Nguyen Tat Thanh University

Faculty of Medicine
Department of Biomedical Engineering

ENGLISH IN BIOMEDICAL ENGINEERING

----

Lecturer: MSc. Nguyen Ngoc Quynh

Ho Chi Minh City, September 05 – 2022

 Contents
---------

Unit 1. Biomedical Engineering .................................................................................. 2

Unit 2. Biomedical Sensor .......................................................................................... 6

Unit 3. Biomedical Photonics ................................................................................... 10

Unit 4. Biomaterial ................................................................................................... 14

Unit 5. Hospital Information System ........................................................................ 18

Unit 6. Patient Monitor ............................................................................................ 21

Unit 7. Magnetic Resonance Imaging (MRI) ............................................................ 25

Unit 8. Computed Tomography (CT) ........................................................................ 28

Unit 9. Ultrasound .................................................................................................... 31

Unit 10. Mammography ........................................................................................... 34

1
 Unit 1. Biomedical Engineering

Unit 1

Biomedical Engineering
K Ỹ THUẬT Y SINH

1. What is Biomedical Engineering?

Biomedical engineering is the application of the principles and problem-solving
techniques of engineering to biology and medicine. This is evident throughout healthcare,
from diagnosis and analysis to treatment and recovery, and has entered the public
conscience though the proliferation of implantable medical devices, such as pacemakers
and artificial hips, to more futuristic technologies such as stem cell engineering and the 3-
D printing of biological organs.

Engineering itself is an innovative field, the origin of ideas leading to everything from
automobiles to aerospace, skyscrapers to sonar. Biomedical engineering focuses on the
advances that improve human health and health care at all levels.

Biomedical engineers differ from other engineering disciplines that have an influence
on human health in that biomedical engineers use and apply an intimate knowledge of
modern biological principles in their engineering design process. Aspects of mechanical
engineering, electrical engineering, chemical engineering, materials science, chemistry,
mathematics, and computer science and engineering are all integrated with human biology
in biomedical engineering to improve human health, whether it be an advanced prosthetic
limb or a breakthrough in identifying proteins within cells.

2
 Unit 1. Biomedical Engineering
XÔ ĐÍP CIP LINE

There are many subdisciplines within biomedical engineering, including the design
and development of active and passive medical devices, orthopedic implants, medical
imaging, biomedical signal processing, tissue and stem cell engineering, and clinical
engineering, just to name a few. IMPLANT : C Y GHÉP Ấ
CLINICAL : LÂM SÀNG

2. The world of biomedical engineering Thi

The breadth of activity of biomedical engineers is significant. The field has moved
significantly from being concerned primarily with the development of medical devices in
the 1950s and 1960s to include a more wide-ranging set of activities. As shown in Figure,
the field of biomedical engineering now includes many new career areas:

c ơ sinh học
phân tích y khoa và sinh h c ọ
b ộ ậ
ph n gi ả và c ơ quan ạ
nhân t o

ả ế
C m bi n sinh h c ọ
hình ảnh y khoa

k ỹ ậ
thu t lâm sàng
ậ ệ
V t li u sinh h c ọ

Công ngh ệ sinh học

y khoa và tin sinh h c ọ
K ỹ ậ
thu t mô

K ỹ ậ ụ
thu t ph c h i ồ
K ỹ ậ ầ
thu t th n kinh

Mô hình sinh lý
ế ị
Thi t b y sinh

Công ngh ệ vi sinh

 Application of engineering system analysis (physiologic modeling, simulation, and

control to biological problems)
máy theo dõi b nh nhân ệ
 Detection, measurement, and monitoring of physiologic signals (i.e., biosensors
and biomedical instrumentation) d ữ liệu điện sinh học
 Diagnostic interpretation via signal-processing techniques of bioelectric data
ị ệ
Tr li u và k ỹ ậ ụ ồ
thu t ph c h i ch ức năng
 Therapeutic and rehabilitation procedures and devices (rehabilitation
x ủ lí
engineering)
tăng c ường ch ức năng c ơ th ể (các c ơ quan nhân t o) ạ
 Devices for replacement or augmentation of bodily functions (artificial organs)
 Computer analysis of patient-related data and clinical decision making (i.e.,
medical informatics and artificial intelligence) Trí tu ệ nhân t o ạ

 Medical imaging—that is, the graphical display of anatomic detail or physiologic

function ả
gi i ph u ẫ

3
 telemedicine : h ệ ố ẩ ệ
th ng chu n b nh t ừ
xa
Unit 1. Biomedical Engineering
study= research :

Nghiên c ứu
 The creation of new biologic products (i.e., biotechnology and tissue engineering)

Typical pursuits of biomedical engineers include the following: Thi

 Research in new materials for implanted artificial organs
 Development of new diagnostic instruments for blood analysis
 Writing software for analysis of medical research data
 Analysis of medical device hazards for safety and efficacy nh ững nguy cơ đối với an toàn và

ệ
hi u qu ả
 Development of new diagnostic imaging systems
 Design of telemetry systems for patient monitoring ế
thi t k ế hệ
ố
th ng đo t ừ xa
 Design of biomedical sensors
 Development of expert systems for diagnosis and treatment of diseases h ệ thống chuyên gia

 Design of closed-loop control systems for drug administration ế

Thi t k ế hệ ố ề
th ng đi u khi n ể
vòng kín cho việc quản lý
 Modeling of the physiologic systems of the human body thu c ố

 Design of instrumentation for sports medicine

 Development of new dental materials
 Design of communication aids for individuals with disabilities
 Study of pulmonary fluid dynamics Nghiên cứu động lực học dịch phổi

 Study of biomechanics of the human body

 Development of material to be used as replacement for human skin

3. What do Biomedical Engineers do?

Biomedical engineers are employed in the industry, in hospitals, in research facilities
of educational and medical institutions, in teaching, and in government regulatory t ư vấn

agencies. They often serve a coordinating or interfacing function, using their background
in both engineering and medical fields. In industry, they may create designs where an in-
depth understanding of living systems and of technology is essential.

They may be involved in performance testing of new or proposed products.

Government positions often involve product testing and safety, as well as establishing
safety standards for devices.

In the hospital, the biomedical engineer may provide advice on the selection and use
of medical equipment, as well as supervising its performance testing and maintenance.

They may also build customized devices for special health care or research needs.

4
 Trong các c ơ sở nghiên c ứu,
ỹ sư y sinh giám
các k
ệ ị ồ ế ờ
sát các phòng thí nghi m và thi t b , đ ng th i tham
gia hoặc điều hành các hoạt động nghiên cứu hợp
tác với các nhà nghiên cứu khác có nền tảng như yUnit 1. Biomedical Engineering
học, sinh lý học và điều dưỡng.

In research institutions, biomedical engineers supervise laboratories and equipment,

and participate in or direct research activities in collaboration with other researchers with
such backgrounds as medicine, physiology, and nursing.

Some biomedical engineers are technical advisors for marketing departments of

companies and some are in management positions. Some biomedical engineers also have
advanced training in other fields. For example, many biomedical engineers also have an
M.D. degree, thereby combing an understanding of advanced technology with direct
patient care or clinical research.

4. Biomedical imaging Hình ảnh ọ

y sinh h c

Biomedical imaging technology has revolutionized medicine. Physicians all over the
world now have access to reliable and safe methods for collecting medical images using
technologies such as conventional radiographic imaging, CT, MRI, and ultrasound imaging.
nguy The wide availability and safety of these techniques have improved our standards for
ể
hi m
following the progress of common conditions such as pregnancy and life-threatening
tính

ạ
m ng
ailments such as cancer. Biomedical engineers have been leaders in the design and
construction of new imaging machines, the creation of medical imaging approaches using
these machines, and the analysis of image data that are acquired from patients. Each year
the state of the art in imaging improves; each improvement in image resolution and quality
means more accurate diagnosis of disease and improved health care. Most current imaging
methods provide information on tissue anatomy, but imaging techniques of the future will
also provide information on the function of tissue, opening new doors for the study of
disease progress and creating opportunities for development of new treatments.

5
 Unit 2. Biomedical Sensor

Unit 2

Biomedical Sensor

1. What is Biomedical Sensor? Thiết bị y tế là gì

Biomedical sensors are special electronic devices that can transduce biomedical
signals into easily measurable electric signals. Biomedical sensors are the key component
in various medical diagnostic instruments and equipment. Research on biomedical sensing
technology is mainly focused on how to improve the understanding of biology processes
and technology for medical diagnosis and treatment. Numerous discoveries and inventions
in biomedical, physical, chemical, and electronic materials have quickly gained importance
in applications for biomedical sensors, such as microstructure and integrated cell molecular
detection sensors, drug analysis and screening sensors, and micronano implantable probes.
Biomedical sensors have been widely applied in medical image analysis and diagnostics,
portable and clinical diagnostics, and laboratory analytical applications.

2. Sensor Classifications
Biomedical sensors are usually classified according to the quantity to be measured
and are typically categorized as physical, electrical, or chemical, depending on their specific
applications. Biosensors, which can be considered a special subclassification of biomedical
sensors, are a group of sensors that have two distinct components: a biological recognition
element, such as a purified enzyme, antibody, or receptor, that functions as a mediator and
provides the selectivity that is needed to sense the chemical component (usually referred
to as the analyte) of interest, and a supporting structure that also acts as a transducer and
is in intimate contact with the biological sensing sensed by the biological recognition
element into a quantifiable measurement, typically in the element. The purpose of the

6
 Unit 2. Biomedical Sensor

transducer is to convert the biochemical reaction into the form of an optical, electrical, or
physical signal that is proportional to the concentration of a specific chemical. Thus, a blood
pH sensor is not considered a biosensor according to this classification, although it
measures a biologically important variable. It is simply a chemical sensor that can be used
to measure a biological quantity.

3. Sensor Specifications
The need for accurate medical diagnostic procedures places stringent requirements
on the design and use of biomedical sensors. Depending on the intended application, the
performance specifications of a biomedical sensor may be evaluated in vitro and in vivo to
ensure that the measurement meets the design specifications.

To understand sensor performance characteristics, it is important first to understand

some of the common terminology associated with sensor specifications. The following
definitions are commonly used to describe sensor characteristics and selecting sensors for
particular applications.
 Sensitivity
Sensitivity is typically defined as the ratio of output change for a given change in
input. Another way to define sensitivity is by finding the slope of the calibration line relating
the input to the output (i.e., ∆Output/∆Input). A high sensitivity implies that a small change in
input quantity causes a large change in its output.

For example, a temperature sensor may have a sensitivity of 20 𝜇V/oC; that is, the
output of this sensor will change by 20 𝜇V for 1oC change in input temperature. Note that
if the calibration line is linear, the sensitivity is constant, whereas the sensitivity will vary
with the input when the calibration is nonlinear. Alternatively, sensitivity can also be
defined as the smallest change in the input quantity that will result in a detectable change
in sensor output.

 Range

The range of a sensor corresponds to the minimum and maximum operating limits
that the sensor is expected to measure accurately. For example, a temperature sensor may
have a nominal performance over an operating range of – 200 to + 500oC.

 Accuracy

Accuracy refers to the difference between the true value and the actual value
measured by the sensor. Typically, accuracy is expressed as a ratio between the preceding
difference and the true value and is specified as a percent of full-scale reading. Note that
the true value should be traceable to a primary reference standard.

7
 Unit 2. Biomedical Sensor

Đ ộ phân gi i ả
 Resolution

When the input quantity is increased from some arbitrary nonzero value, the output
of a sensor may not change until a certain input increment is exceeded. Accordingly,
resolution is defined as the smallest distinguishable input change that can be detected with
certainty.
có kh ả ậ ế
năng nh n bi t
đ ộ lặ p
 Reproducibility ụ
Small và high là đ c l ỗ
lạ i

Reproducibility describes how close the measurements are when the same input is
measured repeatedly over time. When the range of measurements is small, the
reproducibility is high. For example, a temperature sensor may have a reproducibility of
±0.1oC for a measurement range of 20oC to 80oC. Note that reproducibility can vary
depending on the measurement range. In other words, readings may be highly
reproducible over one range and less reproducible over a different operating range.

 Offset Giá trị bù

Offset refers to the output value when the input is zero.

 Linearity tuy nế
tính
đ ộ lệch
Linearity is a measure of the maximum deviation of any reading from a straight
calibration line. The calibration line is typically defined by the least-square regression fit of
the input versus output relationship. Typically, sensor linearity is expressed as either a
percent of the actual reading or a percent of the full-scale reading.

 Response Time ả
Ph n h i ồ

The response time indicates the time it takes a sensor to reach a certain percent (e.g.,
95 percent) of its final steady-state value when the input is changed. For example, it may
take 20 seconds for a temperature sensor to reach 95 percent of its maximum value when
a change in temperature of 1oC is measured. Ideally, a short response time indicates the
ability of a sensor to respond quickly to changes in input quantities.

 Drift trôi Lệch

Drift refers to the change in sensor reading when the input remains constant. Drift
can be quantified by running multiple calibration tests over time and determining the
corresponding changes in the intercept and slope of the calibration line. Sometimes, the
input-output relation may vary over time or may depend on another independent variable
ế ộ ậ
bi n đ c l p
that can also change the output reading.
 Hysteresis
Đ ộ trễ
In some sensors, the input-output characteristic follows a different nonlinear trend,
depending on whether the input quantity increases or decreases. For example, a certain

8
 Unit 2. Biomedical Sensor

pressure gauge may produce a different output voltage when the input pressure varies
from zero to full scale and then back to zero. When the measurement is not perfectly
reversible, the sensor is said to exhibit hysteresis. If a sensor exhibits hysteresis, the input-
output relation is not unique but depends on the direction change in the input quantity.

4. Biomedical sensor’s application Không

In biomedical field, main applications of biomedical sensor are as follows:

1. Detecting the information of clinical chemistry. In the field of medical clinic and
basic research, the biology’s information needs to be detected to ensure the present state
of given biology. For example, before operating on a patient, a doctor needs to know the
body temperature and blood pressure. Under this condition, clinic thermometer and blood
sensor has to be employed to help doctor quickly detect body temperature and blood
pressure of patient.

2. Continuously monitoring some parameters of biology outside and inside. In

biomedical field, heart frequency has to be monitored continuously by heart sound sensor
for a few days after operation. In military, some viruses need to be found by biosensor to
hold back the attacking from enemy. tham s ố
3. Control. In medicine, people usually utilize some parameter detected by
biomedical sensor to control or adjust physiological course of body. In the food industry,
biomedical sensor could be utilized to measure some enzyme and its concentration to
control the process of fabricating food and to analyze the nutritional ingredient of food. In
military, biomedical sensor could be employed to detect the situation of battle field to
adjust the strategy of spying or attacking enemy.

Of course, biomedical sensor such as PH sensor could be also employed to detect our
atmos‐ phere and condition to improve our living situation.

9
 Unit 3. Biomedical Photonics

Unit 3

Biomedical Photonics

1. A Definition Không đ ược xác đinh t ương đối

The field of biomedical photonics is often not well defined because it is a relatively
t ương đối mới new field that has emerged from research conducted at the interface of the physical and giao di nệ
ậ
v t lý
biological sciences and engineering. Therefore, it is useful to provide a definition here.
xem xét

A related term that has commonly been used is “biomedical optics”. Let us examine
the similarity and difference between biomedical photonics and biomedical optics. By
general definition, the field of optics involves “optical” light or “visible” light, which is a
particular type of electromagnetic radiation that can be seen and sensed by the human
eye. On the other hand, the field of photonics, which involves photons, the quanta of
energy in the entire spectrum of electromagnetic radiation, is broader than the field of
optics. We tend to think of optical radiation as “light,” but the rainbow of colors that make
up optical or visible light is just a very small part of a much broader range of the energy
range of the photon.
kt Photonics includes optical and nonoptical technologies that deal with
electromagnetic radiation, which is the energy propagated through space between electric
and magnetic fields. The electromagnetic spectrum is the extent of that energy, ranging
from cosmic rays, gamma rays, and x-rays throughout ultraviolet, visible, infrared,
microwave, and radio frequency energy.

Biomedical photonics, therefore, may be defined as science and technology that use
the entire range of electromagnetic radiation beyond visible light for medical applications.

10
ọ
Do đó, quang sinh h c y h c có th ọ ể được định nghĩa là khoa học và công ngh ệ sử dụng toàn b ộ ph ổ
b ức xạ ệ
đi n t ừ ngoài ánh sáng nhìn thấy cho các ứng dụng y tế.
 Unit 3. Biomedical Photonics

This field involves generating and harnessing light and other forms of radiant energy whose
quantum unit is the photon. The science includes the use of light absorption, emission,
transmission, scattering, amplification, and detection and uses a wide variety of methods
and technologies, such as lasers and other light sources, fiber optics, electro-optical
instrumentation, sophisticated microelectromechanical systems (MEMS), and
nanosystems, for medical applications. The range of applications of biomedical photonics
extends from medical diagnostics to therapy and disease prevention.

2. Laser
A laser is a device that emits light through a process of optical amplification based on
the stimulated emission of electromagnetic radiation. The term "laser" originated as an
acronym for "light amplification by stimulated emission of radiation".

Lasers are now used as excitation light sources in disease diagnostics and as optical
scalpels in interventional surgery. Ideal light sources because of their monochromaticity
and intensity, lasers can be coupled to optical fibers inserted into endoscope for in vivo
diagnosis of diseases. They also have the advantages of increased precision and reduced
rates of infection and bleeding. Computers are used to control the intensity and direction
of the laser beam, thus reducing human error. Nowadays lasers are commonly used to
perform surgery on the skin and can be used to remove wrinkles, tattoos, birthmarks,
tumors, and warts. Other types of growths can also be removed. Lasers are used to treat
eye conditions; in some individuals, vision problems can be corrected with laser surgery.
Lasers can help treat some forms of glaucoma and eye problems related to diabetes and
are being incorporated into surgical procedures for other parts of the body as well. These
include the heart, prostate gland, and throat. Lasers are also used to open clogged arteries
and remove blockages caused by tumors. Knives and scalpels may be completely eliminated
one day.

3. Biomedical Applications of Biophotonics

Biophotonics is the science of producing and utilizing photons or light to image,
identify, and engineer biological materials. It is the integration of four major technologies:
biotechnology, lasers, photonics, and nanotechnology. Biomedical applications of
biophotonics include light interactions in medicine and biology for the purposes of health
care.
 Diagnostic biophotonics
Diagnostic biophotonics is used to detect diseases in their initial stages before actual
medical symptoms occur in patients. By using optics, diagnostic biophotonics provides
several advantages of sensing and imaging at the molecular level and also collects

11
 Unit 3. Biomedical Photonics

multidimensional data for evaluation. Technologies based on light are generally contact-
free with less effect on integrity of living subjects and, consequently, can easily be applied
in situ.
 Optical tagging: Proteins, cells, DNA, and tissues are tagged with optical tags and their
incandescence or fluorescence is measured; also, according to the pathological or
physiological situation the changes are analyzed.
 Visualization of complex structures: Advanced laser technology has enhanced
imaging of vasculature retinal structures and other optic nerves to provide precise
diagnosis of ocular diseases. By observing the modifications occurring in ocular
capillaries, the diagnosis of common vascular disorders is enabled.
 Cellular level diagnosis: Sophisticated optical technologies involving lasers, and
photonic and biophotonic applications in medicine provide assistance in observing
and identifying cellular biochemistry and their functions, organ integrity, and the
characteristics of tissues.
 Optical endoscopes: In medical applications, the combination of optical fibers and
endoscopes is used for less invasive imaging and surgery of internal organs. Laser light
with high-level intensity is delivered using an optical fiber to an inner region of the
body, for instance, to eradicate tumors.
 Therapeutic biophotonics
Applications of light include treatment of diseases by altering biological processes.
Light is used for modifying the cellular functions photochemically and to remove tissues by
photomechanical or photothermal process.
 Thermal contact: In this method, heat is produced by high-energy laser light, which
is used to disrupt the tissues and, hence the main impact of laser light is
photothermal. The response to laser light of the target tissue depends on the extent
of increase in temperature and water content in that specific tissue.
 Bioimaging: This is noninvasive imaging technique that visualizes real-time biological
processes. This technique aims at lowering the impact of cellular processes as much
as possible. Through bio-imaging, the ion or metabolite levels of molecular processes
are quantified. Latest developments in bio-imaging include fluorescence resonance
energy transfer and two-photon fluorescence excitation microscopy. Images that are
reconstructed in both 2D and 3D have enhanced the effective visualization of disease
processes and models.
 Photobiostimulation: The process of activating live cells or organisms by laser
radiation is known as biostimulation. Low intensity laser and light emitting diode are
broadly used in various aspects by dermatologists, dentists, and surgeons. These laser
radiations are low powered and do not generate heat that can disrupt biological

12
 Unit 3. Biomedical Photonics

tissues. They promote a curing effect by deep penetration into the tissues, enabling
progression of the photochemical effect.
 Optical coherence tomography (OCT): This method can offer label-free high
resolution optical imaging with higher sampling frequency of intraoperative
evaluation. OCT is a fast developing technology with the ability to influence many
fields of human biology and clinical medicine. It is analogous to ultrasound in which
reflected light is detected instead of sound. It can be used in the functioning of optical
biopsies by generating images that are similar to histological sections without any
removal or blotting of tissues. OCT is used potentially in the study of various tumors
and is also applied as intraoperative surgery in breast cancer.

13
 Unit 4. Biomaterial

Unit 4

Biomaterial

a) Heart valves b) Contact lenses

1. What are biomaterials?

Biomaterials play an integral role in medicine today—restoring function and
facilitating healing for people after injury or disease. Biomaterials may be natural or
synthetic and are used in medical applications to support, enhance, or replace damaged
tissue or a biological function. The first historical use of biomaterials dates to antiquity,
when ancient Egyptians used sutures made from animal sinew. The modern field of
biomaterials combines medicine, biology, physics, and chemistry, and more recent
influences from tissue engineering and materials science. The field has grown significantly
in the past decade due to discoveries in tissue engineering, regenerative medicine, and
more.

Metals, ceramics, plastic, glass, and even living cells and tissue all can be used in
creating a biomaterial. They can be reengineered into molded or machined parts, coatings,
fibers, films, foams, and fabrics for use in biomedical products and devices. These may
include heart valves, hip joint replacements, dental implants, or contact lenses. They often
are biodegradable, and some are bio-absorbable, meaning they are eliminated gradually
from the body after fulfilling a function.

2. How are biomaterials used in current medical practice?

14
 Unit 4. Biomaterial

Doctors, researchers, and bioengineers use biomaterials for the following broad
range of applications:
 Medical implants, including heart valves, stents, and grafts; artificial joints,
ligaments, and tendons; hearing loss implants; dental implants; and devices that
stimulate nerves.

 Methods to promote healing of human tissues, including sutures, clips, and

staples for wound closure, and dissolvable dressings.

 Regenerated human tissues, using a combination of biomaterial supports or

scaffolds, cells, and bioactive molecules. Examples include a bone regenerating
hydrogel and a lab-grown human bladder.

 Molecular probes and nanoparticles that break through biological barriers and
aid in cancer imaging and therapy at the molecular level.

 Biosensors to detect the presence and amount of specific substances and to

transmit that data. Examples are blood glucose monitoring devices and brain
activity sensors.

 Drug-delivery systems that carry and/or apply drugs to a disease target. Examples
include drug-coated vascular stents and implantable chemotherapy wafers for
cancer patients.

3. Materials and their medical uses

Class of Material Current Uses

Metal

Stainless steel Joint replacements, bone fracture fixation, heart

valves, electrodes

Titanium and titanium alloys Joint replacements, dental bridges and dental
implants, coronary stents

Cobalt-chrome alloys Joint replacements, bone fracture fixation

Gold Dental fillings and crowns, electrodes

Silver Pacemaker wires, suture materials, dental amalgams

Platinum Electrodes, neural stimulation devices

15
 Unit 4. Biomaterial

Ceramics

Aluminum oxides Hip implants, dental implants, cochlear replacement

Calcium phosphate Bone graft substitutes, surface coatings on total joint

replacements, cell scaffolds

Calcium sulfate Bone graft substitutes

Carbon Heart valve coatings, orthopedic implants

Glass Bone graft substitutes, fillers for dental materials

Polymers

Nylon Surgical sutures, gastrointestinal segments, tracheal

tubes

Silicone rubber Finger joints, artificial skin, breast implants,

intraocular lenses, catheters

Polyester Resorbable sutures, fracture fixation, cell scaffolds,

skin wound coverings, drug delivery devices

Polyethylene (PE) Hip and knee implants, artificial tendons and

ligaments, synthetic vascular grafts, dentures, and
facial implants

Polyvinylchloride (PVC) Tubing, facial prostheses

Natural Materials

Collagen and gelatin Cosmetic surgery, wound dressings, tissue

engineering cell scaffold

Cellulose Drug delivery

Chitin Wound dressings, cell scaffold, drug delivery

4. What technologies are researchers developing with biomaterials?

Smart wound dressing for treating chronic diabetic ulcers
Patients with diabetic ulcers that don’t heal experience decreased quality of life,
infections, amputations, and death. Researchers are developing a smart wound dressing
that can deliver oxygen and blood-vessel-promoting biochemical factors while monitoring
healing. Combining electronics, wound healing, microfabrication, biomaterials, and
drug delivery, the dressing integrates sensors and actuators in close contact to skin.

16
 Unit 4. Biomaterial

It is expected to promote healing while reducing unnecessary dressing replacements

and visits to medical facilities.
Dissolvable dressing for the treatment of burns

Burn patients experience acute pain when undergoing dressing removal.

Current clinically approved dressings stick to the wound surface, traumatizing newly
formed tissue and delaying healing. Researchers are developing a hydrogel dressing
that will automatically dissolve, provide a barrier to infection, and promote healing.
By dissolving into safe by-products in a controlled way, the hydrogel will permit on-
demand dressing removal and re-exposure of the wound without the need for
mechanical debridement and cutting, resulting in easier, less traumatic treatment.
Dissolvable zinc stents
Metal stents are commonly used to keep blood vessels open, but stents can
cause long-term complications, including re-narrowing of the vessel, blood clots,
and bleeding. Researchers are developing a bio-absorbable zinc stent that
harmlessly erodes away over time, minimizing the normal chronic risks associated
with permanent stents. Early testing with absorbable zinc stents have been
promising.

17
 Unit 5. Hospital Information System

Unit 5

Hospital Information System

1. Hospital Information System

A hospital information system (HIS) is an element of health informatics that focuses
mainly on the administrational needs of hospitals. In many implementations, a HIS is a
comprehensive, integrated information system designed to manage all the aspects of a
hospital's operation, such as medical, administrative, financial, and legal issues and the
corresponding processing of services. Hospital information system is also known as hospital
management software (HMS) or hospital management system.

Hospital information systems provide a common source of information about a

patient's health history. The system has to keep data in a secure place and controls who
can reach the data in certain circumstances. These systems enhance the ability of health
care professionals to coordinate care by providing a patient's health information and visit
history at the place and time that it is needed. Patient's laboratory test information also
includes visual results such as X-ray, which may be reachable by professionals. HIS
provide internal and external communication among health care providers. Portable
devices such as smartphones and tablet computers may be used at the bedside.
Hospital information systems are often composed of one or several software
components with specialty-specific extensions, as well as of a large variety of sub-systems

18
 Unit 5. Hospital Information System

in medical specialties from a multi-vendor market. Specialized implementations name for

example laboratory information system (LIS), Policy and Procedure Management System,
radiology information system (RIS) or picture archiving and communication system (PACS).

Potential benefits of hospital information systems include:

 Efficient and accurate administration of finance, diet of patient, engineering, and

distribution of medical aid. It helps to view a broad picture of hospital growth

 Improved monitoring of drug usage, and study of effectiveness. This leads to the
reduction of adverse drug interactions while promoting more appropriate
pharmaceutical utilization.

 Enhances information integrity, reduces transcription errors, and reduces

duplication of information entries.

 Hospital software is easy to use and eliminates error caused by handwriting. New
technology computer systems give perfect performance to pull up information
from server or cloud servers.

2. Radiology Information System (RIS)

Radiology information system (RIS) is the core system for the electronic management
of imaging departments. The major functions of the RIS can include patient scheduling,
resource management, examination performance tracking, reporting, results distribution,
and procedure billing. RIS complements HIS (hospital information systems) and PACS
(picture archiving and communication system), and is critical to efficient workflow to
radiology practices.
3. Picture archiving and communication system (PACS)
A picture archiving and communication system (PACS) is a medical imaging
technology which provides economical storage and convenient access to images from
multiple modalities (source machine types). Electronic images and reports are transmitted

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 Unit 5. Hospital Information System

digitally via PACS; this eliminates the need to manually file, retrieve, or transport film
jackets, the folders used to store and protect X-ray film. The universal format for PACS
image storage and transfer is DICOM (Digital Imaging and Communications in Medicine).
Non-image data, such as scanned documents, may be incorporated using consumer
industry standard formats like PDF (Portable Document Format), once encapsulated in
DICOM. A PACS consists of four major components: The imaging modalities such as X-ray
plain film (PF), computed tomography (CT) and magnetic resonance imaging (MRI), a
secured network for the transmission of patient information, workstations for interpreting
and reviewing images, and archives for the storage and retrieval of images and reports.
Combined with available and emerging web technology, PACS has the ability to deliver
timely and efficient access to images, interpretations, and related data. PACS reduces the
physical and time barriers associated with traditional film-based image retrieval,
distribution, and display.

PACS has four main uses:

 Hard copy replacement: PACS replaces hard-copy based means of managing
medical images, such as film archives. With the decreasing price of digital
storage, PACS provide a growing cost and space advantage over film archives in
addition to the instant access to prior images at the same institution. Digital
copies are referred to as Soft-copy.

 Remote access: It expands on the possibilities of conventional systems by

providing capabilities of off-site viewing and reporting (distance education,
telediagnosis). It enables practitioners in different physical locations to access
the same information simultaneously for teleradiology.

 Electronic image integration platform: PACS provides the electronic platform for
radiology images interfacing with other medical automation systems such as
Hospital Information System (HIS), Electronic Medical Record (EMR), Practice
Management Software, and Radiology Information System (RIS).

 Radiology Workflow Management: PACS is used by radiology personnel to

manage the workflow of patient exams.

PACS is offered by virtually all the major medical imaging equipment manufacturers,
medical IT companies and many independent software companies. Basic PACS software
can be found free on the Internet.

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 Unit 6. Patient Monitor

Unit 6

Patient Monitor

1. Intended use
Patient Monitor or Multi-Parameters Patient Monitor is used to monitor patient’s
physiological parameters such as ECG, RESP, SPO2, NIBP, IBP, TEMP, EtCO2 and HR/PR, in
dynamic and long time. Its intended to be used in various hospital rooms such as Coronary
Care Unit, Intensive Care Unit, Neonatal Intensive Care Unit and Operating Room to provide
additional information to medical and nursing staff about the physiological condition of the
patient.
 ECG: Electrocardiogram
 RESP: Respiration Rate (RR)
 SpO2: Saturation of peripheral oxygen
 NIPB: Non-invasive Blood Pressure
 IBP: Invasive Blood Pressure
 TEMP: Temperature
 EtCO2: End-Tidal CO2
 HR/PR: Heart Rate/ Pulse Rate
2. Electrocardiogram
What does an ECG show and why you need to monitor your ECG

21
 Unit 6. Patient Monitor

An ECG test monitors your heart’s electrical activity and displays it as moving line of
peaks and dips. It measures the electrical current that runs through your heart. Everybody
has a unique ECG trace but there are patterns of an ECG that indicate various heart
problems such as arrhythmias. So what does an electrocardiogram show? In a nutshell, an
electrocardiogram shows if your heart is working properly or if it’s experiencing a problem
and indicates what that problem is.

What are the benefits of getting ECG?

An ECG test helps screen and diagnose a variety of cardiac problems. It’s the most
common way to check if your heart is healthy or monitor existing heart diseases. If you are
experiencing symptoms related to heart problems, have a heart disease in your family or
have a lifestyle that negatively impacts your health, you might benefit from an ECG scan or
long term monitoring.

Can an ECG detect stroke?

Yes. ECG can detect a heart problem that might lead to a stroke or even uncover a
past problem such as a previous heart attack. Such ECG results would be classified as
abnormal ECG. Often ECG is the prefered method to detect these problems and is
frequently used, for example, to confirm and monitor atrial fibrillation (AFib), a condition
that leads to blood clots that can result in stroke.

What else can an ECG scan find?

There are many heart problems that can be found with the help of an ECG test. The
most common are arrhythmias, heart defects, heat inflammation, cardiac arrest, poor
blood supply, coronary artery disease or heart attack and many more.

3. Respiration Rate
A person's respiratory rate is the number of breaths you take per minute. The normal
respiration rate for an adult at rest is 12 to 20 breaths per minute. A respiration rate under
12 or over 25 breaths per minute while resting is considered abnormal.

4. Pulse Oximetry - SpO2

SpO2 is the measurement of the amount of oxygen attached to the blood cells. It helps
to assess the adequacy of blood flow in the peripheral tissues, and determine whether
sufficient oxygen is reaching the closer vital organs such as the brain.

The principle of Pulse Oximetry is based on the Red and Infrared (IR) light absorption
characteristics of oxygenated and deoxygenated blood. A typical pulse oximeter uses an
electronic processor and a pair of small light-emitting diodes (LEDs) facing a photodiode
through a translucent part of the patient's body, usually a fingertip or an earlobe. One LED

22
 Unit 6. Patient Monitor

is red, with wavelength of 660 nm, and the other is infrared with a wavelength of 940 nm.
Absorption of light at these wavelengths differs significantly between blood loaded with
oxygen and blood lacking oxygen. Oxygenated hemoglobin absorbs more infrared light and
allows more red light to pass through. Deoxygenated hemoglobin allows more infrared light
to pass through and absorbs more red light. The LEDs sequence through their cycle of one
on, then the other, then both off about thirty times per second which allows the
photodiode to respond to the red and infrared light separately and also adjust for the
ambient light baseline.

5. Measuring Blood Pressure

Blood Pressure is the force of the blood pushing against the walls of the arteries.
Adequate pressure is essential to keep blood circulating to body tissues. Blood pressure
can be measured using a variety of techniques. They can be classified into two major
categories. They are known as invasive and non-invasive. The invasive approach inserts a
catheter into an artery of a test subject. The catheter may contain a pressure transducer at
its tip or it may be fluid filled and couple the blood pressure thru the fluid to an external
transducer. The change of fluid pressure (blood pressure) in the subject's artery is said to
be measured invasively. This technique is also referred to as a direct measurement,
because the parameter being measured is directly coupled to the transducer.

The non-invasive technique can be realized several ways. It usually involves the use
of an inflatable cuff wrapped around the limb of a test subject. The cuff is inflated and
deflated at a controlled rate and physical parameters are observed. The auscultatory and
oscillometric techniques are well known non-invasive methods. These methods are indirect
because they do not couple directly to the artery

6. Temperature
Temperature is the balance between heat loss and heat production in the body.
Metabolic processes and muscular activity (including shivering) produce body heat. This
body heat is lost mainly by radiation, conduction, convection, and vaporization

Temperature is displayed as a numeric value only. The normal body temperature of a

healthy human being is approximately 37.0oC (98.6oF). Body temperature is normally
maintained within limits of ±2oC (3.6oF), despite large variations in ambient temperature.
The temperature is different at different sites in the body, being lowest on the skin of the
extremities and highest in the core of the body.

23
 Unit 6. Patient Monitor

Categories Temperature Monitoring Sites

• Tympanic (ear)
Non-Invasive
• Axillary (armpit)

• Oral
Minimally Invasive
• Rectal

• Pulmonary Artery
Invasive • Esophageal
• Bladder

7. Heart rate / Pulse rate

Heart rate is the speed of the heartbeat measured by the number of contractions
(beats) of the heart per minute (bpm). The heart rate can vary according to the body's
physical needs, including the need to absorb oxygen and excrete carbon dioxide, but is also
modulated by a myriad of factors including but not limited to genetics, physical fitness,
stress or psychological status, diet, drugs, hormonal status, environment, and
disease/illness as well as the interaction between and among these factors.

The American Heart Association states the normal resting adult human heart rate is
60–100 bpm. Tachycardia is a fast heart rate, defined as above 100 bpm at rest. Bradycardia
is a slow heart rate, defined as below 60 bpm at rest. During sleep a slow heartbeat with
rates around 40–50 bpm is common and is considered normal. When the heart is not
beating in a regular pattern, this is referred to as an arrhythmia. Abnormalities of heart rate
sometimes indicate disease.

24
 Unit 7. Magnetic Resonance Imaging (MRI)

Unit 7

Magnetic Resonance Imaging (MRI)

1. What is MRI?
Magnetic Resonance Imaging (MRI) is a non-invasive imaging technology that
produces three dimensional detailed anatomical images. It is often used for disease
detection, diagnosis, and treatment monitoring. It is based on sophisticated technology
that excites and detects the change in the direction of the rotational axis of protons found
in the water that makes up living tissues.

2. How does MRI work?

MRIs employ powerful magnets which produce a strong magnetic field that forces
protons in the body to align with that field. When a radiofrequency current is then pulsed
through the patient, the protons are stimulated, and spin out of equilibrium, straining
against the pull of the magnetic field. When the radiofrequency field is turned off, the MRI
sensors are able to detect the energy released as the protons realign with the magnetic
field. The time it takes for the protons to realign with the magnetic field, as well as the
amount of energy released, changes depending on the environment and the chemical
nature of the molecules. Physicians are able to tell the difference between various types
of tissues based on these magnetic properties.

To obtain an MRI image, a patient is placed inside a large magnet and must remain
very still during the imaging process in order not to blur the image. Contrast agents (often
containing the element Gadolinium) may be given to a patient intravenously before or

25
 Unit 7. Magnetic Resonance Imaging (MRI)

during the MRI to increase the speed at which protons realign with the magnetic field. The
faster the protons realign, the brighter the image.

3. What is MRI used for?

MRI scanners are particularly well suited to image the non-bony parts or soft tissues
of the body. They differ from computed tomography (CT), in that they do not use the
damaging ionizing radiation of x-rays. The brain, spinal cord and nerves, as well as muscles,
ligaments, and tendons are seen much more clearly with MRI than with regular x-rays and
CT; for this reason MRI is often used to image knee and shoulder injuries.

In the brain, MRI can differentiate between white matter and grey matter and can
also be used to diagnose aneurysms and tumors. Because MRI does not use x-rays or other
radiation, it is the imaging modality of choice when frequent imaging is required for
diagnosis or therapy, especially in the brain. However, MRI is more expensive than x-ray
imaging or CT scanning.

One kind of specialized MRI is functional Magnetic Resonance Imaging (fMRI.) This is
used to observe brain structures and determine which areas of the brain “activate”
(consume more oxygen) during various cognitive tasks. It is used to advance the
understanding of brain organization and offers a potential new standard for assessing
neurological status and neurosurgical risk.

4. Are there risks?

Although MRI does not emit the ionizing radiation that is found in x-ray and CT
imaging, it does employ a strong magnetic field. The magnetic field extends beyond the
machine and exerts very powerful forces on objects of iron, some steels, and other
magnetizable objects; it is strong enough to fling a wheelchair across the room. Patients
should notify their physicians of any form of medical or implant prior to an MRI scan.

When having an MRI scan, the following should be taken into consideration:
 People with implants, particularly those containing iron, — pacemakers, vagus
nerve stimulators, implantable cardioverter- defibrillators, loop recorders,
insulin pumps, cochlear implants, deep brain stimulators, and capsules from
capsule endoscopy should not enter an MRI machine.

 Noise—loud noise commonly referred to as clicking and beeping, as well as

sound intensity up to 120 decibels in certain MR scanners, may require special
ear protection.

 Nerve Stimulation—a twitching sensation sometimes results from the rapidly

switched fields in the MRI.

26
 Unit 7. Magnetic Resonance Imaging (MRI)

 Contrast agents—patients with severe renal failure who require dialysis may risk
a rare but serious illness called nephrogenic systemic fibrosis that may be linked
to the use of certain gadolinium-containing agents, such as gadodiamide and
others. Although a causal link has not been established, current guidelines in the
United States recommend that dialysis patients should only receive gadolinium
agents when essential, and that dialysis should be performed as soon as possible
after the scan to remove the agent from the body promptly.

 Pregnancy—while no effects have been demonstrated on the fetus, it is

recommended that MRI scans be avoided as a precaution especially in the first
trimester of pregnancy when the fetus’ organs are being formed and contrast
agents, if used, could enter the fetal bloodstream.

 Claustrophobia—people with even mild claustrophobia may find it difficult to

tolerate long scan times inside the machine. Familiarization with the machine
and process, as well as visualization techniques, sedation, and anesthesia
provide patients with mechanisms to overcome their discomfort. Additional
coping mechanisms include listening to music or watching a video or movie,
closing or covering the eyes, and holding a panic button. The open MRI is a
machine that is open on the sides rather than a tube closed at one end, so it does
not fully surround the patient. It was developed to accommodate the needs of
patients who are uncomfortable with the narrow tunnel and noises of the
traditional MRI and for patients whose size or weight make the traditional MRI
impractical. Newer open MRI technology provides high quality images for many
but not all types of examinations.

27
 Unit 8. Computed Tomography (CT)

Unit 8

Computed Tomography (CT)

1. What is a computed tomography (CT) scan?

The term “computed tomography”, or CT, refers to a computerized x-ray imaging
procedure in which a narrow beam of x-rays is aimed at a patient and quickly rotated
around the body, producing signals that are processed by the machine’s computer to
generate cross-sectional images—or “slices”—of the body. These slices are called
tomographic images and contain more detailed information than conventional x-rays. Once
a number of successive slices are collected by the machine’s computer, they can be digitally
“stacked” together to form a three-dimensional image of the patient that allows for easier
identification and location of basic structures as well as possible tumors or abnormalities.

2. How does CT work?

Unlike a conventional x-ray—which uses a fixed x-ray tube—a CT scanner uses a
motorized x-ray source that rotates around the circular opening of a donut-shaped
structure called a gantry. During a CT scan, the patient lies on a bed that slowly moves
through the gantry while the x-ray tube rotates around the patient, shooting narrow beams
of x-rays through the body. Instead of film, CT scanners use special digital x-ray detectors,
which are located directly opposite the x-ray source. As the x-rays leave the patient, they
are picked up by the detectors and transmitted to a computer.

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 Unit 8. Computed Tomography (CT)

Each time the x-ray source completes one full rotation, the CT computer uses
sophisticated mathematical techniques to construct a 2D image slice of the patient. The
thickness of the tissue represented in each image slice can vary depending on the CT
machine used, but usually ranges from 1-10 millimeters. When a full slice is completed, the
image is stored and the motorized bed is moved forward incrementally into the gantry. The
x-ray scanning process is then repeated to produce another image slice. This process
continues until the desired number of slices is collected.

Image slices can either be displayed individually or stacked together by the computer
to generate a 3D image of the patient that shows the skeleton, organs, and tissues as well
as any abnormalities the physician is trying to identify. This method has many advantages
including the ability to rotate the 3D image in space or to view slices in succession, making
it easier to find the exact place where a problem may be located.

3. When would I get a CT scan?

CT scans can be used to identify disease or injury within various regions of the body.
For example, CT has become a useful screening tool for detecting possible tumors or lesions
within the abdomen. A CT scan of the heart may be ordered when various types of heart
disease or abnormalities are suspected. CT can also be used to image the head in order to
locate injuries, tumors, clots leading to stroke, hemorrhage, and other conditions. It can
image the lungs in order to reveal the presence of tumors, pulmonary embolisms (blood
clots), excess fluid, and other conditions such as emphysema or pneumonia. A CT scan is
particularly useful when imaging complex bone fractures, severely eroded joints, or bone
tumors since it usually produces more detail than would be possible with a conventional x-
ray.

4. What is a CT contrast agent?

As with all x-rays, dense structures within the body—such as bone—are easily
imaged, whereas soft tissues vary in their ability to stop x-rays and, thus, may be faint or
difficult to see. For this reason, intravenous (IV) contrast agents have been developed that
are highly visible in an x-ray or CT scan and are safe to use in patients. Contrast agents
contain substances that are better at stopping x-rays and, thus, are more visible on an x-
ray image. For example, to examine the circulatory system, a contrast agent based on
iodine is injected into the bloodstream to help illuminate blood vessels. This type of test is
used to look for possible obstructions in blood vessels, including those in the heart. Oral
contrast agents, such as barium-based compounds, are used for imaging the digestive
system, including the esophagus, stomach, and GI tract.

5. Are there risks?

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 Unit 8. Computed Tomography (CT)

CT scans can diagnose possibly life-threatening conditions such as hemorrhage, blood

clots, or cancer. An early diagnosis of these conditions could potentially be life-saving.
However, CT scans use x-rays, and all x-rays produce ionizing radiation. Ionizing radiation
has the potential to cause biological effects in living tissue. This is a risk that increases with
the number of exposures added up over the life of an individual. However, the risk of
developing cancer from radiation exposure is generally small.

A CT scan in a pregnant woman poses no known risks to the baby if the area of the
body being imaged isn’t the abdomen or pelvis. In general, if imaging of the abdomen and
pelvis is needed, doctors prefer to use exams that do not use radiation, such as MRI or
ultrasound. However, if neither of those can provide the answers needed, or there is an
emergency or other time constraint, CT may be an acceptable alternative imaging option.

In some patients, contrast agents may cause allergic reactions, or in rare cases,
temporary kidney failure. IV contrast agents should not be administered to patients with
abnormal kidney function since they may induce a further reduction of kidney function,
which may sometimes become permanent.

Children are more sensitive to ionizing radiation and have a longer life expectancy
and, thus, a higher relative risk for developing cancer than adults. Parents may want to ask
the technologist or doctor if their machine settings have been adjusted for children.

30
 Unit 9. Ultrasound

Unit
Unit 99

Ultrasound

1. What is medical ultrasound?

Medical ultrasound falls into two distinct categories: diagnostic and therapeutic.

Diagnostic ultrasound is a non-invasive diagnostic technique used to image inside the

body. Ultrasound probes, called transducers, produce sound waves that have frequencies
above the threshold of human hearing (above 20KHz), but most transducers in current use
operate at much higher frequencies (in the megahertz (MHz) range). Most diagnostic
ultrasound probes are placed on the skin. However, to optimize image quality, probes may
be placed inside the body via the gastrointestinal tract, vagina, or blood vessels. In addition,
ultrasound is sometimes used during surgery by placing a sterile probe into the area being
operated on.

Diagnostic ultrasound can be further sub-divided into anatomical and functional

ultrasound. Anatomical ultrasound produces images of internal organs or other structures.
Functional ultrasound combines information such as the movement and velocity of tissue
or blood, softness or hardness of tissue, and other physical characteristics, with anatomical
images to create “information maps.” These maps help doctors visualize
changes/differences in function within a structure or organ.

Therapeutic ultrasound also uses sound waves above the range of human hearing
but does not produce images. Its purpose is to interact with tissues in the body such that
they are either modified or destroyed. Among the modifications possible are: moving or
pushing tissue, heating tissue, dissolving blood clots, or delivering drugs to specific

31
 Unit 9. Ultrasound

locations in the body. These destructive, or ablative, functions are made possible by use of
very high-intensity beams that can destroy diseased or abnormal tissues such as tumors.
The advantage of using ultrasound therapies is that, in most cases, they are non-invasive.
No incisions or cuts need to be made to the skin, leaving no wounds or scars.

2. How does it work?

Ultrasound waves are produced by a transducer, which can both emit ultrasound
waves, as well as detect the ultrasound echoes reflected back. In most cases, the active
elements in ultrasound transducers are made of special ceramic crystal materials called
piezoelectrics. These materials are able to produce sound waves when an electric field is
applied to them, but can also work in reverse, producing an electric field when a sound
wave hits them. When used in an ultrasound scanner, the transducer sends out a beam of
sound waves into the body. The sound waves are reflected back to the transducer by
boundaries between tissues in the path of the beam (e.g. the boundary between fluid and
soft tissue or tissue and bone). When these echoes hit the transducer, they generate
electrical signals that are sent to the ultrasound scanner. Using the speed of sound and the
time of each echo’s return, the scanner calculates the distance from the transducer to the
tissue boundary. These distances are then used to generate two-dimensional images of
tissues and organs.

During an ultrasound exam, the technician will apply a gel to the skin. This keeps air
pockets from forming between the transducer and the skin, which can block ultrasound
waves from passing into the body.

3. What is ultrasound used for?

Diagnostic ultrasound. Diagnostic ultrasound is able to non-invasively image internal
organs within the body. However, it is not good for imaging bones or any tissues that
contain air, like the lungs. Under some conditions, ultrasound can image bones (such as in
a fetus or in small babies) or the lungs and lining around the lungs, when they are filled or
partially filled with fluid. One of the most common uses of ultrasound is during pregnancy,
to monitor the growth and development of the fetus, but there are many other uses,
including imaging the heart, blood vessels, eyes, thyroid, brain, breast, abdominal organs,
skin, and muscles. Ultrasound images are displayed in either 2D, 3D, or 4D (which is 3D in
motion).

Functional ultrasound. Functional ultrasound applications include Doppler and color

Doppler ultrasound for measuring and visualizing blood flow in vessels within the body or
in the heart. It can also measure the speed of the blood flow and direction of movement.
This is done using color-coded maps called color Doppler imaging. Doppler ultrasound is

32
 Unit 9. Ultrasound

commonly used to determine whether plaque build-up inside the carotid arteries is
blocking blood flow to the brain.

Another functional form of ultrasound is elastography, a method for measuring and

displaying the relative stiffness of tissues, which can be used to differentiate tumors from
healthy tissue. This information can be displayed as either color-coded maps of the relative
stiffness; black-and white maps that display high-contrast images of tumors compared with
anatomical images; or color-coded maps that are overlayed on the anatomical image.
Elastography can be used to test for liver fibrosis, a condition in which excessive scar tissue
builds up in the liver due to inflammation.

Ultrasound is also an important method for imaging interventions in the body. For
example, ultrasound-guided needle biopsy helps physicians see the position of a needle
while it is being guided to a selected target, such as a mass or a tumor in the breast. Also,
ultrasound is used for real-time imaging of the location of the tip of a catheter as it is
inserted in a blood vessel and guided along the length of the vessel. It can also be used for
minimally invasive surgery to guide the surgeon with real-time images of the inside of the
body.

Therapeutic or interventional ultrasound. Therapeutic ultrasound produces high

levels of acoustic output that can be focused on specific targets for the purpose of heating,
ablating, or breaking up tissue. One type of therapeutic ultrasound uses high-intensity
beams of sound that are highly targeted, and is called High Intensity Focused Ultrasound
(HIFU). HIFU is being investigated as a method for modifying or destroying diseased or
abnormal tissues inside the body (e.g. tumors) without having to open or tear the skin or
cause damage to the surrounding tissue. Either ultrasound or MRI is used to identify and
target the tissue to be treated, guide and control the treatment in real time, and confirm
the effectiveness of the treatment. HIFU is currently FDA approved for the treatment of
uterine fibroids, to alleviate pain from bone metastases, and most recently for the ablation
of prostate tissue. HIFU is also being investigated as a way to close wounds and stop
bleeding, to break up clots in blood vessels, and to temporarily open the blood brain barrier
so that medications can pass through.

4. Are there risks?

Diagnostic ultrasound is generally regarded as safe and does not produce ionizing
radiation like that produced by x-rays. Still, ultrasound is capable of producing some
biological effects in the body under specific settings and conditions. For this reason, the
FDA requires that diagnostic ultrasound devices operate within acceptable limits. The FDA,
as well as many professional societies, discourage the casual use of ultrasound (e.g. for
keepsake videos) and recommend that it be used only when there is a true medical need.

33
 Unit 10. Mammography

Unit 10

Mammography

1. What is mammography?
Mammography is an x-ray imaging method used to examine the breast for the early
detection of cancer and other breast diseases. It is used as both a diagnostic and screening
tool.

2. How does it work?

During a mammogram, a patient’s breast is placed on a flat support plate and
compressed with a parallel plate called a paddle. An x-ray machine produces a small burst
of x-rays that pass through the breast to a detector located on the opposite side. The
detector can be either a photographic film plate, which captures the x-ray image on film,
or a solid-state detector, which transmits electronic signals to a computer to form a digital
image. The images produced are called mammograms.

On a film mammogram, low density tissues, such as fat, appear translucent (i.e.
darker shades of gray approaching the black background)., whereas areas of dense tissue,
such as connective and glandular tissue or tumors, appear whiter on a gray background. In
a standard mammogram, both a top and a side view are taken of each breast, although
extra views may be taken if the physician is concerned about a suspicious area of the breast.

3. What will the results look like?

34
 Unit 10. Mammography

A radiologist will carefully examine a mammogram to search for high density regions
or areas of unusual configuration that look different from normal tissue. These areas could
represent many different types of abnormalities, including cancerous tumors, non-
cancerous masses called benign tumors, fibroadenomas, or complex cysts. Radiologists
look at the size, shape, and contrast of an abnormal region, as well as the appearance of
the edges or margins of such an area, all of which can indicate the possibility of malignancy
(i.e. cancer). They also look for tiny bits of calcium, called microcalcifications, which show
up as very bright specks on a mammogram. While usually benign, sites of
microcalcifications may occasionally signal the presence of a specific type of cancer. If a
mammogram shows one or more suspicious regions that are not definitive for cancer, the
radiologist may order additional mammogram views, with or without additional
magnification or compression, or they may order a biopsy. Another alternative may be
referral for another type of non-invasive imaging study.

4. Why does the breast need to be compressed?

Compression holds the breast in place to minimize blurring of the x-ray image that
can be caused by patient motion. Also, compression evens out the shape of the breast so
that the x-rays can travel through a shorter path to reach the detector. This reduces the
radiation dose and improves the quality of the x-ray image. Finally, compression allows all
the tissues to be visualized in a single plane so that small abnormalities are less likely to be
obscured by overlying breast tissue.

5. What is digital mammography?

A digital mammogram uses the same x-ray technology as conventional
mammograms, but instead of using film, solid-state detectors are used to record the x-ray
pattern passing through the breast. These detectors convert the x-rays that pass through
them into electronic signals that are sent to a computer. The computer then converts these
electronic signals into images that can be displayed on a monitor and also stored for later
use. Several advantages of using digital mammography over film mammography include:
the ability to manipulate the image contrast for better clarity, the ability to use computer-
aided detection of abnormalities, and the ability to easily transmit digital files to other
experts for a second opinion. In addition, digital mammograms may decrease the need for
the re-takes, which are common with film mammography due to incorrect exposure
techniques or problems with film development. As a result, digital mammography can lead
to lower x-ray exposures. To date, there is no evidence that digital mammography is better
that film mammography for reducing a woman’s risk of dying from breast cancer, however,
digital screening may be more accurate for finding cancers in younger women or women
with dense breasts.

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 Unit 10. Mammography

6. What is tomosynthesis (3D mammography)?

Digital Breast Tomosynthesis, also known as 3D mammography, is an FDA-approved
method for breast cancer screening in which x-rays of the breast are taken at different
angles to generate thin cross-sections. The 3D representation of the breast is similar to the
3d images created by standard CT technology. Tomosynthesis differs from CT technology
in that significantly fewer x-ray beams are projected through the breast than with CT and
the x-ray exposure to the rest of the chest is dramatically reduced. Hence, the radiation
dose delivered to the breast by tomosynthesis is similar to that delivered 2D
mammography. While tomosynthesis uses very low-dose x-rays, it is currently most often
used in addition to 2D mammography, making the total radiation dose higher than
standard mammography. Early evaluations of 3D mammography suggest an improved
detection of breast cancers than seen with 2D mammography, but extensive large-scale
comparisons of tomosynthesis with 2D mammography in randomized studies are still in
process. Therefore, researchers do not know with full certainty whether 3D mammography
is better or worse than standard mammography at avoiding false-positive results and
identifying early cancers in all types of patients.

7. What are the limits of mammography?

For certain types of breasts, mammograms can be difficult to interpret. This is
because there is a wide variation in breast tissue density among women. Denser breasts
are more difficult to image, and more difficult to assess for tumor diagnosis. For this and
other reasons, the sensitivity of mammography in detecting cancer can vary over a wide
range.

For many difficult cases, x-ray mammography alone may not be sufficiently sensitive
or accurate in detecting cancer, so additional imaging technologies, such as ultrasound or
magnetic resonance imaging (MRI) may also be used to increase the sensitivity of the exam.
Recently, studies have shown that a type of nuclear medicine called molecular breast
imaging (MBI) may be an effective and less expensive alternative to MRI for clarifying test
results in patients with dense breasts. During MBI, patients are given an injection of
radioactive molecules that are selectively taken up by cancer cells. Special cameras that
detect radioactivity are then used to reveal these cancer cells in the breast tissue.

8. Are there risks?

Because mammography uses x-rays to produce images of the breast, patients are
exposed to a small amount of ionizing radiation. For most women, the benefits of regular
mammograms outweigh the risks posed by this amount of radiation. The risk associated
with this dose appears to be greater among younger women (under age 40). However, in
some cases, the benefits of using mammography to detect breast cancer under age 40 may

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 Unit 10. Mammography

outweigh the risks of radiation exposure. For example, a mammogram may reveal that a
suspicious mass is benign and, therefore, doesn’t need to be treated. Additionally, if a
tumor is malignant and is caught early by mammogram, a surgeon may be able to remove
it before it spreads and requires more aggressive treatment such as chemotherapy.

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