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BM 402

ENGINEERING IN MEDICINE
LECTURE NOTES

Ata AKIN
Institute of Biomedical Engineering
Boğaziçi University

© 2009 by Ata Akın


Biomedical Engineering

“Health care delivery team” that seeks new (innovative) solutions for the difficult problems

confronting modern society

Innovation patent:

1. Novel Æ no one should have taught about these before

2. Non-(not) obvious

3. Applicable Æ must serve a new purpose

History of Medicine

Primitive medicine (BC 10,000)

They did not have any medication but they were interested in:

¾ Art of herb doctoring

¾ Bone setting

¾ Midwifery

¾ Surgery

They believed that diseases are visitations of evil spirits.

Egyptians (BC 3,000)

Imhotep (peaceful sleep), the architect of the 1st pyramid

1
Greek Medicine (BC 500)

God of healing: Aesculapius

¾ Hospitals with tempts

¾ Island of Cos: Hippocrates

o Injected “scientific spirit” into medicine.

Scientific spirit: systematic approach (cause ↔ effect), observation

o He was able to bring diagnostic observation Æ clinical treatment

Romans (AD 500)

¾ To use proper sewer system (public health)

¾ Refrigerated foods (sterile and fresh)

¾ First aid (they were warriors)

Dark Ages

¾ Church dominates medicine

¾ Belief in drugs meant distrust to the healing power of pray

Renaissance (AD 1,500)

¾ Anatomical investigations

Leonardo daVinci Æ Golden Ratio

Florence Nightingale (19th century) (English Nurse)

¾ Hospital conditions accounted more than the diseases in death amounts

¾ She discovered the importance of nursing


2
1896 Æ Wilhelm Conrad Roentgen discovered X-ray

1901 Æ He won the Nobel Prize

1906 Æ Siemens & General Electric made the first X-ray machine

1914 Æ X-ray machine became mobile and it could work without electric.

1903 Æ Electrocardiogram (ECG)

Biomedical Engineering

Diagnostic Systems Therapeutic Systems

- Medical Instrumentation - Instrumentation


- Signal / Image Processing - Prosthetic devices
- Nanomedicine - Rehabilitation

Clinical Engineering Medical Informatics Biotechnology

- Biosensors

3
PHYSIOLOGY & ANATOMY (REVIEW)

Physiological Systems

A group of interconnected or independent organs that work together to perform a specific

function or a group of functions in the body

x (t) h (t) y (t)

System (Transfer) Function

System: processes inputs to produce outputs

Biochemical Biochemical
Physical Physiological Physical
System
Electrical Electrical
Environmental
OUTPUTS
INPUTS

HW 1

PART I: Find 2 different definitions of Biomedical Engineering

PART II: Find websites related to Biomedical Engineering and organize them under the

following headings:

1. Academic Websites

2. Industry

3. Professional Organizations

4
Circulatory (Cardiovascular) System

Organs: heart, blood vessels

Lung

Aorta
Left Atrium
Left Ventricle

Body

Left Ventricle: Responsible for pumping oxygen rich blood to the body

The heart works with electricity.

SA node

AV node

5
SA node has a direct contact from central nervous system to control / modulate the rhythm of

the heart.

Heart rate modulators:

1. Central nervous system

2. Hormonal stimulation

3. Blood flow (mechanical)

4. Biochemical / ionic modulations on a heart muscle

Coronary arteries supply oxygen, glucose, blood to the tissue of the heart.

¾ No blood supply due to obstruction Æ occlusion Æ ischemia Æ hypoxia Æ cell death

Ectopic focus Æ ventricular fibrillation

6
Nervous System

Integration and control of all body functions

Central Nervous System (CNS) Peripheral Nervous System (PNS)

- All the nerve tissue enclosed by the bone - Nerve tissue that is not enclosed by the bone

- Brain & spinal cord - Nerve fibers from the spinal cord, muscle

nerve fibers

Stroke: Bleeding of blood vessels Æ resulting in partial paralysis

Blood Vessels

7
Coagulant Æ fills where there’s an explosion

¾ Fibers cross over in brain stem, left side of the brain controls the right side of the body.

Frontal Æ executive function

Parietal Æ motor-sensory systems

Temporal Æ auditory

Occipital Æ vision

8
Reflex Arch

There are multiple control systems in the brain

Corpus Callosum

Î Bridge to share information

¾ Split brain syndrome (still used to treat epilepsy)

Underneath the frontal lobe Æ emotional control and memory

9
¾ Cerebrospinal fluid underneath and around the brain

The top and under pressures are the same

The fluid is inside 4 ventricular chambers

10
Respiratory (Pulmonary) System

Enables cardiovascular system to exchange gases with air

¾ Nose, pharynx, larynx, trachea, lungs

Pair Vair = Plung Vlung

Pair Vair is constant Æ Plung decreases, Vlung increases Æ rush of fresh air through the lungs

Huge oxygen gradient between the deoxygenated blood and alveolar

As the red blood cell flows, oxygen is diffused through mucosa (secreted by the certain cells

that have hair) and the red blood cell fills with oxygen. CO2 is formed as HCO3- because it is

not desired in gas phase in the plasma. It is dissolved in acid form. The undissolved part is

carried by the red blood cell.

CO2 is diffused freely in alveolar.

11
Smoking: Smoke has tar in it. Tar sits on top of mucosal layer. Alveolar needs to secrete

more mucosa. The thickness has increased, diffusion takes longer. If you smoke more, the

distance that the oxygen should travel increases and there’s no more oxygen transfer.

Î Emphysema

Respiratory system is controlled by signals if cerebellum.

Gastrointestinal (Digestive) System

Concerned with the ingestion and digestion of food, elimination of the residues of the

gastrointestinal system

¾ Liver, gallbladder, pancreas, stomach, intestines colon

Esophagus Æ peristaltic activity

(Squeezes the food down)

12
Gastroesophageal reflux

1. Neoplasia

2. Dysplasia

3. Cancerous formation

o Immortality

o Uncontrolled growth

¾ Metastate

¾ Barnett’s Esophagus

Urogenital System

¾ Production, storage, elimination of urine

¾ Reproduction

o Kidneys, bladder, ovaries, prostate

Kidneys: Responsible for maintaining water equilibrium, balance of minerals, and removal of

toxic components from the blood.

¾ Filtration system, continuous blood flow

13
Input: Blood Output: Blood

Bladder

Kidneys maintain mineral level (Ca, Mg, Zn, Fe)

Æ maintain homeostasis (static state of the body)

Kidneys are responsible for maintaining blood pressure.

Too much water Æ pressure in blood vessels

Kidneys send hormones to blood vessels to relax the vessels Æ renin activates angiotensin

Æ Squeezing down the vessels

14
Central Nervous System

Autonomic Nervous System

Sympathetic Nervous System Parasympathetic Nervous System

Fight Mode! Flight Mode!

- Excitatory

Dialysis: A filtration system to remove toxins and urea from the blood.

Kidney Stone:

Pancreas: Responsible for secreting hormones to maintain blood glucose level.

¾ Hypoglycemia

¾ Diabetes Mellitus

15
Musculoskeletal System

¾ Muscles & skeleton

Maintaining balance, movement, keeping warm

Amount of signals determine how many muscles should be recruited to carry the weight.

Signals can be sent as a whole or one by one.

16
Force generated by muscles is a function of

¾ Neuronal stimulation from the brain (frequency & intensity)

¾ Amount of blood supply

¾ Available nutrients

¾ Ionic concentration around muscle (Ca2+)

¾ Previous activity level

¾ Lactic acid vs. endurance

¾ Hypertrophy

Endocrine System

Regulation and control of visceral functions

¾ Secretes hormones via glands that control growth, metabolism and reproduction.

o Pituitary gland, thyroid, parathyroid, adrenalin gland, thymus

Glands are bags that are covered by muscles.

17
Pituitary gland: growth, reproduction

Thyroid gland: around the trachea at the larynx

¾ Controls the rate of metabolism

o Hyperthyroidism

o Hypothyroidism

Parathyroid gland: on top (around) the thyroid gland

¾ Responsible for maintaining calcium balance in the blood stream and tissues

Adrenal glands Æ epinephrine

• Small amounts Æ vasodilation

• Large amounts Æ vasoconstriction

18
Hematopoietic System & Lymphatic System

Production of blood & blood components

Immune system components

¾ Bone marrow, spleen, lymphatic tissues

Bone marrow: production of red & white blood cells

Spleen: storage of blood cells

Lymphatic tissues: collection of plasma, dead red blood cells

¾ Production of immune system components

Red blood cells: storage of hemoglobin

White blood cells: soldiers of the body

Integumental System

Skin, hair, nails

Skin Æ protection

Nails Æ finger support

Hair Æ protects the brain from heating, provides sweating

HW 2

PART I: Pick a physiological system of your choice and describe its functions, organs in 2

pages

19
PART II: Find a major disease of this system. Explain its pathophysiology, progression,

diagnosis and therapeutic interventions in 1 page.

20
BIOMEDICAL SENSORS

Sensors that are used to measure electrical, chemical, physical activities from human body

Biomedical Instruments

Diagnostic Therapeutic

Invasiveness

Non-invasive Minimally Invasive


invasive

Invasive

¾ Ionization (radiation) X-ray, UV, γ-ray

¾ Contact with blood

¾ Intrusion into the body

Minimally invasive

¾ Contact with blood

¾ Intrusion into the body

Non-invasive

¾ Surface or remote diagnosis / therapy

21
Biomedical Instruments

A General Block Diagram for a Diagnostic Instrument

BIOMEDICAL SENSORS

Chemical Sensors

Blood components, glucose, ions, hormones, pH, O2, CO2

O2 measurement

Clark Electrode Pulse Oximetry


- Invasive (accurate) - Non-invasive (not so accurate)
- Non-invasive (not so accurate)

Clark Electrode

Rate of electron transfer is measured by the resistance of electrodes.

V = IR Ohm' sLaw
ρL
R=
A
22
O2 + H 2 O + 4e − → 4OH −
Ag ↔ Ag + + e −
Ag + + Cl − → AgCl ↓

Pulse Oximetry

Detector

Hb
HbO2

Finger
λ1 λ2

¾ Detector: non-laser red light sources

Light is used to measure the concentrations of [HbO2] and [Hb]

(Near infrared)

⎡ OD(λ1 ) ⎤
S O2 = A − B ⎢ ⎥
⎣ OD(λ 2 ) ⎦

S O2: Saturation of O2

OD: Optical Density

Offline Sensors

¾ Glucose, hormone, blood components

¾ O2 measurement: spirometer to measure O2 gas amount and CO2 gas in the air

exchanged by the lungs

23
Electrical Measurements

¾ Results of biopotentials Æ biologically generated electrical signals

Cells are electrically excitable.

Resting membrane potential

Æ Due to the existence of ions across the cell

membrane

Action Potential

¾ is due to the rapid exchange of ions

across cell membrane through channels

and gates

¾ muscle cell Æ gates

¾ heart muscle Æ gap junctions transfer electrical potentials between cells

¾ Dipole

¾ Einthoven’s triangle

24
Electrocardiogram (ECG)

P: atrial contraction

QRS: left ventricle contraction

T: refilling of the ventricle

¾ Heart Rate

¾ Pacemaker

Electrical Sensors

Non-invasive Invasive

Surface type Æ Surface electrodes Needle Æ deep tissue measurement

Wire
Ag / AgCl

Electrolyte

Skin

Double side adhesive

Electrolyte: electrically conductive gel with NaCl

25
¾ It allows the passage of electrical signals to the metal

Adhesive secures the electrode onto the skin surface.

Electromyogram (EMG)

¾ Measurement of electrical signals of the muscle

+
_

Cable of electricity

Stimulus

Needle electrodes

200-400 µm thick wires


+
Invasive _

Electroencelophalogram (EEG)

The electrodes make a goof approximation about the electrical

activity.

26
¾ 20 electrodes across the head (cap electrodes)

¾ Visual Evoked Potential

¾ Evoked Response

¾ Cortical electrodes

HW 3

PART I: What are the operational principles and clinical applications of

1. ECG

2. EMG

3. EEG (1 page each)

PART II: What is functional electrical stimulation (FES)? What are its clinical applications?

(1 page)

Physical Measurements

¾ Volume, force, temperature, pressure, sound

Volume Measurement

Breath

Rubber strand

27
To measure the change in current:

V
R= ρ∝R
I
∆R ∝ ∆l
ρL
R=
A

¾ Calibration curve Linear sensitivity

I Æ limit of detection
I II III
II Æ linear range

III Æ saturation (cut-off) range

∆V

¾ Transducer

Breathing by rubber strand:

T no of breaths
period
Breath Rate =
min

12-15 min-1 28
- Amplitude gives basic info about
the amount of air exchange
Force & Strain Measurement

I F

+
V

l Rubber
substrate
∆l

F ∝ ∆R ∝ ∆l

1. Intraesophageal balloon

Pump

2. Radiofloroscopy

29
o Ingest a liquid Æ absorber of X-ray

3. Strain Gage

Rubber

Needle Surface of stomach

3 of these techniques are not accurate.

4. Piezoelectric Transducer

o Force, pressure, flow

A crystal that produces electricity when mechanically strained.

Metal

Voltmeter
F F

30
Q = kF

Q: electric charge produced F: force applied

k: coefficient of the crystal

Blood Pressure Measurement

Temperature Measurement

1. Mercury Based Measurement

2. Electrical Thermometer

3. Optical Thermometer

Electrical Thermometer

Thermistor
I

31
⎡ ⎛ 1 1 ⎞⎤
R (T ) = R0 exp ⎢ β ⎜⎜ − ⎟⎟ ⎥
⎣ ⎝ T T0 ⎠ ⎦

1
∆ I ∝ ∆ R ∝
Biosensors (≠ medical sensors)
T
Sensors that measure the concentration of chemical components of solution

Cholesterol Biological
compound

Glucose
Enzyme Transducer
Membrane

Glucose + enzyme → glucanic acid → alters the pH of the sheet

pH  Glucose

HW 4

PART I: What is a biosensor? Find 1 clinical application for it.

PART II: What is a molecular beacon? What is a quantum dot? Find their usage in biology.

32
BIOMEDICAL INSTRUMENTATION

A generalized block diagram of a biomedical device

Data Processing Unit

Noise Removal

¾ Elimination of unwanted signals

¾ Electromagnetic interference

= powerlines, TV-Radio broadcast, mobile phones, computers, lab equipment

33
1. Noise filter

x (t) h (t) y (t)

Transfer Function

Transfer function Æ filter out unwanted noise

2. Data Filter

¾ Designed to extract relevant physiological information out of others

Low pass filter, high pass filter, band pass filter

x (t) hD (t) y (t)

Convolution: y(t) = x(t) * hD(t)

3. Gain

¾ Performed to increase the amplitude of the signal

x (t) G y (t) = G · x (t)

34
4. Differential Measurement

n(t)

V1(t)
+
Vo(t)
VR(t) _
VL(t)
V2(t)

V1 (t ) = VR (t ) + n(t )
− V2 (t ) = VL (t ) + n(t )
Vo (t ) = V1 − V2 = VR (t ) − VL (t )

¾ To eliminate “common” noise

Typical signal conditional steps

Differential Noise Data


Gain
measure filter filter
+
hN (t) hD (t) G y (t)
_

[x1 (t ) − x2 (t )] [x1 (t ) − x 2 (t )]∗ hN (t ) {[x1 (t ) − x 2 (t )] ∗ hN (t )}∗ hD (t )

y (t ) = G{[x1 (t ) − x 2 (t )] ∗ h N (t )}∗ hD (t )

Sensor SCU CPU

CPU = A/D converter + Microprocessor 35


Analog to Digital Convertors

Types of Signals

1. Analog Æ real world, continuous signal

2. Digital Æ digitized signals Æ sampled and stored in the computer

o A digital representation of the signal

A / D Converter

Î Resolutions

1. Temporary Resolution

o How fast a signal is sampled [samples/sec] = sampling rate Fs

Typically Fs = 1000 samples/sec

2. Dynamic Resolution

o How fine are you quantizing a signal? [bits]

Dynamic Range Vmax − Vmin


λ= =
no of levels 2n

n: number of bits = 10-12 bits

Ex: 12 bit A / D converter, Fs = 200 samples/sec records data for 10 min from 16 electrodes.

What is the size of the data file?

Data size = no of bits × Fs × Duration of record × no of sensors

= 12 × 200 × (10 × 60 ) × 16 = 23M bits ≈ 2.8MBytes

36
Biomediccal Signal Processing
P

Bioelecctric Signalss

¾ Generated by
b nerve annd muscle tissues when
n they are electrically acctive.

Æ Result of
o electrocheemical channges across the cell mem
mbrane.

Biomaggnetic Signaals

¾ Magnetic fields
fi are generated duee to changess in electric field.

Î Maagnetoencepphalogram ((MEG)

¾ Transcrranial Magnnetic Stimullator

¾ Electriccal convulsiion therapy

Biochem
mical Signaals

¾ concentrations of ions (Ca2+, K+, Na+, Cl-…)), hormoness, chemical compounds, blood

gases

Biomecchanical Siggnals

¾ motion, dissplacement, tension, forrce, pressurre, flow

Bioacusstic Signals

¾ due to vibraation, flow of blood, reespiratory sy


ystem (lungg) sounds

37
Characteristics of Signals

Deterministic Signals Random (stochastic) Signals

Periodic Aperiodic

Deterministic: an explicit mathematical representation exists

¾ periodic signals Æ x(t ) = x(t + T )

x(t)

¾ aperiodic signals Æ x(t ) = Ae − t / T

x(t)

A-

e −t / T

38
Random: characterized by statistical values (mean, standard deviation)

¾ EEG signals

Fourier Transform

A means of representing the contribution (weight) of different frequencies within a signal

1. x1 (t ) = A1 sin(ω1t )

T1
A1

1
- A1 ω 1 = 2π f 1 f1 = = 12 Hz
T1

1
ω 2 = 2π f 2 f2 = = 25Hz
T2
2. x 2 (t ) = A2 sin(ω 2 t )
f1 < f 2
T1 > T2
T2
A2 < A1
A2

-A2 ∞

∫ x(t )e
− jωt
x( f ) = dt
−∞

xT(t) ∞
1
∫ x ( f )e
− jωt
x(t ) = dω
2π −∞

39
x(f)

A1 Data Compression

A2

frequency
f1 f2

¾ Fourier Transform is random.

¾ EEG

o Grand averaging – Ensemble overgoing

40
Medical Imaging

Functionality Invasiveness

Morphological Physiological Non-invasive Min-invasive Invasive

Anatomical Provide information Remote Intrusion into the Radiation

on how well an organ Surface contact body


Map of organs
is functioning Contact w/ blood

Quality in Medical Imaging

1. Spatial Resolution

¾ How small can we detect [pixels/area]

2. Contrast Resolution

¾ How fine of colors do we see? [bits/pixel]

3. Temporal Resolution

¾ How many images can you take in 1 second?

[frame rate] = [frames / second] ≥ 24 frames/sec (real time)

41
Radiation Imaging

- Depends on the use of X-rays to image the absorption (attenuation) distribution of the

tissues

Object
I0
I

Photographic film
covered with
fluorescent material
I < I0

Source

Object

Visible light
Fluorescent material

1896 – Discovery of X-ray

1901 – The very first Nobel Prize was given to Wilhelm Conrad Roentgen

42
Principles of X-Ray Imaging

Attenuation of X-rays by tissues between body parts having minimally different density, fat,

muscle, result in a shadow image

e-
Photographic
film

A grid of photo
Pulse detector
generation

X-ray lamp Collimator

Florescent
cover

¾ Collimator: aligns X-ray beam

Holes

Pb

43
Physics of X-Ray Imaging

Ionizing radiation

E = hf

h: Planck’s constant

f: frequency of electromagnetic wave

c
↑ f =
λ↓

Ionization: decomposition of matter

- Vaporization of tissues

γ rays, X rays pass through tissues and give permanent damage to skin

X-ray source Detector

I0

44
I ( z ) = I 0 e − ρmz

z: distance between source and detector

ρ: density of the object

µ: attenuation coefficient

Units of X-ray Exposure

Roentgen Æ R = 2.58 * 10-14 C/kg

- Produces ionization of either charge (+ or -)

When light enters (I0), some of it is absorbed by the body not to eliminate X-ray

immediately.

A typical X-ray session: 10 – 100 millirads

- Absorption of X-ray by body (chest X-ray)

Onset of radiative effect: 50 rads

Radiation death > 200 rads

Geometric Unsharpness

X-ray
source
Fan beam
s
f

Image plane
45
s: source to image plane distance

t: center of object to image plane distance

f: fixed size of the object

f ⋅t
d=
s−t

Goal: minimize d (f fixed)

1. Increase s Æ increase source – detector distance

2. Decrease t Æ bring the object close to image plane

X-rays Æ planar image

Computer Aide Tomography Scanner (CAT Scan)

- Computerized Tomography (CT)

Source

Detector

The detector rotates and cross-section images are obtained at every 1-2o

46
 2 + 4

1 2
 1 + 2
ρ1 µ1 ρ2 µ2

3 4

ρ3 µ3 ρ4 µ4

 1 + 3  1 + 4

α i = ρi µi

We have 4 unknowns

We need 4 independent projections to solve ’s

Î Back Projection Algorithm

- Reconstruct cross-sectional image of an object by projected data

1st Generation CT

1 source, 1 detector

60 seconds to 4-5 minutes for each rotation

Rotates at every 6o angle for one cross-section

2nd Generation CT

1 source 30 detectors

All detectors are close to the source at equal distances to reduce geometrical sharpness

3rd Generation CT

47
300 detectors Æ 2 – 4 seconds

4th Generation CT

Only the source (fan beam) is rotating

700 detectors around (2 – 4 seconds)

Fluoroscopy

Patient is given a radio opaque (X-ray absorber) material and the movement of this material

is observed under light by camera.

Angiography

Injection of radio opaque material into the veins for observation of occlusions

HW 5

1. What is X-ray mammography?

2. What is balloon angioplasty?

48
Radionuclide Imaging

Nuclear medicine Æ radioactive elements

Invasive Æ ionizing radiation

Functional physiological imaging Æ Curries

Nuclear particles

e-

n, p+

energy
n → p + e + υ + energy
+ − −
e

p + → n + e + + υ e− + energy

Through a
catheter

Pow der

radioactive mix in
solution

The solution circulates in the body and targets several organs

I Æ radioisotope Æ mixed in the solution and accumulates in thyroid

C6H12O6 Æ Isotopes C11, C15 Æ accumulates in the parts where glucose is consumed

49
Positron Emission Tomography (PET Scan)

An imaging technique that uses γ cameras ( cameras) to monitor the whereabouts and

intensity of a radioactive element injected into the body

It is possible to monitor the progress of the activity in

time.

It can be used to measure the effect of chemotherapy.

It can also be used to measure the effect of the drugs..

Radioactive Decay

N (t ) = N 0 e − λt

N0: initial amount of material

λ: decay constant

t: time

0.693
T1 / 2 =
λ

50
Biological Half-life

Time needed for the body to excrete half of the amount of radionuclide. Tb1/2

T 1 / 2 ×T1b/ 2
T eff
1/ 2 =
T 1 / 2 +T1b/ 2

O15, T1/2 = 122 sec

C11, T1/2 = 20.5 min

¾ Molecular Beacon

¾ Quantum Dot

51
Magnetic Resonance Imaging (MRI)

- Uses non-ionizing radiation to probe the soft tissue contrast

- Provides excellent soft tissue contrast

Physics of MRI

Uses electromagnetic waves at radiofrequency (50-60 MHz)

Charged electron spinning around the axis

- Creation of 2 poles

- Magnetic dipole moment

Non-magnetic
-
Because all moments facing different directions

Magnet

S N
All moments are at the same
direction

1. All spinning nuclei have a characteristic resonance frequency which depends on the

atomic composition

2. When atoms are combined to form larger molecules, their overall resonance frequency

depends on their total weight

52
Nuclear Magnetic Resistance Spectroscopy (NMRS)

Different proportion of molecules

Î Different spinning frequency

Larmor Frequency

ω = γ β0
ω = 2π f

γ: gyromagnetic ratio

0: applied magnetic field

Each molecule starts to rotate according to gyromagnetic ratio, resulting in ωA, ωB, ωC, ωD.

IA
A% ∝ × 100
IT
IT = I A + I B + IC + I D

53
PG Re

PG: Pulse Generator

Re: Receiver

B1

S N

B0

1. Place the sample inside a static magnetic field (B0)

2. Close S1 (off S2)

Æ Generate a B1 ┴ B0, B1 << B0 at a specific “ω0”

3. Off S1, on S2

Æ Listen to incoming signal

Free Induction Decay which is a signal like this:

FID

τ
A

A  the amount of compound present within the sample

τ  the density of compound present within the sample

54
Imaging Takes Place In MR

Idea: Image 3-D object according to the distribution of H+ ion

Each cube is called a voxel.

Min resolution: 1 mm x 1 mm x 1 mm

H + → γ H+
BT ↑=ωT ↑

Srec

Rec PC Display

SX SY
PGX PGY

S N
SZ
PGZ 55
PG require high current to operate

High current means heat generation Æ cooling system is necessary

MRI

- An anatomical imaging technique

- Used in observing tissue contrast changes

(Inflammations, lesions, tumor formation, muscle injury)

- Contrast agents Æ enhances MR signal to investigate joints (Gd injection)

Functional MRI (fMRI)

- Used only for research

- Measurement of physiological changes in human body

(Manic depressive – normal brain)

It uses hemoglobin molecule to trace the functional activity level of the brain.

HW 6

PART I: What is CT-PET Scanner? What is its clinical use?

PART II: What is functional MRI and its clinical use?

56
ULTRASOUND IMAGING

Uses sound waves to probe the mechanical properties of the tissues (pressure waves)

= 1500 m/sec

Some sound waves reflect from the boundary. Some continue their way.

“ultra” Æ not audible ≈ 5 – 30 MHz

−α f z f
Pfat ( z ) = P0 e

P0: initial intensity of pressure wave

f: attenuation coefficient of the tissue

f = 0 f f: frequency of operation

0: initial coefficient

zf: thickness of the tissue

f ↑ Pf ↓ (more attenuation) Æ less penetration depth Æ but spatial resolution increases

57
Med
dical Ultrasound

Diaagnostic Therapeuttic

- Kiidney stoness (lithotripsy


y)
Anattomical Functional - Wound healinng
Bloodd flow - Boone healing

- Muuscle injuryy rehab

- Suurgical

Amplittude (A – mode)
m Ultraasound

Brightn
ness Mode (B Mode)

58
The echoes are turned into gray scale image

Array of US sensors

Non-invasive!

Doppler Ultrasound

Doppler Effect is the result of changing the wavelength of a source by its velocity.

US Beam
θ
P0
f0

P1 (fd) 59
2ϑ cos θ
fd = f0
C

: velocity of object

C: speed of sound

Front (coronal) view


Occlusion

f0
: measure the change in blood velocity
fd

Kidney Imaging
Blood moving away
from the probe

60
Blood towards
the probe

B – Mode + Doppler US

Kidney stone

Echocardiogram

Æ Live anatomical image of the heart

+ Movement of blood through the heart

B – mode: observe anatomical problems

Doppler: quantify the degree of disease

Doppler is less invasive than B – mode because the patient is exposed to less Ultrasound.

(Still the two applications are non-invasive)


61
Therapeutic Ultrasound

Æ Lithotripsy (stone breaking)

Locating the Stone

Ultrasound (transmitter)

Bathtub

62
Electro Shock Wave Lithotripsy

Biomedical Optics

The use of light in diagnostic and therapeutic applications

Diagnostic Therapeutic

Microscopic Macroscopic Surgical Rehab Cosmetic

(<100µm) (>100µm)

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Light and Matter Interaction
γ ray X ray UV vis Infrared

Absorption Scattering Invasive Non-invasive

(Treat cancer) (Diagnostic)

Æ Depends on the

1. Wavelength Less water High water


absorption absorption
2. Intensity

Visible Light Imaging

- Endoscopy

- Coils to move the tubes to look around the organs

- 4 holes, 5 mm in dimension

Fluorescence Imaging

- A certain color of light is used to excite certain chromophores

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Therapy

Æ Surgical inventions

o Cut the tissues

o Coagulate the vessels and tissues

o Ablate the vessels and tissues

o Weld the tissues

Laser

Coherent, focused light beam

Cornea

Pupil

Rehabilitation Procedures of Light

Infrared Therapy

o Tissue Damage

Cosmetic applications

1. Plastic Surgery

2. Epilation

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Rehabilitation Engineering

Application of technology to help (ease) the problems faced by people with disabilities

Activities in Rehabilitation Engineering

1. Prosthetics and Orthotics

Artificial hand, wrist, arms, foot, legs,

Hand splits, upper limb braces

Bone / joint prosthetics

- Functional

- Biocompatible

2. Assistive Devices for persons with severe visual impairments

- Devices to aid reading, writing

TV magnifiers, electronic Braille

- Aids for independent mobility (laser cane)

3. Assistive Devices for persons with severe auditory impairments

- Digital hearing aids Æ cochlear implant

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Mic

Cochlea

Skull

- Lip reading instruments

4. Mobility manipulation aids

- Grabbers, feeders, page turners, wheel chairs, driving aids

A general block diagram of an assistive technology

Analog data
Sensors

Digitalized Perception Cognition Motor Control Effectors

data
information knowledge

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Clinical Engineering

- An engineer who manages, maintains and improves the safe use of medical equipment in

hospitals

- It started when safety problems aroused

Electroshock, electrocution – proper grounding issue

Job Descrptions of Clinical Engineers

¾ Supervise performance of safety testing of medical equipment by companies

¾ Repair medical instruments

¾ Inspect of incoming equipment

¾ Organize inventory control

¾ Manage calibration and repair services

¾ Coordinate outside use of technical services

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¾ Train medical personnel in safe and effective use of equipment

¾ Develop and implement documentation protocols required by external accreditation

and licensing agencies

Safety Issues in Hospitals

Dangers: - Electrical Hazards

- Mechanical Hazards

- Environmental Hazards (solid, waste, noise, utilities, gas…)

- Biological Hazards: infection control (isolation, contamination, sterilization,

biological waste disposal)

- Radiation Hazards

Medical Ethics

Nature of Life and Its Significance

Immanuel Kant (1724 – 1804)

- What can I know?

- What I ought to do?

- What can I hope?

- What is man?

Ethics

- Represents the codes of conduct of society, the study of right and wrong, good and evil in

human conduct

Questions

1. Should body deformed infants kept alive?

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2. Should treatment be stopped to allow terminally ill patients to die?

3. Should humans be used in experiments?

Medical Dilemmas

1. Is it more important to preserve life or prevent pain?

2. Is it right to withhold treatment when doing so may lead to a shortening of life?

3. Does an individual have the right to refuse treatment when refusing it may lead to

death? (Euthanasia: good death)

Kant’s theory: Humans are owed a special kind of respect simply because they are people

Experiments

Human Ethics Review Board Animal Ethics Review Board

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