Table Of ContentThe Biomedical Engineering Handbook
Third Edition
Medical Devices
and Systems
Bronz: “2122_c000” — 2006/2/24 — 11:31 — page ii — #2
The Electrical Engineering Handbook Series
Series Editor
Richard C. Dorf
University of California, Davis
Titles Included in the Series
The Handbook of Ad Hoc Wireless Networks, Mohammad Ilyas
The Avionics Handbook, Cary R. Spitzer
The Biomedical Engineering Handbook, Third Edition, Joseph D. Bronzino
The Circuits and Filters Handbook, Second Edition, Wai-Kai Chen
The Communications Handbook, Second Edition, Jerry Gibson
The Computer Engineering Handbook, Vojin G. Oklobdzija
The Control Handbook, William S. Levine
The CRC Handbook of Engineering Tables, Richard C. Dorf
The Digital Signal Processing Handbook, Vijay K. Madisetti and Douglas Williams
The Electrical Engineering Handbook, Third Edition, Richard C. Dorf
The Electric Power Engineering Handbook, Leo L. Grigsby
The Electronics Handbook, Second Edition, Jerry C. Whitaker
The Engineering Handbook, Third Edition, Richard C. Dorf
The Handbook of Formulas and Tables for Signal Processing, Alexander D. Poularikas
The Handbook of Nanoscience, Engineering, and Technology, William A. Goddard, III,
Donald W. Brenner, Sergey E. Lyshevski, and Gerald J. Iafrate
The Handbook of Optical Communication Networks, Mohammad Ilyas and
Hussein T. Mouftah
The Industrial Electronics Handbook, J. David Irwin
The Measurement, Instrumentation, and Sensors Handbook, John G. Webster
The Mechanical Systems Design Handbook, Osita D.I. Nwokah and Yidirim Hurmuzlu
The Mechatronics Handbook, Robert H. Bishop
The Mobile Communications Handbook, Second Edition, Jerry D. Gibson
The Ocean Engineering Handbook, Ferial El-Hawary
The RF and Microwave Handbook, Mike Golio
The Technology Management Handbook, Richard C. Dorf
The Transforms and Applications Handbook, Second Edition, Alexander D. Poularikas
The VLSI Handbook, Wai-Kai Chen
The Biomedical Engineering Handbook
Third Edition
Edited by
Joseph D. Bronzino
Biomedical Engineering Fundamentals
Medical Devices and Systems
Tissue Engineering and Artificial Organs
The Biomedical Engineering Handbook
Third Edition
Medical Devices
and Systems
Edited by
Joseph D. Bronzino
Trinity College
Hartford, Connecticut, U.S.A.
Boca Raton London New York
A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
2122_Discl.fm Page 1 Wednesday, December 14, 2005 4:52 PM
Published in 2006 by
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2006 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 0-8493-2122-0 (Hardcover)
International Standard Book Number-13: 978-0-8493-2122-1 (Hardcover)
Library of Congress Card Number 2005056892
This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with
permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish
reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials
or for the consequences of their use.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or
other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information
storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com
(http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA
01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For
organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Medical devices and systems / edited by Joseph D. Bronzino.
p. cm. -- (The electrical engineering handbook series)
Includes bibliographical references and index.
ISBN 0-8493-2122-0
1. Medical instruments and apparatus--Handbooks, manuals, etc. I. Bronzino, Joseph D., 1937- II.
Title. III. Series.
R856.15.B76 2006
610.28--dc22 2005056892
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
Taylor & Francis Group and the CRC Press Web site at
is the Academic Division of Informa plc. http://www.crcpress.com
Introduction and Preface
During the past five years since the publication of the Second Edition — a two-volume set — of the
BiomedicalEngineeringHandbook,thefieldofbiomedicalengineeringhascontinuedtoevolveandexpand.
Asaresult, thisThirdEditionconsistsof athreevolumeset, whichhasbeensignificantlymodifiedto
reflectthestate-of-the-fieldknowledgeandapplicationsinthisimportantdiscipline. Morespecifically,
thisThirdEditioncontainsanumberofcompletelynewsections,including:
• MolecularBiology
• Bionanotechnology
• Bioinformatics
• Neuroengineering
• InfraredImaging
aswellasanewsectiononethics.
Inaddition,allofthesectionsthathaveappearedinthefirstandsecondeditionshavebeensignificantly
revised. Therefore, this Third Edition presents an excellent summary of the status of knowledge and
activitiesofbiomedicalengineersinthebeginningofthe21stcentury.
Assuch,itcanserveasanexcellentreferenceforindividualsinterestednotonlyinareviewoffunda-
mentalphysiology,butalsoinquicklybeingbroughtuptospeedincertainareasofbiomedicalengineering
research.Itcanserveasanexcellenttextbookforstudentsinareaswheretraditionaltextbookshavenot
yetbeendevelopedandasanexcellentreviewofthemajorareasofactivityineachbiomedicalengineering
subdiscipline,suchasbiomechanics,biomaterials,bioinstrumentation,medicalimaging,etc. Finally,it
canserveasthe“bible”forpracticingbiomedicalengineeringprofessionalsbycoveringsuchtopicsasahis-
toricalperspectiveof medicaltechnology,theroleof professionalsocieties,theethicalissuesassociated
withmedicaltechnology,andtheFDAprocess.
Biomedical engineering is now an important vital interdisciplinary field. Biomedical engineers are
involvedinvirtuallyallaspectsofdevelopingnewmedicaltechnology.Theyareinvolvedinthedesign,
development,andutilizationofmaterials,devices(suchaspacemakers,lithotripsy,etc.)andtechniques
(suchassignalprocessing,artificialintelligence,etc.)forclinicalresearchanduse;andserveasmembers
of the health care delivery team (clinical engineering, medical informatics, rehabilitation engineering,
etc.)seekingnewsolutionsfordifficulthealthcareproblemsconfrontingoursociety.Tomeettheneeds
ofthisdiversebodyofbiomedicalengineers,thishandbookprovidesacentralcoreofknowledgeinthose
fieldsencompassedbythediscipline.However,beforepresentingthisdetailedinformation,itisimportant
toprovideasenseof theevolutionof themodernhealthcaresystemandidentifythediverseactivities
biomedicalengineersperformtoassistinthediagnosisandtreatmentofpatients.
Evolution of the Modern Health Care System
Before 1900, medicine had little to offer the average citizen, since its resources consisted mainly of
the physician, his education, and his “little black bag.” In general, physicians seemed to be in short
Bronz: “2122_c000” — 2006/2/24 — 11:31 — page v — #5
supply, but the shortage had rather different causes than the current crisis in the availability of health
careprofessionals.Althoughthecostsofobtainingmedicaltrainingwererelativelylow,thedemandfor
doctors’servicesalsowasverysmall,sincemanyoftheservicesprovidedbythephysicianalsocouldbe
obtainedfromexperiencedamateursinthecommunity. Thehomewastypicallythesitefortreatment
andrecuperation,andrelativesandneighborsconstitutedanableandwillingnursingstaff.Babieswere
delivered by midwives, and those illnesses not cured by home remedies were left to run their natural,
albeitfrequentlyfatal,course.Thecontrastwithcontemporaryhealthcarepractices,inwhichspecialized
physicians and nurses located within the hospital provide critical diagnostic and treatment services, is
dramatic.
Thechangesthathaveoccurredwithinmedicalscienceoriginatedintherapiddevelopmentsthattook
placeintheappliedsciences(chemistry,physics,engineering,microbiology,physiology,pharmacology,
etc.) at the turn of the century. This process of development was characterized by intense interdis-
ciplinary cross-fertilization, which provided an environment in which medical research was able to
take giant strides in developing techniques for the diagnosis and treatment of disease. For example,
in 1903, Willem Einthoven, a Dutch physiologist, devised the first electrocardiograph to measure the
electrical activity of the heart. In applying discoveries in the physical sciences to the analysis of the
biologic process, he initiated a new age in both cardiovascular medicine and electrical measurement
techniques.
Newdiscoveriesinmedicalsciencesfollowedoneanotherlikeintermediatesinachainreaction.How-
ever, the most significant innovation for clinical medicine was the development of x-rays. These“new
kinds of rays,” as their discoverer W.K. Roentgen described them in 1895, opened the“inner man”to
medicalinspection.Initially,x-rayswereusedtodiagnosebonefracturesanddislocations,andinthepro-
cess,x-raymachinesbecamecommonplaceinmosturbanhospitals.Separatedepartmentsofradiology
wereestablished,andtheirinfluencespreadtootherdepartmentsthroughoutthehospital.Bythe1930s,
x-rayvisualizationofpracticallyallorgansystemsofthebodyhadbeenmadepossiblethroughtheuseof
bariumsaltsandawidevarietyofradiopaquematerials.
X-raytechnologygavephysiciansapowerfultoolthat,forthefirsttime,permittedaccuratediagnosis
of a wide variety of diseases and injuries. Moreover, since x-ray machines were too cumbersome and
expensive for local doctors and clinics, they had to be placed in health care centers or hospitals. Once
there,x-raytechnologyessentiallytriggeredthetransformationofthehospitalfromapassivereceptacle
forthesicktoanactivecurativeinstitutionforallmembersofsociety.
Foreconomicreasons,thecentralizationofhealthcareservicesbecameessentialbecauseofmanyother
importanttechnologicalinnovationsappearingonthemedicalscene.However,hospitalsremainedinsti-
tutionstodread,anditwasnotuntiltheintroductionofsulfanilamideinthemid-1930sandpenicillinin
theearly1940sthatthemaindangerofhospitalization,thatis,cross-infectionamongpatients,wassigni-
ficantlyreduced.Withthesenewdrugsintheirarsenals,surgeonswereabletoperformtheiroperations
withoutprohibitivemorbidityandmortalityduetoinfection. Furthermore, eventhoughthedifferent
bloodgroupsandtheirincompatibilitywerediscoveredin1900andsodiumcitratewasusedin1913to
prevent clotting, full development of blood banks was not practical until the 1930s, when technology
providedadequaterefrigeration.Untilthattime,“fresh”donorswerebledandthebloodtransfusedwhile
itwasstillwarm.
Once these surgical suites were established, the employment of specifically designed pieces of med-
ical technology assisted in further advancing the development of complex surgical procedures. For
example, the Drinker respirator was introduced in 1927 and the first heart-lung bypass in 1939. By
the1940s,medicalproceduresheavilydependentonmedicaltechnology,suchascardiaccatheterization
andangiography(theuseofacannulathreadedthroughanarmveinandintotheheartwiththeinjection
of radiopaque dye) for the x-ray visualization of congenital and acquired heart disease (mainly valve
disordersduetorheumaticfever)becamepossible, andaneweraof cardiacandvascularsurgerywas
established.
FollowingWorldWarII,technologicaladvanceswerespurredonbyeffortstodevelopsuperiorweapon
systems and establish habitats in space and on the ocean floor. As a by-product of these efforts, the
Bronz: “2122_c000” — 2006/2/24 — 11:31 — page vi — #6
developmentofmedicaldevicesacceleratedandthemedicalprofessionbenefitedgreatlyfromthisrapid
surgeoftechnologicalfinds.Considerthefollowingexamples:
1. Advancesinsolid-stateelectronicsmadeitpossibletomapthesubtlebehaviorofthefundamental
unitofthecentralnervoussystem—theneuron—aswellastomonitorthevariousphysiological
parameters,suchastheelectrocardiogram,ofpatientsinintensivecareunits.
2. Newprostheticdevicesbecameagoalofengineersinvolvedinprovidingthedisabledwithtoolsto
improvetheirqualityoflife.
3. Nuclear medicine — an outgrowth of the atomic age — emerged as a powerful and effective
approachindetectingandtreatingspecificphysiologicabnormalities.
4. Diagnosticultrasoundbasedonsonartechnologybecamesowidelyacceptedthatultrasonicstudies
arenowpartoftheroutinediagnosticworkupinmanymedicalspecialties.
5. “Spare parts” surgery also became commonplace. Technologists were encouraged to provide
cardiac assist devices, such as artificial heart valves and artificial blood vessels, and the artifi-
cial heart program was launched to develop a replacement for a defective or diseased human
heart.
6. Advancesinmaterialshavemadethedevelopmentofdisposablemedicaldevices,suchasneedles
andthermometers,aswellasimplantabledrugdeliverysystems,areality.
7. ComputerssimilartothosedevelopedtocontroltheflightplansoftheApollocapsulewereused
tostore,process,andcross-checkmedicalrecords,tomonitorpatientstatusinintensivecareunits,
andtoprovidesophisticatedstatisticaldiagnosesofpotentialdiseasescorrelatedwithspecificsets
ofpatientsymptoms.
8. Developmentofthefirstcomputer-basedmedicalinstrument,thecomputerizedaxialtomography
scanner,revolutionizedclinicalapproachestononinvasivediagnosticimagingprocedures,which
nowincludemagneticresonanceimagingandpositronemissiontomographyaswell.
9. A wide variety of new cardiovascular technologies including implantable defibrillators and
chemicallytreatedstentsweredeveloped.
10. Neuronalpacingsystemswereusedtodetectandpreventepilepticseizures.
11. Artificialorgansandtissuehavebeencreated.
12. Thecompletionofthegenomeprojecthasstimulatedthesearchfornewbiologicalmarkersand
personalizedmedicine.
The impact of these discoveries and many others has been profound. The health care system of today
consistsof technologicallysophisticatedclinicalstaff operatingprimarilyinmodernhospitalsdesigned
toaccommodatethenewmedicaltechnology.Thisevolutionaryprocesscontinues,withadvancesinthe
physicalsciencessuchasmaterialsandnanotechnology,andinthelifesciencessuchasmolecularbiology,
thegenomeprojectandartificialorgans.Theseadvanceshavealteredandwillcontinuetoalterthevery
natureofthehealthcaredeliverysystemitself.
Biomedical Engineering: A Definition
Bioengineeringisusuallydefinedasabasicresearch-orientedactivitycloselyrelatedtobiotechnologyand
geneticengineering,thatis,themodificationofanimalorplantcells,orpartsofcells,toimproveplants
oranimalsortodevelopnewmicroorganismsforbeneficialends.Inthefoodindustry,forexample,this
has meant the improvement of strains of yeast for fermentation. In agriculture, bioengineers may be
concernedwiththeimprovementof cropyieldsbytreatmentof plantswithorganismstoreducefrost
damage. It is clear that bioengineers of the future will have a tremendous impact on the qualities of
human life. The potential of this specialty is difficult to imagine. Consider the following activities of
bioengineers:
• Developmentofimprovedspeciesofplantsandanimalsforfoodproduction
• Inventionofnewmedicaldiagnostictestsfordiseases
Bronz: “2122_c000” — 2006/2/24 — 11:31 — page vii — #7
