CO2

Medical Instrumentations

By:
A. Prasanna Lakshmi
 Cardiac DC Heart-lung
pacemakers Defibrillator Dialyzer machine

Diathermies- Telemetry principles, Recent Trends in

Shortwave, ultrasonic Surgical frequency selection,
Medical
and microwave type Diathermy biotelemetry, radio-
and their applications pill, electrical safety, Instrumentations

Contents
Endoscopy unit Laser in Cryogenic
Thermograph medicine Application,

Introduction to
telemedicine
THE HEART’S
ELECTRICAL
SYSTEM
What is the need of Artificial
Cardiac Pacemakers

• A pacemaker is a small electrical device that's

implanted in the chest or abdomen. It's used
to treat some abnormal heart rhythms
(arrhythmias).An arrhythmia is a problem with
the rate or rhythm of the heartbeat.
• During an arrhythmia, the heart can beat too
fast, too slowly, or with an irregular rhythm.
• When a heart beats too fast, the condition is
called tachycardia. When a heart beats too
slowly, the condition is called bradycardia.
Some pacemakers can also help the chambers
of your heartbeat in sync.
What a pacemaker
Consists
A pacemaker has two parts:

• Pulse generator: This small metal container

houses a battery and the electrical circuitry that
controls the rate of electrical pulses sent to the
heart.

• Leads (electrodes): One to three flexible,

insulated wires are each placed in one or more
chambers of the heart and deliver the electrical
pulses to adjust the heart rate. However, some
newer pacemakers don't require leads. These
devices, called leadless" pacemakers, are
implanted directly into the heart muscle.
What are the different types
of pacemaker?
There are several different types of pacemaker.
• The main types are:
• Single-chamber pacemaker – this has 1 wire/lead,
which is connected to either the right atrium
(upper heart chamber) or right ventricle (lower
heart chamber)
• Dual-chamber pacemaker – this has 2 wires, which
are connected to the right atrium and right
ventricle
• Biventricular pacemaker – this has 3 wires, which
are connected to the right atrium, right ventricle
and left ventricle
The type of pacemaker you need will depend on your
specific heart problem.
Concepts of Defibrillator
 Block
Diagram of
pacemaker
1.Timing circuit: The timing circuit determines the basic timing rate of the pulse generator. It consists of an
RC network, reference voltage source, a comparator etc.

2. Pulse width circuit: The stimulating pulse duration is determined by the pulse width circuit. It is triggered
by the output from the timing circuit. The pulse width circuit is also an RC circuit as the timing circuit. The
output of the pulse width circuit is fed into the pace limiting circuit.

3.Pace limiting circuit: The function of pace limiting circuit is to limit the pacing rate. The maximum pacing
rate is usually selected as 120 pulses per minute. The pace limit circuit limit the pacing rate by disabling the
comparator for a preset interval of time.

4. Heart stimulator circuit: This is also called output circuit since it provides the proper input pulse to
stimulate the heart and hence called heart stimulator circuit.

5. Refractory circuit: This circuit provides a period of time following an output pulse or sensed R-wave.
During this time the amplifier will not respond to outside signals.

6. R-wave sensing circuit: The function of R-wave sensing circuit is to detect or sense a spontaneous R-
wave and to reset the oscillator when the pulse is not needed.
7. Reversion circuit (Return circuit): It allows the amplifier to detect a spontaneous R-wave. In the absence
of R-wave, this circuit again allows the oscillator to generate pulses at its preset rate. This circuit is called
reversion or return circuit since it allows to return the oscillator to its active state.

8. Voltage monitor and controller: This circuit continuously monitors the battery voltage. As the pacing
rate is depending on the efficiency of battery, it has to be monitored regularly. If the battery voltage is
decreased, it triggers the energy compensation and pulse duration controller circuit.

9. Energy compensation/ Pulse duration controller circuit: If the battery voltage is decreased the energy
compensation circuit increases the pulse duration so that the pulses delivered to the patient are not
affected by the battery charge loss.

10. Rate slow down circuit: It is a special circuit which slows down the heart rate during certain conditions
such as cell depletion. So, the cell depletion is monitored by the voltage controller circuit, and whenever
cell depletion occurs, the voltage monitor/controller circuit activates the rate slow down circuit. This circuit
slows down the rate by limiting the current to the basic timing network.
Normal Heart Rate
What is meant by fibrillation and types of
fibrillation?
Atria Fibrillation
Ventricle fibrillation
Need and types for defibrillators
AC defibrillation
DC defibrillation
 Class of
Discharge
waveform
What is dialyses?

Dialysis is a treatment that takes over your kidney

function if those organs stop doing their job. This
treatment is been done with the help of a dialysis
machine.
Generally, there are two types of dialysis as –

Hemodialysis – In this type of dialysis the blood is

put through a filter outside the body, cleaned and
returned back to the body.

Peritoneal Dialysis – In this type, a special body is

been put into the abdomen and the blood is been
cleaned inside the body itself.
 When the nephrons in the kidney are not working
properly then we go through the hemodialysis.
There are a certain disease of renal failure caused
that are nephrotoxins, diabetics etc. And hence, in
order to avoid or prevent from this, we go through
the dialysis.
Need for
Hemodialysis ‘Hemodialysis’ the name indicates itself ‘hemo’
means blood and ‘dialysis’ means diffusion of
solute molecules. Hemodialysis is also known as
hemodialysis, kidney dialysis or simply dialysis. The
treatment is useful in the removal of waste
products such as creatinine and urea from the
blood
What does a dialyzer (artificial kidney) do?

1. Two tubes are connected via your hemodialysis access. Blood

flows from your body into the machine through 1 of the tubes.
2. If your doctor prescribes blood thinner as part of your
treatment, it will be added to keep your blood from clotting
while it’s in the machine.
3. A pressure monitor and pump work together to keep the flow
at the right rate.
4. Your blood enters the dialyzer, where it is filtered.
5. Dialysate solution enters the dialyzer. It draws the waste out of
your blood.
6. Used dialysate solution is pumped out of the machine and
discarded.
7. Your blood goes through another pressure monitor and an air
trap to make sure it’s safe to go back into your body.
8. Your cleaned blood returns to your body through the second
tube attached to your access site.
What does a dialyzer (artificial kidney) do?

A dialyzer is the part in the hemodialysis

machine where your blood gets filtered.
• The core of the dialyzer is made up of
thousands of tiny mesh tubes.
• Your blood flows inside each tube, and
the dialysate stays on the outside of the
tubes.
• Tiny pores in the tubes let waste and
excess fluids pass from your blood into
the dialysate.
• Your cleaned blood then leaves the
dialyzer and is returned to your body.
 Dialyzer
processes
Advantages : Disadvantages
❖ Easy to cleaning and ❖ Haemodialysis is associated with a restriction
disinfecting in the intake of fluid and dietary changes,
❖ The device has flow rate of which may be difficult for some people to adjust
blood Up to 600 ml/min . to.
❖ Fluid exchanges batteries ❖ The reuse of dialyzer is associated with
because to provide environment
uninterruptable contamination
power supply. ❖ Allergic reaction residual chemical infusion
(rebound release)

Application
❖ In medicine, dialysis is a process for removing waste and excess water
from he blood and in used primarily a as an artificial replacement for lost
kidney functions in people with kidney failure.
Dialyzer
What is a heart-lung (HI)machine?

• A heart-lung machine—also called a

cardiopulmonary bypass machine—is a device
that takes over the function of the body’s heart
and lungs during open heart or traditional
surgery.
• The heart-lung machine intercepts the blood at
the right atrium (upper heart chamber) before it
passes into the heart. Using a pump, the
machine delivers the blood to a reservoir, which
adds oxygen to the blood. The pump then
sends the oxygen-rich blood to the aorta and
through the rest of the body.
• HI Machine is also known as cardiopulmonary
bypass machine (CBM)
✓ A medical equipment called Cardiopulmonary bypass (temporary
mechanical circulatory support) to the stationary Heart and
Lungs
Main components of HL Machine
Parts
• Five pump assemblies
• Venous Cannula
• Arterial Cannula - dual-stream aortic perfusion catheter
/meshed cannula
• Venous Reservoir
• Oxygenators
• Heat Exchangers
• Cardiotomy Reservoir and Field Suction
• Filters and Bubble Traps
• Tubing and Connectors
What is diathermy?
• Diathermy is a therapeutic treatment most prescribed for
muscle and joint conditions. It uses a high-frequency electric
current to stimulate heat generation within body tissues.

The heat can help with various processes, including:

• Increasing Blood Flow

• Relieving Pain
• Improving The Mobility Of Tissues As They Heal
 There are three main types of diathermy: shortwave, microwave, and ultrasound.
Shortwave: Shortwave diathermy uses high-frequency electromagnetic energy to generate
heat. It may be applied in pulsed or continuous energy waves. It has been used to treat pain
from kidney stones, and pelvic inflammatory disease. It’s commonly used for conditions that
cause pain and muscle spasms such as:
• sprains
• strains
• bursitis
What are the • tenosynovitis

types of Microwave : Microwave diathermy uses microwaves to generate heat in the body. It can be
used to evenly warm deep tissues without heating the skin. Since it can’t penetrate deep
muscles, it’s best suited for areas that are closer to the skin, such as the shoulders.
diathermy? Ultrasound: Ultrasound diathermy uses sound waves to treat deep tissues. Heat is generated
by the vibration of the tissue. This promotes blood flow into the area. Ultrasound diathermy is
used for:
• musculoskeletal sprains
• strains
• muscle spasms
• joint contractures or adhesions
• neuromas
Shortwave • Frequency :27.33 MHz
• wave lengths of 11 meters.
diathermy
2. Microwave
❖ Microwave diathermy uses microwaves to generate heat in the body. It can be used to
evenly warm deep tissues without heating the skin. Since it can’t penetrate deep
muscles, its best suited for areas that are closer to the skin, such as the shoulders.

3. Ultrasound: Ultrasound diathermy uses sound waves (2MHz – 15MHz) to treat deep tissues. Heat is
generated by the vibration of the tissue. This promotes blood flow into the area. Ultrasound
diathermy is used for: musculoskeletal sprains, strains, muscle spasms joint contractures or
adhesions neuromas and shoulders.
Principle of diathermy

❖ Diathermy uses high-frequency electric current to produce heat deep inside a

targeted tissue.
❖ It can reach areas as deep as two inches beneath the skin’s surface.
❖ The diathermy machine does not apply heat directly to the body.
Instead, the waves generated by the machine allow the body to
generate heat from within the targeted tissue.
❖ Diathermy is usually part of a complete physical therapy or rehabilitative
regimen.
❖ Frequency and length of treatments vary.
Benefits
❖ Treating injuries with heat can increase blood flow and make connective tissue
more flexible.
❖ It can also help minimize inflammation and reduce the incidence of edema, or
fluid retention.
❖ By increasing blood flow to the site of an injury, the deep heat generated with
diathermy can accelerate healing.

Diathermy is used to treat the following conditions:

• arthritis
• back pain
• fibromyalgia
• muscle spasms
• myositis
Risks of diathermy

❖ The electromagnetic energy used in shortwave and microwave diathermy can

cause extreme heat in metal devices such as:
• bone pins
• dental fillings
• metal sutures
❖ This could cause burns in the tissue near the implant.
❖ The procedure should not be used over these areas to avoid the risk of burning.
❖ During diathermy treatment, you become a part of the electrical field. Touching a
bare metal object, including a metal part of the diathermy cabinet, can cause a
shock or burn.
Who’s not qualified for diathermy?
❖ People with implanted metal devices may be at risk for injury if they undergo
any type of diathermy. These devices include:
• pacemaker
• prosthesis
may not be an appropriate candidate for this treatment if he have:
• cancer
• reduced skin sensation
• peripheral vascular disease
• tissue with restricted blood supply (ischemia)
• infections
• fractured or broken bones
• bleeding disorders
• severe heart, liver, or kidney conditions
• pregnancy
 Telemetry
✓ Telemetry is the automatic recording and transmission of data from
remote or inaccessible sources to an IT system in a different location for
monitoring and analysis.
✓ Telemetry data may be relayed using radio, infrared, ultrasonic, GSM, satellite or
cable, depending on the application.

How Telemetry Works

1. In a general sense, telemetry works through sensors at the remote source which measures
physical (such as precipitation, pressure or temperature) or electrical (such as current or
voltage) data.
2. This is converted to electrical voltages that are combined with timing data.
3. They form a data stream that is transmitted over a wireless medium, wired or a
combination of both.
4. At the remote receiver, the stream is disaggregated and the original data
displayed or processed based on the user’s specifications.

42
Applications

• ECG telemetry system

• Temperature telemetry system

• Obstetrical telemetry system

• Telemetry in Operation theatres

• Physiology studies through telemetry systems

• Implantable blood flow telemetry system

ECG Telemetry system

There are two main parts:

• The Telemetry Transmitter which consists of an ECG amplifier, a sub-carrier oscillator and a UHF
transmitter along with dry cell batteries.
• Telemetry Receiver consists of a high frequency unit and a demodulator, to which an electrocardiograph
can be connected to record, a cardioscope to display and a magnetic tape recorder to store the ECG. A
heart rate meter with an alarm facility can be provided to continuously monitor the beat-to-beat heart
rate of the subject.
Bio-Telemetry

Need

Sometimes, it becomes essential to monitor physiological events from a distant place.

Some of such situations are:

(a) Monitoring of astronauts during flight.

(b) Monitoring of patients in ambulance while transit to hospital.
(c) Monitoring of patients while obtaining their exercise electrocardiogram.
(d) Monitoring of patients who are permitted to stay away from the hospital.
(e) Monitoring of animals in their natural habitat.
(f) Transmission of ECG or other medical information through telephone link
(g) Isolating the patients from electricity operated measuring equipment
such as ECG equipment in order to prevent any accidental shock to them.
Definition

✓ Biotelemetry is a method of measuring biological parameters from a distance.

✓ It is in fact modification of existing methods of measuring physiological
variables to a method of transmission of resulting data.
✓ The transmission of data from the point of generation to the point of reception
can be done in various ways.
✓ The stethoscope is the simplest device which uses this principle of
biotelemetry.
✓ The device amplifies acoustically the heartbeats and transmits their sound to
the ears of a doctor through a hollow tube system.
✓ Certain applications of biotelemetry use telephone lines for transmission.
Application

Biotelemetry mainly uses radio transmission by suitably modifying the biological data. Earlier times, the
telemetry could be applied to measure

(1) Temperature by rectal or oral thermistor

(2) Electrocardiograms by surface electrodes
(3) Indirect blood pressure by contact microphone and cuff
(4) Respiration by impedance pneumograph.

• However it is possible now to apply biotelemetry to almost all measurements such as bioelectrical
variables e.g. ECG, EMG and EEG and physiological variables that require transducers eg blood pressure,
blood flow and temperatures.
• The signal is obtained directly in electrical form in bioelectrical measurements require external excitation
for the conversion of physiological variables into variations of resistance, induction or capacitance.
• Used for diagnosis of internal part
mainly gastrointestinal system which cannot be
easily done with the help of normal endoscope.

• It is modern wireless type of

endoscopic monitoring system.
Definition & principle

✓ The Radio pill is a small capsule shaped electronic pill that can
be comfortably swallowed by any normal patient.

✓ It consists of lens, antenna, transmitters, camera or sensors and

battery.
✓ It can reach regions such as small intestine and provides the
video wirelessly to the receiving device connected to the
monitoring system outside the human body and kept at distance of
1 meter.
✓ The transmission of data takes place through the radio
communication between electronic pill transmitter and external
receiver.
✓ Parameters such as temperature, pH and pressure of
gastrointestinal tract can be measured
✓ For the detection of diseases and disturbance in gastro
intestinal system which prevents the entry of conventional
endoscopic tube, a micro pill with single channel radio telemetric
function is preferred.

✓The invention of semiconductors provides ease in development

of concise electronic pill capable to carry and transmit huge
amount of data at a time without affecting the human body.
✓The diagram below represents the wireless video transmission
between transmitter and receiver:
Advantages

• Outside the lab or clinic, the pills are also useful.

• When monitoring variables from a moving object, for example: in studying

athletes during a sporting event or fish with a specific identification swimming
close to the aerial, the signal can be picked up and recorded on a small tape
recorder and the recording can then be analyzed in the laboratory.

• It would be feasible in factories to have a small solid-state tape recorder in each

situation that requires monitoring, and the data could then be analyzed at a
central station.
Endoscopy

❖ A procedure in which an instrument is introduced into the body to give a

view of its internal parts.
❖ "an upper gastrointestinal endoscopy revealed gastritis"

❖ An endoscopy is a test that looks inside the body.

❖ The endoscope is a long flexible tube that can be swallowed.
❖ It has a camera and light inside it.
❖ Some doctors call it a telescope.
Parts of endoscope
An endoscope can consist of
➢ A rigid or flexible tube
➢ A light delivery system to
illuminate the organ or object
under inspection.
➢ The light source is normally
outside the body and the light is
typically directed via an optical
fiber system A lens system
transmitting the image
to the viewer from the fiberscope
➢ An additional channel to allow
entry of medical instruments or
manipulators
Upper GI endoscopy can be used to identify many different diseases:
gastroesophageal reflux disease.
ulcers.
cancer link.
inflammation, or swelling.
precancerous abnormalities such as Barrett's esophagus.
celiac disease.
strictures or narrowing of the esophagus.
blockages.

Types of Endoscopy:

•Capsule endoscopy.
•Colonoscopy.
•ERCP.
•ERCP biliary study.
•Endoscopic ultrasound.
•Esophageal manometry.
•Small bowel manometry.