EC2021-Medical Electronics Lesson Notes

Bio-Potential
Electrode Electrolyte Interface
General Ionic Equations
If electrode has same material as cation, then this material gets oxidized and enters the
electrolyte as a cation and electrons remain at the electrode and flow in the external
circuit.
If anion can be oxidized at the electrode to form a neutral atom, one or two electrons are
given to the electrode
The dominating reaction can be inferred from the following :
Current flow from electrode to electrolyte : Oxidation (oss of e!"
Current flow from electrolyte to electrode : #eduction ($ain of e!"
Half Cell Potential
% characteristic &otential difference established by the electrode and its surrounding
electrolyte which de&ends on the metal, concentration of ions in solution and tem&erature
(and some second order factors" .
Half cell otential cannot !e "easured #it$out a second electrode%
The half cell &otential of the standard hydrogen electrode has been arbitrarily set to zero.
Other half cell &otentials are ex&ressed as a &otential difference with this electrode.
&eason for Half Cell Potential ' C$ar(e )earation at Interface

+
+
+
me A A
ne C C
m
n
Oxidation or reduction reactions at the electrode!electrolyte interface lead to a double!
charge layer, similar to that which exists along electrically active biological cell
membranes.
Measurin( Half Cell Potential
Polari*ation
If there is a current between the electrode and electrolyte, the observed half cell &otential
is often altered due to &olarization.
Nernst Equation
'hen two a(ueous ionic solutions of different concentration are se&arated by an ion!
selective semi!&ermeable membrane, an electric &otential exists across the membrane.
The )ernst e(uation for half cell &otential is
where *+ : ,tandard -alf Cell .otential * : -alf Cell .otential
a : Ionic %ctivity (generally same as concentration"
n : )umber of valence electrons involved
Polari*a!le and Non-Polari*a!le Electrodes
Perfectly Polari*a!le Electrodes
These are electrodes in which no actual charge crosses the electrode!electrolyte interface
when a current is a&&lied. The current across the interface is a dis&lacement current and
the electrode behaves li/e a ca&acitor. *xam&le : %g0%gCl *lectrode
Perfectly Non-Polari*a!le Electrode
These are electrodes where current &asses freely across the electrode!electrolyte
interface, re(uiring no energy to ma/e the transition. These electrodes see no
Over &otentials. *xam&le : .latinum electrode
Example: Ag-AgCl is used in recording while Pt is use in stimulation
1
]
1

+


B A
D C
a a
a a
nF
RT
E E ln
+
Equi+alent Circuit
Cd : ca&acitance of electrode!eletrolyte interface
Rd : resistance of electrode!eletrolyte interface
Rs : resistance of electrode lead wire
Ecell : cell &otential for electrode
Electrode ),in Interface
,weat glands
and ducts
R
u
R
s
R
d
C
d
R
e
E
se
E
P
R
P
C
P
C
e
Motion -rtifact
.$y
'hen the electrode moves with res&ect to the electrolyte, the distribution of the double
layer of charge on &olarizable electrode interface changes. This changes the half cell
&otential tem&orarily.
.$at
If a &air of electrodes is in an electrolyte and one moves with res&ect to the other, a
&otential difference a&&ears across the electrodes /nown as the motion artifact. This is a
source of noise and interference in bio&otential measurements
1otion artifact is minimal for non!&olarizable electrodes
Body )urface &ecordin( Electrodes
2. 1etal .late *lectrodes (historic"
3. ,uction *lectrodes
Electrode
Eider"is
/er"is and
su!cutaneous layer
C
d
Gel
)tratu" Corneu"
Capillary
(historic interest"
2. 4loating *lectrodes
3. 4lexible *lectrodes
Co""only 0sed Biootential Electrodes
Metal late electrodes
5 arge surface: %ncient, therefore still used, *C$
5 1etal dis/ with stainless steel6 &latinum or gold coated
5 *1$, **$
5 smaller diameters
5 motion artifacts
5 7is&osable foam!&ad: Chea&8
(a" 1etal!&late electrode used for a&&lication to limbs.
(b" 1etal!dis/ electrode a&&lied with surgical ta&e.
(c"7is&osable foam!&ad electrodes, often used with *C$
Co""only 0sed Biootential Electrodes
)uction electrodes
! )o stra&s or adhesives re(uired
! &recordial (chest" *C$
! can only be used for short &eriods
1loatin( electrodes
! metal dis/ is recessed
! swimming in the electrolyte gel
! not in contact with the s/in
! reduces motion artifact
Co""only 0sed Biootential Electrodes
1le2i!le electrodes
! 9ody contours are often irregular
! #egularly sha&ed rigid electrodes
may not always wor/.
! ,&ecial case : infants
! 1aterial :
! .olymer or nylon with silver
! Carbon filled silicon rubber
(1ylar film"
7ouble!sided
%dhesive!ta&e
ring
*lectrolyte gel
in recess
(a" (b"
(c"
,na& coated with %g!%gCl *xternal sna&
.lastic cu&
Tac/
.lastic dis/
4oam &ad
Ca&illary loo&s
7ead cellular material
$erminating layer
$el!coated s&onge
1loatin( Electrodes
(a" Carbon!filled silicone rubber electrode.
(b" 4lexible thin!film neonatal electrode.
(c" Cross!sectional view of the thin!film electrode in (b".
Electrodes in Biootential Measure"ents
:. 7escribe the construction of commercial *C$ electrode (not the chea& &olymer
electrode used in the lab". 'hat is the common electrode metal, and why is it &referred;
,o, you are an inventor who has a better idea. 7escribe an im&rovement
< to ma/e the electrode chea&er
< more suitable for lower noise measurement for **$
< circumvent &atents that are based on &lastic0foam electrode body
< attractive to consumers for use with their *C$ machines at home
< reduce artifact (minimize the motion of s/in0electrode" in ambulatory recording

=. In a research laboratory, scientists want to record from single cells in a culture dish.
They want to record action &otentials from single, isolated heart cells. 'hat /ind of
electrode would they need to use (describe material and design"; $ive a sim&lified
schematic (circuit model of the electrode" described in the notes given to you.

'hat is the challenge involved in designing an am&lifier for use with a microelectrode
for single cell recording; I.e. what are the critical am&lifier design characteristics and
s&ecifications (hint: this is not the usual differential0instrumentation am&lifier" ;
Electrodes and Microelectrodes 3"iscellaneous4

< -ow would you detect bacteria or other microorganisms in water su&&ly; 1a/e
sure that your method distinguishes inert &articulate matter from living cellular
matter.
< 7raw the e(uivalent circuit model of the s/in and an *C$ electrode. Identify the
/ey sources of electrical interference and otherwise the elements that would li/ely
contribute to the &oor (uality of recordings.
< 7esign an am&lifier interface for the following two a&&lications: .atch clam& ion
channel current am&lifier: >our goal is to am&lify &% level current to &roduce 2
?olt out&ut.
< ,train gauge sensor am&lifier: >our goal is to convert 2+ ohm change in
resistance of a strain gauge to &roduce 2 volt out&ut.
Neural electrodes5"icroelectrodes
>ou want to record from neurons in the brain. -owever, you want to record from dozens
of neurons all at once from several closely s&aced microelectrodes. 'hat material and
&rocess would you use to ma/e the microelectrode array;
< 'hat metal would you &refer to use to ma/e electrode arrays of about 2+ micron
s(uare size to ma/e electrical contacts with dozens of neurons;
< 'hat metal would you &refer to use to stimulate dozens of neurons in a dee&
brain microelectrode based stimulator;
< (which metal &rovides good recording vs stimulating &ro&erties 5 and at the same
time not be toxic to brain tissue";
< >ou are as/ed to develo& an ex&erimental set u& to record from rat brain cells
using microelectrodes. 'hat &recautions would you ta/e to minimize the
electrical interference in your recording set u&;
Biootential -"lifiers
< These are very im&ortant &art of modern medical instrumentation
< 'e need to am&lify bio&otentials which are generated in the body at low levels with a high
source im&edance
< 9io&otentials am&lifiers are re(uired to increase signal strength while maintaining fidelity
Basic &equire"ents of Biootential -"lifiers
*ssential functions of a bioam&lifier are:
< To ta/e a wea/ bio&otential and increase its am&litude so that it can be &rocessed, recorded or
dis&layed
< To am&lify voltage, but it could be considered as a &ower am&lifier as well
< To am&lify current since in some cases a bio&otential am&lifier is used to isolate the load from
the source current gain only
Inut I"edance 36in4
< %ll bio&otential am&lifiers must have $i($ inut i"edance minimize loading (remember
the characteristics of bio&otential electrodes resulting into loading and distortion if in&ut
im&edance of the am&lifier is not high enough" 5 ty&ical values of @in over the fre(uency range
of the measurand A 2+ 1B (remember the loading rule"
Protection 7 Isolation
< The in&ut circuit of a bio&otential am&lifier must &rovide &rotection to the live measurand
8!io
< %ny &otential or current at am&lifierCs in&ut terminals can affect
8!io
< *lectric currents &roduced by the bio&otential am&lifier can result in microshoc/ and
macroshoc/
< The bioam&lifier must have isolation and &rotection circuitry so that the current through the
electrodes can be /e&t at safe levels and any artifact generated by such current can be minimized
9utut I"edance 36out4
< The out&ut circuit does not &resent any critical &roblems, all it needs to do is to drive the load
< 9utut i"edance "ust !e lo# with res&ect to the load im&edance and it must be ca&able of
satisfying the &ower re(uirements of the load
Band#idt$ 3B.4
1requency resonse re(uirements
< The bio&otential am&lifier must be sensitive to im&ortant fre(uency com&onents of the biosignal
< ,ince bio&otentials are low level signals, it is im&ortant to limit bandwidth o&timize signal!to!
noise ratio
Gain 3G4
< 9io&otential am&lifiers have a gain of 1000 or greater
Mode of 9eration
< ?ery fre(uently biosignals are obtained from bi&olar electrodes
< *lectrodes sy""etrically located #it$ resect to (round need differential am&lification
< -igh CM&& re(uired because:
2. Common mode signals much greater than the biosignal a&&ear on bi&olar electrodes
3. ,ymmetry with res&ect to ground is not &erfect (mismatch between electrode im&edances" 5
more on this later
Cali!ration )i(nal
< 1edical and clinical e(ui&ment re(uire (uic/ calibration < The gain of the bio&otential am&lifier
must be calibrated to &rovide us with an accurate indication of the signalCs am&litude
< .ush button to a&&ly standard signal to the in&ut of the bio&otential am&lifier
< %dDustable gain switch carefully selects calibrated fixed gains (in micro&rocessor5based
systems, gain adDustment can be
Electrocardio(ra$y
E % very widely used medical instrument, which is utilized to diagnose and monitor cardiac beat
abnormalities is the
electrocardio(ra$
E It measures the electrical activity of the heart (more &recisely bio&otential differences arising
from the electrical activity of myocardium". 'eCve already tal/ed about the genesis of the
*C$ signal.
E The *C$ machine uses surface electrodes and high in&ut im&edance
E 7ifferential am&lifiers with good common mode reDection ratio to record the electrocardiogram
E )ormal *C$ am&litude ranges between +.F!= m?. )ormal fre(uency content of *C$ (for
diagnostic &ur&oses" is +.+F!2++ -z. % ty&ical *C$ waveform is shown below:
Obviously all human hearts are not the same and this leads into
variability in different &arts of the *C$ signal
,ignificant diagnostic features of the *C$ signal are:
E 7uration of com&onent &arts of the signal
E .olarities and magnitudes
E The details of the *C$ signal and the degree of variability in different
&arts of the *C$ signal is shown below:
The G#, am&litude, &olarity, time duration, the ## interval (indicator of heartbeat &er min." and
the T!wave am&litude are some very im&ortant and distinctive features of the *C$ signal.
The $eart rate in BPM A 9eats .er 1inute" is sim&ly A :0 3&& inter+al in seconds4
,ome *C$ waveform abnormalities that may indicate illness are:
E %n extended .# interval may be diagnosed as %? node bloc/
E % widening of the G#, com&lex may indicate conduction &roblems in the bundle of -is
E %n elevated ,T segment may indicate occurrence of myocardial Infarction (MI"
E % negative &olarity in the T wave may be due to coronary insufficiency
ECG Leads
)ormal *C$ recordings for the standard lead connections leads I; II and III (ead II &rovides
the strongest signal"
Obviously, all human hearts are not the same and this results into a high degree of +aria!ility
E )ote the degree of variability of different &arts of the *C$ ,ignal
,ome abnormalities that may indicate illness:
%n extended .!# interval may be diagnosed as %? node bloc/
'idening of the G#, com&lex conduction &roblems in the bundle of -is
*levated ,T segment may indicate occurrence of 1I
)egative &olarity T wave may be due to coronary insufficiency G#, am&litude, &olarity, time
domain, .# interval (indicator of heat beat &er min. H T!wave am&litude are some very im&ortant
distinctive features.
2. oss
3.
9ri(in of t$e ECG si(nal
E 'e have already covered this conce&t extensively in the &revious lectures (The /iole filed of
the heart, the Eind$o+en<s =rian(le, the electrical circuit "odel for the electrocardiogra&hic
&roblem, etc."
E )tandard Li"! Leads 3I; II; III4
E The
The lead wires are color!coded according to some conventions. One exam&le is: 'hite 5&-
(#ight %rm", 9lac/ 5 L- 3eft %rm4, $reen 5 &L 3#ight eg4, #ed 5 LL 3eft eg4, and 9rown
5 C (Chest"
Note' There is a CM (common mode" am&lifier connected to the right leg. 'e will discuss this in
detail later.
-u("ented Li"! Leads
These leads offer a free F+I increase over leads 8&; 8L, and 81 connections (uni&olar leads"
with res&ect to 'ilson terminal -8& A -I III03, -8L A I II03, a81 A II I03
*ach measurement is made from the reflected limb and the average of the other two limbs.
C$est Leads 3Precordial4
C$est Lead -nato"ical Positions
81 - >t$ intercostal sace &i($t sternal "ar(in
82 - >t$ intercostal sace Left sternal "ar(in
8? Mid#ay !et#een 82 7 8>
8> @t$ intercostal sace on "id-cla+icular line
8@ )a"e as 8>; on t$e anterior a2illary line
8: )a"e as 8@; on t$e "id-a2illary line
12 Lead Clinical Electrocardio(ra$y
=$e ECG Mac$ine
1ost re&resentative ,&ecs:
< @in A 2+ 1B
< 4re(uency res&onse A +.+F 52++ -z
< ,tri& Chart #ecorder ,&eed A 3F mm0sec.
< 4ast ,&eed A 2++ mm0sec.
4or detailed ,&ecs. #efer to the Table in your text J,ummary of
&erformance re(uirements for electrocardiogra&hsK
ocation of the -eart
< The heart is located between the lungs behind the sternum and above the dia&hragm.
< It is surrounded by the &ericardium.
< Its size is about that of a fist, and its weight is about 3F+!:++ g.
< Its center is located about 2.F cm to the left of the midsagittal &lane.
%natomy of the heart
< The walls of the heart are com&osed of cardiac muscle, called myocardium.
< It consists of four com&artments:
5 the right and left atria and ventricles
The -eart ?alves
< The tricus&id valve regulates blood flow between the right atrium and right
ventricle.
< The &ulmonary valve controls blood flow from the right ventricle into the
&ulmonary arteries
< The mitral valve lets oxygen!rich blood from your lungs &ass from the left atrium
into the left ventricle.
< The aortic valve lets oxygen!rich blood &ass from the left ventricle into the aorta,
then to the body
9lood circulation via heart
< The blood returns from the systemic circulation to the right atrium and from
there goes through the tricus&id valve to the right ventricle.
< It is eDected from the right ventricle through the &ulmonary valve to the lungs.
< Oxygenated blood returns from the lungs to the left atrium, and from there
through the mitral valve to the left ventricle.
< 4inally blood is &um&ed through the aortic valve to the aorta and the systemic
circulation..
*lectrical activation of the heart
< In the heart muscle cell, or myocyte, electric activation ta/es &lace by means of
the same mechanism as in the nerve cell, i.e., from the inflow of )a ions across
the cell membrane.
< The am&litude of the action &otential is also similar, being 2++ m? for both nerve
and muscle
< The duration of the cardiac im&ulse is, however, two orders of magnitude longer
than in either nerve cell or sceletal muscle cell.
< %s in the nerve cell, re&olarization is a conse(uence of the outflow of L ions.
< The duration of the action im&ulse is about :++ ms
1echanical contraction of Cardiac 1uscle
< %ssociated with the electric activation of cardiac muscle cell is its mechanical
contraction, which occurs a little later.
< %n im&ortant distinction between cardiac muscle tissue and s/eletal muscle is
that in cardiac muscle, activation can &ro&agate from one cell to another
in any direction.
< *lectrical signal begins in the sinoatrial (,%" node: Mnatural &acema/er.M causes
the atria to contract.
< The signal then &asses through the atrioventricular (%?" node.
5 sends the signal to the ventricles via the Jbundle of -isK
5 causes the ventricles to contract.
The Conduction ,ystem
=$e -ction Potential
#ecording an %. re(uires the isolation of a single cell.
1icroelectrodes (with ti&s a few Nm across" are used to stimulate and record the
res&onse. % ty&ical %. is 3!=ms long with an am&litude of about 2++1v
=$e Electroence$alo(ra" EEG
**$ is the gra&hical re&resentation of the electrical activity of the brain
?ery commonly used to diagnose certain neurological disorders, such as e&ile&sy
1ore recently, also investigated whether it can detect various forms of dementia
or schizo&hrenia
**$ is the s&ecific recording obtained using the scal& electrodes from the
surface of the s/ull
7uring surgery, electrodes may also be &laced directly on the cortex. The
resulting signal is then electrocortico(ra" (*Co$".
Oust li/e *C$, **$ is also obtained using several different electrodes &laces on
different regions of the head 0 brain
=$e E+ent &elated
Potentials E&Ps
*#.s are really **$s obtained under a s&ecific &rotocol that re(uires the
&atient to res&onse to certain stimuli 5 hence event related &otentials.
%lso called e+o,ed otentials these signals can be used to diagnose certain
neurological disorders such as dementia, and they can also be used as a liedetector
< The oddball paradigm
< The guilty knowledge test
Electroretino(ra" E&G
The *#$ is the record of the retinal action currents &roduced by the retina in
res&onse to a light stimulus.
It measures the electrical res&onses of the light!sensitive cells (such as rods and cones".
The stimuli are often a series of light flashes or rotating &atterns
The *#$ is recorded using contact lens electrode that the subDect wears while watching
the stimuli.
P$onocardio(ra" PCG
The .C$ is the gra&hic record of the heart sounds and murmurs. It is thus a
mechanical 0 audio signal, rather than an electrical signal
Can be easily heard using a stethosco&e
Or can be converted into an electrical signal using a transducer
Ty&ically used to determine the disorders related to the heart valve, since their
routine o&ening and closing create the well!/nown sounds.
< ,2 sounds: 4irst heart sounds 5 ventricular contractions move blood into atria closing
of the %? (mitral and tricus&id" valves, then semilunar valves o&en and blood eDected
out of ventricles 5 immediately follows the G#, com&lex
< ,3 sounds: ,econd heart sounds 5 Closure of semilunar (aortic and &ulmonary" valves
< %ny unex&ected sound may indicate a malfunctioning valve that causes the blood flow
into 0 out of a chamber when it should not. %lso called heart murmurs.
7efine ultrasound
1echanical waves in different modalities (longitudinal0lateral" needs medium
to be &ro&agated (solid, li(uid, gas"
P 3+ /-z
Continuous0&ulsed
,&herical0&lanar0narrow beam0surface wave0amb!wave
.hysical &henomena behind ultrasound measurements
Transmission

reflection
transit time
differences in &ro&agation velocities
returns to transit time
do&&ler!shift in fre(uency
flow velocity
change of acoustic im&edance
com&aring to reference
interference of ultrasound waves (hologra&hy"
interaction of ultrasound and light (&hotoacousticz"
ultrasound needs medium for &ro&agation it doesnCt &ro&agate in vacuum
because mechanical waves need moving massunits and s&ring forces between
them
in acoustic emission the medium creates ultrasound (for exam&le, during &ressure
changes", which is received by sensors
&ulsed mode more common than continuous
continuous reguires se&arate transducers for transmitting and receicving
in &ulsed mode an ultrasound burst is sent to the obDect and the same transducer is
switched to listen echoes
standing wave &roblem
in us!thera&y &ulsed mode gives more effective care without too much heating
The 7o&&ler *(uation describes the relationshi& of the 7o&&ler fre(uency shift to target velocity.
The fre(uency difference is e(ual to the reflected fre(uency (4#" minus the originating fre(uency
(4T". If the resulting fre(uency is higher, then there is a &ositive 7o&&ler shift and the obDect is
moving toward the transducer, but if the resulting fre(uency is lower, there is a negative 7o&&ler
shift and it is moving away from the transducer. In its sim&lest form it would be calculated as if
the ultrasound was &arallel to the targetCs direction, as shown in diagram - below.
-owever, this would be a rare occurrence in clinical &ractice, because the transducer is rarely
&ointed head on to a blood vessel. In real life, the ultrasound waves would a&&roach the target
at an angle, called the 7o&&ler angle ( ". On the following &age, diagram B shows the 7o&&ler
e(uation used in general clinical situations, which includes the 7o&&ler angle.
=$e /oler -n(le
The ultrasound beam usually a&&roaches the moving target at an angle called the
Doppler angle 3 4. This reduces the fre(uency shift in &ro&ortion to the cosine of this
angle. If this angle is /nown then the flow velocity can be calculated. The e(uation used
is:
=$e /oler Equation
Q 7o&&ler shift fre(uency (the difference between the transmitted and
received fre(uencies"
Q transmitted fre(uency
Q reflected fre(uency
8 Q velocity of the blood flow towards the transducer
C Q velocity of sound in tissue
R Q the angle between the sound beam and the direction of moving blood
.$ere'
The 7o&&ler angle ( " is also /nown as the angle of insonation. It is estimated by
the sonogra&her by a &rocess /nown as angle correction, which involves aligning an
indicator on the du&lex image along the longitudinal axis of the vessel.
There are a few considerations that affect the &erformance of a 7o&&ler
examination that are inherent in the 7o&&ler e(uation, which are:
5 The cosine of S+T is zero, so if the ultrasound beam is &er&endicular to the
direction of blood flow, there will be no 7o&&ler shift and it will a&&ear as if
there is no flow in the vessel.
5 %&&ro&riate estimation of the angle of insonation, or angle correction, is
essential for the accurate determination of 7o&&ler shift and blood flow velocity.
The angle of insonation should also be less than U+T at all times, since the
cosine function has a stee&er curve above this angle, and errors in angle
correction will be magnified.
The sim&lest 7o&&ler devices use continuous wave (C' 7o&&ler", rather than the &ulsed
wave used in more com&lex devices. C' 7o&&ler uses two transducers (or a dual element
transducer" that transmit and receive ultrasound continuously. The transmit and receive
beams overla& in a 7o&&ler sam&le volume some distance from the transducer face, as
shown in the diagram below.
volume" is the region of transmitting and receiving beam overla& (shaded region".
9ecause there is continuous transducer transmission and rece&tion, echoes from all
de&ths within the area arrive at the transducer simultaneously.
,o although C' 7o&&ler can determine the direction of flow, it cannot discriminate
the different de&ths where the motion originates. The usefulness of C' 7o&&ler
devices is limited, but they are used clinically to confirm blood flow in su&erficial
vessels, as they are good at detecting low velocities. %s they are easily &ortable, this
can be done at the bedside or in the o&erating room. 1ost other clinical a&&lications
re(uire &ulsed wave 7o&&ler.
Pulsed .a+e /oler 3P. /oler4
.ulsed wave 7o&&ler (.' 7o&&ler" uses a single!element transducer that emits brief
&ulses of ultrasound energy. The time interval between transmitting and then receiving the
echoing sound can be used to calculate the de&th from where the echo arises.
The 7o&&ler sam&le volume can be chosen as to sha&e, de&th, and &osition in sam&ling the flow
data. 4or exam&le, the de&th is chosen by &rocessing only the signals that return to the transducer
in a sti&ulated time. 4or this techni(ue, the ultrasound system transmits a short &ulse. The eceiver
is o&ened to detect the returning echoes only after a controlled delay, and only for a s&ecific
duration. This time!based gating of the receiving channel allows the definition of a fixed
easuring distance which is often referred to as the ,am&le volume or 7o&&ler gate.
Then the next ultrasound wave is transmitted. The number of &ulses transmitted by the system
within a second is referred to as the &ulse re&etition fre(uency (.#4". The u&&er .#4 limit is
given by the time interval re(uired for the echoes to arrive from a sam&le volume located at a
certain de&th. The greater the sam&le!volume de&th, the longer the time before the echoes are
returned, and the longer the delay between &ulse transmission. The greater the sam&levolume
de&th, the lower will be the maximum .#4 setting. *rrors in the accuracy of the information
arise if the velocities exceed a certain s&eed. The highest velocity accurately measured is called
the )y(uist limit. 9eyond this limit, the errors that occur are referred to as aliasing.
?olume and flow measurement
4low 5 volume of a li(uid0gas &assing some &oint over a given time
$ases are com&ressible
9enedict #oth ,&irometer
'idely used for &hysiological H clinical studies
ight bell moves with the &tCs breathing
1ovement recorded by a &en on a rotating drum
'ater seal &revents lea/age of gas
,mall seal minimises volume of gas dissolved in water
,uitable for measuring limited gas vols (few litres"
.neumotachogra&h
Cardiac Out&ut
7efn: vol of blood &um&ed by the heart &er min
CO A ,? x -#
)orm V F l0min
Cardiac index 5 corrected for body surface area
%ffected by :
1et. #ate 5 &regnancy, hy&erthyroid, se&tic
.reload 0 contractility 0 afterload
Clinical indicators of CO im&recise
%ffected by anaesthetic agents used in everyday &ractice
.rovides estimate of:
whole body &erfusion
oxygen delivery
left ventricular function
.ersistently low CO assoc. with &oor outcome
1ethods:
4ic/ method
7ilution techni(ues 5 dye 0 thermal 0 lithium
.ulse contour analysis! i7CO H .iCCO
Oeso&hageal do&&ler
TO*
Transthoracic im&edance &lethysmogra&hy
Inert gas through flow
)on!invasive cardiac out&ut measurement
4ic/ .rinci&le: measure volume dis&lacement
2st &ro&osed 2WX+
Jthe total u&ta/e or release of a substance by an organ is the &roduct of the
blood flow through that organ and the arteriovenous concentration
difference of the substanceK
CO A O3 consum&tion (ml0min" art 5 mixed
venous O3 conc. (ml0l"
imited by cumbersome e(ui&ment, sam&ling errors, need for invasive
monitoring and steady!state haemodynamic and metabolic conditions
Indicator dilution techni(ues
J%n indicator mixed into a unit volume of constantly flowing blood can be used to
identify that volume of blood in time, &rovided the indicator remains in the system
between inDection and measurement and mixes com&letely in the bloodK
7ye dilution
Inert dye 5 indocyanin green
InDected into &ulmonary artery and arterial conc. measured using a
calibrated cuvette densitometer
.lot indicator dilution curve (see diagram"
CO derived from area under curve
Indicator 7ilution Curve
Cardiac Out&ut 1easurement
.$y !ot$er to c$ec, !lood ressureA
4or each 3+ mm rise in systolic blood &ressure or 2+ mm rise in diastolic blood
&ressure over 22F0XF:
#is/ of stro/e increases
#is/ of heart disease doubles
#is/ of renal failure increases
)ystolic and diastolic !lood ressure '
,ystolic blood &ressure is the highest &ressure in the arteries, Dust after the heart
beats
7iastolic blood &ressure is the lowest &ressure in the arteries, Dust before the heart
beats
9lood &ressure is measured indirectly by blood &ressure cuff
(s&hygmomanometer"
Inflating cuff increases &ressure until it cuts off arterial circulation to the arm
7eflating cuff, decrease &ressure by 3 to : mm of mercury &er second until blood
first enters the artery, creating turbulence6 this causes a sound with each heartbeat
,ounds continue with each heartbeat until &ressure lowers to the lowest &ressure
in the artery6 then turbulence sto&s, so the sound sto&s
,ystolic blood &ressure is the cuff &ressure at the first sounds6 diastolic is the cuff
&ressure Dust before the sounds sto&
.hase 2: shar& thuds, start at systolic blood &ressure
.hase 3: blowing sound6 may disa&&ear entirely (the auscultatory ga& "
.hase :: cris& thud, a bit (uieter than &hase 2
.hase =: sounds become muffled
.hase F: end of sounds !! ends at diastolic blood &ressure
1a/e sure the cuff is the right size ! its width should be at least =+I of the armYs
circumference. The cuff will overestimate blood &ressure if too small and
underestimate if too large.
.lace the cuff snugly on &atientYs &roximal arm, on s/in ( not cloth", centered over
the brachial artery (most cuffs have mar/ings"
,u&&ort the &atientYs arm at heart level, using your arm or a des/
>our &atient should sit in the chair for F minutes before 9. is measured, and
should have no caffeine or nicotine for :+ minutes before (O%1% 3X:, &.2322!
232W, 2SSF"
'ith fingers &al&ating radial or brachial artery, inflate cuff ra&idly until you canYt
feel the &ulse, then 3+ mm higher
#elease cuff at 3 to : mm -g &er second until you again feel the &ulse6 this is the
&al&able systolic &ressure
'ait :+ seconds before measuring blood &ressure
1easuring &al&able &ressure first avoids ris/ of seriously underestimating blood
&ressure because of the auscultatory ga& (mista/ing Lorot/off &hase : for &hase
2". 1any doctors s/i& this ste& for time reasons and instead &um& cuff to 3++ mm
-g at the next ste&"
.hase 3 of the Lorot/off sounds can be inaudible ! es&ecially in older &atients
with systolic hy&ertension, who are at es&ecially high ris/ of stro/e. Inflating the
cuff until you donYt hear sounds can give you a reading of 2=+0WU when the
&atientYs actual blood &ressure is 33+0WU. 1ost &hysicians are &ressed for time, so
they instead inflate the cuff to 3++ mm, which is beyond the auscultatory ga& in
most &atients. 9ut &al&able systolic blood &ressure is, according to research, more
reliable.
.lace bell of stethosco&e (dia&hragm is acce&table" over brachial artery
#a&idly &um& the cuff to 3+ to :+ mm -g above &al&able systolic &ressure
#elease &ressure in the cuff by 3 to : mm -g &er second and listen for Lorot/off
sounds, including systolic (first" and diastolic (last"
#ecord as systolic0diastolic. Chec/ in both arms the first time you chec/ a
&atientYs blood &ressure. It may differ by 2+ mm -g or more.
If the sounds continues to zero, record diastolic blood &ressure as the &oint when
sounds become muffled (&hase =" over zero: e.g. 2:+0X+0+, or Dust as 2:+0X+.
#ate
5 )umber of beats in :+ seconds x 3
,trength
5 9ounding, strong, or wea/ (thready"
#egularity
5 #egular or irregular
>ou need three readings on two occasions to diagnose hy&ertension, unless blood
&ressure is very high
)ormal blood &ressure in children is:
5 2+30FF at 2 year, 2230US at F years, 22S0XW at 2+ years
9lood &ressures in adults (O)C ?II: O%1% 3WS:3FU+!X3, 3++:":
5 )ormal: Z23+0ZW+
5 .rehy&ertensive: 23+!2:S0W+!WS
5 ,tage 2 hy&ertension: 2=+!2FS0S+!SS
5 ,tage 3 hy&ertension: P2U+0P2++
%dult: U+ to 2++
)ewborn: 23+!2X+
2 year: W+!2U+
: years: W+!23+
U years: XF!22F
2+ years: X+!22+
Ho# to "easure' observe rise and fall of chest
In infants, count for U+ seconds6 in adults, 2F or :+ seconds
Nor"al resiration'
%dults: 23 to 3+
Children:
newborn :+!W+
2 year 3+!=+
: years 3+!:+
U years 2U!33
#ate
)umber of breaths in :+ seconds x 3
Guality
Character of breathing
#hythm
#egular or irregular
*ffort
)ormal or labored
)oisy res&iration
)ormal, stridor, wheezing, snoring, gurgling
7e&th
,hallow or dee&
&- electrode
$overning e(uation is the )ernst *(uation
&CO3 *lectrode
The measurement of &CO3 is based on its linear relationshi& with &- over the range of
2+ to S+ mm -g.
The dissociation constant is given by
Ta/ing logarithms
&- A log[-CO:!\ 5 log / 5 log a 5 log &CO3
[ ]
[ ]
E
R T
n F

_
,
l n
+
! C ! C ! C !
3 3 3 : :
+ +
+
[ ] [ ]
"
C !
a p C !

+
:
3
Diathermy
In the natural sciences, the term diathermy means electrically induced heat and is
commonly used for muscle rela!ation. It is also a method of heating tissue
electromagnetically or ultrasonically for therapeutic purposes in medicine.Contents
[hide\
2 -eating uses
3 ,urgical uses
: Trivia
= #eferences

Heating uses
]ltrasonic diathermy refers to heating of tissues by ultrasound for the &ur&ose of
thera&eutic dee& heating. )o tissue is ordinarily damaged hence it is generally used in
biomedical a&&lications.
*lectric diathermy uses high fre(uency alternating electric or magnetic fields, sometimes
with no electrode or device contact to the s/in, to induce gentle dee& tissue heating by
induction. %gain, no tissue is ordinarily damaged.
Surgical uses
#urgical diathermy is usually better /nown as Melectrosurgery.M (It is also referred to
occasionally as MelectrocauteryM, but see disambiguation below". *lectrosurgery and
surgical diathermy involve the use of high fre(uency %.C. electrical current in surgery as
either a cutting modality, or else to cauterize small blood vessels to sto& bleeding. This
techni(ue induces localized tissue burning and damage, the zone of which is controlled
by the fre(uency and &ower of the device. ,ome sources
[2\
insist that electrosurgery be
a&&lied to surgery accom&lished by high fre(uency %.C. cutting, and that
MelectrocauteryM be used only for the &ractice of cauterization with heated nichrome wires
&owered by 7.C. current, as in the handheld battery!o&erated &ortable cautery tools.
Trivia
1edical 7iathermy devices were used to cause interference to $erman radio beams used
for targeting night time bombing raids in ''II during the 9attle of the 9eams.
I. 7iathermy
%. Thera&eutic use
2. $eneration of local heating by high!fre(uency electromagnetic waves
3. Ca&acitance techni(ue^body is &laced in an electric field
a. 7i&oles^structures with &ositive and negative &oles
b. ,tructures with large numbers of di&oles have a greater
ca&acitance to store an electrical charge
c. $reatest heating occurs in tissues with fewer di&oles, &articularly
fatty tissues
:. #a&id rotation of di&oles causing mechanical friction and movement of
electrons results in local heating
=. Inductance techni(ue^body is not &laced in an electric field
a. 1agnetic waves generated by driving current through a coiled
wire
b. 1agnetic field creates currents in tissues
c. $reatest heating occurs in tissues with low im&edance,
es&ecially muscle
9. .recautions and contraindications
2. 7iathermy should not be used:
a. Over metal im&lants and cardiac &acema/ers^more research
needed regarding its use over metallic fixations
b. )ear the uterus of a &regnant woman or near the abdomen or
bac/ of a woman who might be &regnant
c. On individuals with infections
d. On individuals with acute inflammation
e. Over moist, o&en wounds
f. On &atients with malignant tumors
g. Over large Doint effusions
C. .ulsed electromagnetic fields and diathermy
2. Can be &ulsed to decrease total energy transmitted to the tissues
3. ,hort!wave diathermy can be adDusted into a nonthermal range
a. Classified as &ulsed electromagnetic field (.*14" or
b. .ulsed radio fre(uency energy (.#4*"
:. Im&ortant reclassification as diathermy im&lies heating
7. *fficiency of diathermy and .*14 thera&y for musculos/eletal conditions
2. Current research is limited, but results suggest that diathermy enhances
treatments directed at soft tissue stretching
3. ,ome studies suggest that .*14 may s&eed wound healing and &romote
healing of nonunion fractures
7iathermy is a modality that uses electromagnetic energy to heat dee&er tissues.
7iathermy is more effective than ultrasound at heating a larger area of dee& tissues.
The athletic trainer must identify and res&ect contraindications to a&&lication of
ultrasound and diathermy.
.ulsed ultrasound and diathermy are used to treat slow!to!heal lesions, including s/in
ulcers and nonunion fractures, and may be able to facilitate re&air of other tissues,
including ligaments and tendons.
/iat$er"y
/efinition
In diathermy, high!fre(uency electrical currents are used to heat dee& muscular tissues. The heat
increases blood flow, s&eeding u& recovery. 7octors also use diathermy in surgical &rocedures by
sealing blood vessels with electrically heated &robes.
The term diathermy is derived from the $ree/ words therma$ meaning heat, and dia$ meaning
through. 7iathermy literally means heating through.
9ri(ins
The thera&eutic effects of heat have long been recognized. 1ore than 3,+++ years ago, the
#omans too/ advantage of heat thera&ies by building hot!s&ring bathhouses. ,ince then, various
methods of using heat have evolved. In the early 2WS+s, 4rench &hysiologist %rs_ne dY%rsonval
began studying the medical a&&lication of high!fre(uency currents. The term diathermy was
coined by $erman &hysician Carl 4ranz )agelschmidt, who designed a &rototy&e a&&aratus in
2S+U. %round 2S3F, ]nited ,tates doctor O. '. ,chereschews/y began studying the &hysiological
effects of high!fre(uency electrical currents on animals. It was several years, however, before the
fundamentals of the thera&y were understood and &ut into &ractice.
Benefits
7iathermy can be used to treat arthritis, !ursitis, and other conditions involving stiff, &ainful
Doints. It is also used to treat &elvic infections and sinusitis. % benefit of diathermy is that it is a
&ainless &rocedure that can be administered at a clinic. %lso, if the treatment relieves ain, then
&atients can discontinue &ain /illers and esca&e their high cost and side effects.
/escrition
7iathermy involves heating dee& muscular tissues. 'hen heat is a&&lied to the &ainful area,
cellular metabolism s&eeds u& and blood flow increases. The increased metabolism and
circulation accelerates tissue re&air. The heat hel&s the tissues relax and stretch, thus alleviating
stiffness. -eat also reduces nerve fiber sensitivity, increasing the &atientYs &ain threshold.
There are three methods of diathermy. In each, energy is delivered to the dee& tissues, where it is
converted to heat. The three methods are:
,hortwave diathermy. The body &art to be treated is &laced between two ca&acitor &lates.
-eat is generated as the high!fre(uency waves travel through the body tissues between
the &lates. ,hortwave diathermy is most often used to treat areas li/e the hi&, which is
covered with a dense tissue mass. It is also used to treat &elvic infections and sinusitis.
The treatment reduces inflammation. The 4ederal Communications Commission
regulates the fre(uency allowed for short!wave diathermy treatment. 1ost machines
function at 3X.:: megahertz.
]ltrasound diathermy. In this method, high!fre(uency acoustic vibrations are used to
generate heat in dee& tissue.
1icrowave diathermy. This method uses radar waves to heat tissue. This form is the
easiest to use, but the microwaves cannot &enetrate dee& muscles.
7iathermy is also used in surgical &rocedures. 1any doctors use electrically heated &robes to seal
blood vessels to &revent excessive bleeding. This is &articularly hel&ful in neurosurgery and eye
surgery. 7octors can also use diathermy to /ill abnormal growths, such as tumors, #arts, and
infected tissues.
Prearations
To /ee& &atients from sweating, &atients are usually as/ed to remove clothing from the body &art
being treated. If a &atient sweats, the electrical currents may &ool in the area, causing !urns.
%lso, clothing containing metal must be removed, as must earrings, buttons, barrettes, or zi&&ers
that contain metal. 'atches and hearing aids should be removed because the thera&y may affect
their function.
.ractitioners of surgical diathermy should steer clear of alcohol!based solutions to &re&are and
cleanse the s/in. These &re&arations can create a flammable va&or and cause burns and fires.
Precautions
.atients with metal im&lants should not undergo diathermy treatment because the metal can act as
a conductor of heat and result in serious internal burns. 4emale &atients with metallic uterine
im&lants, such as an I]7, should avoid treatment in the &elvic area. 7iathermy should not be
used in Doints that have been re&laced with a &rosthesis or in those with sensory im&airment who
may not be able to tell if they are burning. 4urthermore, &ulsed shortwave diathermy should be
avoided during re(nancy, as it can lead to abnormal fetal develo&ment.
.atients with hemo&hilia should avoid the treatment because the increased blood flow could
cause them to hemorrhage.
)ide effects
,ome &atients may ex&erience su&erficial burns. ,ince the thera&y involves creating heat, care
must be ta/en to avoid burns, &articularly in &atients whose inDuries have caused decreased
sensitivity to heat. %lso, diathermy may affect &acema/er function.
4emale &atients who receive treatment in the lower bac/ or &elvic area may ex&erience an
increased menstrual flow.
&esearc$ 7 (eneral accetance
4or years, &hysiothera&ists and &hysical thera&ists have used diathermy as a routine &art of
&hysical rehabilitation.
Electrical )afety
*lectrical safety is very im&ortant in hos&itals as &atients may be undergoing a diagnostic or
treatment &rocedure where the &rotective effect of dry s/in is reduced. %lso &atients may be
unattended, unconscious or anaesthetised and may not res&ond normally to an electric current.
4urther, electrically conductive solutions, such as blood and saline, are often &resent in &atient
treatment areas and may dri& or s&ill on electrical e(ui&ment.
*lectric Current
ea/age Current
*xtension eads
7ouble %da&tors
*(ui&ment Classification
Class I
Class II
7efibrillator!.roof
.rotective 7evices
#esidual Current 7evices (#C7"
ine Isolation overload 1onitors (I1s"
*(ui&ment *arthing
%rea Classification
9ody .rotection %rea
Cardiac .rotected %rea
Other *lectrical Issues
*xtension eads
7ouble %da&ters
1ain *xtension 7evices
.ower 9oards
Installation of %dditional .ower .oints
Electric Current
InDuries received from electric current are de&endent on the magnitude of current, the &athway
that it ta/es through the body and the time for which it flows.
The nature of electricity flowing through a circuit is analogous to blood flowing through the
circulatory system within the human body. In this analogy the source of energy is re&resented by
the heart, and the blood flowing through arteries and veins is analagous to current flowing
through the conductors and other com&onents of the electric circuit.
The a&&lication of an electric &otential to an electric circuit generates a flow of current through
conductive &athways. This is analogous to the changes in blood &ressure caused by contraction of
cardiac muscle that causes blood to flow into the circulatory system. 4or electric current to flow
there must be a continuous &athway from the source of &otential through electrical com&onents
and bac/ to the source.
"eakage Current
*lectrical com&onents and systems are encased in non conducting insulation, to ensure that the
electric current is contained and follows the intended &athways. If the insulation deteriorates or
brea/s down, current will lea/ through the insulation barrier and flow to earth. This may
be through the &rotective earth conductor or through the o&erator.
1edical e(ui&ment and clinical areas are fitted with a number of &rotective devices to &rotect the
&atient and o&erator from harmful lea/age currents.
E!tension "eads
*xtension leads are not &ermitted in clinical areas of #C- organisations. They may cause high
earth resistance and excessive earth lea/age current. %n extension lead can allow e(ui&ment to
be &owered from areas other than the relevant &rotected treatment area. The &ower from the
other area may not be &rotected to the same level as the &ower in the treatment area.
%s the connection between the extension lead and the e(ui&ment mains cable is often on the floor
there is a high danger from fluid s&ills, tri&&ing and damage to the mains cable by trolleys when
an extension lead is used.
Double #daptors
7ouble ada&tors must not be used in #C- organisations. They may not sit securely in a wall
outlet, may not be able to &rovide ade(uate earth &rotection and may cause overloading,
overheating, fire or loss of electrical su&&ly.
E$%IP&E'T C"#((I)IC#TI*'(
There are several methods of &roviding &rotection for o&erators and &atients from electrical faults
and harmful lea/age current.
Class I
Class I e(ui&ment is fitted with a three core mains cable containing a &rotective earth wire.
*x&osed metal &arts on class I e(ui&ment are connected to this earth wire.
,hould a fault develo& inside the e(ui&ment and the ex&osed metal comes into contact with the
mains, the earthing conductor will conduct the fault current to ground. #egular testing &rocedures
ensure that earthing conductors are intact, as the integrity of the earth wire is of vital im&ortance.
Class II
Class II e(ui&ment is enclosed within a double insulated case and does not re(uire earthing
conductors. Class II e(ui&ment is usually fitted with a 3!&in mains &lug. %n internal electrical
fault is unli/ely to be hazardous as the double insulation &revents any external &arts from
becoming alive. Class II or double insulated e(ui&ment can be identified by the class II symbol
on the cabinet.
Class II ,ymbol:
Defibrillator+Proof
,ome medical e(ui&ment within the hos&ital is classified as defibrillator &roof. 'hen a
defibrillator is discharged through a &atient connected to defibrillator &roof e(ui&ment,
the e(ui&ment will not be damaged by the defibrillatorYs energy. 7efibrillator &roof e(ui&ment
can remain connected to the &atient during defibrillation. It is identified by one of the following
symbols.
7efibrillator &roof symbols.
9ody &rotected Cardiac &rotected
PR*TECTI,E DE,ICE(
1ost &atient care areas in the hos&ital are fitted with &rotective devices. These devices are
regularly tested, in accordance with the relevant guidelines &ublished by ,tandards %ustralia. The
level of &rotection &rovided is de&endent u&on the device and the area in which it is located.
Residual Current De-ices .RCD/
#C7Ys (safety switches" are used in &atient treatment areas to monitor and &rotect the mains
su&&ly. #C7Ys sense lea/age currents flowing to earth from the e(ui&ment. If a significant
lea/age current flows, the #C7 will detect it and shut off the &ower su&&lied to the e(ui&ment
within =+ milliseconds. -os&ital #C7Ys are more sensitive than those fitted in homes. % hos&ital
#C7 will tri& at 2+ milliam&eres lea/age current.
.ower outlets su&&lied through an #C7 have a Y,u&&ly %vailableY lam&. The lam& will extinguish
when the #C7 tri&s due to excessive lea/age current.
#esetting a #C7
am& indicates su&&ly is no longer available
7isconnect all e(ui&ment from the su&&ly
O&erate the reset button or lever on the su&&ly &anel and the Y,u&&ly %vailableY lam&
should illuminate. If not, contact 9iomedical *ngineering.
Connect an item of e(ui&ment. If the #C7 tri&s again, then this is the faulty item and
should be labelled and sent to 9iomedical *ngineering.
If the #C7 does not tri&, continue connecting e(ui&ment until the #C7 tri&s. The last
&iece of e(ui&ment connected to the su&&ly is most li/ely to be faulty as it will have
caused the #C7 to tri&. #emove the faulty item from service, label it and send to
9iomedical *ngineering as mentioned above.
"ine Isolation o-erload &onitors ."I&s/
In critical life su&&ort a&&lications where loss of &ower su&&ly cannot be tolerated, s&ecial &ower
outlets &owered by isolation transformers are installed.
ine Isolation 1onitors are installed to continually monitor electrical lea/age in the &ower
su&&ly system. If an electrical fault develo&s in a medical device connected to an isolated &ower
outlet, the I1 will detect the lea/age current. The I1 will alarm and indicate the level of
lea/age current, but will not shut off the electric su&&ly.
The faulty e(ui&ment can be identified by un &lugging one item of e(ui&ment at a time from the
su&&ly until the alarm sto&s sounding. *(ui&ment that is not faulty may be reconnected. 4aulty
e(ui&ment should be a&&ro&riately labelled and sent to 9iomedical *ngineering for re&air.
The I1 also monitors how much &ower is being used by the e(u&iment connected to it. If too
much &ower is being used, the I1 will alarm and indicate that there is an overload. The &ower
used must be reduced immediately by moving some e(ui&ment to another circuit as soon as
&ossible until the alarm sto&s sounding. 4ailure to reduce the load on the I1 will result in the
circuit brea/er tri&&ing and loss of &ower to the circuit.
E0uipotential Earthing
*(ui&otential earthing is installed in rooms classified as YCardiac .rotectedY electrical areas.
*(ui&otential earthing in treatment areas used for cardiac &rocedures is intended to minimise any
voltage differences between earthed &arts of e(ui&ment and any other ex&osed metal in the room.
This reduces the &ossibility of lea/age currents that can cause microelectrocution when the
&atient comes into contact with multi&le items of e(ui&ment, or if the &atient ha&&ens to come
into contact with metal items in the room whilr they are connected to a medical device.
%ll conductive metal in an e(ui&otential area is connected to a common e(ui&otential earth &oint
with s&ecial heavy duty cable.
#RE# C"#((I)IC#TI*'(
1ody Protected #rea
These areas are designed for &rocedures in which &atients are connected to e(ui&ment
that lowers the natural resistance of the s/in. %&&lied &arts such as electrode gels,
conductive fluids entering the &atient, metal needles and catheters &rovide an easy
&athway for current to flow.
The main occurrence of inDury from 9ody!Ty&e &rocedures is from high current levels
causing electric shoc/. % direct connection to the &atientYs heart is not &resent so the ris/
of Y1icroelectrocutionY ! fibrillation from minute current levels ! is reduced.
#esidual Current 7evices (#C7" or Isolation Transformers and ine Isolation 1onitors
(I1`s", are used in 9ody .rotected areas to &rovide &rotection against electrocution
from high lea/age currents. 9ody!.rotected %reas are identified with this sign.
Cardiac Protected #rea
'here the &rocedure involves &lacing an electrical conductor within or near the heart,
&rotection against fibrillation induced from small lea/age currents is re(uired. *lectrical
conductors used in these &rocedures include cardiac &acing electrodes, intracardiac *C$
electrodes and intracardiac catheters.
*(ui&otential earthing in conDunction with #C7Ys or I1Ys &rovides &rotection against
microelectrocution in Cardiac!Ty&e &rocedures.
4ault currents are reduced to magnitudes that are unli/ely to induce fibrillation. ]sed in
conDunction with #C7Ys or I1Ys, the magnitude and duration of any fault currents
sourced from e(ui&ment are limited.
Cardiac!.rotected %reas are identified with this sign.
*ther electrical issues
This &olicy aims to &rovide guidance to those who find that they need more electrical outlets than
those available, or that the existing electrical outlets are inconveniently located.
%s extension leads and multi&le outlet &ower boards can introduce additional hazards into an area
the following &rocedures should be observed.
E!tension leads
%&&roved extension leads (%, :XU+, 2SSU" may be used in some areas within the hos&ital but
1],T )OT 9* ],*7 I) .%TI*)T %#*%,. %ll electrical extension leads must be tagged with
an *ngineering 7e&artment maintenance tag, and re(uire a yearly safety ins&ection and test, via
the *ngineering 7e&artment.
Double adapters
7ouble ada&ters may cause overloading or e(ui&ment earthing &roblems and are not to be used in
'C-
&ains e!tension de-ice
The only mains extension device that is to be used in M.atient care areasM is the =!way or W!way
&ortable Core 9alance ]nit.
The 9iomedical *ngineering 7e&artment must a&&rove all units &rior to use. These units contain
a safety switch and can detect excessive lea/age current and disconnect the &ower in the event of
a hazardous situation.
Care must be exercised in the use of a &ortable Core 9alance ]nit. It should be located off the
floor and in a &osition that will &rotect it from &hysical abuse and &ossible entry of fluids. These
devices are ex&ensive and easily damaged. The device must be sent to 9iomedical *ngineering
every U months for safety testing.
Power boards
%&&roved multi&le!outlet &ower boards can be used across #C- but must not be used in &atient
care areas, exce&t areas a&&roved by the 9iomedical *ngineering 7e&artment.
The &ower boards must have overload &rotection, be fitted with internal safety shutters that
&rotect unused outlets and be fitted with an on0off switch for each outlet.
Medical Laser -lications
The main research subDects of the grou& of 1edical aser %&&lication are in the field of online
monitoring and diagnostics as well as the develo&ment of new thera&heutic methods. The main
focus in research is based u&on the use of ultrashort (fs" laser &ulses.
The main advantage of ultrashort laser &ulses is the extrem short interaction time which su&&ress
any unwanted side effects of the laser irradiation of the tissue. ,econdly the broad s&ectra of the
fs laser &ulses give the advantage to use the same laser &ulses for diagnostic a&&lications li/e the
o&tical coherence tomogra&hy (OCT".
4ollowing research subDects have s&ecial attention at the moment:

9tical Co$erence =o"o(ra$ie 39C=4
% fs!laser light source can be used to obtain images from inside the tissue when the &ulses are
coherent su&er&osed. This grou& uses this a&&lication to obtain an inside view of the vocal fold
and to measure the outline of the crystalline lens.

&efracti+e )ur(ery
The &rinci&le of getting rid of glasses with the hel& of a laser surgery (fs!%,IL", is underlying
ra&id im&rovements concerning &recision and safety. )ew technologies were evaluated and
transferred very fast in coo&eration with an industrial &artner.

=reat"ent of Pres!yoia
The flexibility of the crystalline lens can be increase by &ricise cuts which are induce by fs laser
&ulse inside the lens. The treatment of the &resbyo&ia is thin/able.




0ltrafast P$ysics
'hereas the a&&lications of ultrashort laser &ulses increase ra&idly is the &hysics of the
interaction between the laser &ulses and tissue in many case not fully understood. To obtain
im&roved /nowledge of the interaction for many fs!laser a&&lication this grou& &reforms
numerical simulations as well as fundamental ex&eriments.
=$er"o(ra$y
=$er"o(ra$y, t$er"al i"a(in(, or t$er"al +ideo, is a ty&e of infrared imaging.
Thermogra&hic cameras detect radiation in the infrared range of the electromagnetic s&ectrum
(roughly S++52=,+++ nanometers or +.S52= am" and &roduce images of that radiation. ,ince
infrared radiation is emitted by all obDects based on their tem&eratures, according to the blac/
body radiation law, thermogra&hy ma/es it &ossible to MseeM oneYs environment with or without
visible illumination. The amount of radiation emitted by an obDect increases with tem&erature,
therefore thermogra&hy allows one to see variations in tem&erature (hence the name". 'hen
viewed by thermogra&hic camera, warm obDects stand out well against cooler bac/grounds6
humans and other warm!blooded animals become easily visible against the environment, day or
night. %s a result, thermogra&hyYs extensive use can historically be ascribed to the military and
security services.
Thermal imaging &hotogra&hy finds many other uses. 4or exam&le, firefighters use it to see
through smo/e, find &ersons, and localize the base of a fire. 'ith thermal imaging, &ower lines
maintenance technicians locate overheating Doints and &arts, a telltale sign of their failure, to
eliminate &otential hazards. 'here thermal insulation becomes faulty, building construction
technicians can see heat lea/s to im&rove the efficiencies of cooling or heating air!conditioning.
Thermal imaging cameras are also installed in some luxury cars to aid the driver, the first being
the 3+++ Cadillac 7e?ille. ,ome &hysiological activities, &articularly res&onses, in human beings
and other warm!blooded animals can also be monitored with thermogra&hic imaging. [2\
The a&&earance and o&eration of a modern thermogra&hic camera is often similar to a camcorder.
*nabling the user to see in the infrared s&ectrum is a function so useful that ability to record their
out&ut is often o&tional. % recording module is therefore not always built!in.
Instead of CC7 sensors, most thermal imaging cameras use C1O, 4ocal .lane %rray (4.%". The
most common ty&es are In,b, In$a%s, -gCdTe and G'I. 4.%. The newest technologies are
using low cost and uncooled microbolometers 4.% sensors. Their resolution is considerably lower
than of o&tical cameras, mostly 2U+x23+ or :3+x3=+ &ixels, u& to U=+xF23 for the most
ex&ensive models. Thermogra&hic cameras are much more ex&ensive than their visible!s&ectrum
counter&arts, and higher!end models are often ex&ort!restricted. Older bolometers or more
sensitive models as In,b re(uire cryogenic cooling, usually by a miniature ,tirling cycle
refrigerator or li(uid nitrogen.
Contents
[hide\
2 7ifference between I# film and thermogra&hy
3 %dvantages of Thermogra&hy
: imitations H disadvantages of thermogra&hy
= %&&lications
F ,ee also
U *xternal lin/s
o U.2 -istory of thermal imager manufacturers
2edit3 Difference between IR film and thermography
Thermal imaging is going to be used on 1ars to detect caves that could hold life.
2edit3 #d-antages of Thermography
>ou get a visual &icture so that you can com&are tem&eratures over a large area
It is real time ca&able of catching moving targets
%ble to find deteriorating com&onents &rior to failure
1easurement in areas inaccessible or hazardous for other methods
It is a non!destructive test method
2edit3 "imitations 4 disad-antages of thermography
Guality cameras are ex&ensive and are easily damaged
Images can be hard to inter&ret accurately even with ex&erience
%ccurate tem&erature measurements are very hard to ma/e because of emissivities
1ost cameras have b3I or worse accuracy (not as accurate as contact"
Training and staying &roficient in I# scanning is time consuming
%bility to only measure surface areas
2edit3 #pplications
Condition monitoring
1edical imaging
)ight vision
#esearch
.rocess control
)on destructive testing
,urveillance in security, law enforcement and defense
Chemical imaging
Thermal infrared imagers convert the energy in the infrared wavelength into a visible light video
dis&lay. %ll obDects above + /elvins emit thermal infrared energy so thermal imagers can
&assively see all obDects regardless of ambient light. -owever, most thermal imagers only see
obDects warmer than !F+ TC.
The s&ectrum and amount of thermal radiation de&end strongly on an obDectYs surface
tem&erature. This ma/es it &ossible for a thermal camera to dis&lay an obDectYs tem&erature.
-owever, other factors also influence the radiation, which limits the accuracy of this techni(ue.
4or exam&le, the radiation de&ends not only on the tem&erature of the obDect, but is also a
function of the emissivity of the obDect. %lso, radiation also originates from the surroundings and
is reflected in the obDect, and the radiation from the obDect and the reflected radiation will also be
influenced by the absor&tion of the atmos&here

*ndosco&y
This &age is about having an endosco&y ! a test that loo/s at the inside of your digestive system.
There is information on
'hat endosco&y is
'hy you may have an endosco&y
-aving an endosco&y
>our results
5hat an endoscopy is
%n endosco&y is a test that loo/s inside the body. The endosco&e is a long flexible tube that can
be swallowed. It has a camera and light inside it. ,ome doctors call it a telesco&e.
5hy you may ha-e an endoscopy
>ou are most li/ely to have an endosco&y to loo/ at the inside of your
$ullet (oeso&hagus"
,tomach
7uodenum ! the first &art of the small bowel that attaches to the stomach
arge bowel (colon"
>our doctor may want to see inside because you have sym&toms, such as abnormal bleeding or
difficulty swallowing. The doctor can loo/ down the endosco&e and see if there are any growths
or other abnormal loo/ing areas. %lso through the endosco&e, the doctor can ta/e sam&les
(bio&sies" of any abnormal loo/ing tissues.
There is more detailed information about having a colonosco&y in the bowel cancer section of
Cancer-el& ]L. 9elow is information about having other ty&es of endosco&y.
6a-ing an endoscopy
>ou can have this test as an out &atient. 1ost &eo&le have a choice between having the test while
they are awa/e, or after having a medicine to ma/e them drowsy (a sedative". >our hos&ital may
not be ha&&y for you to have a sedative if you live alone and will have no one to loo/ after you
when you go home. If you live alone but really want sedation, your hos&ital may allow you to
stay overnight. >ou should as/ your doctor about this as early as &ossible, as extra arrangements
will need to be made beforehand.
If you donYt have a sedative, you will have a s&ray to numb the bac/ of your throat and ma/e it
easier for you to swallow the endosco&y tube.
If you would &refer to be aslee& during the test, you will have an inDection to ma/e you very
drowsy Dust before the test. >ou will need to ta/e someone with you to the hos&ital a&&ointment.
>ou wonYt be able to drive for the rest of the day and should have someone to go home with you.
>ou canYt eat or drin/ for about W hours before the test so that your stomach and duodenum are
em&ty. >our doctor will give you written instructions about this beforehand, or they may arrive
with your a&&ointment letter. 'hen you get to the clinic, you may be as/ed to ta/e your u&&er
clothing off and &ut on a hos&ital gown. ,ome hos&itals &refer to use gowns because your clothes
wonYt get messy. Once you are ready, you get onto the bed or c!ray couch. 'hen you are lying
comfortably you have the sedative inDection to ma/e you very drowsy. Or your doctor will s&ray
the bac/ of your throat to numb it.
Once the sedative or throat s&ray has wor/ed, the doctor will &ass the endosco&e tube down your
throat to the area being investigated. >our doctor will as/ you to swallow as the tube goes down,
but if youYve had a sedative, you wonYt remember that afterwards. If there are any abnormalities,
the doctor will ta/e &ieces of tissue from the abnormal loo/ing area to send to the laboratory for
closer ins&ection under a microsco&e. These tissue sam&les are called bio&sies.
'hen the test is over you will need to rest for a while. If youYve had a sedative, you may not
remember much (if anything" about the test once you have come round. >ou should be able to go
home the same day.
The results
It can ta/e time for test results to come through. -ow long will de&end on why you are having
the test. ]sually, the doctor who carries out the endosco&y dictates a re&ort straight way. The
re&ort is ty&ed u& by the de&artment secretary and goes to your s&ecialist, who gives the results to
you. If your $. has sent you for the test, the results will go directly to the $. surgery.
]nderstandably, waiting for results can ma/e you anxious. It usually ta/es a cou&le of wee/s for
the results to come through. If your doctor needed them urgently, it would have been noted on
the test re(uest form and the results will be ready sooner than that. Try to remember to as/ your
doctor how long you should ex&ect to wait for the results when you are first as/ed to go for the
test. If it is not an emergency, and you have not heard a cou&le of wee/s after your test, ring your
doctorYs secretary to chec/ if they are bac/.
Endoscoy
4rom 'i/i&edia, the free encyclo&edia
Oum& to: navigation, search
*ndosco&ic images of a duodenal ulcer
% flexible endosco&e.
Endoscoy means loo"ing inside and ty&ically refers to loo/ing inside the human body for
medical reasons using an instrument called an endoscoe. *ndosco&y can also refer to using a
boresco&e in technical situations where direct line!of!sight observation is not feasible.
Contents
[hide\
2 Overview
3 Com&onents
: ]ses
= -istory
F #is/s
U %fter The *ndosco&y
X #ecent develo&ments
W ,ee also
S #eferences
2+ 4ootnotes
22 *xternal lin/s
*-er-iew
*ndosco&y is a minimally invasive diagnostic medical &rocedure that is used to assess the interior
surfaces of an organ by inserting a tube into the body. The instrument may have a rigid or flexible
tube and not only &rovide an image for visual ins&ection and &hotogra&hy, but also enable ta/ing
bio&sies and retrieval of foreign obDects. *ndosco&y is the vehicle for minimally invasive surgery.
1any endosco&ic &rocedures are considered to be relatively &ainless and, at worst, associated
with mild discomfort6 for exam&le, in eso&hagogastroduodenosco&y, most &atients tolerate the
&rocedure with only to&ical anaesthesia of the oro&harynx using lignocaine s&ray.
[2\

Com&lications are not common (only FI of all o&erations"
[citation needed\
but can include &erforation
of the organ under ins&ection with the endosco&e or bio&sy instrument. If that occurs o&en
surgery may be re(uired to re&air the inDury.
Components
%n endosco&e can consist of
a rigid or flexible tube
a light delivery system to illuminate the organ or obDect under ins&ection. The light
source is normally outside the body and the light is ty&ically directed via an o&tical fiber
system
a lens system transmitting the image to the viewer from the fibersco&e
an additional channel to allow entry of medical instruments or mani&ulators
%ses
*ndosco&y can involve
The gastrointestinal tract ($I tract":
o eso&hagus, stomach and duodenum (eso&hagogastroduodenosco&y"
o small intestine
o colon (colonosco&y,&roctosigmoidosco&y"
o 9ile duct
endosco&ic retrograde cholangio&ancreatogra&hy (*#C.",
duodenosco&e!assisted cholangio&ancreatosco&y, intrao&erative
cholangiosco&y
The res&iratory tract
o The nose (rhinosco&y"
o The lower res&iratory tract (bronchosco&y"
The urinary tract (cystosco&y"
The female re&roductive system
o The cervix (col&osco&y"
o The uterus (hysterosco&y"
o The 4allo&ian tubes (4allosco&y"
)ormally closed body cavities (through a small incision":
o The abdominal or &elvic cavity (la&arosco&y"
o The interior of a Doint (arthrosco&y"
o Organs of the chest (thoracosco&y and mediastinosco&y"
7uring &regnancy
o The amnion (amniosco&y"
o The fetus (fetosco&y"
.lastic ,urgery
.anendosco&y (or tri&le endosco&y"
o Combines laryngosco&y, eso&hagosco&y, and bronchosco&y
)on!medical uses for endosco&y
o The &lanning and architectural community have found the endosco&e useful for
&re!visualization of scale models of &ro&osed buildings and cities (architectural
endosco&y"
o Internal ins&ection of com&lex technical systems (boresco&e"
o *ndosco&es are also a tool hel&ful in the examination of im&rovised ex&losive
devices by bomb dis&osal &ersonnel.
o The 49I uses endosco&es for conducting surveillance via tight s&aces.
6istory
The first endosco&e, of a /ind, was develo&ed in 2W+U by .hili& 9ozzini with his introduction of a
MichtleiterM (light conductor" Mfor the examinations of the canals and cavities of the human
bodyM. -owever, the ?ienna 1edical ,ociety disa&&roved of such curiosity. %n endosco&e was
first introduced into a human in 2W33 by 'illiam 9eaumont, an army surgeon at 1ac/inac Island,
1ichigan
[citation needed\
. The use of electric light was a maDor ste& in the im&rovement of endosco&y.
The first such lights were external. ater, smaller bulbs became available ma/ing internal light
&ossible, for instance in a hysterosco&e by Charles 7avid in 2S+W
[citation needed\
. -ans Christian
Oacobaeus has been given credit for early endosco&ic ex&lorations of the abdomen and the thorax
with la&arosco&y (2S23" and thoracosco&y (2S2+"
[citation needed\
. a&arosco&y was used in the
diagnosis of liver and gallbladder disease by -einz Lal/ in the 2S:+s
[citation needed\
. -o&e re&orted in
2S:X on the use of la&arosco&y to diagnose ecto&ic &regnancy
[citation needed\
. In 2S==, #aoul .almer
&laced his &atients in the Trendelenburg &osition after gaseous distention of the abdomen and thus
was able to reliably &erform gynecologic la&arosco&y
[citation needed\
.
The first gastrocamera was released in 2SF+ by Olym&us O&tical Co., td. The device too/
&ictures on monochromatic film using a small light bulb that was triggered manually. The device
was of limited use, however, because it did not im&lement real!time o&tical ca&ability. Olym&us
continued its develo&ment of endosco&es by incor&orating fiber o&tics in the early 2SU+s, leading
to the first useful endosco&es. In 2SU=, it released a gastrocamera guided by a fibersco&e.[2\ %
few articles claim that 7r.9asil -irschowitz of ]niv.Of 1ichigan,%nn %rbor discussed the
endosco&e in early F+Ys.[3\
%s endosco&ic technology im&roved, so did the methods of gastrointestinal endosco&y. Owing
&rimarily to the efforts of 7r. -iromi ,hinya in the late 2SU+s, $I endosco&y develo&ed into what
is more recognizable as todayYs colonosco&y. 'hile many doctors ex&erimented with techni(ues
to ta/e advantage of the new iterations of endosco&es, 7r. ,hinya focused on techni(ues that
would allow for successful o&eration of the endosco&e by an individual, reDecting the common
&ractice at the time of utilizing two &eo&le. Conse(uently, many of the fundamental methods and
&rocedures of modern colonosco&y were develo&ed by 7r. ,hinya.
7r. ,hinyaYs other great contribution was to thera&eutic endosco&y, in his invention of the
electrosurgical &oly&ectomy snare with the aid of Olym&us em&loyee -iroshi Ichi/awa. ,hinya
s/etched his first &lans for the device on Oanuary W, 2SUS. -e envisioned a loo& of wire attached
to the end of a colonosco&e that would allow for easy removal of &oly&s during investigation by
&assing a current through the wire. 9y ,e&tember of 2SUS, the first &oly&ectomy using this device
was &erformed. .oly&ectomy has since become the most common thera&eutic &rocedure
&erformed with an endosco&e. (,iva/ 3++="
9y 2SW+, la&arosco&y training was re(uired by gynecologists to &erform tubal ligation &rocedures
and diagnostic evaluations of the &elvis. The first la&arosco&ic cholecystectomy was &erformed in
2SW= and the first video!la&arosco&ic cholecystectomy in 2SWX
[citation needed\
. 7uring the 2SS+s,
la&arosco&ic surgery was extended to the a&&endix, s&leen, colon, stomach, /idney, and
liver
[citation needed\
. 'ireless ca&sule endosco&y or Ca&sule *ndosco&y is now a&&roved in all the
countries including Oa&an where government reimbusement will be available from
Oct.3++X.Ca&sule *ndosco&y [:\ increases detection of ,mall 9owel tumors where traditional
*ndosco&y is not very efficient.
Risks
Infection
.unctured organs
%llergic reactions due to Contrast agents or dyes (such as those used in a CT scan"
Over!sedation
#fter The Endoscopy
%fter the &rocedure the &atient will be observed and monitored by a (ualified individual in the
endosco&y or a recovery area until a significant &ortion of the medication has worn off.
Occasionally a &atient is left with a mild sore throat, which &rom&tly res&onds to saline gargles,
or a feeling of distention from the insufflated air that was used during the &rocedure. 9oth
&roblems are mild and fleeting. 'hen fully recovered, the &atient will be instructed when to
resume his0her usual diet (&robably within a few hours" and will be allowed to be ta/en home.
9ecause of the use of sedation, most facilities mandate that the &atient is ta/en home by another
&erson and not to drive on his0her own or handle machinery for the remainder of the day.
Recent de-elopments
'ith the a&&lication of robotic systems, telesurgery was introduced as the surgeon could o&erate
from a site &hysically removed from the &atient. The first transatlantic surgery has been called the
indbergh O&eration.

0er Endoscoy
]&&er endosco&y enables the &hysician to loo/ inside the
eso&hagus, stomach, and duodenum (first &art of the
small intestine". The &rocedure might be used to discover
the reason for swallowing difficulties, nausea, vomiting,
reflux, bleeding, indigestion, abdominal &ain, or chest
&ain. ]&&er endosco&y is also called *$7, which stands
for eso&hagogastroduodenosco&y (eh!,%-!fuh!goh!
$%,!troh!doo!%-!duh!)%-!s/uh!&ee".
4or the &rocedure you will swallow a thin, flexible,
lighted tube called an endosco&e (*)!doh!s/o&e". #ight
before the &rocedure the &hysician will s&ray your throat
with a numbing agent that may hel& &revent gagging. >ou
may also receive &ain medicine and a sedative to hel& you
relax during the exam. The endosco&e transmits an image
of the inside of the eso&hagus, stomach, and duodenum,
so the &hysician can carefully examine the lining of these
organs. The sco&e also blows air into the stomach6 this
ex&ands the folds of tissue and ma/es it easier for the
&hysician to examine the stomach.
The &hysician can see abnormalities, li/e inflammation or bleeding, through the endosco&e
that donYt show u& well on x rays. The &hysician can also insert instruments into the sco&e to
treat bleeding abnormalities or remove sam&les of tissue (bio&sy" for further tests.
.ossible com&lications of u&&er endosco&y include bleeding and &uncture of the stomach
lining. -owever, such com&lications are rare. 1ost &eo&le will &robably have nothing more
than a mild sore throat after the &rocedure.
The &rocedure ta/es 3+ to :+ minutes. 9ecause you will be sedated, you will need to rest at
the endosco&y facility for 2 to 3 hours until the medication wears off.
Prearation
>our stomach and duodenum must be em&ty for the &rocedure to be thorough and safe, so
you will not be able to eat or drin/ anything for at least U hours beforehand. %lso, you must
arrange for someone to ta/e you home^you will not be allowed to drive because of the
sedatives. >our &hysician may give you other s&ecial instructions.
The digestive system
What is Endoscopy and Why is it Performed?
Endoscopy allows physicians to peer through the body's passageways. Endoscopy is the
examination and inspection of the interior of body organs, joints or cavities through an
endoscope. An endoscope is a device that uses fiber optics and powerful lens systems to provide
lighting and visualization of the interior of a joint. he portion of the endoscope inserted into the
body may be rigid or flexible, depending upon the medical procedure.
An endoscope uses two fiber optic lines. A !light fiber! carries light into the body cavity and an
!image fiber! carries the image of the body cavity bac" to the physician's viewing lens. here is
also a separate port to allow for administration of drugs, suction, and irrigation. his port may also
be used to introduce small folding instruments such as forceps, scissors, brushes, snares and
bas"ets for tissue excision #removal$, sampling, or other diagnostic and therapeutic wor".
Endoscopes may be used in conjunction with a camera or video recorder to document images of
the inside of the joint or chronicle an endoscopic procedure. %ew endoscopes have digital
capabilities for manipulating and enhancing the video images.
This figure shows a rigid endoscope used for arthroscopy. The "image fiber" leads from the ocular
(eye piece) to the inserted end of the scope. The "light fiber" is below and leads from the light
source to the working end of the endoscope.
Why Is Endoscopy Performed
Endoscopy can be used to diagnose various conditions by close examination of internal organ
and body structures. Endoscopy can also guide therapy and repair, such as the removal of torn
cartilage from the bearing surfaces of a joint. &iopsy #tissue sampling for pathologic testing$ may
also be performed under endoscopic guidance. 'ocal or general anesthetic may be used during
endoscopy, depending upon the type of procedure being performed
(nternal abnormalities revealed through endoscopy include) abscesses, biliary #liver$ cirrhosis,
bleeding, bronchitis, cancer, cysts, degenerative disease, gallbladder stones, hernia,
inflammation, metastatic cancer, polyps, tumors, ulcers, and other diseases and conditions.
Endoscopy is a minimally invasive procedure and carries with it certain minor ris"s depending
upon the type of procedure being performed. *owever, these ris"s are typically far outweighed by
the diagnostic and therapeutic potential of the procedure.
+rior to the widespread use of endoscopy and diagnostic imaging, most internal conditions could
only be diagnosed or treated with open surgery. ,ntil the last several decades, exploratory
surgery was routinely performed only when a patient was critically ill and the source of illness was
not "nown. -or example, in certain dire cases, the patient's thorax or abdomen were surgically
opened and examined to try to determine the source of illness.
Endoscopy can often be done on an outpatient basis. !.utpatient! means that the procedure
does not re/uire hospital admission and acute care and observation and may be performed
outside the premises of a hospital. .utpatient procedures performed at hospitals or ambulatory
centers allow the patient to go home or return to wor" within a short while after their procedure.
Types of Endoscopy
-iber optic endoscopes now have widespread use in medicine and guide a myriad of diagnostic
and therapeutic procedures including)
Arthroscopy: examination of joints for diagnosis and treatment #arthroscopic surgery$
Bronchoscopy: examination of the trachea and lung's bronchial trees to reveal
abscesses, bronchitis, carcinoma, tumors, tuberculosis, alveolitis, infection, inflammation
Colonoscopy: examination of the inside of the colon and large intestine to detect polyps,
tumors, ulceration, inflammation, colitis diverticula, 0hrohn's disease, and discovery and
removal of foreign bodies.
Colposcopy: direct visualization of the vagina and cervix to detect cancer, inflammation,
and other conditions.
Cystoscopy: examination of the bladder, urethra, urinary tract, uteral orifices, and
prostate #men$ with insertion of the endoscope through the urethra.
ERCP (endoscopic retrograde cholangio-pancreatography) uses endoscopic guidance to
place a catheter for x1ray fluorosocopy with contrast enhancement. his techni/ue is used to
examine the liver's biliary tree, the gallbladder, the pancreatic duct and other anatomy to chec"
for stones, other obstructions and disease. 21ray contrast is introduced into these ducts via
catheter and fluoroscopic x1ray images are ta"en to show any abnormality or bloc"age. (f disease
is detected, it can sometimes be treated at the same time or biopsy can be performed to test for
cancer or other pathology. E30+ can detect biliary cirrhosis,.
cancer of the bile ducts, pancreatic cysts, pseudocysts, pancreatic tumors, chronic
pancreatitis and other conditions such as gallbladder stones.
E! (Esophogealgastrod"odensoscopy): visual examination of the upper gastro1
intestinal #4($ tract. #also referred to as gastroscopy$ to reveal hemorrhage, hiatal hernia,
inflammation of the esophagus, gastric ulcers.
Endoscopic #iopsy is the removal of tissue specimens for pathologic examination and
analysis.
astroscopy: examination of the lining of the esophagus, stomach, and duodenum.
4astroscopy is often used to diagnose ulcers and other sources of bleeding and to guide
biopsy of suspect 4( cancers.
$aparoscopy: visualization of the stomach, liver and other abdominal organs including
the female reproductive organs, for example, the fallopian tubes.
$aryngoscopy: examination of the larynx #voice box$.
Proctoscopy% sigmoidoscopy, proctosigmoidoscopy) examination of the rectum and
sigmoid colon.
Thoracoscopy: examination of the pleura #sac that covers the lungs$, pleural spaces,
mediastinum, and pericardium.
A Brief &istory of Endoscopy
(n the early 5677s, the first attempts to view inside the body with lighted telescopes were made.
hese initial devices were often fully rigid. (n the 5687s, semi1flexible endoscopes called
gastroscopes were developed to view inside of the stomach. -iber1optic endoscopy was
pioneered by 9outh African1born physician &asil *irschowitz at the ,niversity of :ichigan in
56;<. =idespread use of fiber optic endoscopes began in the 56>7s.
A fiber optic cable is simply a bundle of microscopic glass or plastic fibers that literally allows light
and images to be transmitted through curved structures. -iber optic cables are also replacing
metal wires as the bac"bone of the world's telecommunications infrastructure. his (nternet page
may have traveled through a fiber optic cable as a stream of digital data #bursts of light$ on its
way to your computer
Endoscoy Equi"ent
Endoscopes have many practical needs. And *.:.&. Endoscopy +roducts #*ollywood, -lorida$
has been providing endoscopic e/uipment and educating people on the use of endoscopes for
more than 5< years. &e sure to &rowse our 0atalog for all the details on how to purchase these
medical instruments that can examine any part of the body.

%ideo
#ystems

Fi&er
Endoscope
s

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Endoscope
s
(n the simplest terms, Endoscopy e/uipment consists of instruments that can loo" at the inside of
many different organs ? these are small, flexible or rigid tubes with a light or lenses on the end
that can loo" into the esophagus, stomach and colon ? and in more general terms endoscopy
e/uipment can help doctors loo" deep inside body structures and hollow organs.
An endoscope and related endoscope products and e/uipment are usually composed of three
components)
An optic system that allows the doctor to loo" through the scope into the organ or cavity,
or to attach a video camera to the scope
A fi#eroptic ca#le to light up the bodily area
A l"men #e.g. the bore of a tube, li"e a needle or catheter$ to ta"e tissue samples of the
area being viewed
he beauty of endoscopic products is that they perform dual functions ? with both diagnostic and
therapeutic capabilities. -or example, this means that these endoscopic products and instruments
can perform biopsies #e.g. to evaluate tissue samples$ as well as provide sclerotherapy #a
medical procedure used to treat varicose veins and @spider veinsA$. (n truth, these brief
explanations only tell part of the story.
TYPES OF ENDOSCOPES
a"e a loo" at the different types of endoscopic e/uipment you can get with *.:.&. Endoscopy
+roducts. Again, in very general terms, there are two main types of endoscopes)

Rigid

Flexi&le
5. rigid endoscopes B the majority of which use a convex #curving out, li"e one half of a
circle$ glass lens system, in which the small glass lenses are separated by large air
spaces.
C. fle'i#le endoscopes allow for just that ? flexibility. (n the animal "ingdom, for example,
a flexible endoscope would be perfect for examining the stomach area of a sna"e.
he popularity of endoscopy e/uipment continues to grow. 9ome of the industryDs household
names include .lympus, +entax, -unjinon and 9torz ? with *.:.&. both selling and repairing
pre1owned and completely refurbished endoscopic products from each of these major
manufacturers. &rowse our 0atalog to get the ones you needE
=HE&M9G&-PH
-PPLIC-=I9N' Thermogra&hs are digital recording thermometers used to log
tem&erature in the
marine environment. The instruments are attached to a com&uter to set u& recording
&arameters for
de&loyment, downloading, and dis&lay of data in gra&hic or numeric format. These units
are &laced in
underwater housings and attached to the bottom or sus&ended in the water column for
de&loyment.
/E)C&IP=I9N' Two ty&es of thermogra&h are currently available. The #yan
Tem&mentor is a
reusable data logger that allows storage of a maximum of U,:U2 tem&erature
measurements in the
range of !:3C to dX+C with +.2 resolution and +.: accuracy. The instrument can be
&rogrammed
to ta/e measurements from once &er second to once every other hour. Instrument
dimensions are :K x
UK x 2.:K and the unit weighs 22 ounces. The -obo Tem& is a miniature, reusable data
logger that
allows storage of 2,W++ measurements in the range of !3+C to dX+C with
+.: resolution and +.X
accuracy. ,am&ling intervals from +.F seconds to =.W hours are available. Instrument
dimensions are
3.=K x 2.SK x +.WK and the unit weighs 2 ounce. 9oth units are battery &owered with the
battery life of
the Tem&mentor being a&&roximately two years and the battery life of the -obo Tem&
being one year. =HE&M9G&-PH
-PPLIC-=I9N' Thermogra&hs are digital recording thermometers used to log
tem&erature in the
marine environment. The instruments are attached to a com&uter to set u& recording
&arameters for
de&loyment, downloading, and dis&lay of data in gra&hic or numeric format. These units
are &laced in
underwater housings and attached to the bottom or sus&ended in the water column for
de&loyment.
/E)C&IP=I9N' Two ty&es of thermogra&h are currently available. The #yan
Tem&mentor is a
reusable data logger that allows storage of a maximum of U,:U2 tem&erature
measurements in the
range of !:3C to dX+C with +.2 resolution and +.: accuracy. The instrument can be
&rogrammed
to ta/e measurements from once &er second to once every other hour. Instrument
dimensions are :K x
UK x 2.:K and the unit weighs 22 ounces. The -obo Tem& is a miniature, reusable data
logger that
allows storage of 2,W++ measurements in the range of !3+C to dX+C with
+.: resolution and +.X
accuracy. ,am&ling intervals from +.F seconds to =.W hours are available. Instrument
dimensions are
3.=K x 2.SK x +.WK and the unit weighs 2 ounce. 9oth units are battery &owered with the
battery life of
the Tem&mentor being a&&roximately two years and the battery life of the -obo Tem&
being one year. =HE&M9G&-PH
-PPLIC-=I9N' Thermogra&hs are digital recording thermometers used to log
tem&erature in the
marine environment. The instruments are attached to a com&uter to set u& recording
&arameters for
de&loyment, downloading, and dis&lay of data in gra&hic or numeric format. These units
are &laced in
underwater housings and attached to the bottom or sus&ended in the water column for
de&loyment.
/E)C&IP=I9N' Two ty&es of thermogra&h are currently available. The #yan
Tem&mentor is a
reusable data logger that allows storage of a maximum of U,:U2 tem&erature
measurements in the
range of !:3C to dX+C with +.2 resolution and +.: accuracy. The instrument can be
&rogrammed
to ta/e measurements from once &er second to once every other hour. Instrument
dimensions are :K x
UK x 2.:K and the unit weighs 22 ounces. The -obo Tem& is a miniature, reusable data
logger that
allows storage of 2,W++ measurements in the range of !3+C to dX+C with
+.: resolution and +.X
accuracy. ,am&ling intervals from +.F seconds to =.W hours are available. Instrument
dimensions are
3.=K x 2.SK x +.WK and the unit weighs 2 ounce. 9oth units are battery &owered with the
battery life of
the Tem&mentor being a&&roximately two years and the battery life of the -obo Tem&
being one year.