Physics & Measurement

Peter C A Kam
Professor of Anaesthesia, UNSW
St George Hospital
 The Gas Laws

 Boyle’s Law
 Charles’ Law
 The Third Perfect Gas Law
 The Ideal Gas Equation
 Henry’s Law
 Dalton’s Law
 Boyle’s Law or First Gas Law

 Boyle's Law
 at a constant temperature,
the volume of a given mass of gas
varies inversely with its absolute pressure,

 or,

PV = k1
 Charles’ Law or Second Gas Law

 Charles' Law
 at a constant pressure,
the volume of a given mass of gas
varies proportionately to its absolute temperature,

 or,
V/T = k2
 The Third Gas Law

 The Third Perfect Gas Law

 at a constant volume,
the absolute pressure of a given mass of gas
varies proportionately to its absolute temperature,

 or,
P/T = k3
 Ideal Gas Equation

 for 1 mol of any perfect gas,

the universal gas constant

R = PV/T

 or, where n = number of mol of gas,

PV = nRT
 A Mole

 the quantity of any substance containing the

same number of particles as there are atoms in
0.012 kg of 12Carbon
 1 mol ~ 6.0223 x 1023
 Avogadro's number
 Avogadro’s Hypothesis

 equal volumes of gases, at the same

temperature and pressure contain equal
numbers of molecules

 STP
 T = 273.15 K (0°C)
 P = 101.325 kPa (760 mmHg)
 for any gas at STP, 1 mol ~ 22.4 litre
 Henry’s Laws

 Henry's Law
 at a constant temperature, the amount of a gas
dissolved in a liquid is directly proportional to the
partial pressure of that gas in equilibrium with that
liquid
 Dalton's Law of Partial Pressures

 Dalton's Law of Partial Pressures

 in a mixture of gases, the pressure exerted by each
gas is equal to the pressure which would be exerted if
that gas alone were present
 Solubility

 Bunsen Solubility Coefficient

 the volume of gas, corrected to STP, which dissolves
in one unit volume of the liquid at the temperature
concerned, where the partial pressure of the gas
concerned is 1 atmosphere
 Solubility

 Ostwald Solubility Coefficient

 the volume of gas which dissolves in one unit volume
of the liquid at the temperature concerned
 the temperature must be specified

 it is independent of pressure

 as the pressure rises the number of molecules of gas

in the liquid phase increases,
however, when measured at the higher pressure the
volume is the same
 Partition Coefficient

 Partition Coefficient
 the ratio of the amount of a substance present in one
phase as compared with than in another
 the two phases being of equal volume
 the temperature must be specified, and
 the phases being in equilibrium
 eg. blood:gas and tissue:blood
 Diffusion
 the spontaneous movement of molecules or
other particles in solution, owing to their random
thermal motion, to reach a uniform concentration
throughout the solvent

 the constant random thermal motion of

molecules, in gaseous or liquid phases, which
leads to the net transfer molecules from a region
of higher concentration to a region of lower
concentration (thermodynamic activity)
 Fick’s Law of Diffusion
 the rate of transfer of a gas through a sheet of
tissue is,
 proportional to the area available for transfer
 proportional to the gas tension difference
 inversely proportional to the tissue thickness

V gas = k.A (P gas 1 - Pgas 2)

T
 Determinants of diffusion

 Characteristics of the Gas

 Pressure Gradient

 Membrane Characteristics
 Gas Characteristics
 Molecular Weight V  1/MW
 Graham's Law: relative rate of diffusion is inversely
proportional to the square root of the gas molecular
weight
 thus, lighter gases diffuse faster in gaseous media

than heavier gases

 lighter molecules for given energy have faster

velocities
 therefore, O diffuses more rapidly than CO in the
2 2
gas phase (1.17 : 1)
 Gas Characteristics: Solubility

 Henry's Law
 the amount of a gas which dissolves in unit
volume of a liquid, at a given temperature,
is directly proportional to the partial
pressure of the gas in the equilibrium phase
 Gas Characteristics: Solubility
 relative solubilities of CO2 & O2 in water ~
24:1
 combining this with Graham's Law from
above,
the relative rates of diffusion
 from alveolus to rbc for CO2:O2 ~ 20.7 : 1
 solubility determines the limitation to the rate of
diffusion, gases being either
• diffusion limited, as for CO
• perfusion limited, as for N2O
 Diffusion, k
 further, the diffusion of gas across a
membrane, or into or out of a liquid, is
proportional to the gases solubility in the
liquid
 CO2 being more soluble than O2 diffuses far more
rapidly across the alveolar membrane and into the
RBC
 N2O being far more soluble than N2 may diffuse
into and expand closed cavities during induction of
anaesthesia
Osmotic Pressure
 Osmosis & pressure

 Osmosis : the movement of solvent across

a semipermeable membrane, down a
thermodynamic activity gradient for that
solvent
 Osmotic Pressure : the pressure which
would be required to prevent the movement
of solvent across a semipermeable
membrane, down a thermodynamic activity
gradient for that solvent
 Osmolality
 the number of osmotically active particles
(osmoles) per kilogram of solvent
 depression of freezing point of a solution is
directly proportional to the osmolality
 1 mol of a solute added to 1 kg of water
depresses the freezing point by 1.86°C
 presence of increased amounts of solute
also lowers the vapour pressure of the
solvent, viz…….
 Raoult’s Law

 the depression or lowering of the vapour

pressure of a solvent is proportional to the
molar concentration of the solute
 as the presence of a solute decreases the
vapour pressure, making the solvent less
volatile, so the boiling point is raised
 Raoult’s Law

These phenomena,
 depression of freezing point, depression of

vapour pressure
 and elevation of boiling point, being related

to osmolarity
 are termed colligative properties of a

solution
 Osmotic Pressure
 1 mol of any solute dissolved in 22.4 litres of
solution at 0°C will generate an osmotic
pressure of 1 atmosphere
 in mixed solutions the osmotic pressure is the
sum of the individual molalities
 Osmotic Pressure

> 99% of the plasma osmolality is due to electrolytes

 contribution of the plasma proteins:  1 mosmol/l
 normal rbc's lyse at osmolalities ~ 200 mosmol/l
 as capillaries are relatively impermeable to protein,
this generates an osmotic pressure difference
between the plasma and the interstitial fluid, the
plasma oncotic pressure ~ 26 mmHg
COLLIGATIVE PROPERTIES OF A SOLVENT

• Presence of solute stabilises solvent

molecules

• More stable solvent molecules cause

(a) Increase in boiling point
(b) Increase in osmotic pressure
(c) Decrease in freezing point
(d) Decrease in vapour pressure
of solvent.
 COLLIGATIVE PROPERTIES

1 Osmole of solute leads to ;

a) Boiling point of water increase by 0.52oC
b) Osmotic pressure increase by 2267kPa (17000)
c) Freezing point 1.85oC depression
d) Vapour pressure 0.04kPa (0.3 mmHg)
 FREEZING POINT OSMOMETER

Thermometer Stirring
Wire

Sample

- 7OC
Ethylene
Glycol

Thermocouple
 MEASUREMENT OF OSMOLALITY

True freezing point

Temperature
Supercooling

Time
GAS OR LIQUID FLOW
 Hagen-Poiseuille

Q = r4P
8l
 where flow is laminar,
 eta (h) = viscosity of the fluid in pascal seconds

 there are no eddies or turbulence

 flow

• is greatest at the centre, being ~ twice the mean

• near the wall  0
• is directly proportional to the driving pressure
 Laminar Flow

 but as R = dP/Q, so
R = 8nl
r4

 thus, resistance in inversely proportional

to the (radius)4
 Turbulent Flow
 the velocity profile across the lumen is lost
 flow becomes directly proportional to the
square root of the driving pressure
 pressure flow is not linear and resistance is not
constant
 flow at which R is measured must be specified
 other factors in turbulent flow follow,
Q = k r2 P
l
  (rho) = density of the fluid in kg.m-3
 Turbulent Flow
 thus, radius has less effect, cf. laminar
 likelihood of the onset of turbulent flow is
predicted by the Reynold's number

Re = vd

 d = the diameter of the tube
 v = the velocity of flow
  =rho, the density of the fluid in kg.m-3
  = eta, the viscosity of the fluid in pascal
seconds
 Turbulent Flow

 empirical studies show that for

cylindrical tubes, if Re > 2000 turbulent
flow becomes more likely
 for a given set of conditions there is a
critical velocity at which Re = 2000
 the breakpoint for turbulent flow versus
Re also varies with the nature of the
fluid
 eg. for blood turbulent flow at Re > 1000
 Viscosity
 for a given set of conditions, flow is inversely proportional to
viscosity
 blood viscosity increases with,
 low temperatures

 increasing age

 cigarette smoking

 increasing haematocrit

 abnormal elevations of plasma proteins

 the viscosity of blood is anomalous due to the presence of

cells
 behavior is said to be non-newtonian
 Tension

 Laplace's Law

P = T.h.(1/r1 + 1/r2)

 T = the tangential force in N/m

 acting along a length of wall

 h = the thickness of the wall (usually

small)
 Laplace’s Law

 thus, for straight tubes,

P = T.h./r

 and, for spheres,

P = 2T.h/r
 Laplace’s Law
 thus, as vessel diameter becomes
smaller, the collapsing force becomes
greater
 this can lead to vessel closure at low
pressures, the critical closing
pressure
 seen in alveoli, leading to instability with
small alveoli tending to fill larger ones
 major action of surfactant is to maintain
alveolar stability
Measurement of Gas Volumes and Flows

Direct methods

Indirect methods
WET SPIROMETER

Recorder

• •
• •
• •
•
•
• •
• •

Disadvantages
1. High inertia
2. Inaccurate at high
CO2 respiratory rate or
Absorber FVC
 VITALOGRAPH

Recorder

Bellows
Patient

Disadvantage : Patient effort dependent

Bellows collect expired gas.

Only measures forced expiratory volumes

and flows.
 WRIGHT RESPIROMETER

1. Gas stream
directed by
tangential slits to Vane
vane
2. Gas flow drives
spinning vane Channels
3. Spinning vane
activates gears to
record flow
Gas Flow
4. Over reads at
peak flow
Under reads at
continuous flow
 DRAGER VOLUMETER

Gas
flow

1. Consists of 2 interlocking dumb bell rotors

2. More accurate
3. Affected by water vapour
INDIRECT MEASUREMENT OF
GAS VOLUMES

1. Magnetometers

2. Pneumographs

3. Capacitance spirometry

4. Respiratory inductance plethysmograph

 MAGNETOMETERS

1. Electromagnets attached to chest wall and

abdomen

2. Electromagnetic field generated .

3. Chest and abdominal diameter changes –

alter magnetic filed.

4. Disadvantage : Inaccurate ++
 PNEUMOGRAPH

Chest wall

Pressure
Transducer

Pressure
Transducer

Disadvantage : frequent recalibration required

CAPACITANCE SPIROMETRY

Top plate

Chest wall
C

Bottom plate

Used for apnoeic monitoring

 INDUCTANCE SPIROMETRY

Chest wall

Oscillator

RECORDER COMPUTER
 GAS FLOW MEASUREMENT

1. Variable orifice (constant pressure drop)

flowmeter eg. rotameter

2. Variable pressure – fixed orifice flowmeter

 ROTAMETER

1. Variable orifice flowmeter

2. Gas flow controlled by control value at bottom of

rotameter

3. Vertical tube with tapering internal diameter

- wider at the top
- narrower at the bottom

4. Bobbin - acts as indicator of flow

5. Pressure drops across the annular space around

bobbin opposes downward pressure produced by
weight of bobbin.
 ROTAMETER

Pressure drop [P1 – P2]

balances weight [W] of bobbin P2
Bobbin

Rotameter tube

W
P1

Gas Flow
 ROTAMETER

1. Non – linear scale

2. At lower flow;
- bobbin length > distance between bobbin and glass (d)
- Laminar flow

3. At high flows;
- bobbin length < d
- turbulent flow

4. Accuracy + 2%
 PNEUMOTACHOGRAPH

1. Measure gas flows.

2. Types
(a) Fixed Resistance
Gas flow across fixed resistance differential
pressure signal & flow eg. screen and
fleisch pneumotachograph.

(b) Hot wire

Signal produced by gas flow cooling a heated
resistance wire.

(c) Pitot tube

SCREEN PNEUMOTACHOGRAPH

Gas Screen

P1 P2

Pressure difference  flow

 FLEISCH PNEUMOTACHOGRAPH

Heating coil to prevent water condensation

HEATING COIL

Fine bore parallel tube

GAS FLOW Ensure laminar flow
HEATING COIL

P1 - P2
PITOT TUBE PNEUMOTACHOGRAPH

GAS FLOW

Upstream Downstream P2
P1 (total) (static P)

P1 - P2  velocity of gas
Heat & Temperature
 Heat & Temperature

 Heat : a form of energy, being the state

of thermal agitation of the molecules of
a substance, which may be transferred
by,
 conduction through a substance
 convection by a substance, and
 radiation as electromagnetic waves
 Heat & Temperature

 Temperature : is the physical state of a

substance which determines whether or not the
substance is in thermal equilibrium with its
surroundings, heat energy being transferred from
a region of higher temperature to a region of
lower temperature
 Heat & Temperature
 Kelvin
 the SI unit of thermodynamic temperature
 equal to 1/273.16 of the absolute temperature of
the triple point of water
 the temperature at which ice, water and water
vapour are all in equilibrium
 Celsius scale
 Temperature (K) = Temperature (°C) + 273.15
 in Celsius the triple point of water is 0.01 °C
 Critical Temperature

 the temperature above which a gas cannot be

liquified by pressure alone
 N2O = 36.5 °C
 O2 = -119 °C
 Gas: a substance in the gaseous phase
above its critical T
 Vapour: a substance in the gaseous phase
below its critical T
 Critical Pressure
 the pressure at which a gas liquifies at
its critical T
 N2O ~ 73 bar @ 36.5 °C
 N2O ~ 52 bar @ 20.0 °C
 Pseudo-Critical Temperature
 for a mixture of gases at a specific pressure, the
specific temperature at which the individual gases
may separate from the gaseous phase
 N O 50% / O 50% = - 5.5 °C
2 2

• for cylinders (most likely at 117 bar)

 N O 50% / O 50% = - 30 °C
2 2

• for piped gas

 Adiabatic Change
 the change of physical state of a gas, without the
transfer of heat energy to or from the surrounding
environment
 rapid expansion & energy required to overcome Van der
Waal's forces of attraction, as this energy cannot be
gained from the surroundings, it is taken from the kinetic
energy of the molecules  basis of the cryoprobe
 rapid compression, the energy level between molecules
is reduced, as this energy cannot be dissipated to the
surroundings, it is transferred to the kinetic energy of the
molecules
 T Measurement: Non-electrical
 mercury thermometers
 accurate, reliable, cheap
 readily made into a thermostat, or max. reading
form
 Angulated constriction at base of stem prevents Hg
column returning to bulb via surface tension forces
 requires 2-3 mins to reach thermal equilibrium
 unsuitable for insertion in certain orifices
 T Measurement: Non-electrical
 alcohol thermometers
 cheaper than mercury
 useful for very low T, mercury  solid at -39°C
 unsuitable for high T, alcohol boils at 78.5°C
 expansion also tends to be less linear than
mercury
 Bimetallic strips
 Bourdon gauge  pressure
 T Measurement: Electrical

 resistance thermometer
 metals R linearly with T
 frequently use a platinum wire resistor, or
similar
 accuracy improved with a Wheatstone
bridge
 Resistance Thermometer

Platinum Wire T α R (linear)

Disadv.

R Not sensitive αRαT

wire Battery
T
 T Measurement: Electrical

 thermistor
 metal oxides R exponentially with T
 made exceeding small
 rapid thermal equilibration
 narrow reference range
  different thermistors for different scales
 accuracy improved with a Wheatstone bridge
 Accuracy reduced with exposure to severe T,
eg. sterilisation
 Thermistor

Thermistor

oxide of R exponentially with Temp.

metal Adv : small - rapid change
- accessible to remote location
Disadv : Drift in calibration

o
T
 T Measurement: Electrical
 thermocouple
 based on the Seebeck effect
 at the junction of two dissimilar metals a small voltage
is produced, the magnitude of which is determined by
the temperature
 metals such as copper and constantan (Cu+Ni alloy)
 requires a constant reference temperature at the
second junction of the electrical circuit
 may be made exceeding small and introduced almost
anywhere
 Thermocouple – “Seebeck effect”

Reference Junction

Copper Constantan

Junction
Potential
mV

Measuring junction
Temp
 Thermocouple
Junction of 2 different metals
o
P. Diff (α T )
Seebeck effect

Metal 1 eg Cu
V
Metal 2 eg. Constantin

Ref Measured Adv. Large linear range

Temp Temp can be very small
(eg.Ice)
Disadv. Small output 40μv
 Specific Heat Capacity

 heat required to raise the temperature of 1 kg

of a substance by 1 K (J/kg/K)
 water SHC = 4.18 kJ/kg/K or, 1 kcal/kg/K
 blood SHC = 3.6 kJ/kg/K
 infusion of 2000 ml of blood at 5°C, requiring
warming to 35°C,  require
 2 kg x 3.6 kJ/kg/°C x (35-5)°C = 216 kJ
 would result in the person's temperature falling by ~
1°C
 Specific Latent Heat
 the heat required to convert 1 kg of a substance
from one phase to another at a given temperature
 latent heat of vaporisation (from liquid to vapour)
 LHV of water
 at 100°C = 2.26 MJ/kg
 at 37°C = 2.42 MJ/kg
  the lower the T the greater the latent heat required
 as T rises, the latent heat falls until ultimately it
reaches zero at a point which corresponds with
the critical temperature = 373°C
Humidity
 ABSOLUTE HUMIDITY

• Mass of water vapour (g) in a given

volume of air (m3)

numerically = mg / 1L

• Fully saturated air

@ 20oC contains 17mg/L water
@ 37oC contains 44mg/L water
 RELATIVE HUMIDITY

• Defined as ratio of mass of water vapour in a

given volume of air to the mass required
to fully saturate that volume of air at a given
temperature. (%).

• By ideal gas equation,

mass is proportional to number of moles present.

 Relative humidity = actual vapour pressure

saturated vapour pressure
 HAIR HYGROMETER

Principle : Hair lengthens as humidity

increases

Accuracy : - Low
- Accurate between RH 15-85%
- very simple & cheap

Hair RH L
WET AND DRY BULB HYGROMETER

T1 T2

 Air
Wet
Gauze

- -- - - - - - Water
- - - -
WET AND DRY BULB HYGROMETER

T1 = temperature of wet bulb decreases

because of evaporation in wet gauze.

Lower humidity causes more evaporation

and T1 decreases more.

Humidity  T1 – T2

δ - % humidity from tables

 DEW POINT

• Defined as temperature at which

ambient air is fully saturated

• At this point condensation occurs

 REGNAULT’S HYGROMETER

Thermometer
AIR

Silver Tube

Ether

Bubble

Condensation at “ dew point”

RH = SVP at dew point

SVP at ambient temperature
OR from tables
 HUMIDITY TRANSDUCERS

• Principle : When a substance absorbs

water, its resistance or capacitance
changes.

• Substance is incorporated into electrical

circuit as resistor or dielectric portion of
a capacitor.
 HUMIDITY TRANSDUCERS

Advantages :
1. Extremely sensitive
2. Rapid response - can be used as
servo-systems.

Disadvantages :
1. Display hysteresis – unsuitable for
critical applications where high
degrees of accuracy required.
MASS SPECTROMETER for measuring humidity

- Used to measure water vapour pressure

- Rapid response - can be used to measure

breath –by- breath changes.

- Disadvantage - very expensive

 WEIGHING TECHNIQUES

a) Weighing quantity of water vapour that has

condensed in a known volume of air

or

b) Warming air so that all water droplets are

evaporated & then weighing volume of air.

c) Absorption techniques
Absorption of water vapour in either
concentrated sulphuric acid, silica gel or
anhydrous CaCl2
PRESSURE – Physics and Measurement
 PRESSURE

• Defined as Force per unit area

• Units : Pascal (Pa) or Newton per square
meter ( N.m-2).

Newton = Force that will accelerate 1 kg

(N) mass at 1ms-2.

1 Pascal = 1 N acting on area of 1m2

• Gravity = 9.81m.s-2
 PRESSURE UNITS

 1 kPa = 10.2 cm H2O

= mm Hg
[mercury = 13.6 times as dense as water]

 1 bar = 100 kPa

= mm Hg
 GAUGE PRESSURE

• Pressure relative to atmospheric

pressure.
i.e. zero at atmospheric pressure

• Gauge Pressure may be determined

by how much pressure is above or
below atmospheric pressure.
 ABSOLUTE PRESSURE

•Pressure relative to a true zero pressure(i.e.vacuum)

Therefore,
Zero gauge pressure = 1 atmosphere absolute
• Gauge pressure 1 atmosphere = 760 mmHg
= 101.325 kPa
= 2 atmosphere
absolute
 MEASUREMENT OF BLOOD
PRESSURE

UNITS OF PRESSURE
Unit Value

Pascal ( Pa) N/m2 SI Unit

mmHg 133.3Pa 1 mmHg = 7.5kP

bar 105Pa

Torr almost = 1 mmHg

cmH2O ~ 1-Pa
PRESSURE

P = p x g x h

p = density of fluid

g = acceleration due to gravity

H = Height of column

Conversions 10cmH2O = 7.4 mmHg

10mmHg = 13.6 cmH2O

Mercury 13.6 x water density

 INDIRECT BLOOD PRESSURE
MEASUREMENT

Principle
a) Utilise cuff - occlude pulse

a) Detection of return of pulse or blood

flow distal to cuff.
 OCCLUDING CUFF

• Cuff pressure transmitted to tissues surrounding

artery.

• Cuff width = 40% limb circumference

• Bladder - at least half circumference

- Centred over artery

• Cuff level with heart

ERRORS WITH CUFF

a) Too narrow or to loose cuff overestimate

SP and DP.

b) Too wide
underestimate SP and DP

(Pressure = F/A)
CUFF – AHA STANDARDS

Arm
Bladder size Circumference
Small Adult 10 x 24 cm 22 – 26 cm

Adult 13 x 30 cm 27 – 34 cm

Large adult 16 x 38 cm 35 x 44 cm

Adult thigh 20 x 42 cm 45 – 52 cm
DEVICES MEASURING CUFF
PRESSURE

Mercury manometers - Used to be standard

- Now phased out
- Column must be vertical
- Air vent on top of column

Aneroid gauges - Convenient

- Commonly under-read BP
- Calibrated 6 monthly
FLOW DETECTION DISTAL
TO CUFF
Palpation Finger palpation
Finger Photoplethysmograph

Auscultation Audible range – Korotkov sound

Ultrasound (5MH2) range – Arteriosounde
Subaudible (10-40mH2) range – Infrasound

Oscillometry Defection of oscillations

von Recklinghausen’s oscillations
NO2 invasive BP
KOROTKOV SOUNDS

Phase I: First appearance of tapping sounds

Phase II: Brief softening of sounds

Auscultation gap : disappearance of sounds

Phase III: Return of sounds

Phase IV: Muffing of sounds

Phase V: Disappearance of all sounds

KOROTKOV SOUNDS

Cuff deflation rate = 2-3 mm Hg per sec.

Rapid deflation = underestimate BP

Note auscultatory gap may be present

DBP = point of disappearance of sound

Difference between phase IV & V ~ 5 mmHg

OSCILLOMETRY

• Basis of NIBP

• Only one cuff

acts as
(i) occluding cuff
(ii) Sensor using microprocessor

• Cuff both actuator & transducer

OSCILLOMETRY

Oscillations begins at SBP

Maximal at MAP

Abruptly diminishes at DBP

OSCILLOMETRY - NATURE OF
OSCILLATIONS

• Diamond shaped pattern

• Pressures at oscillation between 2

heart beats compared.

• Average is recorded

• MAP most accurate

OSCILLOMETRY

Advantage : 1. Not operator dependent

2. “hands free”
3. Automated
Disadvantage :
1. Inaccurate in shock or
arrhythmia.
2. Cuff placement important
3. Bruising + skin damage
4. Venous congestion
5. Nerve compression
FINAPRES

• Cuff placed around finger

• Changes in volume of arterial blood in

finger detected by plethysmography

• MAP - cuff inflated to maximal

- cuff pressure approximates
arterial pressure waveform
ARTERIAL TONOMETER

• Force transducer placed over artery with under

lying bone.

• Electrical signal - reproduces arterial waveform

• Needs to be calibrated
5 – 10 min against oscillometric measurements
INVASIVE (DIRECT) BP MEASUREMENT

Advantages

1. Continuous monitoring
2. Trends observed
3. Accuracy over wide range
4. Enables visual analysis of pulse
pressure
VISUAL ANALYSIS OF WAVEFORM

Myocardial Contractility
Upstroke of pulse pressure ~ LV dp/dt
Steep upstroke = strong LV contraction
Stroke Volume
Area under systolic ejection ~ LV stroke volume
Systemic Vascular Resistance
Low diastolic notch = Rapid run off &
Steep down stroke low SVR
CIRCULATING BLOOD VOLUME
Exaggerated beat to beat variation with
ventilation = hypovolaemia
INDICATIONS FOR INVASIVE BP

1. Rapid changes in BP
2. Monitor effects of potent hypotensive or
vasopressor agents
3. During CP bypass
4. Operation with volume shifts eg. AAA or
phaeochromocytoma.
5. Shock
6. Difficult access eg. Morbid obesity
 VARIATION OF BP

• Waveform distorted the further away from the heart.

• High frequency components eg. incisura damped out /

disappear.

• Systolic BP increases distally.

• Hump becomes more prominent in diastolic part of

waveform
VARIATION OF BP

• SBP increases towards periphery

• DBP decreases towards periphery
• MAP - only slight drop
eg. MAP radial 5% < MAP aorta
• Pulse Pressure increases towards periphery

Causes : a) Reflection of pressure wave from

peripheral arterioles
b) Resonance
BP AND POSTURE

- 42 mmHg

+80 mmHg
COMPONENTS OF INVASIVE BP

• Mechanical coupling of blood to transducer

intravascular catheter
connecting tubing
stop lock

• Transducer
Converts pressure changes to voltage changes

• Electronic processing

• Display + recorder
 REQUIREMENTS FOR ACCURACY
INVASIVE BP

1. STATIC Accuracy - Ability to measure stationary events

- No baseline/sensitivity drifts
- Input & output linearity
- No hysteresis

2. DYNAMIC Accuracy - Ability to accurately record over

rapid changes.

3. PHYSIOLOGICAL Reactance - measuring system must

have effect on event recorded / measured.
TRANSDUCER

• Coverts pressure energy movement

electrical signal

• Commonly diaphragm resistance

movement change
Wire stretch resistance

• Wheatstone bridge used to convert resistance

change to voltage signal
 STATIC CALIBRATION

• Linear response (straight line) between pressure and output

voltage.

Output
Gain = slope of line
offset

Pressure

• Offset - Transducer output at zero pressure

• Gain - Change in output for given change in pressure
must be constant.
• Sensitivity (factory set) at 5V/V/mmHg
MEAN BLOOD PRESSURE

a
MAP
b

• Average Pressure
• Equal to pressure when a = b
• Electronically averaged instantaneous measurements
• Highly damped system eg. aneroid gauge gives MAP
• MAP = diastolic pressure + 1/3 pulse pressure
= SBP + 2DBP
3
DYNAMIC RESPONSE

• Basic or Fundamental Harmonic (1st)

Heart Rate 60 beats/min = 1 Hz
Heart Rate 120 beats/min = 2 Hz

• By Fourier Analysis
Fundamental = f = 2Hz (HR 120)
2nd Harmonic = 2 x f = 4Hz
3rd Harmonic = 3 x f = 6Hz
10th Harmonic = 10 x f = 20Hz

• Accurate waveform without amplitude

distortion achieved with 10th harmonic
~ 20Hz
PRACTICAL ASPECTS OF DYNAMIC RESPONSE

• Natural frequencies of clinical systems approx, 30Hz

• Acceptable if damping ratio is optimal

• To achieve dynamic accuracy

- fundamental frequency (fo) must be maximised.
MAXIMISING Fo

Note : fo = 1 E
2 M

To minimize fo
Minimize M (mass)
- Minimal volume of fluid in transducer
- Short tubing

Maximise E, modulus of elasticity

- Stiff tubing
- Stiff diaphragm
- Eliminate air bubbles
FACTORS THAT INCREASE DAMPING

• Increase fluid viscosity eg. blood clots

• Narrow tubing eg. kinked catheter

• Increased tubing length

• Decreased stiffness of tubing

LIQUID MANOMETERS
(Absolute Pressure)

Mercury Barometer
Torricellian Vaccum

• •
•
P • h
• •
•
•
•
• • •
• • ••
• • • Mercury
• • • •
•
• • • •

Measures Absolute Pressure

LIQUID MANOMETERS
(Gauge Pressure)

P

 h - Amount by which
 pressure exceeds
atmospheric

       
       
Note tube open at both ends
 LIQUID MANOMETERS
Methods to increase sensitivity

• Use low density liquid

• Amplify vertical movement of

meniscus.
a) inclined plane manometer
b) differential liquid manometer
 MECHANICAL PRESSURE GAUGE

Bourdon Gauge

Wheel

Pointer

Cross Section

Coiled tube unwinds High

at high pressure Pressure

Fixed
Point Low
Pressure
Pressure

• Usually for measuring high pressure

• Can be adapted for temperature or flow measurement
MECHANICAL PRESSURE GAUGE

Aneroid Gauge
Lever System - amplifies change

Pointer

Bellows
Expands with pressure

Uses : BP, Airway Pressures on IPPV

 DIAPHRAGM GAUGE

• Pressure measurement made by sensing

movement of flexible diaphragm.

• Diaphragm movement sensed by

a) Direct movement of levers etc. (not sensitive)
b) Optical method
pressure Diaphragm Mirror
stretched more rotated
& curved
c) Electromechanical transducers
 OPTICAL ELECTROMECHANICAL
TRANSDUCERS

Principles :

1. Increased pressure Diaphragm more convex

2. Light beam reflected off silvered surface of

diaphragm on to photoelectric cell.

3. Reflected light beam more divergent.

4. Light intensity sensed by photo-electric cell

decreases and electrical output falls
OPTICAL ELECTROMECHANICAL
TRANSDUCERS

P1 P2

Photoelectric Photoelectric
Slivered
Convergent
Cell surface Cell
Reflected
light Divergent reflected light

Mirror Mirror
Slivered
surface

Light
Source
STRAIN GAUGE ELECTROMECHANICAL
TRANSDUCERS

Principles :

Wire stretched or compressed

Change in length and diameter
atomic stricture change

Resistance change
 STRAIN GAUGE TRANSDUCER

Diaphragm Fixed point

Movable block

Wired compressed

Resistance wire
stretch

1. Resistance wires arranged in 2 sets

2. When pressure increases, one set stretches & other set compresses
3. Difference in resistance is measured by wheatstone bridge system.
 BONDED STAIN GAUGE

Strain gauge
P Bonded to
diaphragm
Single Bond Double Bond

1. Resistance wires in zig-zag patter cemented to diaphragm

surfaces.
2. Robust but subject to hysteresis.
3. Resistance wire – low temperature coefficient.
4. Double bonded strain gauge one stretched & other
compressed.
WHEATSTONE BRIDGE ARRANGEMENT OF
RESISTANCE WIRES

OUTPUT OUTPUT

Strain Strain
Gauge Gauge
element element

Half bridge circuit Full bridge circuit

CAPACITANCE TRANSDUCER

Diaphragm 2ND plate

as one plate

Charge

Characteristics : 1. Very sensitive

2. High natural frequency
3. Temperature drift
4. Unstable
 VARIANCE INDUCTANCE
TRANSDUCER

Diaphragm

P Iron Core

Coil magnetic field

 WHEATSTONE BRIDGE

Wheatstone bridge is a special arrangement of resistors

designed to amplify change in resistance.

R adjust R measure

A Ammeter reads
zero

R measure = R2
R1 R2 R adjust R1

Balanced Wheatstone bridge

 FREQUENCY RESPONSE

1. Measurement systems respond to restricted range of

frequencies.

2. Input signals of same amplitude at different frequencies will

produce output over a limited range of frequencies.

3. Within this frequency range, response may be more

sensitive to some frequencies than others.

4. Response of system (system gain) plotted against signal

frequency is called “ Frequency Response of System”.
 FREQUENCY RESPONSE OF
A SYSTEM

System
gain

Bandwidth

Frequency

Lower cut off Upper cut off

 DETERMINANTS OF
FREQUENCY RESPONSE

MECHANICAL SYSTEM
Inertial elements (eg. mass)
Compliance elements (eg. spring)

ELECTRICAL CIRCUIT
Inductance
Capacitance
 NATURAL OR RESONANT
FREQUENCY

1. When a constant amplitude waveform is applied at

increasing amplitude occurs at resonant or
natural frequency (fo) of the system.

2. Beyond fo (higher frequencies), amplitude of

oscillations increase and then fall to zero.

3. Fo depends on inertial and compliance etc.

 AMPLITUDE AS FREQUENCY
INCREASES

Amplitude of
oscillation Natural or resonant
Frequency (fo)
(maximal oscillation)

Increasing frequency

Amplitude decreased
Beyond fo
 ENERGY INTERCHANGE IN
OSCILLATING SYSTEM
1. Continental interchange between kinetic energy of mass in
motion and potential energy.

2. Kinetic energy = ½ mv2.

3. Narrow Tube

(a) More energy required to make given mass of fluid to

oscillate because it has to reach higher velocity.

(b) Catheter fluid velocity > fluid velocity at diaphragm.

(c) E, Effective mass catheter > E, diaphragm.

(d) Larger effective mass lower fo.

 RESONANT FREQUENCY

OUTPUT

FREQUENCY FO Resonant
frequency
UNDAMPED NATURAL FREQUENCY

S
Fo = 1 M
2

Fo = undamped natural frequency

S = stiffness of transducer diaphragm

M = Effective mass
 HIGH UNDAMPED NATURAL
FREQUENCY

Catheter - Transducer System

- Needs high fo
- Occurs when fluid velocity is minimized
- Achieved by;
(a) Stiff diaphragm
(b) Short and wide catheter.
 DAMPING

• Defined as tendency of a system to resist

oscillations caused by a sudden change.

• In mechanical devices, damping arises from

frictional effects on mechanical moving parts.

• In fluid operated devices, damping is caused by

vicious forces that oppose fluid movement.

• In electrical devices, electrical resistance oppose

passage of electrical currents.
 EXTENT OF DAMPING

Underdamping - Results in oscillation and over-

estimation of measurement (overshoot of
output) .

Overdamping - Results in slow response and

underestimation of measurement.

Critical damping - No overshoot of output signal

but speed of response is too slow.
 SIGNAL AMPLITUDE & DAMPING

Relative 0.2
Amplitude

0.5

D=1.0
0.64

0.5
0.1 0.5 1.0 1.5
 OPTIMAL DAMPING

1. State of damping in which

(a)Minimal overshoot
(b)Response speed only slightly reduced

2. D = 0.64 (i.e. 64% critical damping)

(a)7% overshoot
(b)Response speed only minimally reduced
 PHASE SHIFT RESPONSE

1. Waveform or signal composed of series of component

frequencies.

2. Each component waveform undergoes different time

delay or phase shift.

3. Phase shift is time delay expressed as an angle

(radians).

4. At fo, waveform delayed by 90%

5. Other frequencies, phase lag is linearly related at

D = 0.64 I.e. phase distortion minimal at D = 0.6.
 SPECIFICATIONS OF TRANSDUCERS

1. To avoid waveform, amplitude and phase

distortion, catheter-transducer system
should have undamped natural frequency
25-40Hz .

2. Standard transducer – undamped natural

frequency of 100 Hz or more.

3. Catheter - tap - cannula arrangement

reduces natural frequency of the system.
 DIRECT BP MEASUREMENT SPECIFICATIONS

1. Transducer : - Frequency response > 100 Hz i,.e.

resonant frequency > 100Hz.

2. Tubing & cannula : - Lowers fo and adds damping.

Length increase - lower fo, more damping
Compliant tube - lower fo, more damping
Small bore tube - lower fo, more damping
air/clot in tube - lower fo, more damping

Factors that increases fo tend to lower damping.

CARDIAC OUTPUT MEASUREMENT
 USES OF CARDIAC OUTPUT MEASUREMENT

1. GENERAL ICU
- Cardiac performance assessment in shocked patients.
- Management of inotropes and vasoconstrictors
- Optimisation of PEEP Therapy.

2. OPERATING THEATRES
- Major Anaesthetic eg. AAA, Liver transplant
- Anaesthesia in severe cardiac disease (eg. L V failure,
Recent MI)
 CARDIAC OUT MEASUREMENT USES

3. Post-cardiac Surgery Intensive Care Units

4. Coronary Care Units / Laboratories
- Assessment of severity of ischaemic & valvular
disease

- Management of inotropes vasoconstrictors and

vasodilators.
INFORMATION FROM C.O. MEASUREMENT

Cardiac output L/min

Cardiac Index = CO
Surface area L/min/m2

Systemic vascular resistance = MAP-RAP mmHg/L/min

CO or PRU
dyne.sec.cm-5

Pulmonary Vascular Resistance = MPAP-LAP

CO mmHg/L/min
or PRU
dyne.sec.cm-5
 INFORMATION FROM C.O. MEASUREMENT

LV stroke work = MAP x SV gm.m

RV stroke work = MPAP x SV gm.m

Oxygen Consumption = CO x (CaO2-Cv-O2) ml/min

Oxygen Delivery = CO x CaO2 ml/min

(D O2)
DIRECT CO MEASUREMENT

1. ELECTROMAGNETIC FLOWMETER PROBE

a) Periaortic
b) Intraaortic

2. Ultrasonic Flow Probe

3. Intravascular thermal velocity transducer

INDIRECT CO MEASUREMENT

A. INVASIVE METHODS
1. Fick method (1970)
i) Direct (O2 Consumption)
ii) Indirect (CO2 production)
2. Dye dilution (Stewart, 1894,
Hamilton, 1979)
3. Thermodilution (Fegler, 1954)

NON-INVASIVE METHODS
1. Radioactive tracer dilution
(radiocardiography)
2. Bollisto cardiography
3. Pneumocardiography
4. Impedance Plethysmography
 ELECTROMAGNETIC FLOW PROBE

Faraday’s Law states that :-

“When a conductor moves with a given velocity across the

Lines of force of a uniform magnetic field, an electromotive
Force will be induced at right angles to the flow, and will be
Proportional to the velocity of the conductor”
MAGNETIC FIELD

Blood flow

Magnetic H
a

V
Magnetic field is held at right angles to blood flow
Electromotive force induced at right angles to moving conductor, the blood flow.

NOTE : EMF technique measures blood velocity

ELECTROMOTIVE FORCE, E

+a
E = v. H 2a 10 -8

-a

V = Velocity of blood
H = strength of magnetic field (gauss)
2a = length of conductor or diameter of blood vessel.
BLOOD VELOCITY

Blood velocity = Flow rate (cm3 / sec)

Cross section area of vessel (cm2)

Flow rate = Blood velocity x cross section

area
TYPES OF EMF FLOW PROBES

NOTE : Peri or intra-aortic flow probes measure CO

(less coronary blood flow)

(a) Periaortic Flow Probe

• used in open heart surgery
• rarely used clinically
(b) Intravascular Flow Probe
• introduced via peripheral artery
• invasive
• velocity depends on exact site
(maximal in centre of blood vessel)
ULTRASONIC FLOW PROBE

Measures velocity of flowing fluid

(a) Pulsed Ultrasound

- Cuff transducer around artery
- Pulse of 5 MHz from piece-electric crystal
in cuff.
- receiver crystal downstream
- Transit time between
 ULTRASONIC FLOW PROBE

(B) Doppler Effect

Principle : frequency shift of emitted wave from
barium titanate crystal when it is reflected from
moving fluid column

Disadvantage :
Cannot detect difference between forward and
backward flow.
eg. aortic blood flow : mean velocity = 40 cm/sec
systolic velocity = 120 cm/sec
ULTRASONIC FLOW PROBE

1. Probe placed at suprasternal notch with beam

directed to aortic arch or

2. Transoesophageal probe with beam directed at

descending aorta

3. Velocity of blood flow and cross – sectional area

of aorta determined.
 ACCUCOM C.O. MONITOR

1. Continuous C.O reading

2. Oesophageal probe containing dual crystal Doppler

probe transducer to measure velocity in descending
aorta.

3. Second Doppler probe placed at suprasternal notch

used to calibrate instrument

4. Aortic diameter determined by echocardiogram or

monogram
2 D COLOUR FLOW – ECHO-DOPPLER

1. Pulse ultrasound for imaging of cardiac flow

2. L V outflow tract imaged and cross sectional

area determined.

3. Velocity of blood flow in LV – outflow tract

measured.

4. CO = Cross Section Area x Velocity.

5. Colour Doppler to demonstrate direction of flow

INTRAVASCULAR THERMAL VELOCITY TRANSDUCER

1. Heated thermistor placed in moving liquid stream

dissipates heat as a function of flow velocity.

2. Probe maintained at fixed position in blood stream

within vessel of fixed diameter.

3. Velocity signal translated into flow.

INDIRECT METHODS OF C.O. MEASUREMENT

I INVASIVE METHODS

Direct Fick Method

Indirect Fick Method
Dye dilution Method
Thermodilution technique

II NON INVASIVE METHODS

Radioactive tracer dilution

Ballisto cardiography
Thoracic impedance plethysmography
FICK PRINCIPLE
(Adolph Fick – 1870)

States that : “ the flow of a liquid in a given period of

Time is equal to the amount of substance entering or
Leaving the stream / or organ) in the same period of
Time, divided by the difference between the
concentration of the substance before and after the
Point of entry or exit “
DERIVATION OF FICK PRINCIPLE

Substance added ( M mg)

 o

Amount of Amount of Amount of

Indicator + Indicator = Indicator at
At entry () Added (M) Exit ( o )

Concentration = Amount
Volume
Amount = Volume x concentration
DERIVATION OF FICK PRINCIPLE

Concentration Volume Mass added

x + = CE VE
At entry (  ) at () (M)

Dividing at entry = Vol at exit

Conc
Conc. At entry x flow rate + M (amount = x Flow
At
added/min) rate
Exit

Therefore Flow Amount indicator added per min

=
Rate Exit conc. – entry conc.
HYDRAULIC ANALOGUE MODEL

M mgs-1 V ml

Q ml sec –1
C mg / m
INDICATOR CONCENTRATION CHANGE AT
CONSTANT INFUSION WITH NO INDICATOR INPUT

Conc.
C max
(mg ml-1)

C1
Time
INDICATOR CONCENTRATION
(known concentration Co at input with constant infusion)

C max

Conc

Co

Time
INDICATOR CONCENTRATION vs TIME
(Bolus Injection)

yo
Conc y1 = yoe-ke

y1

Time
FICK METHOD

Used in 3 ways

1. Direct Fick - uses oxygen uptake as indicator

Co = ___Vo2____
CaO2 - CVO2

2. Indirect Fick – uses CO2 production as indicator

Co = VCO2
CVCO2 – CaCO2
3. INERT GAS METHOD
eg. N2O xe137, K85, K7a
- Used for specific organ blood flow measurement
- basis of Kety – Schmidt Method
DIRECT FICK METHOD

Assumptions ;

1. Steady State of both flow (Q) and oxygen consumption.

2. CaO2 and CVO2 constant.

3. Closed system
I.e. blood is only source of substance taken up.
DIRECT FICK METHOD

Measurement of O2 consumption

1. Breathe O2 (FIO2) via one-way valve

2. Expires into Douglas bag or Tissot Spirometer

.
V E = Volume measured
Time
DIRECT FICK METHOD

Calculation of Oxygen consumption

Inspired x FiO2 - Expired x FEO2

VO2 =
Gas Vol Gas Vol
DIRECT FICK METHOD
Oxygen consumption calculations

Nitrogen is in steady state

V inspired N2 = V expired N2
VI x FIN2 = VE x FEN2
VI = VE x FEN2
FIN2
FIN2 = I - FIO2
FEN2 = 1 – FEO2 – FECO2
VI = VE x 1 – FEO2 – FECO2
1 – FIN2
 DIRECT FICK METHOD

CaO2 = Hb (g/L) x SaO2 x 1.34 ( mIO2) + 0.003 x PaO2

SaO2 measured using arterial blood and calibrated oximeter

DIRECT FICK METHOD

( Mixed Venous Oxygen Content)

Need pulmonary artery blood for mixed venous

Sample.

CVO2 = Hb x SVO2 x 1.34

dissolved component usually ignored
DIRECT FICK METHOD

CO = 250 ml / min_____
200ml/L - 150 ml/L

= 5 L / Min

Features : 1. Steady state of CO, VO2, CO2 production

N2 balance arterial; and venous O2 concentration.

2. Accuracy + 10% used as reference.

3. Slow, cumbersome, unsuitable for rapid

measurements.

4. Unsuitable during GA
- Not a steady state
- Uptake of volatile agents and N2 washout.
INDIRECT FICK METHOD

1. CO2 used as indicator

2. Theoretical advantage :
Mixed venous CO2 estimated by rebreathing
technique - No need for CVP.

3. Problem :
Large CO2 stores - steady state not easily
achieved.
 DYE DILUTION METHOD

1. Applies to bolus of indicator

2. Also known as Stewart – Hamilton principle.

3. Basis of dye dilution and thermodilution techniques.

DYE DILUTION METHOD

Exit
Conc.
Cmax

Ct C (t)

0 time T 00

Ct = C maxe-kt

Where e = 2.718
K = decay constant of exponential
DYE DILUTION METHOD: CALCULATIONS

At any moment
c = M
V
 M =CxV
Integrating :
  

o
Mdt =
o
Cdt x oVdt
Where

 Mdt = Original injected
o 
= total volume flow
o

STEWART – HAMILTON FORMULA


M =
o
 cdt x Q

Q = ___M___

o
 cdt
DYE – DILUTION INFUSION TECHNIQUE

C exit

C entry

Q = __M__ t t
t=1 o 1

t-0
Cdt

= __M__
Ct1 - Ct0
= _______M________
C exit - C entry
DYE – DILUTION METHOD

Dye - Indocyanine green (ICG)

- peak absorption = 805 nm

(isobestic point of HbO2)

- non toxic

- rapid removal 18-24% per min

- 2.5-5mg injected into right atrium

DYE DILUTION – GRAPH ANALYSIS

recirculation
C

t


o
 Cdt = area under curve

Methods used (a) Trapezoid Method

(b) Forward method

Triangle area - Peak Height x width at halve peak height

(c) Computer integrator
DYE DILUTION METHOD

EQUIPMENT

1. Withdrawal Pump/syringe ~ 20ml/min

2. Optical densitometer ~ 805 nm

3. Chart Recorder
THERMODILUTION TECHNIQUE

Bolus of “Negative Heat”

Sensor = Thermistor in pulmonary artery

Cardiac Output = ___Amount of –ve Heat (M)__



Tdt
o
THERMODILUTION METHOD

Negative Heat M = V1 x (TB – T1) D S

DBSB
Where M = Amount of negative heat
VI = Volume injectable ( 10ml 5% D)
TB = Patient’s blood temperature
TI = Injectable temperature
DI = Injectable density
DB = Blood density
SI = Specific heat of injectate
SB = Specific heat of blood

For 5% Dextrose = __DS SI__ = 1.08

DB - SB
THERMODILUTION ADJUSTMENTS

(a) Correction factor

(b) AVC = Calculated to

t
Tdt
1.22 0
t where C = _30 Cmax
100
(c) Final Formula

CO = VI x (TB – TI) x 1.08 x CT x 60


1.22 Tdt

o
THERMODILUTION

1. Room temperature D 5% used

2. Inject within 1.5 sec.

3. Inject at end-expiration
ICED vs ROOM TEMPERATURE INJECTATE

1. Random error greater with injectate

at room temperature

2. Iced Injectate slightly overestimates at

low cardiac output.

3. Room temperature significantly overestimates

at CO < 2-3L/min by 20-50%.
FICK METHOD

ADVANTAGES

Correlates with direct measurements reference

Method.

DISADVANTAGES

Slow and cumbersome

Not suitable for rapid repeated measurements.
DYE DILUTION

ADVANTAGES
1. Correlates well with direct and Fick method

DISADVANTAGES
1. Arterial cannulation needed
2. Limited to 3 measurements
3. Recirculation “Noise”
4. Unsuitable for rapid, repeated measurements
THERMODILUTION METHODS

ADVANTAGES

1. Simple and convenient

2. No blood withdrawal

3. Limited recirculation

4. Unlimited number of measurements

5. Rapid repeated measurements possible

RADIOACTIVE TRACER DILUTION

Risa washout over heart

Scintillation Counter

Difficult to calibrate

Radiation hazard.
BALLISTOCARDIOGRAPHY

Patient coupled to light bed

Ultralow frequency recording
Body acceleration (recoil) measures aortic
Acceleration ( dQ/dt) and stroke volume
H

F
L

G Lo
I
t
I and J waves = dQ/dt
IMPEDANCE PLETHYSMOGRAPHY

1
2 -100Yz sinusoidal current 4 mA
through chest

-Wheatstone bridge to measure

resistance
3
4 -Voltage change with constant
current I

-R = Voltage change
I

-Resistance change reflect

pulmonary blood flow
LITHIUM DILUTION CARDIAC OUTPUT

- Indicator = Lithium chloride (150 mM)

- Dose ~ 0.3 mmol via any venous line

- Artyerial litium plasma concentration measured

by lithium sensitive electrode aspirated at 4 ml/min.

- Co = LiCl dose x 6- Area (1 – haemocrit)

PULSE PRESSURE ANALYSIS

- Arterial pulse pressure waveform analysed

- Cardiac output ~ Area under systolic portion

of arterial waveform from diastole to end-systole

- Calibrated initial using lithium dilution technique.

Measurement of pH
 Measurement of pH
 pH = - log10 of the hydrogen ion activity (~ []'n)
 at 37°C, normal blood pH = 7.4 ± 0.04
 circuit consists of,
 capillary tube of pH sensitive glass ® dV
 reference buffer solution the other side of the glass
+ a silver/silver chloride electrode
 an electrolyte solution (KCl) in contact with blood
+ a silver/silver chloride electrode
 surrounding water jacket at 37°C
 voltmeter
Measurement of pH
 MEASUREMENT OF pH
pH electrode

- Depends on ion selective electrode

- pH sensitive Glass Electrode
- Utilises glass membrane which is
selectively permeable to hydrogen ions.
- Glass electrode - placed in series with 2
half cells which generate a constant
potential gradient
pH ELECTRODE SYSTEMS

• Electrode consists of:

metal – conducts - electrons
electrolyte – conducts ions.

• Ag:AgCl + Hydrochloric Acid

Hg:Hg2Cl2 + saturated KCl Solution

• EMF generated at interface of 2 electrodes.

SCHEMATIC ARRANGEMENT OF pH ELECTRODE

V
Voltmeter
pH sensitive
Porous Plug glass

Hg / Hg2Cl2 KCl Ag/AgCl

Calomel Salt Reference
HCl
Reference bridge SAMPLE Electrode
Electrode

Potential Constant Constant Variable Constant

 pH ELECTRODE

Saturated KCl
• Provides salt bridge
• Completes circuit between blood sample and
calomel electrode.
• Porous plug prevents diffusion of KCl into
blood sample.
 pH ELECTRODE

• Measures activity of H+; not concentration

• Calibrated against 2 standard buffers;

(a) pH 6.841 = Zero

(b) pH 7.383
 pH ELECTRODE

SENDING CIRCUIT
AND DISPLAY
Ag : AgCl
electrode Platinum Wire

Mercurous chloride
HCl

Mercury

Saturated KCl

SAMPLE Porous Plug

CUVETTE

pH sensitive glass
Measurement of Gases
 GAS ANALYSIS

CHEMICAL METHODS
Absorption in chemicals using Haldane apparatus
CO2 : 10 – 20% KOH or NaOH
O2 : Alkaline pyrogallol or sodium anthraquinone

PHYSICAL METHODS :
• Mass spectrometers
• Infra-red absorption
• Polarography
• Galvanic fuel cell
• Ultra violet absorption
• Paramagnetism
• Thermal conductivity
 Spectrophotometry
 first used to determine the [Hb] the 1930's, by
application of the Lambert-Beer Law

ITrans = ISource x e- DC

 Ii = the incident light

 It = the transmitted light
 D = the distance through the medium
 C = the concentration of the solute
  = the extinction coefficient of the solute
 Spectrophotometry

 the extinction coefficient is specific for

a given solute at a given wavelength of
light
 therefore, for each wavelength of light
used an independent Lambert-Beer
equation can be written
 if the number of equations = the number
of solutes, then the concentration for
each one can be solved
 Spectrophotometry

 by convention oxyhaemoglobin
concentration, HbO2 is the fractional
concentration as measured by
cooximetry
 a 4 wavelength device, and includes
COHb and MetHb in the denominator
%HbO2 = 100 [ HbO2 ]
Hb + HbO2 + COHb + Met Hb
 ULTRA-VIOLET ABSORPTION

• Halogenated vapours absorb uv light

• used for measuring halothane

• Disadvantage : Slow response time

produce toxic product
 THERMAL CONDUCTIVITY
(KATHAROMETERS)

1. High thermal conductivity gas - more rapid heat conduction

eg. Helium 600%
CO2 35% compared with air

2. Gas passed over heated wire which cools.

3. Decreased wire temperature – depends on flow rate and

thermal conductivity of gas.

4. Temperature leads to wire resistance

5. Advantages : Simple and inexpensive

6. Disadvantage : Slow response time ( ~ 5s)

 Measurement: Methods

 Mass spectrometry
 Raman spectrography
 Photo-acoustic spectrography
 Infra-red spectrography
 RAMAN LIGHT SCATTERING

1. Photon of light passes thro’ gas

2. Photon energy partly given to gas molecule

3. Light is re-emitted at longer wavelength

characteristic to gas.
 Measurement: Raman Spectrography

 Raman scattering occurs with illumination with high intensity

argon laser light
 absorbed light energy produces unstable energy states
(rotational & vibration)
 emitted low energy light, Raman light
 measured at 90° to the laser path
 can be used to identify all types of molecules in the gas
sample, and has been incorporated into new monitors
(RASCAL) which instantaneously identify & quantify CO2 and
inhalational agents
 Measurement: Photo-acoustic spect.
 relies on the absorbance of IR light by CO2
  gas expansion
 IR light is pulsed at acoustic frequencies and the
energy absorbed is detected by a microphone
 amount of light absorbed is measured directly
 without the need for a reference chamber
 no zero point drift
 other claimed advantages over IR spectrometry,
 higher accuracy
 increased reliability
 reduced maintenance & reduced need for calibration
 MASS SPECTROMETER

PRINCIPLE :

1. Gas passed into ionizing chamber

2. Electron beam ionizes gas

3. Ions diffuse thro’ slit in chambers

4. Negatively charge plate accelerate ions

5. Different particles streams separate according to

mass & charge.

6. Detector plate
 MASS SPECTROMETER

Detector
Magnetic field

Low charge / mass ratio

Deflection Angle
GAS

High charge / mass ratio

Accelerator
Potential
On screen electrode
 MASS SPECTROMETER

ADVANTAGES

1. Rapid response time ( < 0.1s)

2. Can measure variety of gases
(May be affected by water vapour)

DISADVANTAGES

1. Complex
2. Expensive
 Capnometry

 capnometry is the measurement and display of

CO2 concentrations on a digital or analogue
display

 capnography is the graphic recording of

instantaneous respired CO2 concentrations
during the respiratory cycle
 Capnometry
 first IR CO2 measuring and recording apparatus
was introduced by Luft in 1943
 expensive, bulky and principally only used for
research
 widespread use within the last 10-15 years with
cost and size reduction
 ASA closed claims  93% of anaesthetic
mishaps preventable by ETCO2 / SpO2
 INFRA-RED ABSORPTION

PRINCIPLE :

1. Molecule composed of 2 or more dissimilar atoms

absorb infra red light.

2. Absorption of  2.5 - 25 m cause covalent bonds to

bend and vibrate; increasing rotational speed.

3. Different gas molecules absorb specific  of infra red

light.

4. Detecting increased absorption allows their

concentrations to be determined
 Measurement: IR Spectroscopy

 Lambert-Beer law applies, (cf. Hb)

 more compact and less expensive
 assymetric, polyatomic gases of two or more
molecules, absorb IR radiation (> 1.0 µm)
 H2O, N2O, CO2
 absorbance peak is characteristic for a gas
 CO2 ~ 4.28 µm
 Measurement: IR Spectroscopy

 glass absorbs IR radiation

 chamber windows must be made of a crystal
 sodium chloride or sodium bromide
 calibration may be achieved by filling the chamber
with a CO2 free gas, or by splitting the incident beam
and passing this through a reference chamber
 Measurement: IR Spectroscopy

 the use of a reference beam also allows for

compensation for variations in the output of the IR
source
 the sample chamber is made small, so that
continuous analysis is possible
 the response time ~ 100 ms
 enabling end-tidal CO2 estimations and real-time
graphical analysis
 INFRA-RED GAS ANALYSER
(SPECTROPHOTOMETER)

1. LED split infra-red into different  .

2. Sample chamber is transilluminated and IR absorption

measured.

3. Reference chamber transilluminated & absorption allows

calibration.

4. IR absorption in sample chamber compared with reference

chamber.
 INFRA-RED SPECTROPHOTOMETER

Chopper
Light splitter

REFERENCE
Known CO2 Detector

SAMPLE CELL

ADVANTAGES : Fast response for CO2 N2O

and volatile anaesthetic agent
DISADVANTAGES : Rapid respiratory rates
decrease accuracy
 ETCO2 : Classification 1

 side-stream
 sensor is located within the main unit and gas is aspirated
from the circuit
 sampling flow rate may be
 high > 400 ml/min, or
 low < 400 ml/min
 optimal gas flow is considered to be 50-200 ml/min,
ensuring reliability with both adults and children
 exhaust gases contain anaesthetic agents & should be
routed to the scavenging unit
 ETCO2 : Classification 2

 mainstream
 sensor is located at the patient, with a curvette placed
within the circuit
 these are heated to > 39° to prevent occlusion by water
vapour
 no mixing of gases occurs during sampling and the
response time is more rapid
 curvettes tend to be bulky, add dead space, are heated,
and are expensive if dropped & broken
 ETCO2 : Sources of Error

 Atmospheric pressure differences

 N2O
 H2O
 Others
 O2
 alinearity
 volatile agents
 ETCO2 : PAtm

 direct effects
  gas density
 for a given chamber thickness, no. of molecules
increases
 eliminated by calibration against a known PCO2 (%
x Atm.)
 units calibrated against CCO2 require correction
(1%:1%)
  IR absorbance
  intermolecular forces ® ­IR absorbance for a given [CO2]
  PAtm ~ 1%  absorbance ~ 0.5-0.8%
 ETCO2 : PAtm

 direct effects (continued)

  sampling flow rate may reduce sample chamber pressure
 units should be calibrated for a given sample rate
 PEEP may  PCO2 reading (some unit compensate
automatically)
 PEEP ~ 20 cmH2O   PCO2 ~ 1.5 mmHg
 ETCO2 : PAtm

 indirect effect : volume percent,

where PCO2 = FCO2 x Atm.
 where PAtm at calibration is different to the time of measurement
 ETCO2 : N2O

 absorbs IR at 4.5 µm (cf. CO2 ~ 4.28 µm)

  N2O falsely elevated CO2 readings
 effect minimised by a narrow bandwidth filter

 however, presence of N2O molecules results in

collision broadening of the absorbance peak of
CO2
 resulting in apparently elevated CO2 readings
 ETCO2 : N2O

 simplest correction is to calibrate the monitor with

the same background gas as is to be used during
anaesthesia

 alternatively correction factors may be applied,

 50% N2O P'CO2 ~ PCO2 x 0.9
 70% N2O P'CO2 ~ PCO2 x 0.94
 ETCO2 : H2O

 condensed water
 result in falsely high readings
 prevented in mainstream units by heating the sensor
 side-stream units use water traps
 some units use semipermeable Nafion® tubing
 ETCO2 : H2O

 water vapour
 mainstream analysers measure breathing circuit gas
 generally saturated at body T. but may be affected by the
use of humidifiers, FGF's, and the ambient T.
 side-stream units, cooling of the gases results in
  water vapour pressure, and
 apparent increase in PCO2 ~ 1.5-2%
 ETCO2

 transit time
 creating a phase shift, but no distortion
 gas is subject to mixing with overdamping of a
square waveform
 results in underestimation of ETCO2, especially in
children
 this error increases both with,
 increased width and length of the sample tubing
 reduced sample flow rates < 50 ml/min
 higher frequency breathing patterns
 ETCO2

 rise time T10-90

 time to change from 10% to 90% of the final value
 depends on size of the sample chamber and flow rate
 capnographs used clinically ~ 50-600 msec
 prolongation may decrease the slope of phase II, and
underestimation of anatomical dead space
 ETCO2 in adults at < 30 bpm with ± 5% accuracy

 faster units are required in children, T70 < 80 msec

 ETCO2

 rise time T10-90 (continued)

 response times have been markedly

reduced by,
 more powerful signal amplifiers
 minimising the volume of the sample

chamber
 use of relatively high sample flow rates >

150 ml/min
 ETCO2 : Other Factors

 oxygen
 O2 does not directly absorb IR light
 may affect reading by collision broadening
 results in falsely low PCO2 readings
 not as great as with N2O (some units incorporate
correction)
 ETCO2 : Other Factors

 halogenated agents
 absorb IR light at ~ 3.3 µm
 interference is not clinically significant
 alinearity of CO2 analysis
 the concentration of the calibration gas should be as close
as possible to the measured gas sample
 Severinghaus CO2 Electrode

 Severinghaus developed the CO2 electrode in

1958
 modern arterial blood gas analysis was born
 Essentially a modified pH electrode
 provides a direct measure of PCO2 from the
change in pH
 Severinghaus CO2 Electrode

 circuit consists of,

 a closed cylinder of pH sensitive glass in the centre
 2 electrodes, 1 inside, the other outside the cylinder
 a surrounding solution of sodium bicarbonate
 a thin film of bicarbonate impregnated nylon mesh
covering the end of the cylinder
 a thin, CO2 permeable membrane covering the end of
the electrode
Severinghaus CO2 Electrode
 Severinghaus CO2 Electrode

 CO2 diffuses from the blood sample through the

membrane into the nylon mesh and by the
formation of carbonic acid lowers the pH of the
bicarbonate solution

 the change in pH alters the dV across the glass,

such that,
pH ~ log10PCO2
 CO2 Electrode

 output of voltmeter calibrated in terms of PCO2

 electrode accuracy ~ 1 mmHg
 response time ~ 2-3 mins
 as for the pH electrode, the CO2 electrode kept at
37°C and regularly calibrated with known
concentrations of CO2
Measurement of OXYGEN
 OXYGEN MEASUREMENT
ELECTROCHEMICAL METHODS

• Based on electrochemical reaction in buffer

solution occurring between 2 electrodes,
involving gas molecules.

• 2 Devices
(a) Polarographic electrode
(b) Fuel cell.
 Measurement of Oxygen

 Leyland Clarke developed the

polarographic oxygen electrode in 1956
 prior to this the PO2 had not been measured
 Other Methods

 PO2 may also be measured by,

 Volumetric - van Slyke/Neill
 Clarke electrode
 Fuel cell
 Paramagnetic
 Hummel Cell - paramagnetic
 Optode - photoluminescence quenching
 Raman scattering
 Mass spectrometer
 PARAMAGNETISM

• Paramagnetic : attracted toward magnetic field

eg. oxygen

• Diamagnetic : repelled by magnetic field

eg. nitrogen

• Paramagnetic molecules = 2 unpaired electrons

in outer electron shell spinning
in the same direction.
PAULING TYPE OF PARAMAGNETIC
OXYGEN ANALYSER

MAGNET POLE

MAGNET POLE
Gas O2

Nitrogen
In Glass
Dumb-Bell

MAGNET POLE
Light beam Detector
Slow response ( 5 – 20 s)
 RAPID PARAMAGNETIC O2 ANALYSERS

Sample Reference Gas

Differential
Pressure transducer

Made more compact Magnetic field

Rapid response time
Gas Mixture out
 POLAROGRAPHIC ELECTRODE

PRINCIPLE

• 1 pair of electrodes in electrolyte solution

• Electrodes maintained at potential difference

• Current through electrolyte solution dependent

on gas concentration in solution

• Reaction driven by voltage applied to electrodes

 CLARKE OXYGEN ELECTRODE

• Cathode - Platinum covered by permeable membrane

• Anode - Silver/Silver chloride covered by membrane

• Electrolyte Solution - KCl

• Electrodes connected to DC voltage 0.6V

• Electrons produced by Ag / AgCl anode migrate to cathode

to reduce O2 molecules.
 Clarke Electrode

 the circuit consists of,

 DC voltage source (0.6 V)
 ammeter
 platinum cathode
 silver/silver chloride anode
 electrolyte solution (KCl), and
 O2-permeable membrane
Clarke Electrode
Clarke Electrode
 Ohm’s Law: for any resistive
circuit: I  V
 for the Clarke
electrode there is a
plateau voltage range
 I does not change with  V
 however: I  PO2
 this occurs as the cathode
reaction requires both O2
and free electrons
 Clarke Oxygen Electrodes (Cont’d)

• Platinum Cathode - O2 + 4e 2O
(reduction) 2 O + 2 H 2O 4 OH

reaction at the platinum cathode,



O2 + 2H2O + 4e-  4OH-

At Ag / AgCl Anode (oxidation) :

4 Ag 4 Ag+ + 4e-
Current flow between both electrodes measured
 Clarke Electrode

 current flow being in direct proportion to the

consumption of oxygen
 the platinum electrode cannot be inserted directly
into the blood stream as protein deposits form an
affect its accuracy
 CLARKE ELECTRODES

Advantages : Robust
Portable

Disadvantages : Limited life span

Silver anode eventually used
up by current
 FUEL CELL

Cathode : Silver - reduces O2 molecules

in solution.
Anode : Lead : 2Pb + 40H 2Pbo +2H2O + 4e-
Electrolyte : potassium bicarbonate
No polarising current required

Lead Anode

M Potassium
Bicarbonate Solution
Silver Cathode
O2 + 4e + 2H2O 4OH-
SAMPLE
 FUEL CELL

Advantages :
Compact
No power supply required
Unaffected by N2O

Disadvantage :

Slow response time

life-span 6-12 months
 OPTODES - PRINCIPLE

1. Oxygen has the property of “quenching” fluorescence

of certain dyes.

2. Dyes exposed to light – electrons excited and release

photons when they return to their original state
(fluorescence).

3. Oxygen absorbs energy from excited electrons

electrons return to original state without releasing
photon

4. Absorption of light and reduction in light emitted is

proportional to PO2
 OPTODE - MECHANISM

• Optical fibre with dye coated tip

• O2 permeable membrane cover

• Sequential illumination of fibre causes dye to fluorescence

• Intensity of fluorescence depends on oxygen concentration

at tip

• Fluorescence measured by photo multiplication.

 OPTODE : Uses

• Intravascular PO2 monitoring

• Advantages :
Independent of blood flow
Stable
Rapid response times

• Disadvantage :
expensive
Dye deteriorate with time
Fibrin deposition
 Oximetry
 Kramer optically measured the O2 in animals in the early
1930's
 Karl Matthes in 1936 was the first to measure O2 from
transmission of red and blue-green light through the human
ear
 the term oximeter was coined by Millikan et al. in the 1940's
 they developed a lightweight oximeter, a smaller version

of Matthes' design, which measured SaO2 by

transillumination of the earlobe using red & green filters
covering Kramer's barrier layer photocells
 Oximetry

 the signal detected from the photocell under the

green filter later proved to be in the IR range
 there were two technical problems with this approach,
 there are many non-Hb light absorbers in tissue
 the tissues contain capillary & venous blood in addition to
arterial blood
 TRANSMISSION OXIMETRY

Based on absorbance laws

Blood consists of a mixture of

Oxyhaemoglobin and
Deoxyhaemoglobin
ABSORBANCE CURVES FOR HbO2 AND Hb

RED INFRARED

ISOBESTIC WAVELENGTH

Absorbance OXY Hb

DEOXY Hb

660 805 940

wavelength
 ABSORBANCE CURVES

Secondary Peaks of Absorbance

660 nm - Deoxyhaemoglobin
940 nm - Oxyhaemoglobin

805 nm - Isobestic point

defined as point at which absorbances of
HbO2 and Hb are equal.
Depends on haemoglobin concentration
 CO - OXIMETER

• Measures Oxygen saturation

• Based on absorbance curves
• Requires haemolysis of blood sample
before “sats” measurement
• 2 types - Reflectance
- Transmission
Measure at 4 wavelength to enable
measurement of metHb and HbCO
 CO-OXIMETER

ADVANTAGES :
Light absorbance measured at several
wavelength enables fraction estimation.

DISADVANTAGES :
Cannot provide continuous monitoring
Expensive cost and maintenance
PULSE OXIMETRY
 Pulse Oximetry

 early 1970's, Japanese engineer Takuo Aoyagi working on a

dye dilution method for CO, using an earpiece densitometer
 noted that the pulsatile components of the red & IR
absorbances were related to SaO2
 prototype, built by Nihon Khoden, was tested clinically in
1973 and the first commercial prototype available in 1974
 further refinements were required and widespread use did
not eventuate until the early 1980's
 Pulse Oximetry

 the signal detected from the photocell under the

green filter later proved to be in the IR range
 there were two technical problems with this approach,
 there are many non-Hb light absorbers in tissue
 the tissues contain capillary & venous blood in addition to
arterial blood
 Pulse Oximetry

 these were overcome by first measuring the

absorbance of the ear while it was compressed
to remove all blood
 after this bloodless "baseline" measurement the
ear was heated to "arterialise" the blood
 this device was shown to accurately predict
intraoperative desaturations, however, due to the
technical difficulties was never adopted on mass
 Nomenclature
 SaO2 = 100.(O2 content)/(O2 capacity)
 arterial blood saturation measured in vitro
 O2 capacity the amount of O2 which can combine with
reduced Hb, without removing COHb or MetHb
 thus, at high PaO2 the SaO2 = 100%
 irrespective of the [COHb + MetHb]

 HbO2= oxyhaemoglobin concentration

 multiwavelength spectrometers measure all species
 SaO2 computed from PO2 and pH approximates SaO2, not
HbO2
 SpO2 = pulse oximeter saturation
 Methodology

 2 wavelengths of light,
 red = 660 nm
 IR = 910-940 nm
 the signal is divided into two components,
 ac = pulsatile arterial blood
 dc = non-pulsatile arterial blood
+ tissue + capillary blood + venous blood
 NB: all pulse oximeters assume that only the
pulsatile absorbance is arterial blood
 AC AND DC SIGNALS
RECEIVED BY PULSE OXIMETER

Variable absorption due to pulsatile

AC arterial blood

Absorption due to arterial blood

VENOUS BLOOD Absorption due to venous blood

DC

TISSUE Tissue absorption

 Methodology

 for each wavelength, the oximeter

determines the ac/dc fraction
 independent of the incident light intensity
= pulse added absorbance
 the ratio (R) of these is calculated,
 R = (ac absorbance/dc absorbance)Red
(ac absorbance/dc absorbance)IR
= A660nm / A940nm
 R and SpO2

 this value varies from,

 SaO2 = 100% R = 0.4 (0.3)

 SaO2 = 85% R = 1.0

 SaO2 = 0% R = 3.4
R and SpO2
 Methodology
 the photo-detector diodes of the sensor will also
register ambient light
 interference is reduced by cycling the light
 red only  infrared only  both off
 repeated at 480-1000 Hz in an attempt to subtract the
ambient light signal, even when this is oscillating
 this allows accurate estimation of SpO2 at arterial
pulse frequencies ~ 0.5-4 Hz (30-240 bpm)
 data is averaged over several cycles
 Uses: Oxygenation
 anaesthesia & recovery
 intensive care
 emergency care & transport
 labour
 premature & newborn infants
 home & hospital monitoring for SIDS
 patients in remote locations eg XRay, MRI
 "office" procedures eg. dentistry, endoscopy
 Uses: Circulation
 systolic BP & pleth waveform appearance
 inflation better than deflation

 sympathetic blockade with central neuraxis anaesthesia

 autonomic dysfunction with valsalva manoeuvre
 anecdotally reported uses
 patency of the ductus arteriosus

 level of ischaemia in PVD

 patency of arterial grafts

 circulation in reimplanted digits or grafts

Uses: Therapy

 optimise FIO2 in ventilated patients

 optimise CPAP or PEEP
 extubation of ventilated patients
 adjust O2 therapy in preterm infants
 no consensus on optimal levels
 optimisation of home O2 therapy
 Signal:Noise
 Freund et al. 1.12% failure
 cumulative > 30 mins in 11,046 anaesthetics
 Gilles et al. found a 1.1% incidence
 2 x 15 mins in 1,403 anaesthetics
 automatic gain controls
 amplification of low signal strengths
 low signal to noise ratio
 most new meters give "low signal strength" warnings once
the ac component falls below an arbitrary fraction of the
total transmitted light (0.2% for the Biox-Ohmeda)
 Low S:N Causes
 low perfusion pressure
 motion artefact
 ambient light
 skin pigments & dyes
 probe position  the "penumbra effect"
 Ventilation - a large paradox may lead to searching
 venous pressure waves - TI, reflectance operation
 electrocautery - most unit are now immune
 MRI interference - rare, usually lead distorts MRI image
Ultrasound and anaesthesia
 ULTRASOUND

• Sound = disturbance propagating in material

(Air, water, tissue or solid)

• Characterized by frequency and intensity.

• Frequency measured in hertz

• ULTRASOUND = sounds waves > 20 KHz

Cannot be perceived by human ear.
 WAVELENGTH OF SOUND

• Sound Wavelength = Velocity

frequency

• Shorter wavelength higher resolution

less penetration

• Compromise between penetration and resolution

required.
 SOUND PRODUCTION

• Ultra-sound probe = Transducer containing an array

of piezo-electric crystals.

• Electrical voltage applied to crystals causes piezo-

electric crystals to oscillate at resonant frequency.

• Electrical energy - converted to sound energy.

 ELECTRICAL ENERGY

Electrical Energy

Piezo – electric Sound

crystals oscillate

Electrical energy
 ULTRASOUND PROPAGATION

In homogenous tissues : -

ultrasound is absorbed
Absorption – least in fluids greatest in solid tissues

Absorbed energy converted to heat (small)

Amount of heat dissipated hence useless

 ULTRASOUND PROPAGATION

In heterogenous tissues :

• Ultrasound strikes interfaces

• Wave is either
a) refracted - transmitted – thro’ interface
b) reflected - depends on smooth (specular) or non-smooth
surfaces.

• Bone and calcium more reflective

 PULSED SOUND WAVES

• Used to prevent transmitted and reflected sound

waves.

• Pulse repetition frequency = 10 – 20 Hz

• Longer path sound wave travels - lower is PRF

PULSES OF ULTRASOUND

Usually 2.5 to 7.5 MHz

Frequency -  resolution
-  penetration
 ULTRASOUND REFLECTION

Reflected Incident
Incident Wave Wave

“Scattering”
of
Surface Ultrasound
REFLECTED ULTRASOUND (ECHO)

Two quantities measured :

(a) Time delay between sound transmission

and reception of reflected echo.

(b) Intensity of reflected signal

High echo reflection - white
Less reflection - grey
No reflection - Black
 A - MODE (AMPLITUDE)

Brief ultrasound pulses in one direction.

Reflected ultrasound amplitude plotted

Against time

Peaks = reflective interface

Amplitude

Time (distance)

Time & distance from probe

 B - MODE (BRIGHTNESS)

Brief ultrasound pulse in one direction

Reflected ultrasound measured

Amplitude = Brightness of reflected ultrasound

 M – MODE (MOTION)

• Repeated B-Mode pulses graphed against time base.

• > 1000 pulses per second

• Good resolution

• Provides one-dimension image

against time.

• useful for value motion

 2-D ULTRASOUND

• Multiple crystals (linear or phased array) or moving crystals

• Sequential B-mode pulses across 90o

• Single image displayed

• Real time movement

 DOPPLER PRINCIPLE

• Frequency of transmitted sound from a moving object

alters depending on velocity and direction of object.

• Change in frequency proportional to

a) ultrasound frequency
b) Cosine of angle between ultrasound beam
direction and moving object.
 DOPPLER SIGNAL

• Maximal signal when sound moves towards probe –

higher pitch (frequency).

• Lower pitch when sound moves away from probe.

• Pitch change is due to compression and rarefaction of

sound waves.
 USES OF DOPPLER

• Examine direction and velocity of blood flow in vessels

and heart

• Estimate velocities and therefore measure pressure

gradients, using Bernoulli equation

P = 4V2

• Types of Doppler used ;

a) Pulse wave
b) Continuous Doppler
 PULSED-WAVE DOPPLER

• Depends on Doppler shift

• Doppler shift  frequency of reflected waves which

depends on velocity or reflected wave.

• Used to measure velocity of red blood cells

V = FDC
2fo Cos Q
V = Velocity of red blood cells
FD = Doppler shift
Fo = Ultrasound frequency
Q = angle between flow and sound wave.
 PULSED-WAVE DOPPLER
- Limitations -

• Large angles - results inaccurate

• High velocity flows > 0.6m/s cannot be accurately

measured by intermittent pulses (causes “aliasing”)
 CONTINUOUS WAVE DOPPLER

Separate crystals - emit & receive ultrasound

continuously along 1 axis

Frequency Spectrum & velocity of interfaces

Graph of Velocity range vs time plotted

CONTINUOUS WAVE DOPPLER

Advantages :
Can measure fast flows
Calculate valve gradients

Disadvantages :
Small incident angle required
 COLOURED DOPPLER

Pulsed wave used on 2 D scan

Velocity depicted as colour

Advantage : Easy visualisation

Disadvantage : high velocity – colour reversal

rapid turbulent flow
produce colour “jets”
 TOE PROBE

Phase array 2 D probe

64 piezo-electric crystals

Mounted on gastroscope (9mm)

Can be monoplane
biplane (2 array)
multiplane (rotating array)
CLINICAL APPLICATIONS OF ULTRASOUND

1. Examination of structure
Brain
Neck
Chest - pleural fluid
Obstetrics
Abdominal structures
Blood vessels

2. Interventional Procedures
Guide placement of needles
 CLINICAL APPLICATIONS - DOPPLER

1. Sense blood flow in blood vessels

e.g. Thrombo-embolism
Thrombosis

2. Measurement of blood pressure

a) sense onset of blood flow
b) sense movement of arterial wall
CLINICAL APPLICATIONS –DOPPLER (CONT’D)

3. Cardiac output measurement

a) mean velocity
b) cross-sectional area of aorta or left ventricular
outflow tract.

4. Fetal Heart movements and heart rate

5. Valve functional, Myocardial wall movement

6. Transcranial Doppler - Velocity of blood flow in

cerebral vessels.