Chapter 8.

Measurement of Flow and

Volume of Blood
John G. Webster

Medical Instrumentation Application

and Design, 4th Edition

John G. Webster, Univ. of Wisconsin, Madison

ISBN: 978-0-471-67600-3
Figure 8.1 Several methods of measuring cardiac output. In the Fick
method, the indicator is O2; consumption is measured by a spirometer. The
arterial-venous concentration difference is measured by drawing samples
through catheters placed in an artery and in the pulmonary artery. In the dye-
dilution method, dye is injected into the pulmonary artery and samples are
taken from an artery. In the thermodilution method, cold saline is injected
into the right atrium and temperature is measured in the pulmonary artery.
Figure 8.2 Rapid-injection indicator-dilution curve. After the bolus is
injected at time A, there is a transportation delay before the concentration
begins rising at time B. After the peak is passed, the curve enters an
exponential decay region between C and D, which would continue decaying
along the dotted curve to t1 if there were no recirculation. However,
recirculation causes a second peak at E before the indicator becomes
thoroughly mixed in the blood at F. The dashed curve indicates the rapid
recirculation that occurs when there is a hole between the left and right
sides of the heart.
Figure 8.3
Electromagnetic
flowmeter. When
blood flows in the
vessel with velocity u
and passes through
the magnetic field B,
the induced emf e is
measured at the
electrodes shown.
When an ac magnetic
field is used, any flux
lines cutting the
shaded loop induce
an undesired
transformer voltage.
Figure 8.4 Solid lines
show the weighting
function that represents
relative velocity
contributions (indicated
by numbers) to the total
induced voltage for
electrodes at the top and
bottom of the circular
cross section. If the
vessel wall extends from
the outside circle to the
dashed line, the range of
the weighting function is
reduced. (Adapted from
J. A. Shercliff, The
Theory of
Electromagnetic Flow
Measurement, © 1962,
Cambridge University
Press.)
Figure 8.5 Electromagnetic
flowmeter waveforms The
transformer voltage is 90° out of
phase with the magnet current.
Other waveforms are shown
solid for forward flow and
dashed for reverse flow. The
gated signal from the gated-
sine-wave flowmeter includes
less area than the inphase
signal from the quadrature-
suppression flowmeter.
Figure 8.6 The quadrature-suppression flowmeter detects the amplifier
quadrature voltage. The quadrature generator feeds back a voltage to balance
out the probe-generated transformer voltage.
For gated sine wave, waveforms are exactly like those in Fig. 8.5. Sample the
composite signal when the transformer voltage is zero.” Transformer voltage
is proportional to dB/dt. Taking the derivative of square wave B yields spikes
at transitions. Because the amplifier is not perfect, these take time to decay.
Best time to sample is near the end of transformer voltage = 0. Trapezoidal B
yields reasonable dB/dt so sample during time transformer voltage = 0.
Figure 8.7 The
toroidal-type cuff
probe has two
oppositely wound
windings on each
half of the core. The
magnetic flux thus
leaves the top of
both sides, flows
down in the center
of the cuff, enters
the base of the
toroid, and flows up
through both sides.
Figure 8.8 Near and far fields for various transducer diameters and
frequencies. Beams are drawn to scale, passing through a 10 mm-diameter
vessel. Transducer diameters are 5, 2, and 1 mm. Solid lines are for 1.5
MHz, dashed lines for 7.5 MHz.
Figure 8.9 Ultrasonic transducer configurations (a) A transit-time probe re­quires two
transducers facing each other along a path of length D inclined from the vessel axis at an
angle . The hatched region represents a single acoustic pulse traveling between the two
transducers, (b) In a transcutaneous probe, both transducers are placed on the same
side of the vessel, so the probe can be placed on the skin. Beam intersection is shown
hatched, (c) Any transducer may contain a plastic lens that focuses and narrows the
beam, (d) For pulsed operation, the transducer is loaded by backing it with a mixture of
tungsten powder in epoxy. This increases losses and lowers Q. Shaded region is shown
for a single time of range gating, (e) A shaped piece of Lucite on the front loads the
transducer and also refracts the beam, (f) A transducer placed on the end of a catheter
beams ultrasound down the vessel, (g) For pulsed operation, the transducer is placed at
an angle.
Figure 8.10 Doppler ultrasonic blood flowmeter. In the simplest instrument,
ultrasound is beamed through the vessel walls, back-scattered by the red
blood cells, and received by a piezoelectric crystal.
Figure 8.11 Directional Doppler block diagram (a) Quadrature-phase
detector. Sine and cosine signals at the carrier frequency are summed with
the RF output before detection. The output C from the cosine channel then
leads (or lags) the output S from the sine channel if the flow is away from (or
toward) the transducer, (b) Logic circuits route one-shot pulses through the
top (or bottom) AND gate when the flow is away from (or toward) the
transducer. The differential amplifier provides bidirectional output pulses
that are then filtered.
Figure 8.12 Directional Doppler signal waveforms (a) Vector diagram. The
sine wave at the carrier frequency lags the cosine wave by 90°. If flow is away
from the transducer, the Doppler frequency is lower than the carrier. The
short vector represents the Doppler signal and rotates clockwise, as shown
by the numbers 1, 2, 3, and 4. (b) Timing diagram. The top two waves
represent the single-peak envelope of the carrier plus the Doppler before
detection. Comparator outputs respond to the cosine channel audio signal
after detection. One-shot pulses are derived from the sine channel and are
gated through the correct AND gate by comparator outputs. The dashed lines
indicate flow toward the transducer.
Figure 8.13 Thermal velocity probes (a) Velocity-sensitive thermistor Ru is
exposed to the velocity stream. Temperature-compensating thermistor R, is
placed within the probe, (b) Thermistors placed down- and upstream from Ru
are heated or not heated by Ru, thus indicating velocity direction, (c)
Thermistors exposed to and shielded from flow can also indicate velocity
direction.
Figure 8.14 Thermal velocity meter circuit. A velocity increase cools Ru,
the velocity-measuring thermistor. This increases voltage to the
noninverting op-amp input, which increases bridge voltage vb and heats
Ru. Rt provides temperature compensation.
Figure 8.15 In chamber plethysmography, the venous-occlusion cuff is
inflated to 50 mm Hg (6.7 kPa), stopping venous return. Arterial flow causes
an increase in volume of the leg segment, which the chamber measures. The
text explains the purpose of the arterial-occlusion cuff.
Figure 8.16 After venous-occlusion cuff pressure is turned on, the initial
volume-versus-time slope is caused by arterial inflow. After the cuff is
released, segment volume rapidly returns to normal (A). If a venous
thrombosis blocks the vein, return to normal is slower (B).
Figure 8.17 (a) A model for impedance plethysmography. A cylindrical limb
has length L and cross-sectional area A. With each pressure pulse, A
increases by the shaded area A (b) This causes impedance of the blood, Zb,
to be added in parallel to Z. (c) Usually Z is measured instead of Zb
Figure 8.18 In two-
electrode impedance
plethysmography,
switches are in the
position shown,
resulting in a high
current density (solid
lines) under voltage-
sensing electrodes. In
four-electrode
impedance
plethysmography,
switches are thrown to
the other position,
resulting in a more
uniform current
density (dashed lines)
under voltage-sensing
electrodes.
Figure 8.19 In four-electrode impedance plethysmography, current is
injected through two outer electrodes, and voltage is sensed between two
inner electrodes. Amplification and demodulation yield Z + Z. Normally, a
balancing voltage vb is applied to produce the desired Z. In the automatic-
reset system, when saturation of vo occurs, the comparator commands the
sample and hold to sample Z + Z and hold it as vb. This resets the input to
the final amplifier and vo zero. Further changes in Z cause changes in vo
without saturation.
Figure 8.20 (a) Light transmitted into the finger pad is reflected off bone
and detected by a photosensor, (b) Light transmitted through the aural pinna
is detected by a photosensor.
Figure 8.21 In this photoplethysmograph, the output of a light-emitting
diode is altered by tissue absorption to modulate the phototransistor. The dc
level is blocked by the capacitor, and switch S restores the trace. A
noninverting amplifier can drive low impedance loads, and it provides a gain
of 100.