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Electrical physics within the body

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

Electricity within the body

Electricity plays an important role in medicine, there are two aspects of

electricity and magnetism in medicine: electrical and magnetic effects
generated inside the body.
Electricity is the flow of electrons (current) through a conductor.
Luigi Galvani made the first contribution in this field in 1786 when he
discovered animal electricity in frog's leg, since then many years of research
have been expanded on a wide variety of experiments dealing with electrical
effects in and on the body ,basic research in this area is called neurophysiology.
The electricity generated inside the body serves for the control and operation of
nerves ,muscle and organs.
Essentially all functions and activities of the body involve electricity in some
way, the forces of muscles are caused by the attraction and repulsion of
electrical charges.
The action of the brain is basically electrical, all nerve signals to and from the
brain involve the flow of electrical currents.
The electrical potentials of nerve transmission and the electrical signals seen in
the electromyogram(EMG) of the muscle, the electrocardiogram(ECG) of the
heart and the electroencephalogram (EEG) of the brain are the best known.
We also discuss some of the less familiar electrical signals of the body ,such as
those seen in the electroretinogram (ERG) and electrooculogram (EOG) of the
eye ,the magnetic signals of the body as shown on the magneto cardiogram
(MCG) of the heart and the magneto encephalogram (MEG) of the brain and
those signals associated with bone growth and biofeedback.
Various medical specialists are involved in the diagnosis and treatment of
malfunctions of this internal electrical system.
If the problem involves any part of the nervous system it is diagnosed and
treated by a neurologist ,an M.D who has had three or more years of special
training in the study of the nervous system, if the problem requires surgery ,it
is usually handled by a neurosurgeon ,an M.D ,who specializes in surgery of
the nervous system and has had three or more years of training in this area of
surgery ,since much of neurosurgery involves the brain ,these specialists are
sometimes called brain surgeons .
Neuroradiologists are M.D.s who have taken a three-year residency in
diagnostic radiology followed by another year in neuroradiological
specialization ,pediatric neurology ,a subspecialty of pediatrics ,deals with
nerve problems in infants and children .Electromyogram tests are usually
performed and interpreted by physiatrists ,M.D.s who have taken residencies in
physical medicine .Cardiologists ,specialists in the study and treatment of heart
disease ,deal with the electrical activity of the heart . Psychiatrists are M.D.s

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who specialize in the diagnosis ,prevention and treatment of emotional illness

and neural disorders ,they may use shock therapy and medication .Clinical
psychologists are Ph.D.s who have studied behavior and also specialize in the
diagnosis and treatment of mental illness ,however ,they cannot use shock
therapy or treat with drugs.
(H.W) Q//1. List five electrical signals from the body that are sometimes
recorded? 2. What is physiatrist?

THE NERVOUS SYSTEM AND THE NEURON:

Fig (1) Basic structural unit of the nervous system

The nervous system can be divided in two parts.

1-Central nervous system consists of the
-brain
-spinal cord
-nerve fibers (neurons)
That transmits sensory information to brain or spinal cord and from
brain or spinal cord to appropriate muscles and glands.
2-The autonomic nervous system
Controls various internal organs such as the heart, intestines, and
glands.
The basic structural unit of the nervous system is a neuron (Fig 1).
A nerve cell specialized for the
-reception
-interpretation
-transmission of the electrical messages
Neuron consists of a cell body that receives electrical messages from
other neurons through contacts called synapses located on the dendrites.
The neuron transmits an electrical signal out word along axon. The axon
carries the electrical signal to muscle, gland, or other neurons.

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Electrical potentials of nerves:

The basic structural unit of the nervous system is the neuron (Look fig.
for schematic of a motor neuron) a nerve cell specialized for the reception,
interpretation and transmission of electrical messages.

There are many types of neurons, basically, a neuron consists of a cell body
that receives electrical messages from other neurons through contacts called
"synapses " located on the dendrites or on the cell body .
The dendrites are the parts of the neuron the specialist for receiving
information from stimuli or from other cells .If the stimulus is strong enough,
the neuron transmits an electrical signal outward along a fiber called an axon.
The axon ,or nerve fiber, which be as long as 1 m ,caries the electrical signal to
muscles ,glands ,or other neurons .
In this section we discuss the electrical behavior of neuron ,much of the early
research on the electrical behavior of nerves was done on the giant nerve fibers
of squid .
The conveniently large diameter (1mm) of these nerve fibers allows electrodes
to be readily inserted or attached for measurements.
A cross the surface or membrane of every neuron is an electrical potential
(voltage) difference due to the presence of more negative ions on the inside of
the membrane than on the outside ,the neuron is said to be polarized.
The inside of the cell is typically 60 to 90mv more negative than the outside ,
this potential difference is called the resting potential of the neuron.[Look
fig.2]…shows schematically the typical concentrations of various ions inside
and outside the membrane of an axon.

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(Fig 2) The typical concentrations of various ions inside and outside the membrane of an axon.

When the neuron is stimulated ,a large momentary change in the resting

potential occurs at the point of stimulation, this potential change called the
action potential ,propagates along the axon ,the action potential is the major
method of transmission of signals within the body.
The stimulation may be caused various physical and chemical stimuli such
as heat, light, sound, and others
We can explain the resting potential by using a model in which a membrane
separates a concentrated neutral solution of KCl from one that is less
concentrated (Fig.3 A).The KCl in solution forms K+ ions and Cl- ions ,we
assume that the membrane permits K+ ions to pass through it but does not
permit the passage of the Cl- ions.
The K+ ions diffuse back and forth across the membrane , however a net
transfer takes place from the high concentration region H to the low
concentration region L, eventually this movement results an excess of positive
charge in L and an excess of negative charge in H.
These charges form layers on the membrane to produce an electrical force that
retards the flow of K+ ions from H to L, ultimately a condition of equilibrium
exists (Fig3.B).

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[fig. 4] shows schematically how the axon propagates an action potential

,graphs of the potential measured between point P and the outside of the axon
are also shown .
This axon has a resting potential of about (-80mv) "Fig 4.a",if the left end of
the axon is stimulated ,the membrane walls become porous to Na + ions and
these ions pass through the membrane ,causing it to depolarize ,the inside
momentarily goes positive to about (50mv).
The reversed potential in the stimulated region causes ion movement as shown
by the arrows in "fig 3.b",which in turn depolarizes the region to the right
"fig.4 c, d, and e" ,mean while the point of original stimulation has recovered
(repolarized) because K+ ions have moved out to restore the resting potential
"fig 4c,d and e".
Examination of the axons of various neurons with an electron microscope
indicates that there are two different types of nerve fibers, the membranes of
some axons are covered with a fatty insulating layer called myelin that has
small un insulated gaps called nodes of Ranvier every few millimeters, these
nerves are referred to as myelinated nerves.
The axons of other nerves have no myelin sleeve (sheath) and these nerves are
called un myelinated nerves, this is a some what artificial classification ,most
human nerves have both types of fibers ,much of the early research on the
electrical behavior of nerves was done on the un myelinated giant nerve fiber
of the squid [fig 4],myelinated nerves ,the most common type in humans
,conduct action potentials much faster than un myelinated nerves.
Fig .3; the transmission of a nerve impulse a long an axon, the graphs show the
potential at point P
(a)The axon has a resting potential of about (-80mv)

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(b)Stimulation on the left causes Na+ ions to move into the cell and depolarize
the membrane.
(c) The positive current flow on the leading edge ,indicated by the arrows
,stimulates the regions to the right so that depolarization takes place and the
potential change propagates .(d and e).mean while K+ ions move out of the core
of the axon and restore the resting potential(repolarize the membrane).the
voltage pulse moving along the nerve is the action potential.

The myelin sleeve is a very good insulator and the myelinated segment of an
axon has very low electrical capacitance. The action potential decreases in
amplitude as it travels through the myelinated segment just as an electrical
signal is attenuated when it passes through a length of cable .The reduced
signal then acts like a stimulus at the next node of Ranvier (gap) to restore the
action potential to its original size and shape. The conduction in the gap is the
same as shown in fig.(4).This process repeats along the axon ;the action
potential seems to jump from one node to the next ,that is ,it travels by
salutatory conduction.
Two primary factors affect the speed of propagation of the action potential: the
resistance within the core of the membrane and the capacitance (or the charge
stored) across the membrane .A decrease in either will increase the propagation
velocity .The internal resistance of an axon decreases as the diameter increases,
so an axon with a large diameter will have a higher velocity of propagation

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than an axon with a small diameter. The greater the stored charge on a
membrane ,the longer it takes to depolarized it and thus the slower the
propagation speed because of the low capacitance ,the charge stored in a
myelinated section of a nerve fiber is a very small compared to that on an
unmyelinated fiber of the same diameter and length, hence the conduction
speed in the myelinated fiber is many times faster .The unmyelinated squid
axons (~ 1mm in diameter ) have propagation velocities of 20 to 50 m/sec
,whereas the myelinated fibers in man (~ 10μ m in diameter )have propagation
velocities of around 100 m/sec .The advantage of myelinated nerves as found
in man is that they produce high propagation velocities in axons of small
diameter .A large number of nerve fibers can thus be packed into a small
bundle to provide for many signal channels.
(H.W).Q. //What is the advantage of myelinated nerves over unmyelinated
nerves?

Electrical signals from Muscle (EMG):-

In this section we briefly trace the transmission of the action potential from the
axon into the muscle, where it causes muscle contraction. the record of the
potentials from muscles during movement is called the electromyogram(EMG).
A muscle is made up of many motor units. motor unit consists of a single
branching neuron from the brain stem or spinal cord and ( 25 – 2000) muscle
fibers(cells)it connects to via motor end plates (Fig 5-a).
Muscle action is initiated by an action potential that travels along an axon and
is transmitted across the motor end plates into the muscle fibers, causing them
to contract. The record of the action potential in signal muscle cell is shown
schematically in fig (5-b)
EMG electrodes usually record the electrical activity from several fibers, either
a surface electrode or a concentric needle electrode is used. Surface electrode
attached to the skin measures the electrical signal from many motor units. A
concentric needle electrode inserted under the skin measures signal motor unit
activity by means of insulated wires connected to its point, In addition to
electrically stimulating the motor units, it is possible to excite the sensory
nerves that carry information to the central nervous system. The reflex system
can be studied by observing the reflex response at the muscle.
A patient with the relatively rare disease myasthenia gravis shows muscular
weakness when carrying out a repetitive muscular task; the EMG of such a
patient shows that in repetitive stimulation the motor nerve to muscle
transmission fails.

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Fig 5: The record of the action potential in a single muscle cell

Electrical potential in the Heart (ECG):

The rhythmical action of the heart is controlled by an electrical signal initiated
by spontaneous stimulation of special muscle cells located in the right atrium,
these cells make up the senatorial (SA) node or the pacemaker.
The SA node fires at regular intervals about (72) times per minutes ,the rate of
firing can be increased or decreased by nerves external to the heart that respond
to the blood demands of the body as well as to other stimuli.
The electrical signal from the SA node initiates the depolarization of the nerves
and muscles of both atria, causing the atria to contract and pump blood into the
ventricles.
Repolarization of the atria follows, the electrical signal then passes into the
atrioventricular (AV) node, which initiates the depolarization of the right and
left ventricles , causing them to contract and force blood into the pulmonary
and general circulation. The ventricle nerves and muscles then repolarize and
the sequence begins again.
The record of the hearts potentials on the skin is called the electrocardiogram
(ECG).
The relationship between the pumping action of the heart and the electrical
potentials on the skin can be understood by considering the propagation of an
action potential in the wall of the heart as shown in (fig.6). The resulting
current flow in the torso leads to a potential drop as shown schematically on
the resister.

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Fig 6: Schematic of an action potential moving down the wall of the heart

Action potential moving down the wall of the heart some of ion current
indicated by circles, passes through torso, indicated by the resistor. The
potential on the chest wall is due to current flow through the resistance
of torso.

Fig 7. The potential distribution on the chest at the moment when the ventricles are one –half
depolarization.
The potential distribution on the chest when the ventricles are one-half
depolarized by equipotential measured on the surface of the body depend
upon the location of the electrodes for obtaining the ECG located on the left
arm(LA), right arm (RA), and left leg (LL).
The measurement of the potential between RA and LA is called Lead I
The measurement of the potential between RA and LL is called Lead II
The measurement of the potential between LA and LL is called Lead III
The surface electrodes for obtaining the ECG are most commonly located on
the left arm (LA),right arm (RA)and left leg(LL),although the location of the
electrodes can vary in different clinical situations, sometimes the hands or
positions closer to the heart are used. The measurement of the potential
between RA and LA is called lead I, that between RA and LL is called lead II,
and that between LA and LL is called lead III, (fig.8); this configuration was
pioneered at the turn of the century by willem Einthoven, a Dutch physiologist,

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and these three leads. Usually all three standard limb leads are used in a
clinical examination.

The potential between any two gives the relative amplitude and direction of the
electric dipole vector in the frontal plane.
Three augmented lead configurations, a VR ,a VL , and a VF, are also obtained in
the frontal plane, for the a VR lead ,one side of the recorder is connected to RA
and the other side is connected to the center of two resistors connected to LL
and LA(fig.9.).
The other two augmented leads are obtained in a similar manner :for the a VL
lead, the recorder is attached to the LA electrode and the resistors are
connected to RA and LL; for the a VF lead, the recorder is attached to the LL
electrode and the resistors are connected to RA and LA.

Each ECG tracing maps out a projection of the electric vector, or the electrical
activity of the heart, through each part of its cycle.(fig.10),shows schematically
the lead II output with the standard symbols for the parts of the pattern.
The major electrical events of the normal heart cycle are:-
1.the atrial depolarization ,which produces the P wave.
2. the atrial repolarization ,which is rarely seen and is unlabeled.
3.the ventricular depolarization ,which produces the QRS complex.
4. the ventricular repolarization ,which produces the T wave [fig.10].

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Fig.11.Six frontal plane ECG, some cases the waveform is positive and in other cases it is negative.
The sign of the waveform depends upon the direction of electric dipole vector and polarity and
position of the electrodes of the measuring instrument. For transverse plane measurement the
negative terminal of ECG recorder is attached an indifferent electrode at the center point of three
resistors connected RA, LL, LA, and other electrode is moved across the chest wall to the six
different positions.

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Fig.12

Fig.13a,b

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Table (1) intervals.

Intervals Normal duration(sec) Event in the heart during interval
(standard intervals)
PR 0.12-0.21 A trial depolarization and conduction
through AV node
QRS 0.08-0.11 Ventricular depolarization and a trial
repolarization
QT 0.35-0.42 Ventricular depolarization puls a trial
repolarization
ST 0.27-0.33 Ventricular repolarization

The sign of the wave form is depends upon the direction of the electric dipole
vector , the polarity and position of the electrodes of the measuring instrument.
In a clinical examination, six transverse plane ECGS are usually made in
addition to the six ,frontal plane ECGS ,for the transverse plane measurements
the negative terminal of the ECG recorder is attached to an indifferent
electrode at the center point of three resistors connected to RA,LL and LA
[Fig14-a] and the other electrode is moved across the chest wall to the six
different positions shown in [fig.14-b].

ECGs are usually interpreted by cardiologists who can quickly determine if the
patterns are normal and if arrhythmias (rhythm disturbances ) exist.
An ECG shows disturbances in the normal electrical activity of an abnormal
condition known as heart block.
If the normal SA node signal is not conducted into the ventricle then a pulse
from the AV node will control the heartbeat at frequency of (30 to 50
beats/min. ),which is much lower than normal (70 to 80 beats/min.),while a
heart block like this could make a patient a semi-invalid ,an implanted
pacemaker could enable him to live a reasonably normal life.

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Electrode name Electrode placement

RA On the right arm, avoiding thick muscle.

LA In the same location where RA was placed, but on the left arm.

RL On the right leg, lateral calf muscle.

LL In the same location where RL was placed, but on the left leg.

In the fourth intercostal space (between ribs 4 and 5) just to the right of the sternum
V1
(breastbone).

V2 In the fourth intercostal space (between ribs 4 and 5) just to the left of the sternum.

V3 Between leads V2 and V4.

V4 In the fifth intercostal space (between ribs 5 and 6) in the mid-clavicular line.

V5 Horizontally even with V4, in the left anterior axillary line.

V6 Horizontally even with V4 and V5 in the midaxillary line.

Category Leads Activity

Inferior leads' Leads II, III and aVF Look at electrical activity
from the vantage point of
the inferior surface
(diaphragmatic surface of
heart)
Lateral leads I, aVL, V5 and V6 Look at the electrical
activity from the vantage
point of the lateral wall
of left ventricle
Septal leads V1 and V2 Look at electrical activity
from the vantage point of
the septal surface of the

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heart (interventricular
septum)
V3 and V4 Look at electrical activity
from the vantage point of
the anterior wall of the
Anterior leads right and left ventricles
(Sternocostal surface of
heart)
In addition, any two precordial leads next to one another are considered to be
contiguous. For example, though V4 is an anterior lead and V5 is a lateral lead,
they are contiguous because they are next to one another.
(H.W) Q//1.Give the locations of the electrodes for the standard ECG limb
leads? 2. What electrical phenomenon in the heart produces the QRS
complex of the ECG?

Electrical signals from Brain (EEG)

The recording of the signals from the brain is called the electroencephalogram
(EEG) ,the EEG is used as an aid in the diagnosis of disease involving the brain
Electrodes for recording the signals are often small discs of chloride silver.
They are attached to the head at locations that depend upon the part of the brain
to be studied. The international standard 10 -20 system of electrode location.
Since asymmetrical activity is often an indication of brain disease, the right
side signals are often compared to the left side signals.

Fig 15: International standard 10 -20 system of electrode location for EEG

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The frequencies of the EEG signals seem to be dependent upon the mental
activity of the subject ,for example , a relaxed person usually has an EEG
signal composed primarily of frequencies from 8 to 13 Hz ,or alpha waves .
When a person is more alert higher frequency range , the beta wave range
(above 13Hz) ,dominates the EEG signal ,the various frequency bands are as
follows:
*Delta ( δ) ,or slow [0.5 to 3.5 Hz]
*Theta (θ) ,or intermediate slow [4 to 7 Hz]
*Alpha (α ) [8 to 13 Hz]
*Beta (β ) ,or fast [greater than 13Hz
As a person becomes drowsy , particularly with his eyes closed ,the frequencies
from 8 to 13Hz (alpha waves) dominate the EEG .The amplitude increases and
the frequency decreases as a person moves from light sleep to deeper sleep.
Occasionally an EEG taken during sleep shows a high frequency pattern called
paradoxical sleep or rapid eye movement (REM) sleep because the eyes move
during this period.
Paradoxical sleep appears to be associated with dreaming , besides recording
the spontaneous activity of the brain ,we can measure the signals that result
when the brain receives external stimuli such as flashing lights or pulses of
sound ,signals of this type are called evoked responses .
The EEG is used as an aid in the diagnosis of diseases involving the brain.
It is most useful in the diagnosis of epilepsy and allows classification of
epileptic seizures.
1-The EEG for a sever epileptic attack with loss of consciousness, called a
grand mal seizure, shows fast high voltage spikes in all leads from the skull
(Fig. 16- a).
2-The EEG for a less severe attack, called a petit mal seizure, shows up to
3 rounded wave per second followed or preceded by fast spikes (Fig.16- b).
The EEG aids in confirming brain tumors since electrical activity is reduced
in the region of a tumor.
_The EEG is used as a monitor in surgery when the ECG cannot be used.
_It is useful in surgery for indicating the anesthesia level of the patient.
_Much research on sleep involves observing the EEG patterns for various
stages of sleep.

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a-As a person becomes drowsy, particularly with eyes closed, the

frequencies from 8 to 13 Hz (α waves) dominate the EEG. The
amplitude increases and the frequency decreases as a person moves
from light sleep to deeper sleep.
b-EEG taken during sleep shows a high frequency pattern called
paradoxical sleep or rapid eye movement ( REM) sleep because the
eyes move during this period. Paradoxical sleep appears to be
associated with dreaming.

Fig. 17

(H.W)….. Q//What is REM sleep?

Electrical signals from the Eye (ERG &EOG):

The recording of potential changes produced by the eye when the retina
is exposed to a flash of light is called the electroretinogram (ERG).
One electrode is located in a contact lens that fits over the cornea and the
other electrode is attached to the ear or forehead to approximate the potential at
the back of the eye.

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An ERG signal is more complicated than a nerve axon signal because it

is the sum of many effects taking place within the eye .The general form of an
ERG is shown in fig.(18).The B wave is the most interesting clinically since it
arises in the retina ,the B wave is absent in the ERG of a patient with
inflammation of the retina that results in pigment changes or retinitis
pigmentosa.
The electrooculogram (EOG) is the recording of potential changes due to eye
movement. For this measurement , a pair of electrodes is attached near the
eye(fig.13-a).The EOG potential is defined as zero with the eye in the position
shown in (fig.19-a) fixed on the reference spot labeled 00. Fig.(19-b) shows the
EOG potential change for horizontal movement of the eyeball

fig.(18). The B wave is the most interesting clinically since it arises in the retina

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EOGs provide information on the orientation of the eye , its angular velocity
and its angular acceleration .Some studies have been done to determine the
effects of drugs on eye movement and the eye movement involved in sleep and
in visual search.
(H.W)..Q. // what is the difference between an ERG & EOG?

Magnetic signals from the Heart & Brain (MCG & MEG):
Since a flow of electrical charge produces a magnetic field, a magnetic field is
produced by the current in the heart during depolarization and repolarization.
Magnetocardiography measured these very weak magnetic fields around the
heart, the recording of the heart's magnetic field is the magnetocardiogram
(MCG).
The magnetic field around the heart is about (5×10 -11tesla"T" ) or about one-
millionth of the earth's magnetic field "the cgs unit for magnetic fields is the
gauss,(T=104gauss)" ,to measure fields of this size it is necessary to use
magnetically shielded rooms and very sensitive magnetic field detectors
(magnetometers).
One such detector called a SQUID (Superconducting Quantum Interference
Device) ,operates at about 50K and can detect both steady (dc) and alternating
magnetic fields as small as 10-14 T. The SQUID is so sensitive that it can detect
the changing magnetic field caused by someone walking past a horseshoe
magnet 400 m (0.25 mile) away from it!
The magnetic detector probe in the low-temperature Dewar almost touches the
subject and various points on the chest are measured by moving the Dewar.
The output of the magnetic detector is recorded at a station outside the shielded
room; the total time involved for each MCG is usually less than 1 minute.
The MCG gives information about the heart without the use of electrodes
touching the body; since the MCG and the ECG arise from the same charge
movement they have similar features and can MCG compared.
The MCG provides information not available in an ECG because it measures
magnetic fields due to direct currents, which occur in injured muscle and nerve
tissue.
The SQUID magnetometer has also been used to record the magnetic field
surrounding the brain .The recording of the this field is called the
magnetencephalogram (MEG).During the alpha rhythm ,the magnetic field
from the brain is about (1×10-11T),this is almost one-billionth of the earth's
magnetic field.

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Not all magnetic fields produced within the body are due to ion currents ;the
body can be easily contaminated with magnetic materials ,for example ;
asbestos workers inhale asbestos fibers which contain iron oxide particles. The
size of the magnetic field from the iron oxide in a worker's lungs can be used to
estimate the amount of inhaled asbestos dust.
(H.W)Q.//What is the difference between an MCG & MEG?

Current research involving Electricity in the body .

- Piezoelectric effect , forces on bone produce currents that induce and control
bone growth.
- Injury current , small direct current arises in an injured zone
- Biofeedback
- Negative feedback
Although the autonomic nervous system is not generally under voluntary
control, it can, as previously mentioned, be influenced by external stimuli.
One means of influencing the system that has been known for some time is
called biofeedback. Recently there has been renewed interest in biofeedback,
while early research on biofeedback has been promising, many aspects are still
not understood, as we learn more about it we may be able to utilize it more in
medicine.
Cardiovascular Instrumentation

1.Biopotentials of the heart:

Ion movements in heart muscle cells constitute a current flow ,which results in
potential differences in the tissue outside the fibers and the surface of the body

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(fig.20),this current only flows while the action potential is propagating(mainly

during the QRS wave of the( ECG)or during the recovery period (the T wave).

At the peak of the R wave, the potentials on the surface of the body are as
shown in (fig.21),we measure these potential differences on the surface of the
body by placing electrodes on the skin, amplifying the potentials, and then
displaying the result as an ECG. moving the electrodes to different positions on
the body may result in amplitude changes or even inversion of the signal,
as( fig.21)shows.

2.Electrodes:-
At the interface between the body and a metal electrode ion flow must be
converted to electron flow through a chemical reaction.

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If ordinary metal are used for electrodes polarization results from this chemical
reaction as shown in (fig.22-a).at one or both electrodes, gas bubbles from due
to electrolysis, and the resulting electrodes-to-solution interface is electrically
unstable. This instability produces electrical noise and drift which may be
much large than the ECG signal. These problems may be avoided by using
silver-silver chloride electrodes, as shown in (fig.22-b) these electrodes are
easily made by electrodepositing a silver chloride coating on pure silver
electrodes, current passes very readily through silver-silver chloride electrodes.
The coating merely depletes on one electrode and builds up on the other. There
is no formation pf gas, and there is no electrical noise from the electrode –to-
solution interface.

For these reasons the silver-silver chloride electrode is the natural choice for
the typical patient monitoring electrode shown in (fig.23), at the electrode-to-
solution interface, complex layers of positive and negative charge form. This
electrical double layer should not be disturbed by patient movement, which
might cause artifacts (undesirable voltage changes).hence the metal electrode is
recessed from the skin, and the space between the electrode and the skin is
filled with a conductive paste. The plastic electrode case is attached to the skin
by a pressure-sensitive adhesive.

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

3.Amplifiers:-
The amplitude of the typical ECG signal is only about 1MV.however, in
atypical building the current competitively coupled into the body from the
120Vpower lines can produce a much larger potential. The amplifier used to
record the ECG must be able to eliminate interference from voltages induced in
the body from such external sources.
4. Patient Monitoring:
After amplification, the ECG signal must be displayed. When a routine
diagnostic ECG is taken, a permanent record is required for analysis and a pen
recorder is usually used (Fig.24).
In a pen recorder, the amplifier output passes through a coil of wire suspended
in a magnetic field. In the same way that a galvanometer twists when current
passes through it, the pen twists to write on a moving strip of paper.

(Fig.24)

5.Defibrillators:-
Prompt therapeutic action can be taken to save the patient's life. Many heart
attack patient's undergo sudden changes in rhythm. The orderly heart muscle
contractions associated with normal heart pumping change to the
uncoordinated twitching of ventricular fibrillation, which halts the heart
pumping action. Death follows within minutes unless the heart can be

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

defibrillated. Defibrillated is accomplished as shown in (fig.25).the paddle

handles are made of plastic and electrically insulated to prevent accidental
shock.
When the switch is thrown, a current of about 20A flows through the heart for
about 5Msec.this current contracts every muscle fiber in the heart at the same
time and the heart can initiate normal rhythm again.
The line voltage is stepped up to several thousand volts by a transformer. a
diode rectifies the alternating current in to direct current to charge up the
capacitor when the switch is thrown the capacitor discharges through the
peddles and the heart.

6.Pacemakers:-
The pacemaker is usually implanted in a pocket on the right side of the chest.
The pacing wire is fed through a vein in the shoulder and advance through the
right atrium and through the valve, until its tip is at the bottom of the right
ventricle. The atria of the heart are separated from the ventricles by a fatty
layer that does not conduct electricity or propagate nerve impulses. At a single
location, the atrioventricular node, impulses from the atria are conducted to the
ventricles, which perform the heart's pumping action.
If AV node is damaged, the ventricles receive no signals from the atria, the
ventricles do not stop pumping, there are natural pacing centers in the
ventricles a pulse if none has been received from the atria for 2 seconds. The
resulting heart rate, 30 beats/min, will sustain life, but the patient may have to
live a life of semi-invalidism.
To improve the quality of life with faulty AV nodes, artificial pacemakers have
been developed. The pacemaker contains pulse generator that puts out 72
pulses /min.
The pacemaker is put in place, the patient is given local anesthetic and flap of
skin just below the right collar is lifted.

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

The pacing wire is fed through a slit in the shoulder vein and advanced under
fluoroscopic control until the tip is imbedded in the wall of the right ventricle,
then the pacemaker is placed in the pocket under the skin and the flap is
replaced.
The pacemaker runs on batteries that last about 2 years, it is made of materials
that are impervious to body fluids and not cause tissue reaction.
About 150,000 patients were wearing pacemakers and living near-normal lives.

Fig.26.Pacemakers provide electrical pulses to the heart in order to produce a normal

heart rate.

Applications of electricity and magnetism in medicine:-

1. Electrical shock.
When an electrode is connected to each hand and 60 Hz currents of different
levels are passed through the body various reactions are produced. The amount
of current depends on the resistance of body between two points due to Ohm's
law:
ν= I x R
As the current is increased from zero, the level at which we can just feel the
current –the perception level-is reached.
About 50% of adult men feel a 60Hz current of about 1.0mA.Women perceive
lower levels-about one-third lower than those felt by Men.
The perception level is frequency dependent; it rises as the frequency increases
above 100Hz.
As the current is increased still further, pain and some cases fainting occur;
near the 100 mA level the portion of the 60Hz current passing through the heart
is sufficient to cause ventricular fibrillation (rapid irregular and ineffectual
contraction of the ventricles).
As a 60 Hz current is increased above the perception level it causes a tingling
sensation in the hands or body, at currents of 10 to 20m A, a sustained
muscular contraction takes place in the hands and many subjects cannot let go
of the electrodes.
For a 60 Hz shock, the estimated maximum current that will not induce
fibrillation in man is given by:

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

(116/t½) mA
Where t is the time (in seconds) the shock lasts …For example, if t=1sec, the
safe current is 116 mA, if t=4sec, the safe current is 58 mA.
Current levels of 6 A and above cause sustained muscular contraction of the
heart similar to the (cannot let go) behavior of the hands. Defibrillators make
use of such current levels. If a potential has ventricular defibrillation, a brief
shock from a defibrillator usually restores normal coordinated pumping in the
heart. The defibrillator uses a brief pulse of up to 10 kV. A defibrillator can
also be used to synchronize the heart to its normal rhythm when a patient has
atrial fibrillation, in this case the electrical pulse is applied after R wave but
before T wave .

Continuous currents above 6 A can cause temporary respiratory paralysis and

serious burns. The damage depends upon the individual, the dampness of the
skin, and the contact of the skin with the conductor.
Macroshock
Which occurs when electrical contact is made on the surface of the body.
Microshock
When the current is applied inside the body, microshock results. In
microshock, the current does not have to pass through the high resistance of the
skin; it instead often follows the arteries and passes directly through the heart.
Ventricular fibrillation can be induced with microshock current levels that are
much smaller than the current levels needed to induce it under macroshock
conditions. It has been estimated that about 30 μA cause ventricle fibrillation.
It is possible for microshock to occur in a medical situation, hazards of this sort
are correct by modern power cords have three wires-two that supply the ac
power and one that serves as ground wire. If either of power wires breaks the
equipment will not operate, and if these wires touch (short) a fuse will blow
and the failure will be obvious. A break in the ground wire may go undetected
and present a serious electrical hazard to patient internal electrodes, some

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

current flow from the ac power parts to the metal case of the instrument is
called Leakage current, usually flows to ground through ground wire in the
power cord. The main source of the Leakage current is capacitance between the
power wires and ground or between power transformer and its case.

The impedance Xc of a capacitance C for applied voltage frequency f is

Xc = 1/ 2 π f c
A typical Leakage capacitance is: 2 ×10-2μf.
If the ac potential V is 110 v at a frequency of 60 Hz, then the capacitive
reactance is 1.3 x 105Ω and Leakage current;
I = V / Xc = 110 / 1.3 x 105 = 8.5 x 10-4 A = 850 μA
Let us consider what would happen if this Leakage current were in a ECG
instrument with broken ground wire and the unit were connected to a patient in
an intensive care units who also had a pacemaker connected. Since the Leakage
current could not flow to ground through the broken ground wire it would flow
through the implanted cardiac pacemaker to ground, microshock current could
result in ventricular fibrillation and death.
There are a number of ways that shock hazards could be reduced.
(1) The body is less sensitive to direct current than to 60 Hz current.
Since Xc = ∞ if f = 0
There would be no Leakage current due to stray capacitance if we operated our
electrical equipment with direct current.
(2) Hazards could also reduce at frequencies much higher than 60 Hz where the
sensitivity of the heart to ventricular fibrillation is much less.
2. High-frequency electricity in medicine.
The heating effects produced by electrical diathermy.
(1) In short wave (30 MHz) diathermy two methods are used to get
electromagnetic energy into the body: the capacitance methods and inductance
method. In both methods the body part to be heated becomes a part of resonant
electrical circuit.
(2) In microwave (2450 MHz) diathermy.
It is used to control hemorrhage during surgery.
3. Low- frequency electricity and magnetism in medicine.
When an electrical conductor is moved perpendicular to a magnetic field, a
voltage is induced in the conductor proportional to the product of the magnetic
field and the voltage of the conductor (Faradays Low). This law, which also
holds for a conducting fluid moving perpendicular to a magnetic field, is the
basis of magnetic blood flow meters.
It is used in the treatment of bursitis, arthritis, traumatic injuries, strains and
sprains.
-Blood acts as a conducting fluid ,if it passes with mean velocity v through a
magnetic field B ,a voltage V is induced between the electrodes such that :

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

V=B dv
Where d is the diameter of the blood vessel, since V, B and d can all be
measured.

The mean velocity can be obtained ,the volume flow of blood Q through the
vessel can then be calculated ,since Q is the product of the mean velocity times
the area of the vessel (πd2/4) ,or
d 2 V
Q
4 Bd
3. Current research involving electricity applied to the body.
At lower current levels than those used for electroanesthesia, electro-sleep can
be induced, a 100 Hz signal of 1mA average current used with electrodes
placed over each eye and mastoid (the bony protuberance behind the ear) is
effective.
Electrosleep has been discussed in the foreign literature for a number of years,
but there has been limited interest in the some world countries, recent research
on this phenomenon in the U.S.A has dealt with its basis and its usefulness in
psychiatry.
The Eastern art of acupuncture and its medical applications have aroused
considerable interest in the U.S.A as communication channels with China have
been renewed ,the origin of acupuncture dates back several thousand years in
China's history.
Acupuncture is used today to reduce or prevent pain associated with surgery
and dental work.
Stainless steel needles are inserted in one or more different acupuncture sites
(there are about 1000) depending upon the area to be anesthetized.
The needles are then either twisted, moved up and down or connected to small
electrical currents, the effectiveness of acupuncture varies with its intended use
and it is more effective on some subjects than on others.

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

The reason that acupuncture appears to control pain is not understood.

Theories range from hypnosis and autosuggestion to physiological block-age of
pain, this last theory is in conflict with our present understanding of the
nervous system.
More studies will have to be done before the mechanisms of acupuncture are
understood.

Electro surgery:
-What makes electrosurgery work?
Current flows when a high frequency probe is immersed in tissue and under
certain conditions a high power density will exist around the probe.
For example, if 15W is dissipated by a 0.25mm diameter, straight wire probe
used at 5MHz, a direct application of electrical principles would show that the
power density at the probe is 3.3×103 W/cm3and the power density 1.25cm
from it is 0.3 W/cm3 ,these power densities would cause rapid temperature rises
of about 8000C at the probe and about 0.10C at 1.25cm from the probe .
The "cutting" of electrosurgery is thought to be the physical rupturing of tissue
due to rapid boiling of the fluids from the intense local heat.
Since the cutting of tissue takes place rapidly, the probe must be moved rapidly
(5 to 10 cm/sec) to reduce the destruction of surrounding tissues.
With proper control ,the destruction can be limited to a depth of about 1mm
from the probe .Electrosurgery is often used in operations on the brain ,spleen
,bladder ,prostate and cervix.

Galvanic skin response (GSR):

Changes in perspiration (sweat gland activity) are related to skin resistance: the
variation from the basal or normal, skin resistance (BSR) due to psychological
changes or external stimuli is called the galvanic skin response (GSR).
A decrease in skin resistance indicates increased sweat gland activity, while an
increase in skin resistance indicates reduced sweat gland activity.
The GSR can be easily measured where there is a concentration of sweat
glands such as the palm of the hand or sole of the foot ,the GSR depends upon
the activity of the sweat glands only and not upon the amount of visible
perspiration .
Galvanic skin response (or GSR), also known as electrodermal response (EDR)
or psychogalvanic reflex (PGR), is a method of measuring the electrical
resistance of the skin and interpreting it as an image of activity in certain parts
of the body.
A constant direct current (~ 10 μA/cm2) is passed: resulting voltage indicates
the GSR proportional to resistance.
The details of this response are still not completely understood.

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 1st stage Medical Physics
Assistant Prof. Dr.Mohammed.O.AL-Lheiby

EX: A magnetic blood flow meter is positioned across a blood vessel (0.005m)
in diameter, with a magnetic field (300gauss), an induced voltage of
(15×10-6V) is measured.
1. Find the mean velocity in the vessel?
2. Assuming all the blood travels at the mean velocity, what is the volume flow
rate?
Solution./
1. 300gauss=3×10-2T

V 1.5 105
v  2 3
 0.1m / sec
Bd 3 10  5 10
2.
d 2 V  (5 103 ) 2
Q  (0.1)  1.9 106 m3 / sec
4 Bd 4

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