1 Introduction ULTRASONIC DOPPLER velocimeters are widely used in clinical practice for the noninvasive assessment of peripheral arterial

and venous haemodynamics and have been found to be extremely useful in routine clinical investigation (BERNSTEIN, 1978; WOODCOCK, 1976). However, despite the advances which have been made in the objective assessment of arterial disease, the success of the reconstructive surgery which follows the diagnosis is often poor. The short-term success of arterial reconstruction can be monitored by measuring blood flow in the reconstructed artery at the time of surgery. It has been found that such interopcrative m e a s u r e m e n t s can significantly reduce the need for reoperation, and mortality rates can be substantially reduced. Technical faults in revasculation can be detected (COTTON et al, 1980; WOODCOCK and BAIRD, 1980; KEITZER et al., 1972) and the likelihood of a successful outcome can be predicted (ROBERTS et al., 1980; LAW et al., 1983). Many methods have been used for peroperative monitoring, but the most important by far has been the electromagnetic blood flowmeter (WYATT, 1984). This instrument has become the gold standard for measuring blood flow in intact vessels, but is costly and not without limitations. For implanted monitoring others have proposed the use of pulsed-wave ultrasound (ALLEN e t al., 1977) and continuous-wave (CW) ultrasound (MATREet al., 1985). The only other work we know of to concern itself with the design of a CW Doppler system for peroperative use is that described by BEARDet al. (1986). Their system is based
First received 13th February and in final form 24th April 1987

9 IFMBE: 1987

on the use of a single pencil probe, operating at 10 MHz, which is inserted into a series of carriers each having a different lumen for application to different sized vessels. MORITAKEet al. (1981) used a bidirectional CW Doppler flowmeter with a sound spectrographic analyser to determine blood flow direction and obtain information peroperatively about the blood flow patterns in the cerebrovasculature. Assessment of carotid artery reconstruction has also been carried out on the basis of a CW Doppler system with audible output only (BARNES and GARRETT, 1978). More recently, ZIERLERet al. (1984) have used a 20MHz pulsed-wave system with spectral analysis to detect flow disturbances consistent with technical imperfections. The use of pulsed-wave velocimeters has also been assessed in aortocoronary grafting (SEGADAL t aL, 1982). e In this study the ultrasonic device was compared with an electromagnetic flowmeter and found to be superior, although this may in part have reflected the difficulties of using an electromagnetic flowmeter in this particular application. More recently several groups have attempted to measure blood flow using duplex scanning/Doppler systems (TEAGUE et al., 1985; SMITH, 1984; SUTTON et al., 1983). None of these systems is ideal for peroperative use; the systems with implanted probes because they lack the necessary accuracy and the duplex systems because of their cost. Despite the attempts that have already been made to introduce ultrasonic technology into peroperative monitoring in arterial surgery, the results reported in the literature often appear ambiguous (in the levels or patterns quoted as leading to success). For the most part, however, the reports have been content to restrict the use of the flow
661

Medical & Biological Engineering & Computing

November 1987

measurements made at surgery to the detection of technical imperfections, which arise in over 12 per cent of cases (BARNES, 1986), a figure which is similar to those reported using nonultrasonic methods. Our experience has, however indicated that more longterm information might be available with suitable signal processing and the use of computer modelling. A prerequisite for this is a flowmeter of known accuracy and performance. Few if any of the papers cited above address the problem of accuracy and errors during measurement, and almost no flowmeter has been designed specifically for use during surgery. This, as will be seen (COWAN et al., 1988), can lead to gross errors and must therefore cast some doubt (with the possible exception of the work involving duplex scanners) on the findings published already. This present paper is an attempt to overcome some of these potential shortcomings. This paper and its companion (CowAN et al., 1988) describes a relatively inexpensive continuous-wave ultrasound Doppler shift flowmeter designed specifically for use during reconstructive arterial surgery.
2 F l o w m e t e r specification Ideally, a blood flowmeter designed for use in surgery would have the characteristics outlined below. Some of these are fairly arbitrary, others are based on existing electromagnetic flowmeter standards. The specification relates to the performance of the flowmeter/probe combination:

The analysis provided data on the optimal distance between the crystals and the centre of the flow stream, the optimal angulation between transmit and receive crystals and the theoretical variation in received acoustic power across the artery along the plane of insonation. The design finally evolved used a large transmitting crystal to provide an ultrasonic 'floodlight', with a small receiving crystal with a narrow 'spotlight' beam falling entirely within the transmitter beam. Fig. 1 shows the optimum geometric configuration chosen and Fig. 2 illustrates the positions of the principal elements. This shows the probe surrounding the blood vessel. This was considered necessary for two main reasons: first to prevent wall movement effects from distorting the measurements (the calculations for the angular orientation of the crystals rely on the fact that the point of intersection of the transmitting and receiving ultrasound beams is at the vessel wall and this is obviously not always the case if the vessel wall is allowed to move in its usual pulsatile fashion); and secondly, to provide secure mechanical location of the probe on the exposed vessel. This feature, however, has the disadvantage that the overall length of artery which needs mobilising to mount the probe is considerably longer than the artery diameter (electromagnetic probes are typically 1.5 diameters wide, ROBERTS, 1973). A full description of the construction and manufacture of the probes is beyond the scope of this paper, but in essence the crystals are mounted at precisely controlled
0
Sv

(a) be able to measure flow in a range of vessels from 5 mm to 12 mm outside diameter (b) have a linear response to flow and be equally sensitive to flow in either direction. Linearity to be within _+ 1 per cent over a velocity-equivalent range of 1 cm s- t to 100 cm s- ~ (c) have an output which is relatively insensitive to flow profile ( < 5 per cent sensitivity change as profile changes from flat to parabolic) (d) exhibit a stable baseline (< 1 per cent drift from turn-on relative to a 'normal' flow rate--this typically represents a 2 . 5 m l m i n -~ drift in baseline from turn-on for an 8 mm diameter probe (e) exhibit stable flow sensitivity, overall variation to be < + 5 per cent (f) exhibit adequate flow resolution, typically + 5 ml min- ~ over the range 5 ml rain- 1 to 500 ml min- 1 for an 8 mm probe. In addition to meeting these performance criteria, it should be possible to measure flow without any damage to the vessel; the system should be user-friendly and require minimal training to use. Maintenance of the equipment should be easy and accessories such as probes should be readily available in millimetric sizes, robust and preferably able to withstand sterilisation by autoclaving.

Wt
/ / ~ wr

. . . . .

. . . . . . . . . . .

--

Fig.

1 Geometric configuration of transducer showing principal

dimensions. Wt is the width of the transmitter crystal, and W, that of the receiver. T is the thickness of the blood vessel wall. S v and Sh are the vertical and horizontal separations of the crystals

..,,,,,.
~ S ~ ~-~ ~J I~ I~:~ ~ I I ~\ ~

p r ob e body transmitter X crystal x~f receiver

3 Probe design 3.1 Probe The first part of the flowmeter system is the probe. This section describes the design and testing of the probe system. The problem involved resolving the need for compact probe dimensions with the requirement for a uniform ultrasonic insonation of the artery. The parameters included in this optimisation analysis included (a) the transmitter and receiver crystal lengths (in the direction of flow) (b) the mean angulation of the crystals relative to the direction of flow (c) the probe diameter (vessel OD).
662

Fig. 2

Positionsof principal elements offlow transducer assembly

November 1987

Medical & Biological Engineering & Computing

angles on a polymer carrier and separated from each other by an acoustic insulant. Final casting of the crystal assembly to generate the vessel lumen and the cavity for the acoustic couplant is achieved using a very low viscosity (0.1 N s m -2) epoxy. This casting also produces a very thin layer on the crystals which serves both for mechanical protection and acoustic matching.

(c) should have a longitudinal ultrasonic wave velocity as close as possible to that of soft tissue (1570 m s-1). This avoids overmuch refraction of the signal at the material interfaces, but the parameter is probably of less importance than attenuation, since refraction effects can be corrected for. (d) should be capable of maintaining contact between

Table 1 Variation of optimal included angle (between crystals), vessel~crystal separation, and received power variation across the vessel lumen, for various probe sizes. Data are for a receive crystal~vessel angle of 45 ~

Probe diameter, Included angle mm ~ Transmitter length 4.0 mm Receiver length 2-0mm 3 27-7 5 19.4 7 15.5 9 13.0 11 11.4 12 10.7 Transmitter length 2.0 mm Receiver length 2.0mm 3 2.6 5 2.9 7 3-0 9 3.0 11 3-0 12 3.0 Table 1 details the theroetical variation in optimum relative crystal angulation, crystal-vessel separation and translumenal variation in received power (a figure of 1.0 is the optimum), for probes in the range 3 - 1 2 m m diameter and for different crystal lengths. In all cases the design is based on crystals whose width is the same as the vessel diameter. (For brevity, data are only quoted for a receiver crystal/vessel angle of 45 ~, and for two crystal lengths). The power ratio is a relative power measurement which compares the power received from a streamline at the top of the artery (lt in Fig. 1, where the ultrasonic beams overlap) with the power received from a streamline at the bottom of the artery (lb). The power loss ratio is proportional to the overlap of the beams axially and can therefore be based on the ratio lJl t with a correction for loss due to the attenuation of blood. This attenuation is set at 0 . 0 8 d B m m - 1 (CARSTENSENand SCHWAN,1959). The equation for lJl t can be obtained from Fig. 1 : l/V~/sin 0
lb/l t = d + TSv/2 Sh d + T + Sv/2

External vessel distance, mm

Power ratio

4.23 5.19 5.73 6.18 6.33 6.48

1.11 1.20 1.30 1-41 1.53 1-59

36.75 30-69 27.64 25.84 24-04 23.14

1-13 1-23 1.33 1-44 1.56 1-63

crystal and probe in a wet warm field (e) should be sufficiently robust to withstand surgeons ( f ) should ideally be sterilisable by autoclaving (g) should be readily manufacturable in the form needed as an insert. We have investigated a number of materials to meet this specification. Of all the materials available water is probably the best and a water-filled probe was considered seriously at an early stage. Use of water as the couplant demands the interposition of a thin retaining film between the water and the artery. However, experience in surgery indicated that it would be very difficult to match the optimal acoustic properties with surgeonproof robustness and the use of water was ultimately rejected. Other, more 'solid' couplants were investigated. Some of these are listed in Table 2. Also given are the acoustic properties measured both in our laboratories and at the National Physical Laboratory at a frequency of 5.3 MHz.
Table 2 Acoustic properties of various couplant materials measured at 5.3 M H z

tan 0

tan (0 + ~b)

Material

Attenuation, dB mm- 1

Acoustic velocity, m s- 1

3.2 Acoustic couplant One of the problems in the use of ultrasonic probes for peroperative use arises from the material used to couple the ultrasound to the blood vessel. For transcutaneous use, a water-based gel is most often adopted. However, during surgery such gels, though sterilisable, are not ideal since they tend to get dissolved away, trapping air between crystal and vessel and leading to distortion of the ultrasound field and signal attenuation. Ideally, the couplant should have the following characteristics: (a) be nontoxic (b) should present minimum attenuation to the ultrasound (water is ideal)
Medical & Biological Engineering & Computing

Water 0"02 1570 Hydrophylic polyurethane 0-12 1610 FS6-6 (Smith & Nephew Ltd.) Hyrophylic polymer 407* 0.10 1650 (Smith & Nephew Ltd.) Silcoset 105 (ICI Ltd.) 0.49 1011 Polycarbonate (ICI Ltd.) 1.10 2237 * copolymer of vinyl pyrrolidone and phenethyl methacrylate As a result of our comparative investigations, we finally opted to use a modified hydrophylic polymer developed by Smith & Nephew Ltd. This material is supplied unswollen and is swollen by immersing in sterile water for 48 h before use. The linear swell factor (i.e. the factor by which it will swell in each of the three directions) of the material is 1.8 and its equilibrium water uptake is 85 per cent, thus combining high water content in a convenient 'solid' form.
663

November 1987

T h e n o n t o x i c i t y of the m a t e r i a l (which is a derivative of m a t e r i a l s used for soft c o n t a c t lenses) was assessed by implanting a sample piece of the material 0-5 c m x 1 c m x 1 c m s u b c u t a n e o u s l y into tw o ad u l t b a b o o n s . T h e specimens were r e m o v e d after h a v i n g been i m p l a n t e d for 6 m o n t h s a n d the s u r r o u n d i n g tissues e x a m ined for any evidence of toxic reaction. N o n e was f o u n d in either case. 3.3 Acoustic field plotting T h e first stage of assessing the likely p e r f o r m a n c e of the f l o w m e t e r r e q u i r e d m e a s u r e m e n t of the sensitivity of the p r o b e s to flow. This was achieved by using a ' c o n s t r a i n e d

xy ! ,

i n s o n a t e d region of the p r o b e an d is c o l l e c t e d with a scavenging tube (not s h o w n in the figure) o n the o t h e r side outside the i n s o n a t e d area. ( N o vessel, si m u l at ed or real, is present within the p r o b e l u m e n d u r i n g this test.) T h e b l o o d a n a l o g u e consisted of 16 per cent Silcolapse 5000 in distilled water, an d was fed f r o m a h e a d e r tank, via a m i c r o p o r e filter (100/~m, to r e m o v e large a g g r e g a t e d particles) to the j et test rig. T h e j et consisted of a straight n y l o n tube ( 0 . 5 m m I D , a p p r o x i m a t e l y 6 0 r a m long) aligned to the f l o w m e t e r axis. T h e flow t h r o u g h the jet was c o n t r o l l e d to give a j et velocity of 10 c m s - 1. Th e ultrasonic p r o b e was m o u n t e d in a m i c r o m a n i p u l a tor an d used to scan across the j et in the x an d y planes an d the received D o p p l e r signal level ( R M S voltage) was measured. In this w ay the entire ultrasonic field was scanned in 0 . 5 m m steps, ef f ect i v el y yielding 392 d a t a points for the 1 2 m m probe. E a c h scan was r e p e a t e d three times to assess repeatability, an d in three c o u p l i n g m o d e s (i) with w at er as the s o u n d c o u p l a n t an d n o artery r et ai n i n g clip in place (ii) with w at er as c o u p l a n t b u t with the r et ai ni ng clip in place (iii) with a h y d r o p h y l i c p o l y m e r insert (RICHARDSON a nd STEVENS, 1985) (see Section 3.2 above) as the c o u p l a n t a n d with the r et ai n i n g clip in place. N o r m a l i s e d sensitivity plots were m ad e, i g n o r i n g the streamlines at the sides. T h e n o r m a l i s a t i o n was carried out

,e t

erged

(fixed position) Fig. 3 Experimental configuration of the "constrained jet" test jet' technique to build up a picture of the sensitivity weighting factor for individual streamlines along the probe axis. The probes used for this test were all ]2mm calibre, but with varying crystal configurations. The experimental data were then used to validate the theoretical response and provide the basis for the design of a family of probes. The essential nature of the 'constrained jet' technique (BAKER and YATES, 1974) is illustrated in Fig. 3. The flow probe, immersed in a water-filled test tank is used to insonatc a jet of blood analogue, which emerges from a tube placed upstream of the flow probe, passes through the

Table 3 Predicted and measured power contribution from various streamplanes for the 12 mm transducer
Distance of streamplane from probe edge (crystal side), mm 1 2 3 4 5 6 7 8 9 10 11 Theoretical normalised power 0.38 0.50 0-63 0.75 0.88 1-00 1.13 1.25 1-38 1.50 1.63 Measured normalised power _+1 SD 0.52 _ +0.06 _ 0.57 _ 0.07 0.66 + 0.09 0.71 _ 0.16 0.89 _ 0.24 1.14 _ 0.30 0.99 _ +0-31 _ 1-21 _ 0.43 1.29 + 0-44 1-38 + 0.42 1.66 _+0.59

Crystal surface
0.02 0.03 0.03 0-03 0.07 0.29 0,83 1.64 1.82 1.09 0-96 2.52 2.31 1.73 3-20 2.11 2-62 2-62 2.62 2.11 0.03 0.03 0.06 0.05 0-09 0.29 0-83 1.64 1.48 0.66 1.24 2-11 1.73 2.11 2.01 2.41 1.73 2-73 2.52 2.01 0-02 0.02 0-02 0.05 0-04 0.08 0.29 0.83 1.56 1.32 0.60 1-40 1.91 1.64 2.20 1.91 2.11 1.91 2-31 2-52 1.91 1.02 0.02 0.02 0.02 0.02 0.03 0.15 0.41 1-02 1-64 1.32 0.66 1.73 1-91 1.82 2.11 2.01 2.01 2.01 2.41 2.41 1.91 1.02 0.02 0-03 0.03 0-05 0.05 0.13 0.29 0.89 1.56 1.24 0.66 1.64 1.73 1-91 2.11 1.82 2.0I 1-91 2.20 2.20 1.82 1.02 0.02 0.03 0.03 0-05 0.05 0.10 0.29 0.66 0-56 0.77 0.50 1.09 1,17 1.24 1-56 1.49 1.49 1.48 1.82 1.73 1-32 0-55 0.02 0.04 0.05 0-05 0.06 0.10 0.26 0.55 0.60 0.66 0.55 1.24 1.09 1.32 1-40 1.64 1.40 1.32 1.48 1.64 1-24 0.60 0.04 0.03 0.02 0.03 0.04 0-09 0.29 0.60 0.89 0.41 0.55 1.02 0.71 1.17 1.40 1.17 1-32 1.17 1.24 1.40 1-09 0.55 0.06 0.04 0-02 0.01 0.03 0.07 0-26 0.55 0.83 0.46 0-71 0.83 0.71 1.17 1.32 1.17 1.09 1.09 1.17 1.24 1.03 0.50 0-02 0.02 0.02 0.02 0-03 0-07 0.29 0.50 0.66 0.33 0-66 0.66 0.71 0.89 1.32 1-17 0.89 0.83 1.09 1.17 0.83 0.50 0.03 0.02 0.01 0.02 0-05 0-26 0.55 0.66 0-37 0.71 0.60 0.71 0.71 1.03 1.24 0.83 0.89 0-89 1.17 0-89 0.05 0.02 0.02 0.03 0.06 0.26 0.55 0.71 0-37 0.71 0.66 0.89 0.71 1.17 1.32 0.83 1.02 0.83 1.24 0.83

0"83 2"11 2"11 1"91 1"09 2"31 3"83 2"01

0-15 0-33 0.86 2.11 2.11 1-82 0.86 2.62 3.78 2.01 3.32 2.95

0.10 0-19 0-45 1-02 2.11 2.01 1.64 1.02 2-73 3.32 1-82 3.70 2.41 2-96

0-04 0-04 0.07 0.33 1.09 1.91 2-11 1.64 0.83 2.73 3.20 1.64 3.57 2.41 2.96 2.96

0-05 0.02 0-04 0.10 0-33 1.09 1.32 1.91 1.40 0-83 2.62 2.73 1.91 3.57 2.01 2.96 2.73 3-08

0.02 0.03 0.03 0.07 0.22 0.50 0.46 0.41 0-71 0-60 0.95 0.83 0.96 1.09 0-71 0.56 0.83 1.09

0.04 0-04 0.07 0-22 0.50 0.45 0.46 0-60 0.55 0.60 0.83 0.96 0.83 0-71 0.77 0.77

0-03 0.14 0.22 0.50 0.37 0-46 0.50 0.55 0.60 0.71 0-83 0.77 0.71 0.71

0-16 0.33 0.46 0.29 0.46 0-50 0.53 0.50 0.71 0-83 0.77 0.66

0.33 0-37 0.50 0.50 0.50 0-50 0.77 9.71

Fig. 4 Normalised sensitivity weightinO plot for a 12 mm transducer

664 Medical & Biological Engineering & Computing November 1987

to give a theoretical normalised power of 1.00 units for the centre streamplane. The measured power contributions were then normalised to give the same average value as the theoretical (see Table 3). Fig. 4 shows a typical pattern achieved in one of the probes tested, in coupling mode (i). The normalised pattern is skewed to one side due to irregularities in the mechanical construction of the probe (principally the alignment of the crystals). Some of the randomness in the power measured is attributable to working in the near field of the transducer. The data from the sensitivity plots were then used to test the prediction of sensitivity of 'flow plates' (a collection of streamlines in a common plane along the flow axis a n d parallel to the flow axis). The results of this comparison are shown in Table 3, which shows a reasonable agreement between predicted and actual sensitivity. N o essential differences were found between these results and those obtained in the other probe coupling modes.
10-

theoretical change in zero-crossing frequency observed when changing from a parabolic to a flat profile (LuNT, 1975). The field plotting also dearly indicates the large variation in sensitivity which can occur throughout a vessel cross-section, a factor considered only for the electromagnetic blood flowmeter in previous reports (WYATT, 1984). Such sensitivity variation could lead to errors in the presence of non-axisymmetric or jet flow, but these errors are unlikely to be as great as those found with the electromagnetic blood flowmeter where weighting factors ranging from 0 to infinity are found for the point electrode systems commonly used (SHERCLIFF, 1962). Furthermore, the performance of the probe is likely to be slightly better than that suggested by Fig. 5 because signal arising from the far side of the vessel will have been attenuated by the blood, an effect not taken into account by the constrained-jet experiment. A companion paper (CowAN et al., 1988) reports on the design and performance of a complete CW ultrasonic Doppler flowmeter which uses this transducer system.
Acknowledgments--The authors gratefully acknowledge the financial support of the British Technology Group and the Joint Research Committee of King's College Hospital and Medical School.

9 9 9 0 9 9 o9
9e

9 9
9 ,

~ 9 1 4 9 1 7 6 194 9

~176
9

9
'

oo
9

9
9 1'2

lume~ diometer, mm

-1C

Fig. 5 Errors in mean velocity estimation due to uneven weighting

as a function of lumen radius

The experimental data were used to estimate the error in flowmeter output for changes in flow profile. This estimation was based on the assumptions of axisymmetric laminar flow and absolute calculation of the first moment of the power density spectrum. The calculations were performed over a wide range of residual lumens, making an allowance for vessel wall thickness (thickness = 10 per cent vessel diameter). Fig. 5 shows the magnitude of the errors that would be induced by a change in velocity profile from flat to fully parabolic. The graph shows that over the likely lumen sizes the maximum error from this source will be around 3 per cent. The variability in the results refects the variability observed in the measured Doppler power (see Fig. 4). 4 D i s c u s s i o n and conclusions This paper has outlined the design of an ultrasonic transducer for perivascular application. The design has been based on the use of CW ultrasound and has been optimised to permit the construction of probes varying from 5 to 12 mm lumenal diameter. The only other work on the design of a CW Doppler system for perivascular application is described by BEARD et al. (1986). These workers are clearly aware of the potential errors arising from nonuniform insonation, and report a sensitivity change of - 8 per cent when changing from steady to pulsatile flow--almost certainly a combination of uneven sensitivity and poor low-velocity resolution. According to their paper, the design of a defocused probe (essentially of the kind we report here) is worthy of further research. The sensitivity of our probe has been investigated using a 'constrained jet' field plotting technique from which an estimate of the potential inaccuracies of the probe can be made. These indicate that, over the range for which the family of probes is designed, the errors caused by weighting errors which are attributable to changes in flow profile are likely to be less than 3 per cent, which is less than the Medical & Biological Engineering & Computing

References ALLEN, H. V., ANDERSON, M. F., MEINDL, J. D. (1977) Direct calibration of a totally implantable pulsed Doppler ultrasonic blood flowmeter. Am. J. Physiol., 232, H537-H544. BAKER, D. W. and YATES,W. G. (1974) Technique for studying the sample volume of ultrasonic Doppler devices. Med. & Biol. Eng., 11, 766-770. BARNES, R. W. (1986) Intraoperative monitoring in vascular surgery. Ultrasound in Med. & Biol., 12, 919-926. BARNES,R. and GARRETT,W. (1978) Intraoperative assessment of arterial reconstruction by Doppler ultrasound. Surg. Gyn, & Obstet., 146, 896-900. BEARD, J. D., EVANS, J. M., SKIDMORE,R. and HORROCKS, M. (1986) A Doppler flowmeter for use in the theatre. Ultrasound in Med. & Biol., 12, 883-889. BERNSTE1N, E. F. (1978) Non-invasive diagnostic techniques in vascular disease. C. V. Mosby, London. CARSTENSEN,E. L. and SCHWAN,H. P. (1959) Acoustic properties of haemoglobin solutions. J. Acoust. Soc. Am., 31, 305-311. COTTON, L. T., HAMILTON,W. A. P., HORROCKS, M., O'REILLY, M. J. G., STEVENS,A. L. and ROBERTS,V. C. (1980) The detection and measurement of blood flow in arterial surgery. In Recent advances in surgery. TAYLOR,S. (Ed.), Churchill Livingstone, London, 65-92. COWAN,D., STEVENS,A. L. and ROnERTS,V. C. (1988) Design of a continuous-wave Doppler ultrasonic flowmeter for perivascular application. Part 2 Signal processing system. Med. & Biol. Eng. & Comput., 26, (in press). KEITZER,W. F., LICUTI,E. L., BROSSART,F. A. and DE WEESE, M. S. (1972) Use of Doppler ultrasonic flowmeter during arterial surgery. Arch. Surg., 105, 308-312. LAW, F. Y., GRAHAM,J. C., COTTON, L. T. and ROBERTS,V. C. (1983) Per-operative assessment of lower limb arterial surgery. Part 1: Hydraulic impedance measurement. J, Biomed. Eng., 5, 185-193. LtJNT, M. J. (1975) Accuracy and limitations of the ultrasonic Doppler blood velocimeter and zero crossing detector. Ultrasound in Med. & Biol., 2, 1-10. MATRE, K., SEGADAL, L. and ENGEDAL, H. (1985) Continuous measurement of aortic blood velocity, after cardiac surgery, by means of an extractable Doppler ultrasound probe. J Biomed. Eng., 7, 84-88. 665

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MORITAKE, K., HANDA, H., IZUMI, H., NAGATA,I., TAKEBE, Y., OKUMURA, A. and HAYASFU,K. (1981) Experimental study on quantitative flow measurement by a Doppler flowmeter with a sound spectrograph. Neurol. Res., 3, 363-380. RICHARDSON,P. C. A. and STEVENS,A. L. (1985) Ultrasonic transducers. UK Patent 2102657B. ROBERTS, V. C. (1973) The measurement of flow in intact blood vessels. CRC Crit. Rev. in Bioeng., 1, 419--452. ROBERTS,V. C., HAMILTON,W. A. P., STEVENS,A. L., WILTON,G. N. and COTTON,L. T. (1980) The electromagnetic flowmeter in the per-operative management of peripheral arterial disease. In Diagnosis and monitoring in arterial surgery. WOODCOCK,J. e. and BAIRD,R. N. (Eds.), John Wright, Bristol, 155-165. SEGADAL,K., MATRE, K., ENGEDAL,H., RESCrI, F. and GRip, A. (1982) Estimation of flow in aortocoronary grafts with a pulsed ultrasound Doppler meter. Thorac. Cardiovasc. Surg., 30, 265268. Si-IERCLIFF,W. (1962) Theory of electromagnetic flow measurement. Cambridge University Press. SMITH, H. (1984) Quantitative Doppler flowmetry 1: Construction and testing of a duplex scanning system. Acta Radiol. (Diagn,), 25, 305-312. SUTTON, M., GREENE,E., JOHNSON,E. and REILLY,P. (1983) Noninvasive echo-Doppler duplex measurements of common femoral artery blood flow variables during supine exercises and post-operative reactive hyperaemia. ISA Trans., 22, 47-57. TEAGUE, M. J., WILLSON, K., BATTYE,C. K., TAYLOR, M. G., GRIFFIN, D. R., CAMPBELL,S. and ROBERTS, V. C. (1985) A combined ultrasonic linear array scanner and pulsed Doppler velocimeter for the estimation of blood flow in the foetus and adult abdomen. 1: Technical aspects. Ultrasound in Med. & Biol., 11, 27-36. WOODCOCK,J. P. (1976) Clinical blood flow measurement in man. Sector Publishing, London. WOODCOCK, J. P. and BAIRD, R. N. (Eds.) (1980) Diagnosis and monitoring in arterial surgery. John Wright, Bristol. WYATT,D. G. (1984) Blood flow and blood velocity measurement in vivo by electromagnetic induction. Med. & Biol. Eng. & Comput., 22, 193-211. ZIERLER, R., BANDYK, D., ZIERLER, R. and THIELE, B. (1984) Detection of technical error during arterial surgery by pulsed Doppler spectral analysis. Arch Surg., 119, 421--428.

Andrew L. Stevens was born in Cambridge in 1950. He was educated at Sussex University, where he read Applied Sciences. Following a brief spell as a mathematics teacher in Cornwall he joined the Department of Medical Engineering & Physics at King's College Hospital as a Research Engineer working predominantly on ultrasonic instrumentation. He is now a senior lecturer at CCAT Cambridge.

Donna Cowan graduated from Nottingham University in 1983 with a B.Sc. in Electrical & Electronic Engineering. After completing a year in industry she joined the Department of Medical Engineering & Physics at King's College, London as a Research Engineer. Her research interests are ultrasound flowmeters and signal processing of blood flow signals.

Saide Calil was born in Sao Paulo, Brazil, in 1950 and graduated with an M.Sc.(Eng.) in Electrical Engineering from the Medical Electronics Department at St. Bartholomew's Hospital, University of London in 1980. He gained his Ph.D. from King's College School of Medicine in 1985, researching ultrasonic instrumentation. He is now on the academic staff of the University of Campinas, Sao Paulo, Brazil.

Authors" biographies
Paul C. A. Richardson received a B.Sc. in Mechanical Engineering from the University of Surrey, after a graduate apprenticeship at CAV, Acton. From 1968 to 1974 he worked for Lucas Medical Equipment and was Senior Mechanical Engineer on the team that won a Design Council Award (for dialysis equipment) in 1973. Since then he has worked on a number of projects at the Department of Medical Engineering & Physics, King's College Hospital, with particular interests in Doppler probe design.

Colin Roberts graduated in Electrical Engineering from the University of London in 1966. After a period in industry he took the M.Sc. in Biomechanics at Surrey University and then went to King,s College School of Medicine & Dentistry, where he is now Professor of Biomedical Engineering. His main area of research has been in circulatory haemodynamics and medical instrumentation, a field in which he gained his doctorate in 1971. A former President of the UK BES, he is currently Editor of Medical & Biological Engineering & Computing.

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Medical & Biological Engineering & Computing

November 1987