effect Transistor 478 10.6 Noninvasive Blood-Gas Monitoring 479 10.7 Blood-Glucose Sensors 486 10.8 Electronic Noses 492 10.9 Lab-on-a-Chip 493 10.10 Summary 494 Problems 495 References 495

11
11.1 11.2 11.3 11.4

CLINICAL LABORATORY INSTRUMENTATION Lawrence A. Wheeler

Spectrophotometry 499 Automated Chemical Analyzers Chromatology 512 Electrophoresis 515 508

498

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11.5

Hematology 517 Problems 526 References 527

12

MEDICAL IMACINC SYSTEMS Melvin P. Siedband

528

12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13

Information Content of an Image 528 Modulation Transfer Function 535 Noise-Equivalent Bandwidth 536 Television Systems 537 Radiography 540 Computed Radiography 549 Computed Tomography 553 Magnetic Resonance Imaging 561 Nuclear Medicine 566 Single-Photon Emission Computed Tomography 572 Positron Emission Tomography 573 Ultrasonography 576 Contrast Agents 585 Problems 587 References 589

I 3 THERAPEUTIC A N D PROSTHETIC DEVICES Michael R. Neuman

13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 Cardiac Pacemakers and Other Electric Stimulators 590 Defibrillators and Cardioverters 606 Mechanical Cardiovascular Orthotic and Prosthetic Devices 611 Hemodialysis 615 Lithotripsy 618 Ventilators 619 Infant Incubators 622 Drug Delivery Devices 624 Surgical Instruments 629 Therapeutic Applications of the Laser 632 Problems 633 References 635

590

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14
14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12

ELECTRICAL SAFETY
Walter H. Olson
Physiological Effects of Electricity 639 Important Susceptibility Parameters 641 Distribution of Electric Power 646 Macroshock Hazards 650 Microshock Hazards 653 Electrical-Safety Codes and Standards 658 Basic Approaches to Protection Against Shock Protection: Power Distribution 660 Protection: Equipment Design 663 Electrical-Safety Analyzers 667 Testing the Electric System 667 Tests of Electric Appliances 669 Conclusion 673 Problems 673 References 674

638

659

APPENDIX
A.l Physical Constants A.2 . International System of (Thompson and Taylor, A.3 International System of (Thompson and Taylor, A.4 Abbreviations A.5 Chemical Elements Units (SI) Prefixes 2008) Units 2008)

676
676 676 677 678 681

INDEX

683