John G. Webster, PhD, is Emeritus Professor of Biomedical Engineering at the University of Wisconsin—Madison.

Amit J. Nimunkar, PhD, is a Faculty Associate in Biomedical Engineering at the University of Wisconsin—Madison.

Acknowledgments xiii

Preface xv

List of Symbols xviii

1 Basic Concepts of Medical Instrumentation 1
Walter H. Olson and John G. Webster

1.1 Terminology of Medicine and Medical Devices 2

1.2 Generalized Medical Instrumentation System 3

1.3 Alternative Operational Modes 5

1.4 Medical Measurement Constraints 7

1.5 Classifications of Biomedical Instruments 10

1.6 Interfering and Modifying Inputs 10

1.7 Compensation Techniques 12

1.8 Biostatistics 14

1.9 Generalized Static Characteristics 18

1.10 Generalized Dynamic Characteristics 26

1.11 Amplifiers and Signal Processing 40

1.12 Inverting Amplifiers 42

1.13 Noninverting Amplifiers 45

1.14 Differential Amplifiers 47

1.15 Comparators 53

1.16 Rectifiers 55

1.17 Logarithmic Amplifiers 60

1.18 Integrators 61

1.19 Differentiators 62

1.20 Active Filters 64

1.21 Frequency Response 68

1.22 Offset Voltage 71

1.23 Bias Current 73

1.24 Input and Output Resistance 75

1.25 Design Criteria 77

1.26 Commercial Medical Instrumentation Development Process 77

1.27 Regulation of Medical Devices 80

Problems 85

References 89

2 Basic Sensors and Principles 91
Robert A. Peura and John G. Webster

2.1 Displacement Measurements 91

2.2 Resistive Sensors 92

2.3 Bridge Circuits 102

2.4 Inductive Sensors 104

2.5 Phase-Sensitive Demodulators 107

2.6 Capacitive Sensors 110

2.7 Piezoelectric Sensors 113

2.8 Accelerometer 119

2.9 Temperature Measurements 119

2.10 Thermocouples 120

2.11 Thermistors 123

2.12 Radiation Thermometry 128

2.13 Fiber-Optic Temperature Sensors 133

2.14 Optical Measurements 133

2.15 Radiation Sources 135

2.16 Geometrical and Fiber Optics 140

2.17 Optical Filters 143

2.18 Radiation Sensors 144

2.19 Optical Combinations 148

Problems 148

References 150

3 Microcontrollers in Medical Instrumentation 153
Amit J. Nimunkar

3.1 Basics of Microcontroller 153

3.2 Embedded Medical System 154

3.3 ECG-Based Embedded Medical System Example 156

3.4 Selection of a Microcontroller 161

3.5 IoT-Based Medical Devices 188

Problems 191

References 193

4 The Origin of Biopotentials 196
John W. Clark, Jr.

4.1 Electrical Activity of Excitable Cells 197

4.2 Volume Conductor Fields 206

4.3 Functional Organization of the Peripheral Nervous System 209

4.4 The Electroneurogram 211

4.5 The Electromyogram 216

4.6 The Electrocardiogram 219

4.7 The Electroretinogram 232

4.8 The Electroencephalogram 238

4.9 The Magnetoencephalogram 259

Problems 260

References 264

5 Biopotential Electrodes 267
Michael R. Neuman

5.1 The Electrode–Electrolyte Interface 268

5.2 Polarization 271

5.3 Polarizable and Nonpolarizable Electrodes 275

5.4 Electrode Behavior and Circuit Models 282

5.5 The Electrode–Skin Interface and Motion Artifact 285

5.6 Body-Surface Recording Electrodes 289

5.7 Internal Electrodes 302

5.8 Electrode Arrays 309

5.9 Microelectrodes 311

5.10 Electrodes for Electric Stimulation of Tissue 320

5.11 Practical Hints in Using Electrodes 323

Problems 325

References 329

6 Biopotential Amplifiers 333
Michael R. Neuman

6.1 Basic Requirements 333

6.2 The Electrocardiograph 335

6.3 Problems Frequently Encountered 348

6.4 Transient Protection 358

6.5 Common-Mode and Other Interference-Reduction Circuits 361

6.6 Amplifiers for Other Biopotential Signals 365

6.7 Example of a Biopotential Preamplifier 370

6.8 Other Biopotential Signal Processors 372

6.9 Cardiac Monitors 381

6.10 Biotelemetry 389

Problems 391

References 394

7 Blood Pressure and Sound 396
Robert A. Peura

7.1 Direct Measurements 399

7.2 Harmonic Analysis of Blood Pressure Waveforms 403

7.3 Dynamic Properties of Pressure-Measurement Systems 405

7.4 Measurement of System Response 414

7.5 Effects of System Parameters on Response 418

7.6 Bandwidth Requirements for Measuring Blood Pressure 419

7.7 Typical Pressure-Waveform Distortion 420

7.8 Systems for Measuring Venous Pressure 422

7.9 Heart Sounds 422

7.10 Phonocardiography 428

7.11 Cardiac Catheterization 428

7.12 Effects of Potential and Kinetic Energy on Pressure Measurements 433

7.13 Indirect Measurements of Blood Pressure 435

7.14 Tonometry 442

Problems 448

References 450

8 Measurement of Flow and Volume of Blood 452
John G. Webster

8.1 Indicator-Dilution Method that Uses Continuous Infusion 453

8.2 Indicator-Dilution Method that Uses Rapid Injection 455

8.3 Electromagnetic Flowmeters 459

8.4 Ultrasonic Flowmeters 467

8.5 Thermal-Convection Velocity Sensors 481

8.6 Chamber Plethysmography 484

8.7 Electrical-Impedance Plethysmography 486

8.8 Photoplethysmography 493

Problems 495

References 497

9 Measurements of the Respiratory System 499
Frank P. Primiano, Jr.

9.1 Modeling the Respiratory System 501

9.2 Measurement of Pressure 508

9.3 Measurement of Gas Flow 511

9.4 Lung Volume 520

9.5 Respiratory Plethysmography 528

9.6 Some Tests of Respiratory Mechanics 535

9.7 Measurement of Gas Concentration 548

9.8 Some Tests of Gas Transport 560

Problems 568

References 571

10 Chemical Biosensors 574
Robert A. Peura

10.1 Blood-Gas and Acid–Base Physiology 576

10.2 Electrochemical Sensors 580

10.3 Chemical Fibrosensors 589

10.4 Ion-Sensitive Field-Effect Transistor (ISFET) 606

10.5 Immunologically Sensitive Field-Effect Transistor (IMFET) 609

10.6 Noninvasive Blood-Gas Monitoring 610

10.7 Blood-Glucose Sensors 620

10.8 Electronic Noses 630

10.9 Lab-on-a-chip 631

10.10 Summary 632

Problems 633

References 633

11 Clinical Laboratory Instrumentation 637
Lawrence A. Wheeler

11.1 Spectrophotometry 638

11.2 Automated Chemical Analyzers 649

11.3 Chromatology 653

11.4 Electrophoresis 656

11.5 Hematology 659

Problems 671

References 671

12 Medical Imaging Systems 673
Melvin P. Siedband

12.1 Information Content of an Image 674

12.2 Modulation Transfer Function 678

12.3 Noise-Equivalent Bandwidth 680

12.4 Image Processing 681

12.5 Radiography 682

12.6 Computed Radiography 690

12.7 Computed Tomography 697

12.8 Magnetic Resonance Imaging 707

12.9 Nuclear Medicine 714

12.10 Single-Photon Emission Computed Tomography 722

12.11 Positron Emission Tomography 723

12.12 Ultrasonography 728

12.13 Contrast Agents 740

Problems 742

References 744

13 Therapeutic and Prosthetic Devices 746
Michael R. Neuman

13.1 Cardiac Pacemakers and Other Electric Stimulators 746

13.2 Defibrillators and Cardioverters 764

13.3 Mechanical Cardiovascular Orthotic and Prosthetic Devices 771

13.4 Hemodialysis 775

13.5 Lithotripsy 778

13.6 Ventilators 780

13.7 Infant Incubators 784

13.8 Drug Delivery Devices 786

13.9 Surgical Instruments 793

13.10 Therapeutic Applications of the Laser 797

Problems 798

References 800

14 Electrical Safety 803
Walter H. Olson

14.1 Physiological Effects of Electricity 804

14.2 Important Susceptibility Parameters 807

14.3 Distribution of Electric Power 813

14.4 Macroshock Hazards 818

14.5 Microshock Hazards 822

14.6 Electrical-Safety Codes and Standards 827

14.7 Basic Approaches to Protection Against Shock 829

14.8 Protection: Power Distribution 830

14.9 Protection: Equipment Design 833

14.10 Electrical-Safety Analyzers 838

14.11 Testing the Electric System 838

14.12 Tests of Electric Appliances 840

14.13 Conclusion 843

Problems 844

References 846

Appendix 848

A.1 Physical Constants 848

A.2 International System of Units (SI) Prefixes 848

A.3 International System of Units 849

A.4 Abbreviations 850

A.5 Chemical Elements 853

Index 855

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