Chapter 4

Flow measurement

Viet Dung Nguyen

Department of Electronic Technology and Biomedical Engineering, Hanoi University of Science and Tech
4.1. CÁC ĐẠI LƯỢNG CẦN ĐO
4.2. ĐO LƯU LƯỢNG MÁU TRONG MẠCH MÁU
ĐƠN
4.3. PHÉP ĐO DÒNG MÁU MÔ
4.4. ĐO LƯU LƯỢNG KHÍ HÔ HẤP

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 4.1. OBJECT QUANTITIES

4.1.1. Unit in Flow Measurements

- For fluid flow
+ Volume flow rate: m3/s, kg/s; l/s, l/min, ml/min
+ Mass flow rate: m3/s.kg; ml/(min.100g): volume flow rate per unit
mass of tissue
+ Volume flow rate per unit volume of tissue: number of turnovers in
the unit of time interval: s-1, min-1...
+ Flow velocity: m/s
- For gas flow: pressure and temperature are known
+ STPD (Standard Temperature and Pressure, Dry): 10C, 101,325 kPa
(1 atm), zero water vapor pressure
+ BTPS (Body Temperature, ambient Pressure and Saturated with
water vapor):
+ ATPS (Ambient Temperature and Pressure Saturated with water
vapor)
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 4.1.2. Requirements for Measurement Range

4.1.2.1. Blood flow in a single vessel

- Flow rate: ~ (2R)3
- Mean velocity: ~ (2R)
- Different flow rate or velocity →
different measurement

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- Flow velocity: not uniform but distributed
Assumption: conduit is a long straight, cylinder tube, flow is steady and
laminar
➔ parabolic velocity profile
R
 r2  1 2
U (r ) = U m  1 − 2  Q =  U (r ).2rdr = R U m
 R  0
2

Parabolic velocity profile in long circular conduit

with steady laminar flow

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 - Blood flow is actually not steady but pulsatile
+ Backward component is commonly observed even in small arteries
+ In large arteries, very high velocities can occur temporarily →
turbulent flow appears

- Velocity profile cannot be identified

➔ flow rates can still be measured by appropriate methods

Schematic of a typical velocity profle in the artery

in one cardiac cycle

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4.1.2.2. Tissue blood flow
- Differs significantly for
different tissues and
physiological conditions
- Average tissue blood flow:
rough estimate of the
circulatory condition
- Local tissue blood flow:
valuable in clinical diagnoses
and physiological studies

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4.1.2.3. Respiratory gas flow
- The ventilation of the lungs can be assessed by studying a gas volume
and its variations in the lung
- Actual gas volumes in the lung cannot be simply determined
- Difference in the relative composition of respiratory gases may affect
flow measurements
+ Corrections when gas composition varies widely
+ Assume a linear relation of the value of each gas

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 4.2. BLOOD FLOW MEASUREMENTS
IN SINGLE VESSEL

4.2.1. Electromagnetic Flowmeter

4.2.2. Ultrasonic Flowmeter
4.2.3. Indicator Dilution Method
4.2.4. Flow Velocity Measurement by Heat Dissipation
4.2.5. Impedance Cardiography
4.2.6. Blood Flow Recording in Single Vessels by Laser Doppler
Flowmetry
4.2.7. Correlation Methods for Microvascular Red Blood Cell
Velocity Measurement
4.2.8. Miscellaneous Mechanical Flowmeters

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 4.2.1. Electromagnetic Flowmeter

4.2.1.1. Principle
- A fluid containing electric charges (like blood) flows in a magnetic
field, an electromotive force is generated
- The blood velocity is
not uniform but the flow F = q(U x B)
rate by replacing Um by qE + q(U x B) = 0
mean velocity (Um /2) as V = S.E = - S.(U x B)
long as the velocity
profile is longitudinal V = d.U.B
axis symmetric
 d 2U  dV
Q= =
4 4B

Relationship between flow velocity U, magnetic flux density B,

developed electric field E, and electromotive force V

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4.2.1.2. Factors affecting measurement
- While the principle is rather simple, but many factors may affect
sensitivity of electromagnetic flowmeter
+ Velocity profile
+ Magnetic field distribution
+ Electric conductivities of the inside vessel wall and outside media
➢ Velocity profile

2 a
2B
V=
a   U (r , ) W (r , )  r  da  d
0 0

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➢ Magnetic field distribution
- When size magnet or stimulus coil is equivalent to that of vessel
→magnetic field is not uniform
➢ Electric conductivities of the inside vessel wall and outside media
V = 2sbBU
2 1  2
s=
( )
1  2 1 − a 2 b 2 + 1 − a 2 b 2
Vessel
wall
❑ Today, electromagnetic
flowmeter is replaced by other
methods like ultrasound and
Blood
thermodilution
+ Require less surgical
incisions
+ More convenient to use
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 4.2.2. Ultrasonic Blood Flowmeter

- A sound wave propagating in a moving medium is affected by the

medium velocity
- Sound scattered by a moving object is also affected by the velocity of
the scattering object
➔used to measure blood velocity or flow rate
+ Transit time or phase shift flowmeter
+ Doppler flowmeter

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4.2.2.1. Ultrasound propagation in tissue
- Ultrasound: sound having frequency higher than 20 kHz
- The sound velocity: c = f.λ
- Sound pressure: p=ρ.c.U
- Characteristic impedance: Z=p/U= ρ.c
- Sound energy or sound power: I=pU/2=p2/2Z
- Sound wave is reflected, absorbed or scattered at the boundary
between two media, having different characteristic impedances

p r = (Z1 − Z2 ) (Z1 + Z2 ) pi I t = Ii − I r = 4.Ii .Z1Z2 (Z1 + Z2 )

2

I r = (Z1 − Z2 ) (Z1 + Z2 ) Ii
2 I(x) = I(0)e −2x

p(x) = p(0)e − x

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4.2.2.2. Lưu lượng kế thời gian truyền và lưu lượng kế dịch pha
- The apparent sound velocity in flowing fluid differs from that in
resting fluid
- Transit time:
T = D (c  U cos )
2DU cos  2DU cos 
T = 
c 2 − U 2 cos 2  c2
2DU cos 
 = T =
c2 Arrangement of crystals for transit time
or phase shift measurement
D = 2 cm, U = 10 cm/s;  = 450→
T  1,3x10-9 s
f=1 MHz→  8x10-3 rad = 28’

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- The velocity profile is not uniform in the actual blood flow → need
correction

Parabolic velocity profile → actual flow > 33% estimated flow with
uniform profile

Minimize influence of velocity profile

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 Transit time measurement

Output of time detector is proportional to transit time

Switch two crystal then synchronously rectify to get a signal
proportional to the transit time difference

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 Phase shift detection

Heterodyne: convert to audio frequency signal having same phase

Phase detector: detect phase change relative to a reference signal
Switch two crystals
Synchronous rectification

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 Phase shift detection

Two crystals work as transmitter and receiver simultaneously

Mix to get signal |f1 - f2| corresponding to each crystal
Invert one signal’s phase

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 Phase difference using single phase excitation

Driven signal to crystals: Vcost

Signal appearing at each crystal
e1 = V cos t − kV cos(t +  + )
e 2 = −V cos t + kV cos(t +  − )
e = e1 + e 2 = 2kV sin   sin(t + )  2kV    sin(t + )

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4.2.2.3. Ultrasonic Doppler flowmeter
- Velocity of particles in a flowing fluid can be determined by the
Doppler shift of the scattered ultrasound by the particles

c + U cos 
f1 = fs
c
c
f2 = f1
c − U cos 
c + U cos 
f = f 2 − f s = fs − fs
c − U cos 
U (cos  + cos  )
 fs
c
2U cos 
f  fs
c

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- The Doppler shift is essentially a frequency modulation by the velocity
of the scattering object
→ 2 step demodulation
* Convert into audio frequency signal
* Using appropriate signal processing techniques

➢ Convert into audio frequency signal

* Mix
* Heterodine
* Quadrature

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 Doppler shift extraction using mixer

Doppler shift proportional to cost as beat of transmitting and

receiving signal
Using phase sensitive detector or multiplier → coherent demudulation

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 Heterodyne demodulation

2  1
Beat frequency corresponding to (1 - 2) appears when Doppler shift
= 0 and increase or decrease up to  positive or negative
Flow direction can be discriminated

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 Quadrature demodulation

Upper and lower parts: coherence demodulation

1st output: ~ cost
2nd output: ~ sint
Flow direction can be determined

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➢Signal processing to get velocity information: zero-cross count or
spectrum analysis
* Zero cross: based on the theory of random noise
- Received signal contain a number of scattered waves → random noise
- Number of zero-crossing in unit time
12
 2 

N = 2  f P(f )df
 P(f )df 
0 0 
- Replace f by mean frequency then N = 2 f
- For parabolic velocity profile
2U cos  4U cos 
N = 1,03  m f s = 1,03  fs
c c
- No information on velocity distribution
- Noise sensitive
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* Spectrum analysis
- Measures the power of each frequency component of the Doppler-
shifted wave corresponding to each velocity component in the blood
flow
- To observe the variation of each velocity component → performed for
every short time interval
- By Fast Fourier Transform (FFT)

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4.2.2.4. Range discrimination
- The blood flow in deep arteries or veins can be assessed noninvasively
by ultrasound Doppler blood flow measurement
- Two or more large vessels exist in an ultrasound beam
→ hard to distinguish
→ range discrimination Doppler flowmeter
* Pulse Doppler system
* Random signal Doppler system

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* Pulse Doppler
- Transmit short ultrasound pulse
- Gating received signals at specific
time interval → get signals from
specific range selectively
- Spectrum analysis

Principle of pulse Doppler

system

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- Time of emitting ultrasound pulse p is small enough to gating time 
then measurement range d  c/2.
- Pulse repetition frequency limit: fp=c/2Dmax
→ Nyquist theorem: signal maximum frequency fmax=fp/2
→ Maximum measurable velocity
U max = cf max 2f s = c 2 8f s D max

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 4.2.3. Indicator Dilution Method

4.2.3.1. Principle

Indicator dilution principle

- Inject indicator upstream and observer concentration of the indicator

downstream
- Injection mode: rapid (slud/bolus) and constant
- Indicator: dyes, radio-isotopes, electrolytes, heat or gas (O2, CO2 …)

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- Rapid injection and no leakage, no
recirculation

I =  Q  c(t )  dt
0

Q=I  c(t )dt
0

Dilution curve for rapid injection

Empirical: an indicator is injected into the vein or the pulmonary artery,

and the dilution curve is observed at the artery

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(a): approximate down slope by
exponential curve
c2 = c1  e−1 2 = 0, 607c1
 t1

 c(t )dt   c(t )dt + 2c (t

0 0
1 2 − t1 )

(b): forward triangle

tp

 c(t )dt  1,35c t

0
p b

tp

(c):  c(t )dt  1,1c t

0
p 12

Empirical approximation to estimating the initial

circulation component of the dilution curve

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4.2.3.2. Dye dilution method
- Dye as indicator
+ Water soluble, nontoxic, sterile
+ Precise determination of concentration in whole blood or plasma
+ Shouldn’t be lost or degenerated metabolically during initial
circulation
+ Preferable to leave the circulatory blood rapidly after initial
circulation
- Concentration of dye is usually detected optically

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- Record dilution curve:
cuvette densitometer, earpiece
densitometer or fiber optic
catheter
➢ Cuvette densitometer
+ Blood drained continuously
via intravascular catheter flows
through a gap between 2 glass
plates
+ Light is detected by photo
detector like photomultiplier
tube
Cuvette densitometer

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- If dye concentration is low enough and dispersed uniformly
 cd = log ( I 0 I ) = log I 0 − log I
- Calibrate absolutely by introducing into the blood a known
concentration of dye into the cuvette

➢ Earpiece densitometer
- Measures dye’s concentration by light absorption in the ear lobe
- If the dye remains only in the earlobe’s blood vessels, Beer–Lambert’s
law is valid approximately
- Calibration
+ Sampling blood when the dye is uniformly mixed
+ Deflection at the terminal of the dilution curve corresponds to the
concentration of dye in the blood sample

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➢ Optic fiber catheter
- The blood is illuminated by a light beam
- Part of the backscattered light is transmitted to the detector through
another bundle of optic fibers
- Similar calibration curve between the dye’s concentration and the
change in intensity of the backscattered light
- Comparative study with cuvette densitometer: correlation coefficient
of about 0.9 in cardiac output measurements

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4.2.3.3. Thermodilution method
- A definite amount of heat is injected into the blood stream then record
the corresponding temperature change downstream
- Cold fluid is often used as an indicator
- Features
+ No toxic effect → can be performed repeatedly
+ Easy to record dilution curve
+ Recirculation component is small enough → accurate
+ Appropriate for large vessels than smaller ones

- Studies in model experiments, animals and humans show that the

thermodilution method with rapid injection for measurement of cardiac
output is acceptable and accurate for most clinical purposes

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 Thermodilution catheter (from Spectramed Co., Oxford, CA)

C
- Flow rate: Q = I I  VI (TB − TI )
 B CB  T dt
0
B

V1, T1: volume and temperature of indicator

B, CB: density and specific heat of blood
I, CI : density and specific heat of indicator
TB: blood temperature change

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The catheter is introduced from a
peripheral vein into the pulmonary
artery
Inject a bolus of cold saline or
dextrose solution into the right
atrium
Mixing occurs in the right atrium
and the right ventricle
The decrease in temperature is
detected by the thermistor placed in
the pulmonary artery.

Thermodilution method for

monitoring cardiac output

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- The thermodilution method with continuous injection can be applied
for cardiac output measurement
Injection rate should be
small
Reynold’s number ≥3000
to achieve good mixing
Additional thermistor is
used to measure true
temperature of injected
fluid

Thermodilution catheters for continuous injection

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4.2.3.4. Fick method
- Pulmonary blood flow can be determined by the rate of gas intake to
or extraction from the blood in the lung, and the change in the gas
concentration in the blood stream through the lung
- A standard method for cardiac output measurement
- Flow rate through the lung

(C )
•
Q = V O2 aO2 − CvO2

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 •
- V O2 :measure tidal volume and oxygen content in the expiratory air as
long as the oxygen content in the atmospheric air is known
C aO2 : by gas analysis of any arterial blood
C vO2 : by the gas analysis of mixed venous blood → sampled in the right
ventricle or the pulmonary artery via cardiac catheterization

- Fick method: the most reliable method of cardiac output measurement

but requires cardiac catheterization
→ Indirect Fick method: blood gas contents are obtained only by
expiratory gas analysis; no cardiac catheterization

(C )
•
Q = V CO2 aCO2 − CvCO2
•
V CO2 : carbon dioxide output
CaCO2 : carbon dioxide contents of the arterial blood

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- CvCO : carbon dioxide contents of the mixed venous blood ???
2

+ Rebreathing
+ Breath-holding
➢ Rebreathing
- Subject
•
breathes the air from an anesthetic bag for 15–30 s
- V CO of air in the bag is equilibrated to that of the mixed venous blood
2

- Approximate the time course of CvCO in the bag by an exponential

2

function
➢ Breath-holding
- Estimate CO2 in mixed venous blood from time course of in the
alveolar gas during breath-holding
+ Inhale gas with CO2 concentration from 5  7% before holding
breath about 20 s•
+ Plot rate of V CO change in expired: point where change is 0
2

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4.2.3.5. Other dilution methods
- Radio isotopes and solutions having different electric conductivities
from that of blood
+ Radio isotopes: 131I-labelled radio-iodinated serum albumin (RISA)
+ Solutions: hypertonic saline

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 4.2.4. Flow Velocity Measurement by Heat Dissipation

- The rate of heat dissipation from a heated element in the blood stream
+ Blood velocity
+ Temperature difference between the element and outer environment
+ The element size and shape
+ Viscosity, thermal conductivity, density, state of the flow…
- Rate of heat dissipation
H = a + bU m
where: U is flow velocity
a, b are constant determined by calibration
m: 0.5

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- To maintain the element at a constant temperature, electric heating is
commonly used
At equilibrium, the rate of heat dissipation is equal to heat production
H=R.I2

If R changes with
temperature → using
bridge circuit with
feedback

Bridge circuit with feedback to keep the

heating element’s temperature constant

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4.2.4.1. Thermistor velocity probe
- The thermistor has large temperature coefficient → being used

- Two thermistors are commonly used

The temperature difference is kept constant

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4.2.4.2. Hot-film velocity probes
- Consist of a thin metal film
used for local flow measurements
- Hot-film velocity probe
Hot-film anemometer: “Lưu tốc
kế”
- Should be calibrated in the
stream of known velocity using
the same fluid and at the same
temperature as in actual
measurement
- Used in dynamic velocity
measurement; velocity wave
form, detecting flow reversal, or
measurement of turbulence

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 4.2.5. Impedance Cardiography

- Impedance cardiography: stroke volume or cardiac output can be

estimated by waveforms of transthoracic electric impedance

Schematic diagram of impedance cardiography with the tetrapolar electrode arrangement

(left), and typical waveforms of impedance change, ΔZ, and its derivative, dZ/dt (right).
PCG: phonocardiogram

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- A steep change in the thoracic impedance happens at the early systole
Blood is injected into the vessels in the thorax → additional parallel
conductor in the thoracic segment between voltage electrodes
Actual amplitude of impedance waveform is about 0.1  0.2  while
average impedance Z0 in adults: 20  30 
- Stroke volume equation: by Kubicek
b L2
SV = 2
Z
Z 0
Assume that the blood is ejected uniformly at a constant rate, and the
impedance change, ΔZ, at the end of systole
Z = T (dZ / dt ) max

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 Different regression equations → difficulty in quantitative estimation of
cardiac output just by a simple model

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- The thoracic impedance waveform: different from subject to subject
and affected by
+ Blood volume changes in various organs in the thorax during a
cardiac cycle. In large arteries < 30%, while in the lung ~ 60%
+ The contribution of each organ to the thoracic impedance due to the
morphological difference
- Blood resistivity changes (10%–15% with the flow velocity) → affect
the sensitivity of the impedance signal to the blood volume change
The correlation coefficient increased significantly when using own
blood resistivities

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✓ Measuring the stroke volume or cardiac output by Patterson
+ Swallow a bipolar pill oesophageal electrode, 2.1 cm long with
thread-like wires
+ 4 mA and 100 kHz a.c current is supplied to the ordinary band
electrodes around the neck and the thorax
+ Electrode position is adjusted by ECG recorded from that electrode

As the electrode moved past near the atrium, the height and shape of the
P-wave changed
sharply → the electrode is placed slightly below the estimated position
of the left atrium for ventricular volume recording

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✓ Intraventricular impedance
+ An electrode catheter is placed along the long axis
of the left ventricle
+ A.c. current is supplied through two outer
electrodes
+ Record induced voltages between six adjacent
pairs of inner electrodes
- Assume that the ventricular wall is insulated → the
stroke volume can be estimated as the sum of blood
volume changes in five segments
- Highly correlated with electromagnetic flowmeter
- Can be applied to obtain intraventricular pressure
volume diagram Intraventricular
impedance

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 4.2.7. Correlation Methods for Microvascular Red Blood Cell
Velocity Measurement

- Blood flow velocity in a small vessel can be measured as the red blood
cell velocity under microscopic observation
➢ Two slits method
- Place 2 photodetectors with fixed
separation on the image of a vessel
- The red blood cells intercept the light
- Each photodetector provides output
when a plasma spacing between red
Using projection microscope
blood cells passes through the and photodetectors
photodetector slit
- Plasma transit time: from time it appears at downstream to time it
appears at upstream slit
- The separation of the two slits < size red blood cell on the image

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- Accurate determination of red blood cell velocity can be done by
correlating 2 outputs
Cross correlation: (t ) =  f1 (t )  f2 (t + )  d
maximum at m
→ red blood cell velocity: U =  m
+ Gaehtgens: two phototransistors with 1mm space center-to-center on a
projection screen of a magnification of 300 → measure red blood cell
velocities in the capillaries, arterioles, and venules up to 60 μm in
diameter in the mesenteric microcirculation (vi tuần hoàn mạc treo ruột) of
the cat

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►Using video system instead of photodetector

Like two-slit method, find time Fixed time. Find distance as

as time cross correlation spatial cross correlation function
function is maximal is maximal

() =  g1 (x)  g 2 (x + )  dx

Using microscope and video system

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- 1st system, time resolution when determination of m is limited
by frame rate of video system → measurement range is lower than
that of 2nd system
- For real time measurement → cross correlation computing time
limits the response to change of red blood cell velocity → use
grating method to get faster response

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►Grating method
The grating is place upon image of
microvessel on projection screen.
Photosensor collects light passed
through the grating
Red blood cell moves with velocity
U →light frequency f=U/d

To discriminate flow direction, with

prism grating with 3 photosensors

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 4.2.8. Miscellaneous Mechanical Flowmeters

- When the flow is disturbed by a mechanical element, it may cause a

force or displacement in the sensing element, corresponding to the flow
rate or flow velocity
► Pressure gradient technique
- The flow rate is measured from
the pressure difference between two
points along the axis
- For steady flow, pressure difference can be
determined as the frictional pressure drop
- Unsteady flow → additional pressure due to fluid inertia
P = . dU( t ) dt + U( t )

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► Kinetic energy detection
- Blood velocity can be determined from pressure
difference between upstream and downstream orifices
caused by blood kinetic
- Used in animal vena cave (tĩnh mạch chủ)

- Blood velocity is determined from

differential pressure between tube having a
funnel-shape opening to
the upstream and the adjacent tube having an
opening to the downstream

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► Using turbine
- Compose of an armature with blades
and an inside magnet
- Rotation of the armature is detected by a
pickup coil
- Relatively insensitive to viscosity
change
- Causes a significant pressure drop
- Can’t measure flow below a certain
critical level due to the friction between Electroturbinometer Potter
the armature shaft and the bearing surface

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► Using float
- The flow causes elevation of the float
- The float position is detected by a differential
transformer
- Relatively insensitive to changes in viscosity
- The pressure drop is not proportional to the flow
rate, but remains in a narrow range

Rotameter

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► Using bristle
- Compose of a fine bristle which is deflected by
flow
- If the deviation of the bristle Is proportional to the
drag force due to the kinetic energy of the fluid, it
will be proportional to the square of the flow
velocity
Bristle flowmeter

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► Mass flow measurement
- Both ends of an elastic tube supported at three
points are driven sinusoidally in opposite
directions → rotational vibration of the segment
is generated
- Detect the Coriollis’ force induced by rotational
motion of the flowing fluid
The induced force F at the segment’s center

d Vibration flowmeter
F = 2QL
dt

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►Direct measurement of volume displacement
-When the flow is obstructed at the valve,
the fluid flows into the bypass where silicone
oil is added
- Two electrodes detect the moment of
arrival at the boundary between conductive
and nonconductive fluid
-The valve opens → the silicone oil moves to
the initial position
Density flowmeter

When the volume of fluid contained between

two electrodes was 1.5 ml, flow ranging
from 2 to 50 ml/min could be measured with
an accuracy of ±4%

Sensors and Measurements in Biomedicine Chapter 4: 68/

- The drop counter can be used in case continuous measurement of a
low flow rate, such as blood perfusion to a small organ or urinary
and lymphatic flow measurement

Drop. counters: (a) optical detection (b) vibration detection (c) collecting electrode
and (d) electrical conductivity

Sensors and Measurements in Biomedicine Chapter 4: 69/

- Size of a drop depends:
+ The diameter of the dropping tube
+ Density and surface tension of the fluid
But flow rates ranging from 0 to 20 ml/min can be measured.
At a higher flow rate, the size of a drop is reduced → number of drops
becomes nonlinear to the flow rate
- The main problem with drop counters is that the volume of each drop
varies with a number of parameters like viscosity, temperature, flow
rate…

Sensors and Measurements in Biomedicine Chapter 4: 70/