Importance of Technology in Medical Science

1 IMPORTANCE OF TECHNOLOGY IN MEDICAL SCIENCE- DOLON SENAPATI
IMPORTANCE OF TECHNOLOGY IN MEDICAL SCIENCE

DOLON SENAPATI
INDIAN SCHOOL OF COMPLEMENTARY THERPAY AND ALLIED SCIENCES, INDIA
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Manuscript info:-
ABSTRACTS .
Now days medicine makes effective treatments for diseases and

Manuscript Number:- SCI-1015 injuries, establishing on existing discoveries and knowledge. As
applying the portable electronic devices are increased in every day
Received date:- 23rd june, 2019
life, medical science needs to accept and welcome modernization so
that we can begin building guideline for the proper use of technology.
Final accepted:- 26th june, 2019
Medicine and medical technology has become the antidote for illness
and diseases that formerly resulted in the destruction of entire
Publishing date:- 1st july, 2019
societies. A large number of digital innovations are revolutionizing
healthcare and technology in medicine is here to stay. Numerous
innovations and new solutions are already on the market and they
have all improved healthcare drastically. Now our society needs a
generation of physicians that are technologically skill and adopted
towards innovation. This paper reviews the greatest technological
innovation that revolutionized the medical science in many aspects of
diagnosis, management and treatment.
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INTRODUCTION
Medical sciences is the science of diagnosing and treating illness or preventing from disease and damage to the body
or mind. Now days medical science creates effective treatments for disease and injury with improving technology and
constructing on existing discoveries and knowledge (varkey, P & Athgal, V.P. 2005).
In todays medical field technology plays a big role when it come to patient care. Technology is huge when it comes
giving the patient the best type of quality care when they are in the hospital.
In the old days people would just write it down on a sheet of paper and record it by hand, which caused mistakes. Now
with the electronic health record these mistakes are drastically decline. Statistics have shown that using the Electronic
Health Record has lowered. Nursing mistakes as well as improved patient care. Our society has progressed through
the airs and has been introduced with the electronic health record which has drastically improved our health care
system. Electronic medical record consists of digital summaries of a patient medical records. They could include
diagnosis and improved patient care. These electronic records facilitate the easy sharing of information and
collaboration between labs and specialists without the time and resource expenditure on physical transmission.
Corresponding author- Dolon Senapati

Technology has placed at the disposal of the medical community various potent tools to improve patient care. Through
the use of technology in medical science, scientist have been able to examine disease on cellular level and produce
antibodies against them. Technology has the advance the medical field in many ways and has improved the mortality
rate and general well-being for patients.
ULTRASONOGRAPHY
Medical ultrasonography is also known as diagnostic sonography or ultrasonography. It is a diagnostic imaging

technique based on the application of ultra sound. It is used to create an imaging of internal body structure such as
tendons, muscles, joints, blood, vessels and internal organs. Its aim is often to find a source of a disease or to exclude
pathology. The practice of examining pregnant woman using ultra sound is called obstetric ultra sound, and was an
early development and application of clinical ultrasonography.
Ultrasound refers to sound waves with frequencies which are higher than those audible to (>20,000 HZ). Ultrasonic
images, also known as sonograms, are made by sending pulses of ultrasound into tissue using a probe. The
ultrasound pulses echo off tissue with different reflection properties and are recorded and displayed an image.
Many different types images can be formed. The commonest is a B-mode image(brightness) which displays the
acoustic impedance of two – dimensional cross- section of tissue. Other types can display blood flow, motion of tissue
over time, the location of blood, the presence of specific molecules, the stiffness of tissue or the anatomy of a three-
dimensional organ.
Compared to other dominant methods of medical imaging, ultrasound has several advantages. It provides images in
real-time and is portable and can be brought to the beside. It is substantially lower in cost than other imaging
modalities and does not use harmful ionizing radiation. Drawbacks include various limits on its field of view, such as
the need for patient co-operation, depends on physique, difficulty imaging structures behind bone and air, and the
necessity of a skilled operator, usually a trained professional.
THE HISTORY OF ULTRASOUND
The use of ultrasound in medical science began during and shortly after the second World War in various centres
around the world. The work of Dr. Karl Theodore Dussik in Austria in 1942 on transmission ultrasound investigation of
the brain provides the first published work on medical ultrasonics.
Although others workers in the USA, JAPAN and EUROPE have also been cited as pioneers, the work of professor
Lan Donald and his colleagues in Glasgow, in the mid 1950s, did much to facilitate the development of practical
technology and applications. This wider use of ultrasound in medical practice in the subsequent decodes.
The BMUS Historical collection was established in 1984 to collect, document, preserve, exhibit and interpret artefacts
and other material relating to diagnostic and therapeutic ultrasound in the UK.
The current collection includes:
 Ultra sound related hardware.

 Images films video and audio tapes.
 Photographs of instruments and people.
 Manufactures documents
 Personal accounts, letters and interviews.
 Originals of papers, Reviews.
The collection is kept in Glasgow, with historical documents in the archives of the Mitchell Library in Glasgow and
some hardware items on display at the Queen of Mother‟s Hospital. Other hardware items are kept in storage at other
sites in Glasgow.
The collection is available to BMUS members and other for education, research and interest.

Modern Ultrasound development
All the events described below, helped with the development of ultra sound in the medical industry, in some way.
st
January 1 , 1915
The Hydrophone:
Used to convert convert acoustic energy into electrical energy.
st
January 1 ,1920
Used of Ultrasound in Therapy:
Used for sterilization of vaccines and physical therapy treatment.
st
January 1 , 1942
Ultrasound in medical Diagnostic:
Detected brain tumours by creating sound waves that emitted through the skull.
st
January 1 , 1948
A-mode ultrasound:
Detects gallstones near the intestines.
st
January 1 ,1950
M-mode ultrasound:
Data in which heart wall motion and valve motion are displayed as functions of time.

st
January 1 , 1953
Development of Echocardiography:
Detects flaws in metals.
st
January 1 , 1958
Ultrasound in obstetrics and Gynecology:
Distinguished between cysts, fibroids and other intra-abdominal tumors.
st
January 1 , 1970
Pulsed Doppler:
Images blood flow from different chambers of the heart.
st
January 1 , 1986
Development of 3-D:
Helped develop the use of 3-D Ultrasounds that gave real time picture of what a fetus looked like.
st
January 1 ,2000
Development of 4-D/ultrasound progression:
Helped develop 4-D ultrasound that gave real time pictures of what a fetus looked like.
th
January 9 , 2013
4-D Ultrasound :

th
April 9 , 2013
2D/3D/4D ultrasound today
OVER VIEW OF USG
Sound is a physical phenomenon that transfers energy from one point to another. In this respect, it is similar to
radiation. It differs from radiation, however, in that sound can pass only through matter and not through a vacuum as
radiation can. This is because sound waves are actually vibrations passing through a material. If there is no material,
nothing can vibrate and sound cannot exist.
One of the most significant characteristics of sound is its frequency, which is the rate at which the sound source and
the material vibrate. The basic unit for specifying frequency is the hertz, which is one vibration, or cycle, per second.
Pitch is a term commonly used as a synonym for frequency of sound
 Transducer probe - probe that sends and receives the sound waves.
 Central processing unit (CPU) - computer that does all of the calculations and contains the electrical power
supplies for itself and the transducer probe.
 Transducer pulse controls - changes the amplitude, frequency and duration of the pulses emitted from the
transducer probe
 Display - displays the image from the ultrasound data processed by the CPU
 Keyboard/cursor - inputs data and takes measurements from the display
 Disk storage device (hard, floppy, CD) - stores the acquired images
 Printer - prints the image from the displayed data
TRANSDUCER
The transducer probe is the main part of the ultrasound machine. The transducer probe makes the sound waves and
receives the echoes. It is, so to speak, the mouth and ears of the ultrasound machine. The transducer probe
generates and receives sound waves using a principle called the piezoelectric effect, which was discovered by
Pierre and Jacques Curie in 1880. In the probe, there are one or more quartz crystals called piezoelectric crystals.
When an electric current is applied to these crystals, they change shape rapidly. The rapid shape changes, or
vibrations, of the crystals produce sound waves that travel outward. Conversely, when sound or pressure waves hit
the crystals, they emit electrical currents. Therefore, the same crystals can be used to send and receive sound waves.
The probe also has a sound absorbing substance to eliminate back reflections from the probe itself, and an acoustic
lens to help focus the emitted sound waves.
Transducer probes come in many shapes and sizes, as shown in the photo above. The shape of the probe determines
its field of view, and the frequency of emitted sound waves determines how deep the sound waves penetrate and the
resolution of the image. Transducer probes may contain one or more crystal elements; in multiple-element probes,
each crystal has its own circuit. Multiple-element probes have the advantage that the ultrasound beam can be
"steered" by changing the timing in which each element gets pulsed; steering the beam is especially important for
cardiac ultrasound. In addition to probes that can be moved across the surface of the body, some probes are
designed to be inserted through various openings of the body (vagina, rectum, oesophagus) so that they can get
closer to the organ being examined (uterus, prostate gland, stomach); getting closer to the organ can allow for more
detailed views .The transducer also focuses the beam of pulses to give it a specific size and shape at various depths
within the body and also scans the beam over the anatomical areas that is being imaged.
HIGH MULTIPLEXING TRANSMITTER
A typical phased-array ultrasound system will have from 32 to as many as 256 transmitters and receivers. In many
cases, the system will have fewer transmitters and receivers than the number of available transducer elements. In
these cases, high-voltage switches located in the transducer or system are used as multiplexers to connect a specific
transducer element to a specific transmitter/receiver (Tx/Rx) pair. In this way, the system can dynamically change the
active transducer aperture over the available transducer element array.
The requirements for these switches are severe. They must handle transmit pulses with voltage swings as large as
200VP-P and with peak currents up to 2A. They must switch rapidly to quickly modify the configuration of the active
aperture and maximize image frame rate. Finally, they must have minimal charge injection to avoid spurious
transmissions and associated image artifacts.
High-Voltage Transmitters
A digital transmit beam former typically generates the necessary digital transmit signals with the proper timing and
phase to produce a focused transmit signal. High-performance ultrasound systems will generate complex transmit
waveforms using an arbitrary waveform generator to optimize image quality. In these cases, the transmit beam former
generates digital 8-bit to 10-bit words at rates of approximately 40MHz to produce the required transmit waveform.
Digital-to-analog converters (DACs) are used to translate the digital waveform to an analog signal, which is then
amplified by a linear high-voltage amplifier to drive the transducer elements. This transmit technique is generally
reserved for more expensive and less portable systems, as it can be very large, costly, and power hungry. As a result,

the majority of ultrasound systems do not use this transmit-beam former technique, but instead use multilevel high-
voltage pulses to generate the necessary transmit signals. In this alternate implementation highly-integrated, high-
voltage pulses quickly switch the transducer element to the appropriate programmable high-voltage supplies to
generate the transmit waveform. To generate a simple bipolar transmit waveform, a transmit pulses alternately
connects the element to a positive and negative transmit supply voltage controlled by the digital beam former. More
complex realizations allow connections to multiple supplies and ground in order to generate more complex multilevel
waveforms with better characteristics.
The slew rate and symmetry requirements for high-voltage pulses have increased in recent years due to the popularity
of second-harmonic imaging. Second-harmonic imaging takes advantage of the nonlinear acoustic properties of the
human body. These nonlinearities tend to translate acoustic energy at f 0 to energy at 2f o. Reception of these second-
harmonic signals has, for a variety of reasons, produced better image quality and is now widely used.
There are two basic methods used to implement second-harmonic imaging. In one method called standard-harmonic
imaging, the second-harmonic of the transmit signal is suppressed as much as possible. As a result, the received
second-harmonic derives solely from the nonlinear behaviour of the body. This mode of operation requires that
second-harmonic content of the transmit energy be at least 50dB below the fundamental. To achieve this, the duty
cycle of the transmit pulse must be less than ±0.2% of a perfect 50% duty cycle. The other method, called pulse
inversion, uses inverted transmit pulses to generate two phase-inverted receive signals along the same image line.
Summation of these two phase-inverted receive signals in the receiver recovers harmonic signals generated by
nonlinear processes in the body. In this pulse-inversion method, the summed phase-inverted transmit pulses must
cancel as much as possible. To do this, the rise and fall times of the high-voltage pulses must match very closely.
FREQUENCY
Ultrasound Pulse Frequency
The frequency of ultrasound pulses must be carefully selected to provide a proper balance between image
detail and depth of penetration. In general, high frequency pulses produce higher quality images but cannot
penetrate very far into the body. These issues will be discussed in greater detail later.
The frequency of sound is determined by the source. For example, in a piano, the source of sound is a string

Transducer Focusing
Transducers can be designed to produce either a focused or non-focused beam, as shown in the following
figure. A focused beam is desirable for most imaging applications because it produces pulses with a small
diameter which in turn gives better visibility of detail in the image. The best detail will be obtained for structures
within the focal zone. The distance between the transducer and the focal zone is the focal depth.
Beam Width and Pulse Diameter Characteristics of Both Unfocused and Focused Transducers
that is caused to vibrate by striking it. Each string within the piano is adjusted, or tuned, to vibrate with a
specific resonant frequency. In diagnostic ultrasound equipment, the sound is generated by the transducer. The
major element within the transducer is a crystal designed to vibrate with the desired frequency. A special
property of the crystal material is that it is piezoelectric. This means that the crystal will deform if electricity is
applied to it. Therefore, if an electrical pulse is applied to the crystal it will have essentially the same effect as
the striking of a piano string: the crystal will vibrate. If the transducer is activated by a single electrical pulse, the
transducer will vibrate, or "ring," for a short period of time. This creates an ultrasound pulse as opposed to a
continuous ultrasound wave. The ultrasound pulse travels into the tissue in contact with the transducer and
moves away from the transducer surface, as shown in the above figure. A given transducer is often designed to
vibrate with only one frequency, called its resonant frequency. Therefore, the only way to change ultrasound
frequency is to change transducers. This is a factor that must be considered when selecting a transducer for a
specific clinical procedure. Certain frequencies are more appropriate for certain types of examinations than
others. Some transducers are capable of producing different frequencies. For these the ultrasound frequency is
determined by the electrical pulses applied to the transducer.
PULSE DIAMETER AND BEAM WIDTH
An important characteristic of an ultrasound pulse is its diameter, which is also the width of the ultrasound beam. The
diameter of a pulse changes as it moves along the beam path. The effect of pulse size on image detail will be
considered in the next chapter.. At this point we will observe the change in pulse diameter as it moves along the beam
and show how it can be controlled.
The diameter of the pulse is determined by the characteristics of the transducer. At the transducer surface, the
diameter of the pulse is the same as the diameter of the vibrating crystal. As the pulse moves through the body, the
diameter generally changes. This is determined by the focusing characteristics of the transducer.

PACEMAKER
A system that sends electrical impulses to the heart in order to set the heart rhythm. The pacemaker can be the
normal "natural" pacemaker of the heart or it can be an electronic device.
It is a small electronic device implanted under the skin that sends electrical impulses to the heart muscle to maintain a
suitable heart rate and to prevent slow heart rates.
The natural pacemaker of the heart is the sinus node, one of the major elements in the cardiac conduction system, the
system that controls the heart rate. This stunningly designed system generates electrical impulses and conducts them
throughout the muscle of the heart, stimulating the heart to contract and pump blood.
HISTORY OF PACEMAKER
The evolution of the modern pacemaker is a wonderful story in the advancement of technology and our understanding
about how the heart rhythm works. The first pacemaker was implanted in a person in 1958. It didn‟t last very long,
though that patient lived to age 88 and had 26 pacemakers in his lifetime.
Pacemakers entered the modern era in 1969 with the first lithium battery. A man landed on the moon the same year
pacemakers had better batteries.
The first pacemakers paced only the ventricle, or bottom chamber of the heart. In fact, all they could do was generate
a regular electrical pulse with no variation. The word "physiologic" was first used in pacing to describe a pacemaker
that could sense the patient‟s underlying rhythm, and not complete with it. It was called a "demand" pacemaker. It
would only generate a pulse if the pacemaker sensed that the patient's own heart had not beat on its own.
But that wasn't good enough. It did not account for the atrium, or upper chamber of the heart, in patients who had an
underlying rhythm in the atrium. The next step in "physiologic" pacing was to have a dual chamber pacemaker, one
that could pace both the atrium, the upper chamber, AND the ventricle, the lower chamber, in sequence, like a normal
heart does. Dual-chamber pacing was then called "physiologic."
But, that might help patients who have an atrium that can increase its rate in response to activity. For patients who
have sinus node dysfunction, or the inability of the atrium to increase rate, pacemakers would pace only at a fixed
rate, and would not increase the heart rate with activity.
The next step in the evolution was the "rate responsive pacemaker." This pacemaker used a piezoelectric crystal. The
crystal would bend or deform with body activity. This electrical signal could be used by a pacemaker to increase the
heart rate with activity just like a normal heart. The crystal has long since been replaced by an "accelerometer" to
reflect activity more accurately. There are also other sensors available for doing this.
A standard pacemaker has a lead that paces the right ventricle. Some patients have decreased heart function, and a
pacemaker that paces both ventricles simultaneously has been proven to improve heart function. This is called "bi-
ventricular pacing" and has leads that can pace the atrium, the right ventricle, and the left ventricle.

The leadless pacemaker is but one more step in the evolution of the pacemaker. It is not dual chamber, but it can
increase heart rate with activity. For patients with an irregular atrial rhythm, it may be right choice.
Pacemakers use electrical impulses to regulate the beating of the heart. They treat disorders making the heart‟s
rhythm too slow, fast or irregular. Abnormal heart rhythms are called arrhythmias.
Electrical activity within the heart was discovered during the 1800s. However, devices for artificially controlling the
heart‟s rate were not devised until the 20th century.
In 1932, American physiologist Albert Hyman built the first device called an „artificial pacemaker‟. It was powered by a
hand-cranked motor. Hyman tested his pacemaker on animals, and never published any results of using his
pacemaker on humans. During the 1930s artificial heart stimulation was controversial and likened to reviving the dead.
After the Second World War innovators such as Paul Zoll and Earl Bakken pioneered smaller pacemakers. Some of
these were worn like a necklace. In 1958 the first pacemaker to be implanted was given to Arne Larsson in Sweden.
The device failed after three hours. A second device lasted two days.
Implanting electronic devices into the body presented problems. Electronic components were too bulky until the
development of silicon transistors in 1956. Early pacemaker batteries had short, unreliable lifetimes until Wilson
Greatbatch pioneered long-life lithium batteries in the 1970s. Another problem was preventing water in the body
affecting the pacemaker‟s electronics. This was solved by using hermetically sealed titanium cases. Pacemakers are
now the size of a large coin and are implanted near the heart.
OVER VIEW OF PACEMAKER

A pacemaker is a small device whose main purpose is to prevent the heart from beating too slowly. The device
stimulates the heart muscle when the heart rate is too slow or all together absent.
Over time pacemakers have become smaller and more durable. Up until recently, they have always involved at least
one wire that goes through the vein to the inside of the heart. An option for "leadless" pacemakers (i.e., without wires)
is now available, and Inova Heart & Vascular Institute was the first facility in Northern Virginia to offer that option.
"Wireless" vs. Traditional Pacemaker
Particularly for patients with certain types of Atrial Fibrillation or ones with vascular access problems – stemming
either from their anatomy or from a medical condition – leadless pacemakers offer a clear advance in technology.
However, they are not appropriate in all cases. For instance, patients whose circumstances require dual chamber
pacing will require use of a traditional pacemaker.
Micra leadless pacemaker
Micra is the first leadless pacemaker to obtain FDA approval. Manufactured by Medtronic, this device is completely
self-contained within the heart. It is also 93% smaller than traditional pacemakers. As it is delivered via catheter
directly into the right ventricle of the heart, there is no chest scar, no bump and results are showing fewer
complications. It also offers a 12-year battery longevity.
Traditional pacemaker
Traditional pacemakers consists of a pulse generator attached to between one and three leads (wires) that are
inserted within the heart. The pulse generator contains a battery and a microchip. The battery (most commonly
lithium-iodide) typically has a life span of 6-10 years depending on its use. The leads are inserted under the skin via
veins into the heart's upper chamber (atrium) or lower chamber (ventricle). The procedure takes 1-2 hours to
complete.
 A determination on the appropriate type of pacemaker is best explored with a cardiologist or

electrophysiologist familiar with your medical history.
Pacemaker vs. Defibrillator (ICD)
A pacemaker is not the same as an implantable cardioverter defibrillator (ICD). They look similar, but the pacemaker
is slightly smaller. An ICD is also a device that monitors and moderates your heart rate, and it uses batteries to send
electric signals to a heart that‟s beating too slow.
ELECTRICAL FUNCTION OF PACEMAKER

A small battery-operated device that helps the heart beat in a regular rhythm. There are two parts: a generator and
wires.
 The generator is a small battery-powered unit.

 It produces the electrical impulses that stimulate your heart to beat.
 The generator may be implanted under your skin through a small incision.
 The generator is connected to your heart through tiny wires that are implanted at the same time.
 The impulses flow through these leads to your heart and are timed to flow at regular intervals just as impulses
from your heart's natural pacemaker would.
 Some pacemakers are external and temporary, not surgically implanted.
 A computerized pulse generator to produce electrical signals to regulate your heartbeat.

 One to three leads, wires that deliver electrical signals between pulse generator and your heart.
 Electrodes at the ends of the leads, to help deliver signals
 A battery
Pacemakers consist of a pager-sized housing device that contains a battery and the electronic circuitry that runs
the device, along with one or two long thin electrical wires that travel from the pacemaker housing device to the
heart. The housing device is implanted below the skin in the shoulder area. The thin wires, which can conduct
electrical impulses, are then threaded from the housing device through a vein that runs in the chest, to the heart.
Pacemakers are capable of both transmitting and receiving information via a wireless telemetry link. This two-way
communication has a baud rate of about 300 bps. The pacemaker can provide real-time information on pulse
amplitude and duration, as well as lead impedance and battery condition, lead current, charge, and energy. The
programmer provides encoded instructions to alter any of the programmable parameters and to retrieve diagnostic
data. These signals are encoded to minimize the likelihood of extraneous interference signals reprogramming the
device. There are concerns that inadequate password protection and encryption are incorporated in the link which
is allowing pacemakers to be “hacked.”
A pacemaker is an electrical stimulator that discharges electrical current within two or three cardiac chambers, as a
treatment for a cardiac arrhythmia or heart failure. It is also a medical instrument that enables cardiac electrograms to
be measured, displayed, recorded, and analysed for pacing on demand. Sensor-based enhancements, which include
an accelerometer, can detect motion and cause the heart rate to be adjusted during physical activity. Other optional
sensors can detect respiration, the presence of thoracic fluid, or pressure. The majority of pacemakers are implanted.
Temporary external pacemakers may be used in a transcutaneous or transvenous manner.
Two classes of arrhythmias are premature beats and heart blocks. Premature beats occur when an ectopic focus in
the atria, AV junction, or ventricles becomes irritable and spontaneously fires. When one premature beat follows
a sinus beat, the group of two beats is called bigeminy. When two premature beats follow and are coupled to the sinus
beat, the group of three beats is called trigeminy. Heart blocks occur when the transmission of a beat in the SA node,

AV node, or a bundle branch is delayed. The most serious block is 3° AV block, when the atrial rate becomes
completely dissociated from the ventricular rate, or R-R interval. When a slower ventricular rate occurs in this block,
blood flow to the brain becomes inadequate, causing the patient to lose consciousness. This effect is known as
Stokes-Adams syndrome.
Pacemakers were developed initially to treat Stokes-Adams syndrome, but they currently provide treatment for various
arrhythmias associated with bradycardia and heart failure. Direct electrical stimulation of the right atrium or a ventricle
may act as therapy to elicit contraction, with the general tissue response modelled as i(t)=ir(1+tct).
A pacemaker system contains three components: the leads, which incorporate electrodes; the pulse generator, which
is informally called the can; and the pacemaker programmer. While many implanting physicians choose to use default
settings, others set at least atrial sensitivity, ventricular sensitivity, AV delay, PV delay, and PVARP. The pulse
generator is typically programmed in DDDxx mode, with the capabilities of rate modulation and left ventricular pacing
dependent on the pulse generator model.
Key pacemaker features include its standardized lead connection, lead mechanical integrity, long-term battery,
accurate sensitivity, and minimum susceptibility to electromagnetic interference.
Reflection
The reflection of ultrasound pulses by structures within the body is the interaction that creates the ultrasound image.
The reflection of an ultrasound pulse occurs at the interface, or boundary, between two dissimilar materials, as shown
in the following figure. In order to form a reflection interface, the two materials must differ in terms of a physical
characteristic known as acoustic impedance Z. Although the traditional symbol for impedance, Z, is the same symbol
used for atomic number, the two quantities are in no way related. Acoustic impedance is a characteristic of a material
related to its density and elastic properties. Since the velocity is related to the same material characteristics, a
relationship exists between tissue impedance and ultrasound velocity. The relationship is such that the impedance, Z,
is the product of the velocity, v, and the material density, Y, which can be written as
Impedance = (Y) (v).
The Production of an Echo and Penetrating Pulse at a Tissue Interface
At most interfaces within the body, only a portion of the ultrasound pulse is reflected. The pulse is divided into two
pulses, and one pulse, the echo, is reflected back toward the transducer and the other penetrates into the other
material, as shown in the above figure. The brightness of a structure in an ultrasound image depends on the strength
of the reflection, or echo. This in turn depends on how much the two materials differ in terms of acoustic impedance.
The amplitude ratio of the reflected to the incident pulse is related to the tissue impedance values by
At most soft tissue interfaces, only a small fraction of the pulse is reflected. Therefore, the reflection process produces
relatively weak echoes. At interfaces between soft tissue and materials such as bone, stones, and gas, strong
reflections are produced. The reduction in pulse amplitude during reflection at several different interfaces is given in
the following table.
The amplitude of a pulse is attenuated both by absorption and reflection losses. Because of this, an echo returning
to the transducer is much smaller than the original pulse produced by the transducer.
Refraction
When an ultrasound pulse passes through an interface at a relatively small angle (between the beam direction and
interface surface), the penetrating pulse direction will be shifted by the refraction process. This can produce certain
artifacts as we will see later.
VENTILATOR
A medical ventilator is a machine designed to provide mechanical ventilation by moving breathable air into and out of
the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. The exchange
of air between the lungs and the atmosphere so that the oxygen can be exchange for carbon dioxide in the alveoli.
HISTORY OF MEDICAL VENTILATOR

The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form
of non-invasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the
[2]
introduction of the "Drinker respirator" in 1928, improvements introduced by John Haven Emerson in 1931, and
the respirator in 1937. Other forms of non-invasive ventilators, also used widely for polio patients, include Biphasic
Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines.
In 1949, John Haven Emerson developed a mechanical assister for anaesthesia with the cooperation of the
anaesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anaesthesia
and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and
the increasing use of muscle relaxants during anaesthesia. Relaxant drugs paralyze the patient and improve operating
conditions for the surgeon but also paralyze the respiratory muscles.
The 1955 release of Forrest Bird‟s "Bird Universal Medical Respirator" in the United States changed the way
mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment.The
unit was sold as the Bird Mark 7 Respirator and informally called the "Bird". It was a pneumatic device and therefore
required no electrical power source to operate.
NEGATIVE PRESSURE VENTILATORS
Throughout the 19th century and the first half of the 20th century the negative-pressure ventilator was the
predominant device used to provide ventilatory assistance. The first description of a negative-pressure ventilator was
of a full-body type ventilator. This “tank ventilator” was first described by the Scottish physician John Dalziel in 1838. It
consisted of an air-tight box, with the patient maintained in the sitting position. Negative pressure was established by
manually pumping air into and out of the box (Fig. 1). The device was equipped with a pressure gauge to monitor the
extent of negative pressure established in the device. A number of other groups developed similar types of manually
operated negative-pressure ventilators. In 1904 Sauer Brach even developed a negative-pressure operating chamber

(Fig. 2). The patient's body, except for the head, was maintained inside the chamber. The chamber was large enough
so that the surgeon was able to perform surgery while also in the chamber. The patient's lower body was encased in a
flexible sack so that positive pressure could be applied to this part of the body, preventing blood from accumulating in
the abdomen and lower extremities, causing what was referred to as “tank shock.”

Negative-pressure ventilation became a much greater clinical reality with the development of the iron lung, originally
designed and built by Drinker and Shaw, but manufactured and sold by Emerson. This approach to ventilatory support
reached its pinnacle during the worldwide poliomyelitis epidemics from 1930 to 1960. The first ICUs were set up to
manage in some cases dozens of patients, of all ages, requiring negative-pressure ventilation because of poliomyelitis
(Fig. 3). Boston Children's Hospital developed a large negative-pressure chamber that could accommodate 4 children
simultaneously and allow a nurse to care for the patients from inside the chamber (Fig. 4).
Figure - 3
Figure - 4
Over time, numerous other types of negative-pressure chambers were developed and used, with varying success,
such as the “raincoat” and the “chest cuirass” (Fig. 5). However, in the 1960s there was a movement away from
negative-pressure ventilation because of several factors. The first volume-targeted ICU/anaesthesia ventilators
began to appear. Second, the development of jet aviation at the close of the second world war lead to the
development of small, compact, intermittent positive-pressure breathing (IPPB) devices: the Bennett and Bird
IPPB machines (Fig. 6). Third, problems with the application of negative-pressure ventilation became too much for
their continued use in the newly developing ICUs. As a group, these devices were large, heavy, and cumbersome,
and it was difficult to avoid excessive leaking (generally resulting in cooling of the patient's body); they had a
difficult time maintaining effective ventilation, were unable to sustain high airway pressure or establish PEEP,
access to the patient was limited, and “tank shock” was an ongoing issue with full-body ventilators.

Positive-Pressure Noninvasive Ventilation
Positive-pressure noninvasive ventilation (NIV) can be traced back to biblical times: 2 specific passages from the Bible
reference NIV4: And the Lord God formed man of the dust of the ground and breathed into his nostrils the breath of
life. (Genesis 2:7) And he [Elisha] went up, and lay upon the child, and put his mouth upon his mouth and the flesh of
the child waxed warm. (II Kings 4:34)
However, the first mechanical apparatus used to provide NIV, a bag and mask manual ventilator, was introduced in
1780 by Chaussier (Fig. 7). A more sophisticated bellows with a mask was introduced in 1887 by Fell (see Fig. 7),
and in 1911 Dräger's Pulmotor was first introduced. This was a fairly sophisticated pneumatically operated positive-
pressure device that has been credited with saving thousands of individuals over its lifetime (see Fig. 7). Another
approach to providing NIV was introduced by Green and Janeway in 1910 (Fig. 8). They referred to their device as a
“rhythmic inflation apparatus.” The patient's head was placed into the apparatus and a seal was secured around the
patient's neck with positive pressure applied to the patient's head. However, the most notable NIV devices of the 20th
century were the Bennett TV and PR series and the Bird Mark series of ventilators (see Fig. 6). These devices were
used primarily to provide intermittent treatments, as opposed to long-term ventilation, but in the 1960s and 1970s it
was common to see them used for life support in both non-invasive and invasive ventilation.

Figure - 7

During the late 1970s and early 1980s, two things happened that changed the concept of NIV. First the IPPB machine
faded from use as a result of reports that the use of the IPPB machine to deliver aerosolized medication was no better
than a simple nebulizer and that incentive spirometer and blow bottle were as good as IPPB in preventing and
reversing postoperative atelectasis. The second event was a series of case studies indicating that NIV could be used
to provide ventilatory support to patients in an exacerbation of chronic lung or neuromuscular/neurologic disease, or to
provide long-term ventilator support to those same patients. In general, this type of support was first provided with
volume control modes capable of only machine-triggered inspiration (Fig. 9). But over time newer more sophisticated
pressure-targeted ventilators (Fig. 10) designed specifically to provide NIV entered the market, and pressure-targeted
ventilation became the norm for NIV. Today, NIV modes have become available on most new ventilators entering the
market, and NIV has become the standard for initial ventilatory support for numerous pathophysiological conditions.

POSITIVE PRESSURE INVASIVE VENTILATORS
First-Generation ICU Ventilators
Ventilators designed for positive-pressure invasive ventilation became available in the 1940s and 1950s. Figure
11 shows some of the early models. The key distinguishing feature of these early invasive ventilators was that they
provided only volume-control ventilation. Patient-triggered ventilation was not possible with these first-generation ICU
ventilators. However, the range of sophistication of these ventilators was quite large. The Morch ventilator was a
single-circuit, simple, piston ventilator. It was one of the least complex of this group and was designed to be placed
under the patient's bed (see Fig. 11). This ventilator had no monitors, no alarms, and no specific setting. The
respiratory rate had to be counted and the tidal volume measured with a secondary device. Gas was always delivered
at an inspiratory/expiratory ratio of 1:2. On the other end of the spectrum was the Engstrom ventilator, which, because
it had a double-circuit, could be used as an anesthesia machine or as an ICU ventilator. Although its monitoring
capabilities were limited by today's standards, it did include airway pressure and tidal volume monitoring and allowed
for more exact setting of respiratory rate, but it still provided only machine-triggered inspiration at a 1:2
inspiratory/expiratory ratio. The Emerson postoperative ventilator was between those 2 extremes. It was also a
volume-controlled ventilator and provided only machine-triggered inspiration, but it had an adjustable
inspiratory/expiratory ratio and pressure and volume monitoring. But it could not be used for anesthetic gas delivery
because it had only a single circuit.
Figure - 11
This first generation of ICU ventilators did not incorporate PEEP. It was not until after the landmark paper by
Ashbaugh et al that PEEP became a standard therapy in the ICU. With this generation of ventilators, PEEP was
applied as shown in Figure 12, by placing the expiratory limb of the circuit under water, at a depth equal to the desired
PEEP. This generation of ventilators ended in the early 1970s with the introduction of the Puritan Bennett MA-1
ventilator.

Second-Generation ICU Ventilators
The second generation of ICU ventilators differed from the first in a number of ways. Simple patient monitors were
incorporated into the ventilator itself. Most monitored tidal volume and respiratory rate, but the most distinguishing
feature of this generation of ventilators was patient-triggered inspiration. But still only volume ventilation was
available. This also is the first group of ventilators that included basic alarms such as high pressure, high rate, and low
tidal volume. Soon after the introduction of this generation of ventilators, intermittent mandatory ventilation (IMV) was
introduced into adult ventilation. Downs et al published the first case series using IMV in 1973. They used an external
secondary IMV gas flow system introduced into the ventilator circuit (Fig. 13). Later ventilators of this generation
added demand values, and IMV became synchronized intermittent mandatory ventilation (SIMV). In addition to the
MA-1, the Siemens Servo and Ohio 560 ventilators were typical ventilators of this generation (Fig. 14). The
introduction of the Servo 900C at the end of this generation introduced into clinical practice pressure-support and
pressure-control ventilation.

In the late 1970s a publication by Hewlett et al provided a glimpse into the future of ventilator modes. As illustrated
in Figure 15, they were the first to demonstrate the concept of closed-loop ventilation. Although their approach to
mandatory minute ventilation was purely mechanical, it did function as a closed-loop controller and provided a model
for many of the modes of today. Gas entered this system (see Fig. 15) at the left and preferentially entered a bellows
from which the patient could breathe spontaneously. If the bellows filled completely, gas was directed to a second
bellows. Once that bellows filled, gas from the bellows was delivered to the patient as a positive-pressure breath.
Dependent on the flow of gas into the system, the setting of the bellows capacity, and the patient's spontaneous
minute volume, all breaths were either spontaneous or mandatory or a mix of the two. The primary problem with this
initial system was that the patient could breathe the entire minute volume with a very rapid and shallow breathing
pattern, but it did provide the first form of close
Figure - 15
Third-Generation ICU Ventilators
Typical third-generation ICU ventilators were the Puritan Bennett 7200, the Bear 1000, the Servo 300, and the
Hamilton Boyler (Fig. 16). The single most important factor that all of these ventilators had in common was
microprocessor control. This was a major event in the development of mechanical ventilators, because it meant that
virtually any approach to gas delivery and monitoring was possible. All that was required was innovation,
engineering skill, and money! In addition, mechanisms for gas delivery were vastly enhanced. These ventilators were
markedly more responsive to patient demand than any of the previous generations of mechanical ventilators. flow-
triggering also became a reality, again reducing the effort patients needed to activate gas delivery. Almost every
ventilator of this era included pressure support, pressure control, volume control, and SIMV. SIMV was not only
available in volume ventilation, but also pressure ventilation and pressure support could be applied during the
spontaneous breaths.

All of the ventilators of this generation also incorporated extensive alarms and monitors. They not only monitored the
patient's status, but almost every aspect of the ventilator's functioning. This was also the generation of ventilators in
which waveforms of pressure, flow, and volume were first introduced, along with pressure-volume and flow-volume
loops.
With this generation of ventilators was the first use of airway pressure release ventilation, by Stock et al. The circuit
used by Stock et al (Fig. 17) was a simple high-flow system that incorporated a solenoid valve and 2 PEEP valves.
The approach applied high levels of continuous positive airway pressure (CPAP) but periodically reduced the CPAP to
a lower level to assist with ventilation. The solenoid could be programmed to apply any ratio of inspiratory and
expiratory time between high and low CPAP, as well as any frequency of dropping to the low CPAP level.
Figure - 17
Fourth-Generation ICU Ventilators
This is the current generation of ICU ventilators, which are the most complex and versatile of any mechanical
ventilators ever manufactured (Fig. 18). In this era there has clearly been a marked increase in the number of
ventilators, of all possible types. Numerous ventilators classified as ICU ventilator are available worldwide. There are
a number of what have been referred to as sub-acute ventilators, as well as transport/home-care ventilators and
ventilators designed specifically for NIV applications.
Figure-18
THE FUTURE ICU VENTILATOR

The ICU ventilator of the future may not look very different from today, but several features will clearly separate
them from the current generation of ventilators. There will be integration with other bedside technology. Within a
few years, all ICUs will have electronic charting, where data from all bedside technology will be transmitted to
electronic documentation systems. As a result, ventilators must be able to be integrated electronically with all other
bedside technology.
The days of specific ventilators designed to do specific tasks such as neonatal ventilation, adult ventilation, NIV, and
transport will be gone. The ICU ventilator of tomorrow will be able to perform all of these tasks as well or better
than the individual ventilators of the past. The available evidence indicates that some ventilators are already capable
of providing ventilation under multiple situations, and in the future all will.
The historical development of the mechanical ventilator is truly a remarkable journey. In just 50 short years we have
gone from relatively crude, totally mechanical devices that could provide only machine-triggered volume ventilation
to highly evolved microprocessor-controlled systems capable of any form of ventilatory support imaginable. The
evolution of the mechanical ventilator mirrors the evolution of the profession of respiratory care as well as critical
care medicine, and may even be the primary reason that respiratory care has grown to its current status. Finally, the
single most descriptive term that will be used to define the future generation of mechanical ventilators will be smart.
OVER VIEW OF VENTILATOR
Normal inspiration generates negative intrapleural pressure, which creates a pressure gradient between the
atmosphere and the alveoli, resulting in air inflow. In mechanical ventilation, the pressure gradient results from
increased (positive) pressure of the air source.
Peak airway pressure is measured at the airway opening (Pao) and is routinely displayed by mechanical
ventilators. It represents the total pressure needed to push a volume of gas into the lung and is composed of
pressures resulting from inspiratory flow resistance (resistive pressure), the elastic recoil of the lung and chest wall
(elastic pressure), and the alveolar pressure present at the beginning of the breath (positive end -expiratory
pressure [PEEP]. Thus
Resistive pressure is the product of circuit resistance and airflow. In the mechanically ventilated patient,
resistance to airflow occurs in the ventilator circuit, the endotracheal tube, and, most importantly, the patient‟s
airways.
PEEP = positive end-expiratory pressure.

Elastic pressure is the product of the elastic recoil of the lungs and chest wall (elastance) and the volume of gas
delivered. For a given volume, elastic pressure is increased by increased lung stiffness (as in pulmonary fibrosis) or
restricted excursion of the chest wall or diaphragm (eg, in tense ascites or massive obesity). Because elastance is
the inverse of compliance, high elastance is the same as low compliance.
End-expiratory pressure in the alveoli is normally the same as atmospheric pressure. However, when the alveoli
fail to empty completely because of airway obstruction, airflow limitation, or shortened expiratory time, end -
expiratory pressure may be positive relative to the atmosphere. This pressure is called intrinsic PEEP or auto PEEP
to differentiate it from externally applied (therapeutic) PEEP, which is created by adjusting the mechanical ventilator
or by placing a tight-fitting mask that applies positive pressure throughout the respiratory cycle.
Any elevation in peak airway pressure (eg, > 25 cm H2O) should prompt measurement of the end-inspiratory
pressure (plateau pressure) by an end-inspiratory hold maneuver to determine the relative contributions of resistive
and elastic pressures. The maneuver keeps the exhalation valve closed for an additional 0.3 to 0.5 sec after
inspiration, delaying exhalation. During this time, airway pressure falls from its peak value as airflow ceases. The
resulting end-inspiratory pressure represents the elastic pressure once PEEP is subtracted (assuming the pa tient is
not making active inspiratory or expiratory muscle contractions at the time of measurement). The difference
between peak and plateau pressure is the resistive pressure.
Elevated resistive pressure (eg, > 10 cm H2O) suggests that the endotracheal tube has been kinked or plugged
with secretions or that an intraluminal mass or bronchospasm is present.
Increased elastic pressure (eg, > 10 cm H2O) suggests decreased lung compliance due to
 Edema, fibrosis, or lobar atelectasis
 Large pleural effusions, pneumothorax or fibrothorax
 Extrapulmonary restriction as may result from circumferential burns or other chest wall deformity, ascites,
pregnancy, or massive obesity
 A tidal volume too large for the amount of lung being ventilated.
Intrinsic PEEP (auto PEEP) can be measured in the passive patient through an end-expiratory hold maneuver.
Immediately before a breath, the expiratory port is closed for 2 sec. Flow ceases, eliminating resistive pressure; the
resulting pressure reflects alveolar pressure at the end of expiration (intrinsic PEEP). Although accurate
measurement depends on the patient being completely passive on the ventilator, it is unwarranted to use
neuromuscular blockade solely for the purpose of measuring intrinsic PEEP. A nonquantitative method of identifying
intrinsic PEEP is to inspect the expiratory flow tracing. If expiratory flow continues until the next breath or the
patient’s chest fails to come to rest before the next breath, intrinsic PEEP is present. The consequences of elevated
intrinsic PEEP include increased inspiratory work of breathing and decreased venous return, which may result in
decreased cardiac output and hypotension.
ELECTRICAL FUNCTION OF MEDICAL VENTILATION
In its simplest form, a modern positive pressure ventilator consists of a compressible air reservoir or turbine, air
and oxygen supplies, a set of valves and tubes, and a disposable or reusable "patient circuit". The air reservoir is
pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the
patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to
meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the lungs'
elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient
manifold.
Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters and ventilator
function, backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by
a computer-controlled turbopump.
Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure
and flow characteristics to an individual patient's needs. Fine-tuned ventilator settings also serve to make ventilation
more tolerable and comfortable for the patient. In Canada and the United States, respiratory therapists are
responsible for tuning these settings, while biomedical technologists are responsible for the maintenance. In the
United Kingdom and Europe the management of the patient's interaction with the ventilator is done by critical care
nurses.
The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g.
inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the
circuit may be either noninvasive or invasive.
Noninvasive methods, such as Continuous positive airway pressure (CPAP) and Non-invasive ventilation, which are
adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive
methods require intubation, which for long-term ventilator dependence will normally be a tracheotomy cannula, as
this is much more comfortable and practical for long-term care than is larynx or nasal intubation.
Life-critical system Edit
Because failure may result in death, mechanical ventilation systems are classified as a life-critical system, and
precautions must be taken to ensure that they are highly reliable, including their power-supply.
Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient.
They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the
mechanical ventilator integrated into an anaesthetic machine). They may also have safety valves, which open to
atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient.
Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide
ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their
mechanisms or software fail.
 "Weaning" is the process of taking you off of a ventilator so that you can start to breathe on your own.
People usually are weaned after they've recovered enough from the problem that caused them to need the
ventilator. Weaning usually begins with a short trial. You stay connected to the ventilator, but you're given a
chance to breathe on your own. Most people are able to breathe on their own the first-time weaning is
tried. Once you can successfully breathe on your own, the ventilator is stopped. If you can't breathe on your
own during the short trial, weaning will be tried at a later time. If repeated weaning attempts over a long
time don't work, you may need to use the ventilator long term. After you're weaned, the breathing tube is
removed. You may cough while this is happening. Your voice may be hoarse for a short time after the tube is
removed.

MAGNETIC RESONANCE IMAGING(MRI)
MRI uses a strong magnetic field and radio waves to create detailed images of the organs and tissues within
the body.
 MRI scanning is a non-invasive and painless procedure.
 Raymond Damadian created the first MRI full-body scanner, which he nicknamed the Indomitable.
An MRI scan uses a large magnet, radio waves, and a computer to create a detailed, cross-sectional image of
internal organs and structures.The scanner itself typically resembles a large tube with a table in the middle,
allowing the patient to slide in. An MRI scan differs from CT scans and X-rays, as it does not use potentially
harmful ionizing radiation.
 anomalies of the brain and spinal cord
 tumours, cysts, and other anomalies in various parts of the body
 breast cancer screening for women who face a high risk of breast cancer
 injuries or abnormalities of the joints, such as the back and knee
 diseases of the liver and other abdominal organs
 the evaluation of pelvic pain in women, with causes including fibroids and endometriosis
The History of MRI
MRI, as with all medical imaging techniques, is a relatively new technology with its foundations beginning during the
year of 1946. Felix Bloch and Edward Purcell independently discovered the magnetic resonance phenomena during
this year, and were later awarded the Nobel Prize in 1952. Up until the 1970s MRI was being used for chemical and
physical analysis. Then in 1971 Raymond Damadian showed that nuclear magnetic relaxation times of tissues and
tumors differed motivating scientists to use MRI to study disease. With the advent of computed tomography (using
computer techniques to develop images from MRI information) in 1973 by Hounsfield, and echo-planar imaging (a
rapid imaging technique) in 1977 by Mansfield, many scientists over the next 20 years developed MRI into the
technology that we now know today.
Founding Fathers
Eward Purcell (left) and Raymond Damadian
(right)
Perhaps one of the most exciting developments of these was the advent of superconductors. These superconductors
make the strong magnetic fields used in MRIs possible. Due to all of these technologies required, the first human
being MRI examination did not occur until 1977. Since then, faster computing has made the MRI process much
faster. The most significant advancement in MRIs occurred in 2003, when the Nobel Prize was won by Paul C.
Lauterbur and Peter Mansfield for their discoveries of using MRIs as a diagnostic tool.
ELECTRICAL FUNCTION OF MRI
The MRI system consists of several major components, as shown in Figure. At this time we will introduce the
components and indicate how they work together to create the MR image. The more specific details of the image
forming process will be explained in later chapters.
Magnetic Resonance Imaging System.

Magnetic Field Shielding
The external magnetic field surrounding the magnet is the possible source of two types of problems. One problem is
that the field is subject to distortions by metal objects (building structures, vehicles, etc.) as described previously.
These distortions produce inhomogeneities in the internal field. The second problem is that the field can interfere
with many types of electronic equipment such as imaging equipment and computers.
It is a common practice to reduce the size of the external field by installing shielding as shown in Figure 2-5.
The principle of magnetic field shielding is to provide a more attractive return path for the external field as it passes
from one end of the magnetic field to the other. This is possible because air is not a good magnetic field conductor
and can be replaced by more conductive materials, such as iron. There are two types of shielding: passive and active.
The principle of magnetic field shielding
Passive Shielding
Passive shielding is produced by surrounding the magnet with a structure consisting of relatively large pieces of
ferromagnetic materials such as iron. The principle is that the ferromagnetic materials are a more attractive path for
the magnetic field than the air. Rather than expanding out from the magnet, the magnetic field is concentrated
through the shielding material located near the magnet as shown in Figure 2-5. This reduces the size of the field.
Active Shielding
Active shielding is produced by additional coils built into the magnet assembly. They are designed and oriented so
that the electrical currents in the coils produce magnetic fields that oppose and reduce the external magnetic field.
The Radio Frequency System
The radio frequency (RF) system provides the communications link with the patient’s body for the purpose of
producing an image. All medical imaging modalities use some form of radiation (e.g., x-ray, gamma-ray, etc.) or
energy (e.g., ultrasound) to transfer the image from the patient’s body.
The MRI process uses RF signals to transmit the image from the patient’s body. The RF energy used is a form
of non-ionizing radiation. The RF pulses that are applied to the patient’s body are absorbed by the tissue and
converted to heat. A small amount of the energy is emitted by the body as signals used to produce an image.
Actually, the image itself is not formed within and transmitted from the body. The RF signals provide information
(data) from which the image is reconstructed by the computer. However, the resulting image is a display of RF signal
intensities produced by the different tissues.
RF Coils

The RF coils are located within the magnet assembly and relatively close to the patient’s body. These coils function
as the antennae for both transmitting signals to and receiving signals from the tissue. There are different coil designs
for different anatomical regions (shown in Figure 2-6). The three basic types are body, head, and surface coils. The
factors leading to the selection of a specific coil will be considered in Chapter 10. In some applications the same coil
is used for both transmitting and receiving; at other times, separate transmitting and receiving coils are used.
Surface coils are used to receive signals from a relatively small anatomical region to produce better image quality
than is possible with the body and head coils. Surface coils can be in the form of single coils or an array of several
coils, each with its own receiver circuit operated in a phased array configuration. This configuration produces the
high image quality obtained from small coils but with the added advantage of covering a larger anatomical region
and faster imaging.
The three types of RF coils (body,head and surface) that are
The antennae for transmitting pulses and receiving signal from the
Patient’s body
Transmitter
The RF transmitter generates the RF energy, which is applied to the coils and then transmitted to the patient’s body.
The energy is generated as a series of discrete RF pulses. As we will see in Chapters 6, 7, and 8, the characteristics of
an image are determined by the specific sequence of RF pulses.
The transmitter actually consists of several components, such as RF modulators and power amplifiers, but for
our purposes here we will consider it as a unit that produces pulses of RF energy. The transmitters must be capable
of producing relatively high power outputs on the order of several thousand watts. The actual RF power required is
determined by the strength of the magnetic field. It is actually proportional to the square of the field strength.
Therefore, a 1.5 T system might require about nine times more RF power applied to the patient than a 0.5 T system.
One important component of the transmitter is a power monitoring circuit. That is a safety feature to prevent
excessive power being applied to the patient’s body, as described in Chapter 15.
Receiver
A short time after a sequence of RF pulses is transmitted to the patient’s body, the resonating tissue will respond by
returning an RF signal. These signals are picked up by the coils and processed by the receiver. The signals are
converted into a digital form and transferred to the computer where they are temporarily stored.
RF Polarization
The RF system can operate either in a linear or a circularly polarized mode. In the circularly polarized mode,
quadrature coils are used. Quadrature coils consist of two coils with a 90˚ separation. This produces both improved
excitation efficiency by producing the same effect with half of the RF energy (heating) to the patient, and a better
signal-to-noise ratio for the received signals.
RF Shielding

RF energy that might be in the environment could be picked up by the receiver and interfere with the production of
high quality images. There are many sources of stray RF energy, such as fluorescent lights, electric motors, medical
equipment, and radio communications devices. The area, or room, in which the patient’s body is located must be
shielded against this interference.
An area can be shielded against external RF signals by surrounding it with an electrically conducted enclosure.
Sheet metal and copper screen wire are quite effective for this purpose.
The principle of RF shielding is that RF signals cannot enter an electrically conductive enclosure. The thickness
of the shielding is not a factor—even thin foil is a good shield. The important thing is that the room must be
completely enclosed by the shielding material without any holes. The doors into imaging rooms are part of the
shielding and should be closed during image acquisition.
Computer Functions
A digital computer is an integral part of an MRI system. The production and display of an MR image is a sequence of
several specific steps that are controlled and performed by the computer.
Acquisition Control
The first step is the acquisition of the RF signals from the patient’s body. This acquisition process consists of many
repetitions of an imaging cycle. During each cycle a sequence of RF pulses is transmitted to the body, the gradients
are activated, and RF signals are collected. Unfortunately, one imaging cycle does not produce enough signal data to
create an image. Therefore, the imaging cycle must be repeated many times to form an image. The time required to
acquire images is determined by the duration of the imaging cycle or cycle repetition time—an adjustable factor
known as TR—and the number of cycles. The number of cycles used is related to image quality. More cycles
generally produce better images. This will be described in much more detail in Chapters 10 and 11.
Protocols stored in the computer control the acquisition process. The operator can select from many preset
protocols for specific clinical procedures or change protocol factors for special applications.
Image Reconstruction
The RF signal data collected during the acquisition phase is not in the form of an image. However, the computer can
use the collected data to create or “reconstruct” an image. This is a mathematical process known as a Fourier
transformation that is relatively fast and usually does not have a significant effect on total imaging time.
Image Storage and Retrieval
The reconstructed images are stored in the computer where they are available for additional processing and
viewing. The number of images that can be stored—and available for immediate display—depends on the capacity
of the storage media.
Viewing Control and Post Processing
The computer is the system component that controls the display of the images. It makes it possible for the user to
select specific images and control viewing factors such as windowing (contrast) and zooming (magnification).
In many applications it is desirable to process the reconstructed images to change their characteristics, to
reformat an image or set of images, or to change the display of images to produce specific views of anatomical
regions.
These post-processing (after reconstruction) functions are performed by a computer. In some MRI systems
some of the post processing is performed on a work-station computer that is in addition to the computer contained
in the MRI system.
Magnetic Resonance Imaging System Components
ELECTROCRADIOGRAM (ECG)
A recording of the electrical activity of the heart. An ECG is a simple, noninvasive procedure. Electrodes
are placed on the skin of the chest and connected in a specific order to a machine that, when turned on, measures
electrical activity all over the heart. Output usually appears on a long scroll of paper that displays a printed graph of
activity on a computer screen. The initial diagnosis of heart attack is usually made through observation of a
combination of clinical symptoms and characteristic ECG changes. An ECG can detect areas of muscle deprived of
oxygen and/or dead tissue in the heart. If a medication is known to sometimes adversely affect heart function, a
baseline ECG may be ordered before the patient starts taking the medicine, and follow-up testing may occur at
regular intervals to look for any changes.

A line graph that shows changes in the electrical activity of the heart over time. It is made by an instrument called an
electrocardiograph. The graph can show that there are abnormal conditions, such as blocked arteries, changes in
electrolytes (particles with electrical charges), and changes in the way electrical currents pass through the heart
tissue. Also called EKG and electrocardiogram.
OVER VIEW OF ECG
An electrocardiogram records the electrical signals in your heart. It's a common test used to detect heart problems
and monitor the heart's status in many situations. An ECG is a non-invasive, painless test with quick results. During
an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and
sometimes your limbs. These sensors are usually left on for just a few minutes.
Electrocardiography in clinical practice is the recording at the body surface of electrical activity in the heart. It is a
record of the average electrical potential generated in the heart graphed in voltage and time. Specific waveforms
represent stages of myocardial depolarization and repolarization. The electrocardiogram (ECG) is a basic and
valuable diagnostic test in veterinary medicine and toxicology studies, and it is easy to acquire. The ECG is the initial
test of choice in the diagnosis of cardiac arrhythmias and may also yield useful information regarding chamber
dilation and hypertrophy. However, the ECG does not record cardiac mechanical activity; therefore it does not yield
information regarding cardiac contractility. Also, extracardiac factors may influence the ECG, including body tissues
with different conductive properties and body anatomy. It is also important to remember that the ECG may be
normal even in the face of advanced cardiovascular disease.
There are three main components to an ECG: the P wave, which represents the depolarization of the atria; the QRS
complex, which represents the depolarization of the ventricles; and the T wave, which represents the repolarization
of the ventricles.[6]
During each heartbeat, a healthy heart has an orderly progression of depolarization that starts with pacemaker
cells in the sinoatrial node, spreads throughout the atrium, passes through the atrioventricular node down into
the bundle of His and into the Purkinje fibers, spreading down and to the left throughout the ventricles.[6] This orderly
pattern of depolarization gives rise to the characteristic ECG tracing. To the trained clinician, an ECG conveys a large
amount of information about the structure of the heart and the function of its electrical conduction system.[7] Among
other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the heart
chambers, the presence of any damage to the heart's muscle cells or conduction system, the effects of heart drugs,
and the function of implanted pacemakers.

Electrode leads on the chest wall are able to detect electrical impulses that are generated by the heart. Multiple
leads provide many electrical views of the heart. By interpreting the tracing, the physician can learn about the heart
rate and rhythm as well as blood flow to the ventricles (indirectly).
Rate refers to how fast the heart beats. Normally, the SA node generates an electrical impulse 50-100 times per
minute. Bradycardia (brady=slow+cardia=heart) describes a heart rate less than 50 beats per minute. Tachycardia
(tachy=fast+cardia=heart) describes a heart rate faster than 100 beats per minute.
Rhythm refers to the type of heartbeat. Normally, the heart beats in a sinus rhythm with each electrical impulse
generated by the SA node resulting in a ventricular contraction, or heartbeat. There are a variety of abnormal electrical
rhythms, some are normal variants and some are potentially dangerous. Some electrical rhythms do not generate a
heartbeat and are the cause of sudden death.
Rhythm strip showing a normal 12-lead ECG.
There can also be short circuits that can lead to abnormal electrical pathways in the heart causing abnormalities of
rate and rhythm. Wolfe-Parkinson-White (WPW) syndrome is a condition where an abnormal accessory pathway at
the AV node can cause tachycardia.
The ECG tracing can also provide information about whether the heart muscle cells are conducting electricity
appropriately. By analyzing the shape of the electrical waves, the physician may be able to determine if there is
decreased blood flow to parts of the heart muscle. The presence of an acute blockage associated with a myocardial
infarction or heart attack can be determined as well. That's one of the reasons that an ECG is done as soon as
possible when a patient presents with chest pain.
The components of a normal ECG tracings, it consists of waveform components which indicate electrical events
during one heartbeat. These waveforms are labeled P, Q, R, S, T and U.P wave is the first short upward movement of
the ECG tracing. It indicates that the atria are contracting, pumping blood into the ventricles.

The QRS complex, normally beginning with a downward deflection, Q; a larger upwards deflection, a peak (R); and
then a downwards S wave. The QRS complex represents ventricular depolarization and contraction. The PR interval
indicates the transit time for the electrical signal to travel from the sinus node to the ventricles. T wave is normally a
modest upwards waveform representing ventricular repolarization.
Electrocardiography is the process of producing an electrocardiogram a recording – a graph of voltage versus time –
of the electrical activity of the heart using electrodes placed on the skin. These electros detect the small electrical
changes that are a consequence of cardiac muscle depolarization followed by repolarization during is cardiac cycle.
Changes in the normal ECS pattern occurs in numerous cardiac abnormalities including cardiac rhythm disturbance
inadequate coronary artery blood flow as myocardial ischemia and myocardial and electrolyte disturbances.
CONCLUSION
Technological development are better are better adopted into the medical fields in some parts of the word than
other. Developed nation have been able to harness technology more efficiently for improve patient care. How ever
developing nations are catching up quickly. Medical science provider who have not yet adopted the tools technology
places at their disposal are realising their vast untapped potential and are making the changes and the investment
required to streamline processes lower cost, increase efficiency at most importantly to improve quality of care.

Importance of Technology in Medical Science

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Importance of Technology in Medical Science

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1 IMPORTANCE OF TECHNOLOGY IN MEDICAL SCIENCE- DOLON SENAPATI

IMPORTANCE OF TECHNOLOGY IN MEDICAL SCIENCE

INDIAN SCHOOL OF COMPLEMENTARY THERPAY AND ALLIED SCIENCES, INDIA

Now days medicine makes effective treatments for diseases and

Corresponding author- Dolon Senapati

Medical ultrasonography is also known as diagnostic sonography or ultrasonography. It is a diagnostic imaging

THE HISTORY OF ULTRASOUND

The current collection includes:

 Ultra sound related hardware.

Corresponding author- Dolon Senapati

Modern Ultrasound development

Used to convert convert acoustic energy into electrical energy.

Used of Ultrasound in Therapy:

Used for sterilization of vaccines and physical therapy treatment.

Ultrasound in medical Diagnostic:

Detects gallstones near the intestines.

Corresponding author- Dolon Senapati

Detects flaws in metals.

Ultrasound in obstetrics and Gynecology:

Distinguished between cysts, fibroids and other intra-abdominal tumors.

Images blood flow from different chambers of the heart.

Development of 4-D/ultrasound progression:

Corresponding author- Dolon Senapati

2D/3D/4D ultrasound today

OVER VIEW OF USG

 Keyboard/cursor - inputs data and takes measurements from the display

 Printer - prints the image from the displayed data

HIGH MULTIPLEXING TRANSMITTER

Corresponding author- Dolon Senapati

Ultrasound Pulse Frequency

Corresponding author- Dolon Senapati

PULSE DIAMETER AND BEAM WIDTH

Corresponding author- Dolon Senapati

Corresponding author- Dolon Senapati

OVER VIEW OF PACEMAKER

Corresponding author- Dolon Senapati

"Wireless" vs. Traditional Pacemaker

Micra leadless pacemaker

 A determination on the appropriate type of pacemaker is best explored with a cardiologist or

Pacemaker vs. Defibrillator (ICD)

ELECTRICAL FUNCTION OF PACEMAKER

Corresponding author- Dolon Senapati

 The generator is a small battery-powered unit.

 A computerized pulse generator to produce electrical signals to regulate your heartbeat.

Corresponding author- Dolon Senapati

Impedance = (Y) (v).

The Production of an Echo and Penetrating Pulse at a Tissue Interface

HISTORY OF MEDICAL VENTILATOR

Corresponding author- Dolon Senapati

Corresponding author- Dolon Senapati

Corresponding author- Dolon Senapati

Positive-Pressure Noninvasive Ventilation

Corresponding author- Dolon Senapati

Corresponding author- Dolon Senapati

Corresponding author- Dolon Senapati

POSITIVE PRESSURE INVASIVE VENTILATORS

First-Generation ICU Ventilators

Corresponding author- Dolon Senapati

Second-Generation ICU Ventilators

Corresponding author- Dolon Senapati

Third-Generation ICU Ventilators

Corresponding author- Dolon Senapati

Fourth-Generation ICU Ventilators