FORCE Biomedical

Short Learning Topics

Biomedical Equipment’s and IEC 60601

Author
Akhil. S

June 2021
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Table of Contents
Introduction to Biomedical Engineering ............................................................................. 4
What Is Biomedical Engineering? ......................................................................................... 4
What Biomedical Engineers do? ....................................................................................... 5
Introduction to IEC Standards – 60601 ................................................................................ 6
Introduction to Biomedical Equipment’s ............................................................................ 9
Aspirator ............................................................................................................................... 9
Clinical Thermometer ....................................................................................................... 10
Sphygmomanometer......................................................................................................... 11
Weighing scale ................................................................................................................... 12
Glucometer ......................................................................................................................... 13
Flowmeter ........................................................................................................................... 14
Pulse oximeter.................................................................................................................... 16
Nebulizer ............................................................................................................................ 17
Breast pump ....................................................................................................................... 20
Electrical wheelchair ......................................................................................................... 20
Oxygen concentrator ......................................................................................................... 21
ABG Machine ..................................................................................................................... 23
ACT Machine ..................................................................................................................... 24
Biothesiometer ................................................................................................................... 25
Bronchoscope ..................................................................................................................... 26
Biosafety cabinet ................................................................................................................ 28
C Arm .................................................................................................................................. 30
Capnography ..................................................................................................................... 32
CT Machine ........................................................................................................................ 34
Anaesthesia machine ........................................................................................................ 38
Defibrillator ........................................................................................................................ 41
Dental chair ........................................................................................................................ 43
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Mammography .................................................................................................................. 45
ECG machine ..................................................................................................................... 47
Electro surgical unit .......................................................................................................... 49
ECT machine ...................................................................................................................... 52
Vein detector ...................................................................................................................... 54
Fetal Monitor ...................................................................................................................... 54
Haemodialysis Unit .......................................................................................................... 57
IABP..................................................................................................................................... 64
Baby Incubators ................................................................................................................. 66
Infusion pump ................................................................................................................... 68
PCA pump .......................................................................................................................... 71
Enteral Feeding pump ...................................................................................................... 72
Multipara Monitor ............................................................................................................ 73
NIBP .................................................................................................................................... 75
Surgical light ...................................................................................................................... 77
OT table ............................................................................................................................... 80
Radiant warmer ................................................................................................................. 86
Phototherapy unit ............................................................................................................. 88
Stethoscope ......................................................................................................................... 90
Syringe pump..................................................................................................................... 91
Neuronavigation system .................................................................................................. 92
Ultrasound machine.......................................................................................................... 93
Ventilator ............................................................................................................................ 96

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Introduction to Biomedical Engineering

What Is Biomedical Engineering?

Biomedical engineering is the application of the principles and problem-solving

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

Engineering itself is an innovative field, the origin of ideas leading to everything

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

There are many subdisciplines within biomedical engineering, including the design
and development of active and passive medical devices, orthopaedic implants,
medical imaging, biomedical signal processing, tissue and stem cell engineering, and
clinical engineering

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What Biomedical Engineers do?

Biomedical engineers work in a wide variety of settings and disciplines. There are
opportunities in industry for innovating, designing, and developing new
technologies; in academia furthering research and pushing the frontiers of what is
medically possible as well as testing, implementing, and developing new diagnostic
tools and medical equipment; and in government for establishing safety standards
for medical devices. Many biomedical engineers find employment in cutting-edge
start-up companies or as entrepreneurs themselves. Tissue and stem cell engineers
are working towards artificial recreation of human organs, aiding in transplants and
helping millions around the world live better lives. Experts in medical devices
develop new implantable and external devices such as pacemakers, coronary stents,
orthopedic implants, prosthetics, dental products, and ambulatory devices. Clinical
engineers work to ensure that medical equipment is safe and reliable for use in
clinical settings. Biomedical engineering is an extremely broad field with many
opportunities for specialization.

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Introduction to IEC Standards – 60601

It can be assumed that not all people will understand the dangers associated with
the exposure to electricity. It is this danger that has triggered several discussions
relating to the safety of all members of the public.

Regulatory bodies world-wide have acknowledged the dangers of electricity by

producing legislation, standards and/or guidelines to control the design of electrical
appliances in order to prevent any hazard to the general public.

COMMONLY USED DEFINITIONS WITHIN IEC 60601

Equipment Under Test

The equipment (EUT) which is the subject of testing.

Device Under Test

The equipment (DUT) which is the subject of testing.

Applied Part

Part of the medical equipment which is designed to come into physical contact with
the patient or parts that are likely to be brought into contact with the patient.

Patient Connection

Individual physical connections and / or metal parts intended for connection with
the patient which form (part of) an Applied Part.

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Patient Environment

Volumetric area in which a patient can come into contact with medical equipment or
contact can occur between other persons touching medical equipment and the
patient, both intentional and unintentional.

F-Type Applied Part

Applied Part which is electrically isolated from Earth and other parts of the medical
equipment i.e., floating F-type Applied Parts are either type BF or type CF Applied
Parts.

Type B Applied Part

Applied Part complying with specified requirements for protection against electric
shock. Type B Applied Parts are those parts, which are usually Earth referenced.
Type B are those parts not suitable for direct cardiac application.

Type BF Applied Part

F-Type Applied Part complying with a higher degree of protection against electric
shock than type B Applied Parts. Type BF Applied Parts are those parts not suitable
for direct cardiac application.

Type CF Applied Part

F-Type Applied Part complying with the highest degree of protection against electric
shock. Type CF Applied Parts are those parts suitable for direct cardiac application.

Medical Electrical Equipment

Electrical equipment designed for treatment, monitoring or diagnoses of patients,

powered from not more than one connection to mains supply and which are not
necessarily in physical or electrical contact with the patient or transfers energy to or
from the patient or detects such energy transfer to or from the patient.

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Medical Electrical System

Combination of equipment of which at least one is classed as medical electrical

equipment and is specified by the manufacturer to be connected by functional
connection or use of a multiple portable socket-outlet.

Class I

Equipment protection against electric shock by (Earthed) additional protection to

basic insulation through means of connecting exposed conductive parts to the
protective Earth in the fixed wiring of the installation.

Class II

Also referred to as Double Insulated. Equipment protection against electric shock by

additional protection to basic insulation through means of supplementary insulation
are provided, there being no provision for the connection of exposed metalwork of
the equipment to a protective conductor and no reliance upon precautions to be
taken in the fixed wiring of the installation.

Symbols and Markings

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Introduction to Biomedical Equipment’s

Biomedical Equipment
Medical and clinical conditions of patients under observation and treatment are detected
and monitored with the help of biomedical equipment. Sometimes these equipment’s are
known as armamentarium. Depending on the usage biomedical equipment’s are of different
types, such as, biomedical equipment for diagnosis, equipment for monitoring, equipment
used for emergency treatment such as life support and so on.

Aspirator
Surgical aspirators consist of a line-powered vacuum pump, a vacuum regulator and
gauge, a collection canister, and an optional bacterial filter. Plastic tubing connects
these components, completing an open-ended system that continuously draws

tissue debris and fluid from the surgical fi eld to the collection canister. The gauge
allows the user to set a safe limit for suctioning, to assess the performance of the
vacuum pump, and to detect leaks or blockages. Units are either portable or

mounted on a stand or cart for mobility

Principles of operation

Various pump configurations include rotary-

vane, diaphragm, and piston. Each
mechanism alternately increases and
decreases the vacuum and/or chamber
volume, creating suction. Air is drawn from
the external tubing into the chamber,
drawing aspirate into a collection canister.
Most surgical aspirators have an overflow-
protection assembly that prevents fluid from
overflowing into the pump and valves

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Clinical Thermometer
Clinical thermometers are meant for clinical purposes. It is developed for measuring
the human body temperature. It is a long narrow glass tube with a bulb containing
mercury at the end. The normal human body temperature is 37˚C; which can
fluctuate between the ranges 35˚C to 42˚C. Hence, the clinical thermometers have the
range 35˚C to 42˚C. The level of mercury tells our body temperature in ˚C. Since
mercury is a toxic element, thus these thermometers have been replaced by digital
thermometers nowadays.

Digital Thermometer

These thermometers are used for measuring the temperature by the means of an
electronic circuit. The information captured is sent to a microchip that processes it
and gets displayed numerically on the digital screen. They are easy to use,
inexpensive, and accurate. Digital thermometers can be considered to be advanced
thermometers that are used for measuring body temperature.

Digital Thermometer

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Sphygmomanometer
A sphygmomanometer is a device that measures blood pressure. It is composes of an
inflatable rubber cuff, which is wrapped around the arm. A measuring device
indicates the cuff's pressure. A bulb inflates the cuff and a valve releases pressure. A
stethoscope is used to listen to arterial blood flow sounds. As the heart beats, blood
forced through the arteries cause a rise in pressure, called systolic pressure, followed
by a decrease in pressure as the heart's ventricles prepare for another beat. This low
pressure is called the diastolic pressure.

The sphygmomanometer cuff is inflated to well above expected systolic pressure. As

the valve is opened, cuff pressure (slowly) decreases. When the cuff's pressure
equals the arterial systolic pressure, blood begins to flow past the cuff, creating
blood flow turbulence and audible sounds. Using a stethoscope, these sounds are
heard and the cuff's pressure is recorded. The blood flow sounds will continue until
the cuff's pressure falls below the arterial diastolic pressure. The pressure when the
blood flow sounds stop indicates the diastolic pressure.

Systolic and diastolic pressures are commonly stated as systolic 'over' diastolic. For
example, 120 over 80. Blood flow sounds are called Korotkoff sounds.

Types

• ANEROID SPHYGMOMANOMETERS

• DIGITAL SPYGMOMANOMETERS

ANEROID DIGITAL

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Weighing scale
Weighting Scales are used to measure the weight of an item. To use a scale, the item
which needs to be weighed is put on one side of the scale. Then, usually stones are
put on the other side to compare the weight of the stone with the weight of the object
you have chosen.

Basic components

• Pressure sensor
• Microprocessor
• Analog to digital converter
• LCD

Weighing scale Block diagram

OPERATIONAL ISSUES

➢ Pressure sensor sensitivity issues

➢ Error reading

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Glucometer

A glucose meter, also referred to as a "glucometer", is a medical device for

determining the approximate concentration of glucose in the blood. It can also be a
strip of glucose paper dipped into a substance and measured to the glucose chart. It
is a key element of home blood glucose monitoring (HBGM) by people with diabetes
mellitus or hypoglycemia. A small drop of blood, obtained by pricking the skin with
a lancet, is placed on a disposable test strip that the meter reads and uses to calculate
the blood glucose level. The meter then displays the level in units
of mg/dL or mmol/L

Glucometer Block diagram

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Flowmeter
The medical gas flowmeter is a medical device for oxygen or medical air inhalation
of first-aid and hypoxic patients in the hospital, including oxygen flowmeter, and
medical air flowmeter. It mainly consists of gas pressure gauge, pressure reducer,
safety valve, flow tube, flow control valve, and humidification bottle, and other
components.

Oxygen flowmeter is mainly used to regulate the flow of oxygen, oxygen

humidification. Whether its performance is accurate and reliable will directly affect
the patient’s personal safety. It can not only accurately measure the instantaneous
flow of oxygen, but also enable healthcare workers to keep abreast of patient oxygen
absorption status. Oxygen flowmeter has spread to all levels of medical institutions;
township hospitals are also widely used.

Parts of oxygen flowmeter

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Safe use of medical oxygen regulator

Oxygen regulators are intended for the administration of oxygen to patients that are
deemed by a physician to need increased oxygen levels to improve or stabilize their
breathing conditions. It is a pressure-reducing device that lowers the pressure of the
oxygen from a cylinder to a level that can safely be used.

Type of safety system is used when connecting the regulator

• Pin Index Safety System

• Diameter index safety system

Pin Index Safety System

The Pin Index Safety System, or PISS, is a means of connecting high

pressure cylinders containing medical gases to a regulator or other utilization
equipment. It uses geometric features on the valve and yoke to prevent
mistaken use of the wrong gas.

Diameter index safety system

The Diameter Index Safety System, or DISS, was designed by the Compressed Gas
Association specifically for medical gases at 200 psig or less. It uses unique, gas-
specific threaded connections to fit equipment to station outlets.

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Pulse oximeter
A pulse oximeter is a small, lightweight device used to monitor the amount of
oxygen carried in the body. This noninvasive tool attaches painlessly to your
fingertip, sending two wavelengths of light through the finger to measure
your pulse rate and how much oxygen is in your system.

SpO2 – Saturation of Peripheral Oxygen

HR - Heart Rate (BPM- Beats Per Minute)

Waveform: Plethysmograph (Pleth)

Fingertip pulse oximeter Block diagram

Types based on Methods

• Transmittance

• Reflectance

Response of Blood to IR and Red Light

Oxygenated Blood: Absorbs IR and Allow Red Light to Pass

De Oxygenated Blood: Allows IR and Absorbs More Red Light

Types of Spo2 Probes (Based on Application)

▪ Finger Probe Foot

▪ Ear lobe Forehead

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Nebulizer
A nebulizer turns liquid medicine into a mist to help treat your asthma. They come
in electric or battery-run versions. They come in both a portable size you can carry
with you and a larger size that’s meant to sit on a table and plug into a wall. Both are
made up of a base that holds an air compressor, a small container for liquid
medicine, and a tube that connects the air compressor to the medicine container.
Above the medicine container is a mouthpiece or mask you use to inhale the mist.

TYPES

➢ Vibrating mesh technology

➢ Jet nebulizer

➢ Ultrasonic wave nebulizer

Vibrating mesh nebulizers

Vibrating mesh nebulizers use mesh deformation or vibration to push the liquid
drug through the mesh. An annular piezo element, which is in contact with the
mesh, is used to produce vibration around the mesh, and the liquid drug is in direct
contact with the mesh. Holes in the mesh have a conical structure, with the largest
cross-section of the cone in contact with the liquid drug [6]. The mesh deforms into
the liquid side, thus pumping and loading the holes with liquid. This deformation
on the other side of the liquid-drug reservoir ejects droplets through the holes,
which can be inhaled by the patient

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Jet nebulizer

Jet nebulization was the first technical operation developed for aerosol production. It
uses gas flow either from a compressor or a central air supply. The gas passes
through a small aperture in the nebulizer in order to pick up and atomize the liquid
drug. The aerosol that is generated by atomization contains large and small droplets,
and is driven to a baffle. Large droplets are impacted by the baffle and forced onto
the side of the nebulizer to be recycled in liquid form in a reservoir. More than 90%
of the droplets produced by atomization are selected and recirculated in the
nebulizer to be recycled in the liquid-drug reservoir. Small droplets are transported
out of the nebulizer by the gas to be inhaled by the patient.

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Ultrasonic nebulizers

Ultrasonic nebulizers use the vibration (1.2–2.4 MHz) of a piezo-electric crystal to

generate the aerosol. Vibrations are transmitted to a liquid drug, generating a liquid-
drug fountain comprising large and small droplets. Large droplets drop into the
liquid-drug reservoir or are thrown onto the side of the nebulizer and recycled.
Small droplets are stored in the nebulization chamber to be inhaled by the patient or
leave the nebulizer with the airflow produced by a ventilator. Like the jet nebulizer,
some residual mass is trapped in the nebulizer, but there is little leakage since there
is no gas source to transport the aerosol out of the nebulizer during exhalation.

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Breast pump
Breast pumps are medical devices
regulated by the U.S. Food and Drug
Administration. They can be used to
maintain or increase a
woman's milk supply, relieve
engorged breasts and
plugged milk ducts, or pull out flat or
inverted nipples so a nursing baby can
latch on more easily.

Breast pump

Electrical wheelchair

A motorized wheelchair, powerchair, electric

wheelchair or electric-powered wheelchair (EPW) is
a wheelchair that is propelled by means of
an electric motor (usually using differential steering)
rather than manual power. Motorized wheelchairs
are useful for those unable to propel a manual
wheelchair or who may need to use a wheelchair for
distances or over terrain which would be fatiguing
in a manual wheelchair. They may also be used not
just by people with 'traditional' mobility
impairments, but also by people
with cardiovascular and fatigue-based conditions.

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Oxygen concentrator
Oxygen concentrator definition: An oxygen concentrator is a type of medical device
used for delivering oxygen to individuals with breathing-related disorders.
Individuals whose oxygen concentration in their blood is lower than normal often
require an oxygen concentrator to replace that oxygen.

BASIC PRINCIPLES

The most common oxygen concentrators molecular sieves that operate in a two-part
cycle

• High pressure intake phase

• Depressurizing exhaust phase

o These units have two cylinders containing zeolite, a nitrogen adsorbent

silicate substance that acts as the sieve material
o The concentrators draws in room air and passes it through a series of filters
that remove duct, bacteria, and other particulates
o In the first step, a compressor forces air into one of the two cylinders
containing the sieve material, where nitrogen is adsorbed, leaving
concentrated oxygen and a small percentage of other gases found in room air
o Simultaneously, in the other cylinder, nitrogen is desorbed and exhausted
into the atmosphere

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o In the second step, the function of the cylinders is reversed in a timed cycle,
providing a continuous flow of oxygen to the patient
o The oxygen concentration produced by molecular sieve concentrators varies
inversely with the flow of gas through the cylinders: the lower the flow, the
higher the oxygen concentration in the end- product gas

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ABG Machine
Blood gas analyzers are used to measure combinations of pH, blood gas (i.e. pCO2
and pO2), electrolytes, and metabolites parameters from whole blood samples.
Blood conservation is an important initiative in every clinical diagnostic lab or
critical care facility. Therefore, a highly accurate blood gas analyzer can streamline
work processes and reduce errors with minimum maintenance. Most blood gas
analyzers offer automatic sample mixing and easy sample aspiration with intuitive
user interface built-in and automatic QC for accuracy and regulatory compliance.
Also available in a lightweight, small footprint design, most models offer simple
replacement of solutions for analysis such as, sensor cassettes and solution packs. A
particularly unique feature to certain blood gas analyzers is liquid calibration,
thereby eliminating previously required gas tanks, regulators, tubing lines, and
humidifiers.

Principle

● PO2: Use of the Clark measurement principle: measurement of current

generated by the reduction of oxygen.
● PCO2: Use of the Severinghouse principle: potentiometric measurement of the
pH changes in the electrode caused by CO2.
● pH- , Na+-,K+-, Ca2+- and Cl- electrodes are potentiometric electrodes. Special
glasses are used as the sensitive element for pH and Na+. The potassium and
calcium membranes contain special neutral carriers. A special ion exchanger
is used for chloride membranes. Calculation of these variables also requires
the use of a reference electrode—a permanently contacted chloride electrode
in the cobas b 221 system.
● Hematocrit: Measurement of the sample's conductivity in the ISE measuring
chamber.
● Glucose, lactate: Glucose oxidizes to form gluconolacton using atmospheric
oxygen and the glucose-oxidase (GOD) enzyme, lactate oxidizes to form
pyruvate using the lactate oxidase enzyme. The generated H2O2 is
determined amperometrically by using manganese dioxide/carbon electrode
at 350 mV.

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● Urea: Urea is broken into ammonia and carbon dioxide through urease.
Ammonia and carbon dioxide react through hydrolysis with physiological pH
to form ammonia or bicarbonate ions. The ammonia ions can be determined
using a potentiometrical ammonia ion-selective electrode. This measurement
requires a reference electrode such as those used in ion-selective electrodes
● tHb/SO2: Light absorption in whole blood is measured at four different
wavelengths, the sample is subjected to light radiation and the dispersed light
is also evaluated.
● COOX: The hemoglobin derivatives and the total bilirubin (= neonatal) are
determined spectrophotometrically based on the Lambert-Beer law.

ACT Machine
The activated clotting time (ACT) is commonly used to monitor treatment with high-
dose heparin before, during, and for a short time after medical or surgical
procedures that require that blood be prevented from clotting, such as heart bypass
surgery, coronary angioplasty, and dialysis. 70 to 120 seconds is the usual amount
of time for blood to clot without heparin. 180 to 240 seconds is the usual amount
of time for blood to clot with heparin. This is called the therapeutic range.

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Biothesiometer
The biothesiometer is an instrument which measures the threshold of appreciation of
vibration sense. The amplitude of the stimulus (measured in volts) is gradually
increased until the threshold of vibratory sensation is reached and the stimulus is
appreciated by the patient.

The aim of review is to give basic information on the method of peripheral

neuropathy examination using biothesiometry technique. Impaired vibratory
threshold can be identified in all patients with peripheral neuropathies, the diabetic,
uremic, alcoholic or paraneoplastic ones. It is a simple, sensitive and comfortable
method for daily screening. On the other hand it is sufficiently sensitive for detection
and evaluation of peripheral neuropathy. Principle is a vibrating probe, vibration
amplitude can be changed by voltage adjustment. Biothesiometry is used in
diagnostics of peripheral neuropathies with impaired vibratory perception
threshold, mainly in diabetology and neurology.

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Bronchoscope

Devices that are introduced at the nose or mouth to observe distal branches of the
bronchi. Through working channels in the bronchoscope, the physician can sample
lung tissue (e.g., when pulmonary malignancies are suspected), instill radiographic
media for bronchographic studies, perform laser therapy, remove foreign objects,
suction sputum for microbiological culturing, insert catheters, and perform difficult
intubations

These devices consist of a proximal housing, a flexible insertion tube ranging from
0.5 to 7.0 mm in diameter, and an “umbilical cord” connecting the light source and
the proximal housing. The proximal housing, which is designed to be held in one
hand, typically includes the eyepiece (fiberoptic models only), controls for distal tip
(bending section) angulation and suction, and the working channel port.

Principles

The bronchoscope (either flexible or rigid) is inserted into the airways, usually
through the mouth or nose. Sometimes the bronchoscope is inserted via a
tracheostomy. Rigid bronchoscopes are used for the removal of foreign bodies while
flexible video bronchoscopes are intended to provide images of a patient’s airways
and lungs. Images provided by the bronchoscope can be focused by adjusting the
ocular on the scope’s proximal housing. A video bronchoscope uses a charge-
coupled device (CCD) located at the distal tip of the scope to sense and transmit
images, replacing the image guide and eyepiece. These images can then be recorded,
printed, stored on digital media, or transmitted to another location for simultaneous
viewing

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Flexible bronchoscope

Rigid bronchoscope

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Biosafety cabinet
A biological safety cabinet (BSC) is a primary engineering control used to protect
personnel against biohazardous or infectious agents and to help maintain quality
control of the material being worked with as it filters both the inflow and exhaust
air. It is sometimes referred to as a laminar flow or tissue culture hood.

These filtered cabinets are primarily designed to protect against exposure to

particulates or aerosols. A portion of the air in most BSCs is recirculated back into
the lab through its exhaust HEPA filter. This purifies the air of potentially infectious
aerosols, animal dander, or both but does not reduce exposure to chemicals.

All procedures should be performed in a manner that reduces the generation of

aerosolized material and prevents spills. Operations such as centrifugation,
vortexing, sonication, and opening containers of infectious materials whose internal
pressure may be different from the ambient pressure are known aerosol-generating
procedures. These procedures should be conducted inside the BSC or additional
measures must be available to mitigate the safety concern.

Classification

o Class I: BSCs should be limited to basic microbiological work with low- and
moderate risk agents
o Class II: BSCs also provide product protection through high-efficiency
particulate air filtration (HEPA filtration) of the intake air.
o Class III: cabinets offer the maximum protection to laboratory personnel, the
community, and the environment because all hazardous materials are
contained in a completely enclosed, ventilated cabinet.

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CLASS I CLASS II

CLASS III

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C Arm
A mobile C-arm is a medical imaging device that is based on X-ray technology
and can be used flexibly in various ORs within a clinic. The name is derived from the
C-shaped arm used to connect the X-ray source and X-ray detector to one another.
Since the introduction of the first C-arm in 1955 the technology has advanced
rapidly. Today, mobile imaging systems are an essential part of everyday hospital
life: Specialists in fields such as surgery, orthopedics, traumatology, vascular surgery
and cardiology use C-arms for intraoperative imaging. The devices provide high-
resolution X-ray images in real time, thus allowing the physician to monitor progress
at any point during the operation and immediately make any corrections that may
be required. Consequently, the treatment results are better and patients recover
more quickly. Hospitals benefit from cost savings through fewer follow-up
operations and from minimized installation efforts

Mobile C-arm working

A C-arm comprises a generator (X-ray source) and an image intensifier or flat-panel

detector. The C-shaped connecting element allows movement horizontally, vertically
and around the swivel axes, so that X-ray images of the patient can be produced
from almost any angle. The generator emits X-rays that penetrate the patient's body.
The image intensifier or detector converts the X-rays into a visible image that is
displayed on the C-arm monitor. The doctor can identify and check anatomical
details on the image such as blood vessels, bones, kidney stones and the position of
implants and instruments at any time.

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C ARM PARTS

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Capnography

Capnography is the measurement of exhaled CO2; the number is displayed in

millimeters of Mercury (mm Hg) or percent (%) CO2. Capnography provides the
clinician with a waveform which tracks exhaled CO2 over time. The measuring
device used is called a capnograph. The waveform displayed by the capnograph is
called a capnogram. End-tidal CO2 (EtCO2) is the partial pressure of CO2 at the end
of an exhaled breath—normally 38mm Hg or 5%.

Capnography, the measurement of exhaled carbon dioxide (CO2), has been gaining
popularity in hospital critical care environments and more recently in the
prehospital setting as well. Capnography was first used in the OR to continuously
and noninvasively estimate arterial carbon dioxide (PaCO2) levels on a breath-to-
breath basis.1 Measuring carbon dioxide in the patient’s exhaled breath allowed
anaesthesiologists to determine the adequacy and effectiveness of ventilation. The
amount of carbon dioxide exhaled at the end of each breath (EtCO2) is measured
through a sensor located between the patient’s airway and ventilator and is then
numerically and graphically displayed as a waveform.

Measurement methods

Single, one-point-in-time EtCO2 measurements may be done using the visual

colorimetric method where a litmus paper device attached to a patient’s
endotracheal tube undergoes a chemical reaction and colour change in the presence
of CO2. Electronic devices can furnish continuous information; they utilize infrared
(IR) spectroscopy to measure the CO2 molecules’ absorption of IR light as the light
passes through a gas sample.

Device CO2 sensors may be mainstream, located directly on the patient’s

endotracheal tube (ETT), or side stream, remote from the patient. Mainstream
sampling occurs at the airway of an intubated patient and is not intended for use on

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non-intubated patients. Heavy and bulky adapter and sensor assemblies may make
this method uncomfortable for non-intubated patients.

In side stream capnographs the exhaled CO2 is aspirated via ETT, cannula, or mask
through a 5–10-foot-long sampling tube connected to the instrument for analysis;
this method is intended for the nonincubated patient. Both mainstream and side
stream technologies calculate the CO2 value and waveform.

Sidestream Mainstream

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CT Machine

These devices are also called as Axial CT scanners, CAT scanners, cine CT scanners,
EBT scanners, helical CT scanners, multislice CT scanners, spiral CT scanners,
ultrafast CT scanners. CT scanners produce thin cross-sectional images of the human
body for a wide variety of diagnostic procedures.

Non-invasive radiographic technique that involves the reconstruction of a

tomographic plane of the body from a large number of collected x-ray absorption
measurements taken during a scan around the body’s periphery.

The result of a CT study is usually a set of transaxial slices, which can be

mathematically manipulated to produce sagittal or coronal image slices

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Basic components

o X-ray subsystem
o Gantry
o Patient table
o Controlling computer
o High-voltage x-ray generator
o X-ray tube
o Detector system
o Collimators
o Rotational frame
o Solid-state detectors
o Silicon photodiodes

BASIC PRINCIPLES

o A high-voltage x-ray generator supplies electric power to the x-ray tube,

which usually has a rotating anode and is capable of withstanding the high
heat loads generated during rapid multiple-slice acquisition
o Most solid-state detectors are made of ceramic materials that produce light
when exposed to ionizing radiation
o Silicon photodiodes convert this light into an electrical signal
o Collimators located near the x-ray tube and, on some systems, next to the
detector are aligned so that scatter radiation is minimized and the x-ray beam
is properly defined for scanning
o The patient table can be moved both vertically and horizontally to
accommodate various scanning positions
o During a CT scan, the table moves the patient into the gantry and the x-ray
tube rotates around the patient
o As x-rays pass through the patient to the detectors, the computer acquires and
processes data to form an image
o The computer also controls the x-ray production, gantry motions, table
motions, and image display and storage

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o Slip-ring scanners can perform helical CT scanning, in which the x-ray tube
and detector rotate around the patient’s body, continuously acquiring data
while the patient moves through the gantry
o The acquired volume of data can be reconstructed at any point during the
scan
o All modern CT scanners are multislice
o In addition to the gantry, a multislice CT scanner has a powerful computer
processor
o Inside the gantry, an x-ray tube projects a fan-shaped x-ray beam through the
patient to the detector array.
o As the x-ray tube and detector rotate, x-rays are detected continuously
through the patient.
o The computer mathematically reconstructs data from each full rotation to
produce an image of one slice.
o The second component is a detector design that incorporates approximately
1,000 elements per row along the length of the arc (x/y axes) and up to 320
rows across the width (z-axis) of the detector.
o When using a multislice CT scanner, the slice width is chosen by combining
data from adjacent rows across the detector in the z-axis.

IMAGE MANIPULATION

o The quantitative nature of the CT image allows the reviewer to easily perform
a large number of image manipulations
o Although the numerical range of pixels in the image is rather large, the
numerical range spanned by most soft tissues is relatively narrow
o To adequately display the values for soft tissue and still maintain the ability
to discriminate density differences, CT scanners are designed to display user-
selected CT numerical ranges (also called Hounsfield units) over the entire
greyscale
o The range to be displayed (window width) and the central value (level) are
also user selectable
o Regions of interest in the image can be selected to obtain average CT values
within the region or to calculate total lesion volume

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o CT-guided needle biopsies are facilitated by the ability to measure distance

and orientation between two operator-selected points in the images, and real-
time needle tracking is possible
o The transaxial images or raw data obtained directly from the scanner can be
reformatted into any arbitrary plane by software manipulation

CT IMAGE RECONSTRUCTION

RADIATION DOSE

o CT uses some of the highest doses of any diagnostic imaging method, and the
fact that multislice CT has the potential to increase these doses adds to the
need for some form of automatic dose control
o The simplest dose-control system uses just one scout view, although some
systems can use two views.
o A more advanced dose-control method uses real-time information about the
patient’s anatomy derived from the beam signal received by the detectors as
the scan is progressing

******

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Anaesthesia machine
An anaesthesia system comprises of a gas delivery platform, a data analysis and
distribution system, and physiologic and multigas monitors (optional in most units),
which indicate levels and variations of several physiologic variables and parameters
associated with cardiopulmonary function and/or gas and agent concentrations in
breathed-gas mixtures. Manufacturers typically offer a minimum combination of
monitors, alarms, and other features that customers must purchase to meet
standards and ensure patient safety.

BASIC PRINCIPLE

o An anesthesia system comprises three basic subsystems

o A gas delivery platform, which creates and delivers gas mixtures and
monitors the patient’s respiration
o A data analysis and distribution system, which includes hardware and
software that collect and process data and display it to the clinician
o physiologic and multigas monitors (optional in most units), which indicate
levels and variations of several physiologic variables
o To meet the minimum standard American Society of Anesthesiologists (ASA)
states that anesthesia systems must continually monitor the patient’s
oxygenation, ventilation, circulation, expired CO2 levels, and temperature

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CIRCUIT DIAGRAM

GAS SUPPLY & CONTROL

o Gases used in anaesthesia are usually supplied under high pressure either in
cylinders or as a piped gas supply
o The cylinders are made from molybdenum steel, in which gases and vapours
are stored under pressure
o H - free-standing, attached to the anaesthesia machine by a flexible hose.
These are most economical, but reduce the mobility of the anaesthesia
machine
o The hose to the anaesthetic machine should be at a regulated pressure of 50
psi
o E - attached directly to the anaesthesia machine via a yoke

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VENTILATION

• Automatic ventilator is generally used to mechanically deliver breaths to the

patient
• The ventilator forces the anaesthesia gas mixture into the patient’s breathing
circuit and lungs and receives exhaled breath from the patient as well as fresh
gas
• The anaesthetist can vary the volume of a single breath (tidal volume) and the
ventilation rate, either directly by setting them on the ventilator or indirectly
by adjusting parameters
• It captures and exhausts waste gases to minimize the exposure of the
operating room staff to harmful anaesthetic agents
• It removes gas by a vacuum, a passive exhaust system, or both
• Vacuum scavengers use the suction from an operating room vacuum wall
outlet or a dedicated vacuum system
• To prevent positive or negative pressure in the vacuum system manifold-type
vacuum scavengers use one or more positive or negative pressure-relief
valves in an interface with the anaesthesia system

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Defibrillator
Defibrillators are devices that restore a normal heartbeat by sending an electric pulse
or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat
that is uneven or that is too slow or too fast. Defibrillators can also restore the heart’s
beating is suddenly stops.

Different types of defibrillators work in different ways. Automated external

defibrillators (AEDs), which are in many public spaces, were developed to save the
lives of people experiencing sudden cardiac arrest. Even untrained bystanders can
use these devices in an emergency.

Other defibrillators can prevent sudden death among people who have a high risk of
a life-threatening arrhythmia. They include implantable cardioverter defibrillators
(ICDs), which are surgically placed inside your body, and wearable cardioverter
defibrillators (WCDs), which rest on the body. It can take time and effort to get used
to living with a defibrillator, and it is important to be aware of possible risks and
complications.

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Types of Defibrillators

• Monophasic Defibrillator
• Biphasic Defibrillator

Monophasic Waveforms: A type of defibrillation waveform where a shock is

delivered to the heart from one vector as shown below. It is shown graphically as
current vs. time.

Biphasic Waveforms: A type of defibrillation waveform where a shock is delivered

to the heart via two vectors

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Dental chair
The Dental Chair is a specially designed medical device intended to support a
patient's whole body, like a recliner, but articulated, so that the dentist can recline
patients to virtually any position. Dental chairs can feature a staggering variety of
attachments, either on the chair itself, or on the ever-present Dental Engine: spit
bowls, suction tubes, pneumatic tubes to power various pieces of equipment used in
cleanings and surgeries, and so forth. Modern dental chairs are crafted from a
combination of metal and plastic, are often infused with antibacterial properties to
minimize the risk of infection, and notably have thin chair backs, which allow the
dentist to sit on a stool behind the patient to facilitate ease of access.

Different Types of Dental Chairs

Ceiling Mounted Design – None of the attachments are on the chair proper, but
built into the ceiling, with the chair positioned beneath them.

Mobile Independent Design – Wheel-mounted chairs with locking mechanisms,

or folding style chairs, designed to be used in mobile operations, typically serving
poorer areas of the country.

Dental Chair Mounted Design – The Dental Engine and all necessary attachments
are built into the chair itself.

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Dental chair controls

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Mammography
Mammographic radiographic units use x-rays to produce images of the breast—a

mammogram—that provide information about breast morphology, normal anatomy,

and gross pathology. Mammography is used primarily to detect and diagnose breast

cancer and to evaluate palpable masses and nonpalpable breast lesions.

A complete mammographic radiographic system includes an x-ray generator, an x-

ray tube and gantry, and a recording medium. The x-ray generator modifies

incoming voltage to provide the x-ray tube with the power necessary to produce an

x-ray beam. They also include a “paddle” for compression and placement of the

breasts during imaging. Screen-film systems consist of a high-resolution

phosphorescent screen with phosphor crystals that emit light when exposed to x-

rays. Digital mammographic computed radiography (CR) uses a “digital” cassette to

replace the traditional film cassette and digital cassette reader, producing a digital

image from the cassette instead of developing film through a film processor.

Principle

Low energy X-rays are produced by the x-ray tube (an evacuated tube with an anode

and a cathode) when a stream of electrons, accelerated to high velocities by a high-

voltage supply from the generator, collides with the tube’s target anode. The cathode

contains a wire filament that, when heated, provides the electron source. The target

anode is struck by the impinging electrons. X-rays exit the tube through a port

window of beryllium. Additional filters are placed in the path of the x-ray beam to

modify the x-ray spectrum. The x-rays that pass through the filter are shaped by

either a collimator or cone apertures and then directed through the breast.

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ECG machine
Electrocardiographs detect the electrical signals associated with cardiac activity and

produce an ECG, a graphic record of the voltage versus time. They are used to

diagnose and assist in treating some types of heart disease and arrhythmias,

determine a patient’s response to drug therapy, and reveal trends or changes in

heart function. Multichannel electrocardiographs record signals from two or more

leads simultaneously and are frequently used in place of single-channel units. Some

electrocardiographs can perform automatic measurement and interpretation of the

ECG as a selectable or optional feature.

ECG units consist of the ECG unit, electrodes, and cables. The 12-lead system

includes three different types of leads: bipolar, augmented or unipolar, and

precordial. Each of the 12 standard leads presents a different perspective of the

heart’s electrical activity; producing ECG waveforms in which the P waves, QRS

complex, and T waves vary in amplitude and polarity. Single-channel ECGs record

the electric signals from only one lead confi guration at a time, although they may

receive electric signals from as many as 12 leads. Noninterpretive multichannel

electrocardiographs only record the electric signals from the electrodes (leads) and

do not use any internal procedure for their interpretation. Interpretive multichannel

electrocardiographs acquire and analyze the electrical signals.

Principles

Electrocardiographs record small voltages of about one millivolt (mV) that appear

on the skin as a result of cardiac activity. The voltage differences between electrodes

are measured; these differences directly correspond to the heart’s electrical activity.

Each of the 12 standard leads presents a different perspective of the heart’s electrical

activity; producing ECG waveforms in which the P waves, QRS complex, and T

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waves vary in amplitude and polarity. Other lead configurations include those of the

Frank system and Cabrera leads. The Frank configuration measures voltages from

electrodes applied to seven locations—the forehead or neck, the center spine, the

midsternum, the left and right midaxillary lines, a position halfway between the

midsternum and left midaxillary electrodes, and the left leg.

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Electro surgical unit

Health problem addressed Devices intended for surgical cutting and for controlling

bleeding by causing coagulation (hemostasis) at the surgical site. Electrosurgery is

commonly used in dermatological, gynecological, cardiac, plastic, ocular, spine,

ENT, maxillofacial, orthopedic, urological, neuro- and general surgical procedures as

well as certain dental procedures.

These systems include an electrosurgical generator (i.e., power supply, waveform

generator) and a handpiece including one or several electrodes.

Principles

o High frequency electrosurgical unit devices transfer electrical energy to human

tissue via a treatment electrode that remains cool

o Most ESU work at frequencies below the AM radio frequency band

o The electrical resistance of

human tissue helps to convert

this electrical energy in

molecular energy, which causes

denaturation of intracellular

and extracellular proteins,

resulting in coagulation or

desiccation effects

o Raising intracellular water

above boiling point causes cell

membrane rupture to produce

a cutting effect

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MAJOR MODALITIES IN ESU

o Electro-desiccation

o Fulguration

o Electrocoagulation

o Electro section

▪ In Electrodesiccation, an active electrode touches or is inserted into the skin to

produce tissue destruction

▪ In Fulguration, the electrode is held away from the skin surface and more

shallow tissue destruction

▪ Electrocoagulation is ideal for clotting small blood vessels in deep and

superficial surgery

▪ In electrosection, the electrode is used to cut tissues

▪ One of the major advantage of electrosection is the capability of performing

nearly bloodless surgery and decreasing treatment time

▪ The blend mode combines both cutting and coagulation characteristics with

various combinations of cutting and coagulation

▪ Fulguration is a high-voltage coagulation mode that provides a substantial

depth of coagulation to major bleeding sites

▪ Desiccation, a very common coagulation mode, is the slow drying of cells to

achieve congealed tissue.

▪ These various modes allow the physician to select the most efficient method

of achieving the desired electrosurgical effect

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▪ COAGULATION MODES

I. soft coagulation
II. Forced coagulation

III. Spray coagulation

TECHNIQUES

MONOPOLAR SURGERY

BIPOLAR TECHNIQUE

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ECT machine
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in
which small electric currents are passed through the brain, intentionally triggering a
brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse
symptoms of certain mental health conditions.

BASIC COMPONENTS

▪ Control module
▪ Electrodes
▪ EEG Cable

TYPES OF ECT

o Bilateral ECT – bitemporal

The bitemporal position (right and left temporal areas) is used to administer
bilateral ECT

o Bilateral ECT – bifrontal

The bifrontal electrodes placed on right and left forehead over the frontal lobes

o Unilateral ECT

The Unilateral electrodes placed over the right hemisphere

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BASIC PRINCIPLES

o During electroconvulsive therapy (ECT), an electric current is conducted

through the head by means of two electrodes placed at the temples at
opposite sides of the head
o The current is divided into alternating positive and negative pulses of about
1ms with a frequency of 50 pulse pairs per second
o The current is limited to less than 1 ampere, and the electric energy applied is
about 15 to 25J
o Therapy done under strict observation
o Electrode treatment decided individually physician
o Dose is given and seizure is monitored
o Dose is given according to response from EEG
o An increase in dose shows

I. response is poor
II. generalised seizures of sufficient duration are not achieved
III. reduction in the length of the seizure

o An decrease in dose may be indicated either

I. If the person is experiencing adverse cognitive side effects

II. Prolonged seizures occur
III. The method carries the disadvantage of causing memory loss for
the time period surrounding the treatment
IV. Does not prevent relapse of the depression

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Vein detector
The device works by using proprietary vein visualization technology that shines an
infrared light on the patients’ skin. The hemoglobin (oxygen-carrying protein)
within the patient’s blood absorbs the light, creating a red pattern that can be seen
on the surface of the skin. The oxygen-depleted veins appear darker in the pattern,
indicating the presence of a vein. These dark “roads” along the skin guide our
specialists to their target as they find a suitable vein to use for treatment.

Vein Detector Hardware parts

Fetal Monitor

Electronic fetal monitoring (EFM) provides graphic and numeric information on fetal
heart rate (FHR) and maternal uterine activity (UA) to help clinicians assess fetal
well-being before and during labor. FHR often exhibits decelerations and
accelerations in response to uterine contractions or fetal movements; certain patterns
are indicative of hypoxia. Examination of these patterns, the baseline level, and
variability characteristics can indicate the need to alter the course of labor with drugs
or perform an operative delivery

Fetal monitors are bedside units that consist of a monitoring unit, cables, and
electrodes. They are designed to measure, record, and display FHR, uterine
contractions, and/or maternal blood pressure and heart rate before and during
childbirth. These monitors may sense FHR and uterine contraction indirectly

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through the mother’s abdomen and/or directly by placing an electrode on the fetal
scalp (or other exposed skin surface) and measuring the change in pressure within
the uterus. Antepartum fetal monitors are typically used in physician’s offi ces and
clinics long before the beginning of labor. Most hospital-based monitors have
additional capabilities, including fetal and maternal ECG recording.

Principles

Fetal monitors detect FHR externally by using an ultrasound transducer to transmit

and receive ultrasonic waves; the frequency (or Doppler) shift of the refl ected signal
is proportional to the velocity of the refl ecting structure—in this case, the fetal heart.
A transducer contains one or more piezoelectric elements that convert an electrical
signal into ultrasonic energy that can be transmitted into tissues. When this
ultrasonic energy is refl ected back from the tissues, the transducer reconverts it to
an electrical signal that can be used to create a waveform for display and recording
and an audible FHR (sound created by the frequency shift of the ultrasonic signal).
Types

o External fetal heart monitoring

o Internal fetal heart monitoring
External fetal heart monitoring

This method uses a device to listen to and record your baby’s heartbeat through
your belly (abdomen). One type of monitor is a Doppler ultrasound device. It’s often
used during prenatal visits to count the baby’s heart rate. It may also be used to
check the fetal heart rate during labor.
The healthcare provider may also check
your baby’s heart rate continuously
during labor and birth. To do this, the
ultrasound probe (transducer) is fastened
to your belly. It sends the sounds of your
baby’s heart to a computer. The rate and
pattern of your baby’s heart rate are
shown on a screen and printed on paper.

External fetal heart monitoring

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Internal fetal heart monitoring

This method uses a thin wire (electrode) put on your baby’s scalp. The wire runs from the
baby through your cervix. It is connected to the monitor. This method gives better readings
because things like movement don’t affect it. But it can only be done if the fluid-filled sac
that surrounds the baby during pregnancy (amniotic sac) has broken and the cervix is
opened. Your provider may use internal monitoring when external monitoring is not giving
a good reading. Or your provider may use this method to watch your baby more closely
during labor.

During labor, your healthcare provider will watch your uterine contractions and your baby’s
heart rate. Your provider will note how often you are having contractions and how long
each lasts. Because the fetal heart rate and contractions are recorded at the same time, these
results can be looked at together and compared.

Your provider may check the pressure inside your uterus while doing internal fetal heart
monitoring. To do this, he or she will put a thin tube (catheter) through your cervix and into
your uterus. The catheter will send uterine pressure readings to a monitor

Internal fetal heart monitoring

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Haemodialysis Unit
These devices perform extracorporeal dialysis to replace the main activity of the

kidneys in patients with impaired renal function, such as those with end-stage renal

disease. Single-patient haemodialysis systems can be divided into three major

components: the dialysate delivery system, the extracorporeal blood-delivery circuit,

and the dialyzer.

Principles

Single-patient haemodialysis systems can be divided into three major components:

the dialysate delivery system, the extracorporeal blood-delivery circuit, and the

dialyzer. Blood is taken via the extracorporeal circuit, passed through a dialyzer for

solute and fl uid removal, and returned to the patient. Each system has its own

monitoring and control circuits. The delivery system prepares dialysate—a solution

of purified water with an electrolyte composition similar to that of blood—and

delivers it to the dialyzer. The external blood-delivery system (extracorporeal blood

circuit) circulates a portion of the patient’s blood through the dialyzer and returns it

to the patient. The dialyzer is a disposable component in which solute exchange, or

clearance, takes place

BASIC COMPONENTS

Dialyzer Roller pump

Heparin pump Blood leak detector

Air detector Dialysate pump

Heater Proportioning pump

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BASIC PRINCIPLES

DIALYSATE DELIVERY SYSTEM

o The delivery system prepares dialysate—a solution of purified water with an

electrolyte composition similar to that of blood—and delivers it to the

dialyzer

o Dialysate acts to remove metabolic wastes from the blood and also acts as a

source of ions to maintain the blood’s proper electrolyte and pH levels

o Either acetate or bicarbonate concentrate is included in the dialysate as a

buffering agent

o Additional water is mixed into the dialysate to approximate normal

bicarbonate ion blood concentrations

o To prevent short- and long-term toxic effects, incoming water must be treated

to remove inorganic and organic contaminants, such as minerals and bacteria

o Water-treatment systems typically use depth filtration, water softeners,

activated carbon filtration, reverse osmosis (RO), and deionization (DI) to

achieve the standard acceptable level of contaminants

o Treated water enters the dialysis machine and usually passes through a heater

and a deaerator before being mixed with the concentrate to form dialysate

o Two types of proportioning systems are used to mix the water and

concentrate

• Fixed-ratio controllers mix specific amounts of each

• Servo-controlled systems monitor the conductivity of the dialysate

and regulate the delivery of concentrate to satisfy specified

conductivity and pH limits

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o The temperature of the dialysate is kept in the 34° to 42°C range to prevent

excessive cooling or heating of the blood

o The temperature and conductivity sensors can initiate alarms and divert the

dialysate away from the dialyzer if the conductivity or temperature is not

within specified limits

EXTRACORPOREAL BLOOD CIRCUIT

o The external blood-delivery system (extracorporeal blood circuit) circulates a

portion of the patient’s blood through the dialyzer and returns it to the

patient.

o Usually, an artery and a vein in the patient’s arm are surgically joined for

circulatory access; this junction is called an arteriovenous (AV) fistula

o Bypassing capillary beds, where arterial blood pressure is markedly

decreased, the blood entering the fistula maintains high pressure, causing the

diameter of the vein to expand greatly

o One or two large-bore needles can then be inserted into the enlarged vessel

o Another technique widely used for chronic hemodialysis patients is a central

venous catheter that has separate connectors and lumens for the venous and

arterial lines

o A blood pump moves blood through the external tubing and dialyzer

o As the pump draws blood into the extracorporeal circuit, it creates a partial

vacuum that will draw air into the tubing if connections are not absolutely

tight

o As a safety feature, air detectors are employed to detect air in the blood line

and prevent it from being pumped into the patient

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o Pressures are monitored on both venous and arterial blood lines; high- and

low-pressure alarms turn off the blood pump if alarm limits are exceeded

o Because blood tends to clot when it comes into contact with foreign surfaces

such as those in the tubing and dialyzer, heparin, an anticoagulant, is infused

through a syringe pump aseptically connected to an infusion line in the

arterial side of the blood circuit

o The infusion pump can be set to deliver heparin at a predetermined rate

o A drip chamber on the venous side of the blood circuit contains a clot-

trapping filter to help prevent upstream clots and other debris from reaching

the patient

DIALYZER

o The dialyzer is a disposable component in which solute exchange, or

clearance, takes place

o There are three basic design configurations: coil, parallel plate, and hollow

fiber

o In all three, electrolytes, waste products, and water pass across a

semipermeable membrane into a flowing stream of dialysate solution

o By diffusion, osmosis, and ultrafiltration (UF), water and metabolites are

exchanged between the blood and the dialysate

o Concentration gradients cause waste products, such as urea and creatinine, to

diffuse across the membrane from the blood to the dialysate

o Electrolytes move in both directions to maintain equilibrium

o Red and white blood cells and proteins are too large to pass through the pores

in the membrane

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o UF by pressure gradient is the primary method of removing excess water

from the blood through the semipermeable membrane

o It occurs when water, a small molecule, is forced across the membrane by

hydrostatic pressure—the primary UF mechanism in haemodialysis

o Another type of dialysis is continuous renal replacement therapy (CRRT)

o This type of therapy allows tighter control of volume transfer and more

gradual waste removal than intermittent treatment

o CRRT is especially useful in patients who cannot tolerate the rapid volume

loss associated with intermittent therapy; in hemodynamically unstable

patients, such as those in the intensive care unit; and in patients undergoing

cardiac surgery

o Some conventional haemodialysis machines are now offering some CRRT

modalities as an option.

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IABP
An intra-aortic balloon pump (IABP) is a mechanical device that helps the heart

pump blood.

This device is inserted into the aorta, the body's largest artery. It is a long, thin tube

called a catheter with a balloon on the end of it. If you are hospitalized, your doctor

may insert an IABP. Your doctor will numb an area of your leg and thread the IABP

through the femoral artery in your leg into your aorta. He or she then positions the

IABP at the center of your aorta, below your heart. The doctor will use an X-ray

machine during this procedure to help accurately position the IABP.

The IABP reduces the workload on your heart, allowing your heart to pump more

blood. The IABP is placed inside your aorta, the artery that takes blood from the

heart to the rest of the body. The balloon on the end of the catheter inflates and

deflates with the rhythm of your heart. This helps your heart pump blood to the

body

BASIC PRINCIPLES

o The coronary arteries, which originate at the base of the ascending aorta,

supply blood and oxygen to the heart

o As the heart contracts (systole), these vessels are compressed, reducing

coronary perfusion

o As a result, 70% to 90% of coronary perfusion occurs during the heart’s filling

stage (diastole)

o To assist in the perfusion of the coronary arteries, the counterpulsation

technique—inflation and deflation in synchrony with the cardiac cycle—was

developed

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o In counterpulsation technique, the balloon catheter is mounted on a flexible

radiopaque catheter, is inserted, typically percutaneously, with a guide wire

through the femoral artery into the aorta

Basic principle of counterpulsation

Counterpulsation is a term that describes balloon inflation in diastole and deflation

in early systole. Balloon inflation causes ‘volume displacement’ of blood within the

aorta, both proximally and distally. This leads to a potential increase in coronary

blood flow and potential improvements in systemic perfusion by augmentation of

the intrinsic ‘Windkessel effect’, whereby potential energy stored in the aortic root

during systole is converted to kinetic energy with the elastic recoil of the aortic root.

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Baby Incubators

An incubator is a self-contained unit roughly the size of a standard crib equipped

with a clear plastic dome. Because preemies lack body fat and skin integrity, they are
less able to regulate their own body temperature.1 To this end, the incubator ensures
the ideal environmental conditions by either allowing the temperature to be adjusted
manually or providing auto-adjustments based on changes in the baby's
temperature. But this is not its only function an incubator serves. An incubator also
protects the preemie from infection, allergens, or excessive noise or light levels that
can cause harm. It can regulate air humidity to maintain the integrity of the skin and
even be equipped with special lights to treat neonatal jaundice common in new-
borns.

Types of Incubators

There are different types of incubators that can accommodate the changing needs of
the preemie. Among the five types commonly found in the NICU:

o Closed box incubators have a fresh air filtration system that minimizes the
risk of infection and prevents the loss of moisture from the air.
o Double-walled incubators have two walls that can further prevent heat and
air moisture loss.
o Open box incubators, also known as Armstrong incubators, provide radiant
heat below the baby but are otherwise open to the air, allowing for easy
access.
o Portable incubators, also known as transport incubators, are used to move the
new born from one part of the hospital to another.
o Servo-control incubators are automatically programmed to adjust
temperature and humidity levels based on skin sensors attached to the baby.

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Incubator

Parts of incubator

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Infusion pump
An external infusion pump is a medical device used to deliver fluids into a patient’s

body in a controlled manner. There are many different types of infusion pumps,

which are used for a variety of purposes and in a variety of environments.

Infusion pumps may be capable of delivering fluids in large or small amounts, and

may be used to deliver nutrients or medications – such as insulin or other hormones,

antibiotics, chemotherapy drugs, and pain relievers.

Some infusion pumps are designed mainly for stationary use at a patient’s bedside.

Others, called ambulatory infusion pumps, are designed to be portable or wearable.

A number of commonly used infusion pumps are designed for specialized purposes.

These include:

o Enteral pump - A pump used to deliver liquid nutrients and medications to a

patient’s digestive tract.

o Patient-controlled analgesia (PCA) pump - A pump used to deliver pain

medication, which is equipped with a feature that allows patients to self-

administer a controlled amount of medication, as needed.

o Insulin pump - A pump typically used to deliver insulin to patients with

diabetes. Insulin pumps are frequently used in the home.

BASIC COMPONENTS

o Drop sensor Clamp

o Air detector Door

o Housing Keyboards & labels

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BASIC PRINCIPLES

Two types of working

Peristaltic mechanism: Rippling, wavelike motion of finger like discs to occlude the

IV tubing successively . The finger like disc is forcing the fluid to flow through the

tubings

Pumping mechanism: using cassette fitted either syringe/piston like device and

tubing running from two sides. Motor-driven plunger moves inward for giving

patient

Alarms includes

• Air in line

• Upstream/downstream occlusion

• Empty fluid container

• Set disengagement

• Flow error

Sensors includes

• Pressure / ultrasonic transducers

• Optical sensors

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Parts of infusion pump

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PCA pump

The patient-controlled analgesia (PCA) pump is a computerized machine that gives

you medicine for pain when you press a button. In most cases, PCA pumps supply

opioid pain-controlling medicines such as morphine, fentanyl and hydromorphone.

The pump is attached to a thin, flexible tube (intravenous or IV line) that is placed in

your vein. This medicine is usually delivered only when you press the button

(bolus), but a continuous rate may be added by your doctor if needed (basal rate).

which are programmed for the pain-relieving drug that the doctor orders based on

your age, weight and type of surgery. The PCA pump is safe to use because you

receive medication by pressing the button when you feel pain, but the pump won’t

give you the drug if it’s not time to receive another dose yet. Remember, no one

should press the button on the PCA pump except you. When the pump is empty, an

alarm lets the nursing staff know

PCA pump

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Enteral Feeding pump

An enteral feeding pump is an electronic medical device that controls the timing and

amount of nutrition delivered to a patient during enteral feeding. Enteral feeding is a

procedure in which the doctor inserts a tube into the patient’s digestive tract to

deliver liquid nutrients and medicines to the body. Tube feeding is administered to

patients who cannot eat normally due to oral cancer, surgery, injury, or another

condition that affects the normal ingestion and digestion process in the

gastrointestinal tract. The enteral feeding pump ensures that the right amount of

liquid is administered to the body over the course of a day.

Enteral Feeding pump

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Multipara Monitor

A multiparameter monitor is a medical device for monitoring a patient's vital signs.

It is mainly used in intensive care, hospitalization or ER. In general, basic models are

used to monitor cardiac activity (ECG), blood pressure (NIBP), respiration (RESP),

oxygen saturation (SpO2) and temperature (TEMP).

Application of Patient Monitors

o Acquisition and Display of Physiological Parameters

o Detection of Unexpected Life threatening conditions

o Recording of Parameter values and Trend

o Guiding in clinical decision making and Treatment

Monitoring Parameters

o Saturation of Peripheral Oxygen

o Non-Invasive Blood Pressure

o ECG

o Respiration

o Temperature

o End Tidal Carbon dioxide

o Invasive Blood Pressure

o Cardiac Output (CO)

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Block diagram

Multipara Monitor Display parameter view

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NIBP

Blood pressure is the pressure exerted by circulating blood upon the walls of blood
vessels.

Principle

Instead of recording the readings acoustically (Ausculatory Method) the

oscillometric method records and evaluates the oscillations of the arteries with the
help of pressure Transducers. Those oscillations have a very typical curve. The
oscillations occur when the blood flow first is interrupted and then starts flowing
again.

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Block Diagram of NIBP

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Surgical light
Surgical lights, also known as surgical lighting or operating lights, are mainly used
in hospital operating rooms and ambulatory surgery centers, but can also be used in
various locations throughout the facility to provide high quality lighting for
procedures. Examples include emergency rooms, labor and delivery, examination
rooms, and anywhere where procedures are completed. They are used by clinicians,
surgeons and proceduralists. A surgical light illuminates the operative site on a
patient for optimal visualization during a procedure.1 Surgical lights can provide
hours of bright light without excessively heating the patient or staff. A variety of
lights are available to meet the needs of providing optimal visualization during
surgery and procedures. An examination light is used during medical exams, while
operating room lights are used during surgical procedures.

Terminology and measurements

• Lux (lx)

Unit for the amount of visible light measured by a luxmeter at a certain point.

• Central illuminance (Ec)

Illuminance (lx) at 1m distance from the light emitting surface in the light field
centre.

• Light field centre

Point in the light field (lighted area) where illuminance reaches maximum lux
intensity. It is the reference point for most measurements.

• Depth of illumination

The distance under the light emitting area where the illumination reaches 20% of the
central illuminance

• Shadow dilution

The lights’ ability to minimise the effect of obstructions.

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• Light field diameter (D10)

Diameter of light field around the light field centre, ending where the illuminance
reaches 10% of Ec. The average of four different cross sections through the light field
centre.

• D50

Diameter of light field around the light field centre, ending where the illuminance
reaches 50% of Ec. The average of four different cross sections through the light field
centre

Scientific principles

Illumination level is measured in foot-candles or lux (1 foot-candle equals 10.764

lux).

o At 1 or 2 foot-candles, a room is considered darkened, but large objects can be

seen.
o 20 to 200 foot-candles are required for reading and other common visual
activities.
o The Illuminating Engineering Society of North America (IESNA) recommends
a minimum illumination level of 2,500 foot-candles at the surgical site when
the light is positioned one meter above the site.
o Some surgeons prefer 3,500 foot-candles or more for certain procedures
o Colour quality is a measure of the spectral content of the light, expressed by
colour temperature in kelvin (K)
o The noon sun yields a colour temperature of 5,000 to 6,000 K
o low colour temperatures cause objects to take on a reddish tint, and high
colour temperatures cause a bluish tint.
o Under most common lighting conditions, exact colour temperature control is
not crucial because of the adaptability of human visual perception; however,
because lights in the OR are often illuminating dark red tissues, they must
deliver visible red light to accentuate contrast and tissue differentiation.

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o A colour temperature of 4,000 K will provide adequate brightness and allow

the surgeon to distinguish true tissue colours with minimal eyestrain. While
IESNA states that an acceptable range for surgical lights is in the 3,500 to 6,700
K range, most surgical lights operate in the 4,000 to 4,500 K range.
o Distracting differences in appearance can occur if adjacent objects are
illuminated by light sources with significantly different color temperatures.

Parts of surgical light

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OT table

An operating table, sometimes called operating room table, is the table on which the
patient lies during a surgical operation. This surgical equipment is usually found
inside the surgery room of a hospital.

Requirements

o Height
o Tilting
o Adjustable segments
o Radiolucent surface

Components and Models

An operating table system is basically made up of three components:

o Table top
o Operating table column
o The transporter

Types

o Fixed/Stationary
o Mobile unit

Fixed operating table

o Table column for a stationary operating table system is fixed to the floor.
o Medical devices like X-ray, C ARM can easily be brought to the operating area
and positioned.

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Mobile operating table

o Position of the table can be changed within the operating room.

o Individual segments of the table top can be easily removed and replaced.

Types of Surgical OT Table

o General Surgery Tables

o Imaging Tables.
o Neurology Tables.
o Urology and CystoTables
o Orthopedics Table

❖ General Surgery Table

o Accessibility
o Stability
o Imaging Support
o weight support

General Surgery Table

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❖ Imaging Table

o Fluoroscopy, Vascular procedures

o 3D Imaging Technique
o lateral/longitudinal float
o Forward/reverse Trendelenburg
o lateral tilt or height adjustment

Imaging Table

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❖ Neurology Table

o Back section,Lateral
slide, Tilt
o Longitudinal slide
o Trendelenburg and
elevations
o Electro Hydraulic
operation

Neurology Table

Urology and CystoTables

o Perform Lithotripsy procedures

o Examination and Urodynamics study.
o Trendelenburg position
o height of the table

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❖ Orthopaedics Table

Operating table for orthopaedic surgery and traumatology.

o Femur treatment
o Arm treatment
o Shoulder treatment
o Hip treatment
o Bi-lateral hip treatment
o Spinal column treatment

Orthopaedics Table

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OT Table positions

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Radiant warmer

Radiant Warmer, is a body warming device to provide heat to the body. This device
helps to maintain the body temperature of the baby and limit the metabolism rate.
Heat has a tendency to flow in the heat gradient direction that is from high
temperature to low temperature.

Principles

A heating element generates a significant amount of radiant energy in the far IR

wavelength region (longer than three microns to avoid damaging the infant’s retina
and cornea). The radiant output of the heating unit is also limited to prevent thermal
damage to the infant. The IR energy is readily absorbed by the infant’s skin;
increased blood flow in the skin then transfers heat to the rest of the body by blood
convection (heat exchange between the blood and tissue surfaces) and tissue
conduction (heat transfer between adjacent tissue surfaces).

Function

The heat output of radiant warmers is usually regulated by servo-control to keep the
skin temperature constant at a site on the abdomen where a thermistor probe is
attached. Compared with incubators, the partition of body heat loss is quite different
under radiant warmers. Radiant warmers increase convective and evaporative heat
loss and insensible water loss but eliminate radiant heat loss or change it to net gain.
The major advantage of the radiant warmer is the easy access it provides to
critically-ill infants without disturbing the thermal environment.

Its major disadvantage is the increase in insensible water loss produced by the
radiant warmer. ‘Insensible' water loss (‘insensible’ because we are not aware of it)
refers to water loss due to:

• water that passes through the skin and is lost by evaporation,

• water loss through breathing out

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Modes

• Servo Mode
• Manual Mode

Servo Mode

• Set temperature at 36.5oC, heater output will adjust automatically to keep

baby at set temperature. If baby temperature is below the set temperature, the
heater output will increase, if baby is at set temperature or higher the heater
output will become zero.
• Look for probe displacement when the baby is in servo mode. Check for and
ensure proper probe placement every hour.

Manual Mode

• Once connected to mains heater output regulated by knob on front panel. The
output is displayed as % or bars or bulbs.
• Use maximum (100% output) for rapid warming of bassinet in labor room 10
minutes before delivery. Reduce output to 25-75% after 10 minutes depending
on ambient temperature. If left on with heater output >80% alarm is activated
within 15 or 20 minutes later and there after the heater output goes to 40%; if
alarm is silenced the heater will kept on for another 15 to 20 minutes as per
manufacturers recommendation.
• For low birth weight or sick neonate adjust heater output depending on baby
temperature.

• Never use full (100%) heater output unsupervised.

• Record baby temperature every 2-4 hourly.

• Use this mode only for pre-warming, during resuscitation and initial
stabilization.

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Phototherapy unit
Devices used to treat hyperbilirubinemia, characterized by high bilirubin
concentrations in the blood. Bilirubin, a product of hemoglobin breakdown, remains
in the body until the liver can convert it to a form that can be excreted. Jaundice, a
yellowish discoloration of the skin, eyes, and mucous membranes, results when
bilirubin levels in the blood are too high. High bilirubin levels can be caused by the
inability of an immature liver to process high levels of bilirubin, particularly in
neonates.

Phototherapy units consist of a light source and a means of allowing the light to
radiate the infant. Devices using overhead lamps can be freestanding on casters,
ceiling or wall mounted, or attached to infant radiant warmers or infant incubators;
some units have height and hood angle adjustments. Bassinet style units, in which
the infant is placed in a
plastic bassinet containing a
bank of lights in an
overhead case, are also
available. Fiberoptic
phototherapy pad systems
use a tungsten halogen bulb
in a metal case, a flexible
fiberoptic cable, and a light-
emitting plastic pad.
Filtered blue light is
delivered from the source
through the fiberoptic cable
and emitted from the sides
and ends of the fibers inside
the pad, which is wrapped
around the infant

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Principles

Visible light, specifically the blue-light wavelengths of approximately 420 to 500

nanometers, photochemically reduces bilirubin to water-soluble products that can be
excreted. The peak absorption wavelength at which bilirubin breaks down is
approximately 458 nm. By exposing patients to light of this wavelength range,
hyperbilirubinemia can be treated. Irradiance level is controlled by light-intensity
switches for both overhead lamps and fiberoptic units and by the distance between
the light source and the patient. (Decreasing the distance between the patient and
the light source increases the irradiance level.) A radiometer with an appropriate
bandwidth is used to measure the irradiance that reaches the patient during
phototherapy

Phototherapy units fall into two general categories

I. Overhead phototherapy lamps

II. Fibre optic phototherapy pads system

Overhead phototherapy lamps

• It can use fluorescent tubes, tungsten halogen bulbs, light emitting diodes or
quartz bulbs as light sources
• Fluorescent tubes should emit wide spectrum white light, wide spectrum blue
light, or narrow spectrum blue light
• It has shields to filter any ultraviolet radiation
• Tungsten-halogen bulbs are filtered for maximum light output within the
blue spectrum
• It has internal filters and dichroic reflectors to reduce harmful radiant energy

Fibre optic phototherapy pads system

• It consists of a light source in a metal case, a flexible fiber optic cable, and a
light emitting plastic pad
• Filtered blue light is delivered from the source through the fiber optic cable
and emitted from the sides and ends of the fibers inside the pad

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Stethoscope
A stethoscope is used to hear the heart beat sounds, sound due to inhalation and
exhalation of air in the lungs and the respiratory pathways and also the stomach
movement. It is a very useful diagnostic tool to help localize problems and to
diagnose disease. Stethoscopes are also used along with the sphygmomanometer.
The first usable binaural stethoscope was invented in 1855. The modern electronic
stethoscopes are high precisioned instruments. These can be used to hear a patient's
heart and lung clearly even in high noisy environments and even through layers of
clothing. The electronic stethoscopes also make it possible to hear the foetal sounds
in mother's womb.

Uses

1. Stethoscope helps to find normal (lub-dub) versus abnormal heart sounds

(heart murmurs) and also to diagnose valve functions.
2. Stethoscopes can indicate fluid in lungs in case of pneumonia and pulmonary
edema. It can diagnose airway diseases like bronchitis and pleuritis.
3. Stethoscopes are also used to compare the movements in the normal versus
overactive or underactive intestinal tracts

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Syringe pump
A syringe pump is a motor-driven precision pump that uses one or more syringes to
deliver precise and accurate amounts of fluid in high-impact research environments.

Types

There are two broad types of pumps: Laboratory syringe pump and medical infusion
pump.

o Laboratory Syringe Pump: They are devices used in research laboratories

for applications that require very accurate fluid deliveries. Lab research
pumps typically handle smaller volumes and offer additional features that
medical pumps do not have. Such as infuse and withdraw syringe pump,
multi syringes syringe pump. OEM module syringe pump and high-pressure
syringe pump. The OEM module syringe pump and high-pressure syringe
pump have been found useful in industrial applications recently.

o Medical Infusion Pump: They are devices used to deliver controlled quantities
of fluids such as nutrients, drugs, and blood to patients. This type of infusion
pump can be used for in vivo diagnosis, treatment, and research.

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Neuronavigation system
Neuronavigation is the set of computer-assisted technologies used by neurosurgeons
to guide or "navigate” within the confines of the skull or vertebral column during
surgery, and used by psychiatrists to accurately target rTMS (Transcranial Magnetic
Stimulation).

BASIC PRINCIPLE

o Image-guided neuronavigation utilizes the principle of stereotaxis

o The brain is considered as a geometric volume which can be divided by three

imaginary intersecting spatial planes, orthogonal to each other (horizontal,
frontal and sagittal) based on the Cartesian coordinate system

o Any point within the brain can be specified by measuring its distance along
these three intersecting planes

o Neuronavigation provides a precise surgical guidance by referencing this

coordinate system of the brain with a parallel coordinate system of the three-
dimensional image data of the patient that is displayed on the console of the
computer-workstation so that the medical images become point-to-point
maps of the corresponding actual locations within the brain

o The integration of functional imaging modalities, in particular, the

magnetoencephalography (MEG), functional magnetic resonance imaging
(fMRI) and positron emission tomography (PET) with neuronavigation has
permitted surgery in the vicinity of eloquent brain areas with minimum
morbidity

o The spatial accuracy of the modern neuronavigation system is further

enhanced by the use of intraoperative MRI that provides real-time images to
document the residual lesion and to assess for brain shift during surgery

o MRI guided neuronavigation was effective for accurately placing the

craniotomy, locating intra-axial lesions, defining the margin of resection
involved, and avoiding critical structures

o It has become the standard of care for resection of many intra-axial tumours

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Ultrasound machine

An ultrasound machine makes images so that organs inside the body can be

examined. The machine sends out high-frequency sound waves, which reflect off

body structures. A computer receives the waves and uses them to create a picture

BASIC PRINCIPLES

o Ultrasound refers to sound waves emitted at frequencies above the range of

human hearing

o For diagnostic imaging, frequencies ranging from 2 to 15 MHz are typically

used

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o Ultrasound waves are mechanical (acoustic) vibrations that require a medium

for transmission; because they exhibit the normal wave properties of

refection, refraction, and diffraction, they can be predictably aimed, focused,

and reflected

o To perform ultrasound imaging, a probe is either placed on the skin or

inserted into a body cavity

o Ultrasonic probes contain one or more elements made of piezoelectric

materials

o When the ultrasonic energy emitted from the probe is reflected from the

tissue, the transducer receives some of these reflections and reconverts them

into electrical signals

o These signals are processed and converted into an image

o Lower sound frequencies provide decreased resolution but greater tissue

penetration, while higher frequencies improve resolution when deep

penetration is not necessary

Types of transducer

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MODES

Various modes are available for displaying the returning echoes

o A MODE

o B MODE

o M MODE

a. A-mode: A-mode is the simplest type of ultrasound. A single

transducer scans a line through the body with the echoes plotted on

screen as a function of depth. Therapeutic ultrasound aimed at a

specific tumour or calculus is also A-mode, to allow for pinpoint

accurate focus of the destructive wave energy.

b. B-mode: In B-mode ultrasound, a linear array of transducers

simultaneously scans a plane through the body that can be viewed as a

two-dimensional image on screen.

c. M-mode: M stands for motion. In m-mode a rapid sequence of B-mode

scans whose images follow each other in sequence on screen enables

doctors to see and measure range of motion, as the organ boundaries

that produce reflections move relative to the probe.

BASIC COMPONENTS

• Pulser (Voltage generator, Transmitter, Output gain)

• Beam former (Master Synchronizer)

• Transducer

• Receiver (signal processor)

• Memory (image processor, Scan converter)

• Display (Cathode ray tube, CRT)

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Ventilator

Ventilators provide temporary ventilatory support or respiratory assistance to

patients who cannot breathe on their own or who require assistance to maintain

adequate ventilation because of illness, trauma, congenital defects, or drugs (e.g.,

anesthetics) Ventilators consist of a flexible breathing circuit, a control system,

monitors, and alarms. The gas is delivered using a double-limb breathing circuit.

The gas may be heated or humidified using appropriate devices. The exhalation limb

releases the gas to the ambient air. Intensive care ventilators are usually connected to

a wall gas supply. Most ventilators are microprocessor controlled and regulate the

pressure, volume, and FiO2. Power is supplied from either an electrical wall outlet

or a battery.

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BASIC COMPONENTS

o Expiratory valve

o Patient circuit

o Flow sensor

o Blender

o Control circuits

o Humidifier

BASIC PRINCIPLES

❖ SPONTANEOUS BREATHING

Inspiration: -

o Contraction of the diaphragm and the intercostal muscles

o Negative pressure is generated in the lungs to the atmospheric pressure

o Expansion of the chest

o Increase in lung volume

o Air comes passive from the environment through the upper airways 

pressure compensation to the atmosphere

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SPONTANEOUS BREATHING

Inspiration

Expiration: -

o relaxation of the diaphragm and the inter-costal muscles

o Positive pressure is generated in the lungs to the atmospheric pressure

o Reduction of the chest

o Decrease in lung volume

o Air comes passive through the airways to the environment  pressure

compensation to the atmosphere

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Expiration

VOCABULARY OF VENTILATION

o FiO2 fraction of oxygen in the inspired air 0.21 – 1.0

o VT tidal volume, volume per breath 4 - 8 ml

o f breathing frequency 10 - 15 / min

o MV minute volume, calculated from the tidal volume and the frequency

MV = f * Vt

o I: E inspiration - expiration ratio 1: 1.5

o PEEP a positive pressure in the alveoli in comparison to the atmospheric

pressure - is increasing the end expiratory lung volume

o paO2 partial pressure of oxygen in the arterial blood 75 - 105 mmHg

o paCO2 partial pressure of carbon dioxide in the arterial blood 35 - 45

mmHg

o SaO2 oxygen saturation of the arterial blood 95 - 98 %

o AaDO2 difference between the partial pressure of oxygen in the alveoli and

the arterial blood

o AaDO2 = pAO2 - paO2

o at FiO2 = 0,2  10 - 20 mmHg

o at FiO2 = 1,0  25 - 65 mmHg

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o paO2/ FiO2 value with information about the transpulmonary oxygen

transport normal > 450

MANDATORY VENTILATION

o Inspiration started by the ventilator

o Gas delivered by the ventilator goes through the tube, through the airways

into the lung

o Lung will be stretched

o Thorax will be extended and the diaphragm will be pressed down  positive

pressure inside the thorax

Modes of ventilation

❖ Volume modes

Assist-Control Ventilation (ACV) Also known as continuous mandatory ventilation

(CMV). Each breath is either an assist or control breath, but they are all of the same

volume. The larger the volume, the more expiratory time required. If the I:E ratio is

less than 1:2, progressive hyperinflation may result. ACV is particularly undesirable

for patients who breathe rapidly – they may induce both hyperinflation and

respiratory alkalosis. Note that mechanical ventilation does not eliminate the work

of breathing, because the diaphragm may still be very active.

❖ Synchronized Intermittent-Mandatory Ventilation (SIMV)

Guarantees a certain number of breaths, but unlike ACV, patient breaths are

partially their own, reducing the risk of hyperinflation or alkalosis. Mandatory

breaths are synchronized to coincide with spontaneous respirations. Disadvantages

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of SIMV are increased work of breathing and a tendency to reduce cardiac output,

which may prolong ventilator dependency. The addition of pressure support on top

of spontaneous breaths can reduce some of the work of breathing. SIMV has been

shown to decrease cardiac output in patients with left-ventricular dysfunction

❖ ACV vs. SIMV

Personal preference prevails, except in the following scenarios: 1. Patients who

breathe rapidly on ACV should switch to SIMV 2. Patients who have respiratory

muscle weakness and/or left-ventricular dysfunction should be switched to ACV

Pressure Modes

❖ Pressure-Controlled Ventilation (PCV)

Less risk of barotrauma as compared to ACV and SIMV. Does not allow for patient-

initiated breaths. The inspiratory flow pattern decreases exponentially, reducing

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peak pressures and improving gas exchange [Chest 122: 2096, 2002]. The major

disadvantage is that there are no guarantees for volume, especially when lung

mechanics are changing. Thus, PCV has traditionally been preferred for patients

with neuromuscular disease but otherwise normal lungs

❖ Pressure Support Ventilation (PSV)

Allows the patient to determine inflation volume and respiratory frequency (but not

pressure, as this is pressure-controlled), thus can only be used to augment

spontaneous breathing. Pressure support can be used to overcome the resistance of

ventilator tubing in another cycle (5 – 10 cm H20 are generally used, especially

during weaning), or to augment spontaneous breathing. PSV can be delivered

through specialized face masks.

❖ Pressure Controlled Inverse Ratio Ventilation (PCIRV)

Pressure controlled ventilatory mode in which the majority of time is spent at the

higher (inspiratory) pressure. Early trials were promising, however the risks of auto

PEEP and hemodynamic deterioration due to the decreased expiratory time and

increased mean airway pressure generally outweight the small potential for

improved oxygenation

❖ Airway Pressure Release Ventilation (APRV)

Airway pressure release ventilation is similar to PCIRV – instead of being a variation

of PCV in which the I:E ratio is reversed, APRV is a variation of CPAP that releases

pressure temporarily on exhalation. This unique mode of ventilation results in

higher average airway pressures. Patients are able to spontaneously ventilate at both

low and high pressures, although typically most (or all) ventilation occurs at the

high pressure. In the absence of attempted breaths, APRV and PCIRV are identical.

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As in PCIRV, hemodynamic compromise is a concern in APRV. Additionally, APRV

typically requires increased sedation

Block diagram

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About Author
My name is Akhil S, born in Kollam.

Kerala. Now I am working in Sur

Hospital Oman as Biomedical Technician

and I have gained 5 years of experience in

biomedical engineering from Kerala.

Previously I worked in Sree Gokulam

medical college. Trivandrum, Aster DM

WIMS Wayanad and KIMS Health Trivandrum. I am interested in R&D

and also interested to gain knowledge in Biomedical engineering field. I

always ready to acquire new skills and new experiences.

Thanking you

Akhil S

Mail ID: engr.akhil@hotmail.com

Mob: +91-9747144464

Linked in: www.linkedin.com/in/engrakhil

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BIOMEDICAL ENGINEERING

Short Learning Topics

Biomedical Equipment

Author
Akhil. S

December 2021

FORCE BIOMEDICAL
1
SHORT LEARNING ARTICLES

Table of Contents

SL.NO Equipment Page No

1. Apnea monitor 03-04

2. Transcutaneous Bilirubinometer 05-06
3. Phacoemulsification machine 07
4. ECMO 08-10
5. Gamma camera 11-13
6. Digital radiography 14-19
7. PET (Positron Emission Tomography) 20-22
8. Alternating pressure pads 23
9. Heart Lung Machine 24-26
10. Autotransfusion unit 27-29
11. Humidifiers 30-32
12. CUSA 33-37
13. LINAC 38-43
14. Steam Sterilizer 44-47
15. Pulmonary Function Analyser 48
16. Cath LAB 49-52
17. Ophthalmoscope 53-55
18. Centrifuge 56-57
19. Lithotripters 58-61
20. Cryosurgical unit 62-64
21. About Author 65

FORCE BIOMEDICAL
2
SHORT LEARNING ARTICLES

01: Apnea monitor

Apnea monitors detect the cessation of breathing (apnea) in infants and adults who
are at risk of respiratory failure and alert the parent or attendant to the condition.
Some prolonged respiratory pauses result in low oxygen concentration levels in the
body, which can lead to irreversible brain damage and, if prolonged, death. The
components of apnoea monitors depend specifically on the type. However, in general
they are composed of a set of sensors which obtain the information of different
physiological parameters. This information is passed to a micro-computer system,
which analyses the sensors’ information and determines if apnea is occurring

Principles

Monitors that use impedance pneumography detect small changes in electrical

impedance as air enters and leaves the lungs and as the blood volume changes in the
thoracic cavity. Mattress-type motion sensors typically monitor changes in the
capacitance or resistance of a mattress transducer. Pneumatic abdominal sensors also
detect breaths as changes in pressure. More direct methods of respiration detection
monitor the airfl ow into and out of the lungs; these include thermistors, proximal
airway pressure sensors, and carbon dioxide (CO2) sensors. The apnoea monitor is
attached to the patient using appropriate sensor for the measurement. Once
connected, as the patient breathes, the unit monitors different body parameters. If an
alarm sounds, the operator must attend the patient immediately.

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02: Transcutaneous Bilirubinometer

Neonatal jaundice occurs in nearly 70% of term and 80% of preterm babies.
Management of jaundiced neonates often requires
measurement of total serum bilirubin (TSB). Total serum
bilirubin (TSB) is commonly determined by Spectro-
photometric methods by analysing plasma or serum sample.
Such techniques require drawing of blood causing pain and
trauma to the neonate. In addition, there is a wide range of
intra- and inter-laboratory variability in the performance of the
bilirubin analysers. These problems have led to search for a non-invasive, reliable
technique for estimation of TSB.

Principle

Bilirubin concentrations are determined either by whole blood or serum analysis

using spectrophotometric methods or by skin-reflectance measurements. The three
methods of spectrophotometric analysis are the direct spectrophotometric method,
the Malloy-Evelyn method, and the Jendrassik-Grof method.

Categories
(i) Multi wavelength Spectral Reflectance meters
(ii) Two-wavelength (460 nm, 540 nm) Spectral Reflectance meters

(i) Multi wavelength Spectral Reflectance meters

The major components which impart the spectral reflectance in neonates are:
melanin, dermal maturity, haemoglobin and bilirubin. Most bilirubinometers analyse
only a few wavelengths; as a result, the dermal maturity and melanin content would
interfere with the result. With these meters, separate analyses for each patient

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population were required. To overcome this problem, multi- reflectance spectral

bilirubin meter has been designed. This instrument performs spectral analysis at
more than 100 different wavelengths and by subtraction of spectral combination of
the known components, bilirubin absorbance is quantified. This technique eliminates
need for different charts for different populations.

(ii) Two-wavelength Spectral Reflectance meters

Blood samples are required for spectrophotometric analysis. The analysis technique
depends on both the type or types of bilirubin being measured and the age of the
patient (neonate versus child or adult). A light-emitting sensor is placed on the
infant’s skin (optimally on the forehead or sternum). The reflected light is split into
two beams by a dichroic mirror, and wavelengths of 455 nm and 575 nm are
measured by optical detectors.

*****

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03: Phacoemulsification machine

Phacoemulsification is a technique which employs the ultrasound energy and fluid
dynamics to facilitate the removal of nucleus and cortex of the lens in the cataract
surgery.
Basic components

o Hollow probe
o Irrigation sleeve
o Foot pedal
o Remote
Principle

o A very small " No Stitch " incision is made in the side of the cornea. Such an
incision promotes fast and more comfortable recovery.
o The bag of the lens is opened and the ultrasonic probe (phacoemulsifier)
removes the cloudy lens.
o A small artificial lens is inserted through the small incision to replace the
cataract lens (IOL)
o In case of opacification of the capsule (secondary cataract) , YAG laser can be
used for treatment
Technique
There are two types.
o Coaxial: a single probe is used for irrigation, aspiration and emulsification
o Bimanual: probes are smaller and can make smaller incisions .

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04: ECMO

Extracorporeal membrane oxygenation (ECMO) is a life support machine. People

who need ECMO have a severe and life-threatening illness that stops their heart or
lungs from working properly. The ECMO machine replaces the function of the heart
and lungs. People who need support from an ECMO machine are cared for in a
hospital’s intensive care unit (ICU). Typically, people are supported by an ECMO
machine for only a few hours to days, but may require it for a few weeks, depending
on how their condition progresses. There are many overlaps and differences between
the use of ECMO in children and adults.
Basic components
o Membrane oxygenator
o Heat exchanger
o Venous reservoir
o O2 blender
o Pump

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Basic principles

➢ VENO-Arterial (VA)
o Venous cannula is usually placed in the right common femoral vein for
extraction and an arterial cannula is usually placed into the right
femoral artery for infusion
o The tip of the femoral venous cannula should be maintained near the
junction of the inferior vena cava and right atrium, while the tip of the
femoral arterial cannula is maintained in the iliac artery

➢ VENO-VENOUS (VV)
o In Veno-venous ECMO – venous cannulae are usually placed in the
right common femoral vein for drainage and right internal jugular vein
for infusion
o Alternatively, a dual lumen catheter is inserted into the right internal
jugular vein, draining blood from the superior and inferior vena cavae
and returning it to the right atrium
o Patient is anticoagulated with intravenous heparin and then the
cannulae are inserted
o ECMO support is initiated once the cannulae are connected to the
appropriate limbs of the ECMO circuit
o Cannula are usually placed percutaneously by the Seldinger technique,
the largest cannulas that can be placed in the vessels are used in order
to maximise flow and minimise pressures bernoulli equation
o ECMO required for complications of cardiac surgery can be placed
directly into the appropriate chambers of the heart or great vessels

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o Following cannulation, the patient is connected to the ECMO circuit

and the blood flow is increased until respiratory and hemodynamic
status is stable

➢ Risks of being on ECMO

o Bleeding
o Kidney Failure
o Infection
o Leg Damage
o Stroke

*****

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05: Gamma camera

It also called a scintillation camera or Anger camera and it is used to image gamma
radiation emitting radioisotopes, a technique known as scintigraphy. The
applications of scintigraphy include early drug development and nuclear medical
imaging to view and analyse images of the human body or the distribution of
medically injected, inhaled, or ingested radionuclides emitting gamma rays

Basic components

Construction
A gamma camera consists of one or more flat crystal planes (or detectors) optically
coupled to an array of photomultiplier tubes, the assembly is known as a "head",
mounted on a gantry. The gantry is connected to a computer system that both
controls the operation of the camera as well as acquisition and storage of acquired
images. The construction of a gamma camera is sometimes known as a
compartmental radiation construction. The system accumulates events, or counts, of
gamma photons that are absorbed by the crystal in the camera. Usually, a large flat
crystal of sodium iodide with thallium doping in a light-sealed housing is used. The

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crystal scintillates in response to incident gamma radiation. When a gamma photon

leaves the patient, it knocks an electron loose from an iodine atom in the crystal, and
a faint flash of light is produced when the dislocated electron again finds a minimal
energy state. The initial phenomenon of the excited electron is similar to the
photoelectric effect and the Compton effect and after the flash of light is produced, it
is detected
Image construction

o Photomultiplier tubes (PMTs) behind the crystal detect the fluorescent flashes
and a computer sums the counts

o The computer reconstructs and displays a two-dimensional image of the

relative spatial count density on a monitor

o This reconstructed image reflects the distribution and relative concentration of

radioactive tracer elements present in the organs and tissues imaged
Signal processing
o Gamma camera uses sets of vacuum tube photomultipliers (PMT)

o Generally, each tube has an exposed face of about 7.6 cm in diameter and the
tubes are arranged in hexagon configurations, behind the absorbing crystal

o The electronic circuit connecting the photodetectors is wired so as to reflect the

relative coincidence of light fluorescence as sensed by the members of the
hexagon detector array

o All the PMTs simultaneously detect the (presumed) same flash of light to
varying degrees, depending on their position from the actual individual event

o Thus, the spatial location of each single flash of fluorescence is reflected as a

pattern of voltages within the interconnecting circuit array.

o The location of the interaction between the gamma ray and the crystal can be
determined by processing the voltage signals from the photomultipliers; in

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simple terms, the location can be found by weighting the position of each
photomultiplier tube by the strength of its signal, and then calculating a mean
position from the weighted positions

o The total sum of the voltages from each photomultiplier is proportional to the
energy of the gamma ray interaction, thus allowing discrimination between
different isotopes or between scattered and direct photons
Spatial resolution
o In order to obtain spatial information about the gamma-ray emissions from an
imaging subject, a method of correlating the detected photons with their point
of origin is required
o The conventional method is to place a collimator over the detection
crystal/PMT array
o The collimator consists of a thick sheet of lead, typically 1-3 inches thick, with
thousands of adjacent holes through it
o The collimator attenuates most of incident photons and thus greatly limits the
sensitivity of the camera system

Imaging techniques

o Scintigraphy is the use of gamma cameras to capture emitted radiation from

internal radioisotopes to create two-dimensional images
o SPECT (single photon emission computed tomography) imaging, as used in
nuclear cardiac stress testing, is performed using gamma cameras
o Multi-headed gamma cameras can also be used for PET(Positron emission
tomography scanning)

*****

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06: Digital radiography

Digital radiography (DR) is an advanced form of x-ray inspection which produces a

digital radiographic image instantly on a computer. This technique uses x-ray
sensitive plates to capture data during object examination, which is immediately
transferred to a computer without the use of an intermediate cassette.

Advantages
o Similar to digital photography
o It does not require dark room procedure and cassette reading
o It reduces X-ray printing time
o X-ray directly converted into electronic signal, convert into digital values and
into images

Basic components
o A digital image receptor
o A digital image processing unit

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o An image management system

o Image and data storage devices
o Interface to a patient information system
o Communications network
o A display device with viewer operated controls

➢ Digital Receptor
The digital receptor is the device that intercepts the x-ray beam after it has passed
through the patient’s body and produces an image in digital form, that is, a matrix of
pixels, each with a numerical value.
This replaces the cassette containing intensifying screens and film that is used in non-
digital, film-screen radiography.

➢ Image Management System

Image management is a function performed by the computer system associated with

the digital radiography process.
These functions consist of controlling the movement of the images among the other
components and associating other data and information with the images.

➢ Patient Information System

The Patient Information System, perhaps known as the Radiology Information

System (RIS), is an adjunct to the basic digital radiography system. Through the
interface, information such as patient ID, scheduling, actual procedures performed,
etc is transferred.

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➢ Imaging Processing

One of the major advantages of digital radiography is the ability to process the
images after they are recorded. Various forms of digital processing can be used to
change the characteristics of the digital images. For digital radiographs the ability to
change and optimize the contrast is of great value.
It is also possible to use digital processing to enhance visibility of detail in some
radiographs. The various processing methods are explored in much more detail in
another module.

➢ Digital Image Storage

Digital radiographs, and other digital medical images, are stored as digital data.

➢ Communications Network
Another advantage of digital images is the ability to transfer them from one location
to another very rapidly.
This can be:
Within the imaging facility to the storage and display devices and To other locations
(Teleradiology) Anywhere in the world (by means of the internet)
➢ Digital Image Display and Display Control

Compared to radiographs recorded and displayed on film, i.e. "softcopy", there are
advantages of "softcopy" displays.
Basic components of Radiography
o X-ray tube
o X-ray detector
o Collimator
o HV generator
o Filters
o Console computer

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➢ X-ray tube
o Includes cathode, anode and casing
o Cathode filament is supplied with 20-150 KV
o X-ray produced by mainly two method electron ejection and electron
deceleration
o Electron ejection (Characteristic X-ray radiation): Fast moving electron
hit electrons in innermost shell, hence electron vacancy is created, to
occupy this vacancy by electron from another shell by emitting X-ray
radiation
o Electron deceleration (Bremsstrahlung radiation): When fast moving
electrons coming to anode, anode atoms look’s as Positive nucleus and
negative electrons thus it moves any of region emitting X-ray radiation
o Heating curve: time taken to achieve particular MA and KV
o Cooling curve: time taken to cool X-ray tube
o Energy at x-ray tube= Kv*MA*Exposure time
o No of electrons in X-ray depends current, voltage which improves the
intensity of x-ray beam
➢ H V generator
o Used for giving supply to the X-ray tube
o Voltages ranges
o This is mainly including single phase or three phases
o Supply specification mainly represented by Peak kilo voltage (Kvp)
o H V: Transformer Step up the input voltage
o Rectifier: It convert High voltage Ac supply into Dc supply
o Chopper: Increases the frequencies up to 200KHZ

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o High frequency supply improves the maximum (Kvp) for exposure, it

gives better image intensity and improves the Tube life time
➢ Image receptor
o It absorbs attenuated X-ray radiation into image form
o It includes image receptor permanent cassette
o It including Matrix array of Semiconductor (Thin film transistor)
devices normally in off position
o During Expose it Changed to ON position
o Signal from each semiconductor amplified by Pre –amplifier
o Amplified signals given to ADC converter which convert analog signal
into digital signal then given to digital processor

❖ Mainly it includes two types

o Direct receptor: Made up of amorphous selenium (A-Sc)

It directly converts Input x-ray into electric signals ,Then Analog to
Digital converter ,this digital signal is processed by the digital
processor

o Indirect receptor: Made up of Gd2o2S/CSI:Ti

It converts input x-ray into light signals then it given to photo
detector, it converts light into electric signal. Then analog to digital
convertor converts the electric signal into digital signal and is
processed by digital processor

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➢ COLLIMATOR & GRIDS

o Present Between X-ray tube and patient
o Collimator light is exposed to patient before x-ray exposure
o It provides proper positioning of X-ray tube
o Grids are lead strips inserted between patient and film cassette
o It is used to reduce the contrast due to scattered radiation

Basic principle

❖ BEER-LAMBERT LAW
When a monochromatic light source pass through a medium,
attenuation of light is directly proportional to concentration of
substance present in the solution

PRINCIPLE OF OPERATION
When an x-ray radiation from an x-ray tube passed through the body,
then it falls to the x-ray detector. Detector converts x-ray into electrical
signal and then it is digitized by A-D Convertor

*****

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07: PET (Positron Emission

Tomography)

In Nuclear medicine, functional imaging technique that produces a three-

dimensional image of functional processes in the body. The system detects pairs of
gamma rays emitted indirectly by a positron-emitting radionuclide, which is
introduced into the body on a biologically
active molecule. Three-dimensional images
of tracer concentration within the body are
then constructed by computer analysis

In modern PET-CT scanners, three-

dimensional imaging is often accomplished
with the aid of a CT X-ray scan performed
on the patient during the same session, in
the same machine.

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Basic principle

o To conduct the scan, a short-lived radioactive tracer isotope is injected into the
living subject

o The tracer is chemically incorporated into a biologically

active molecule.

o There is a waiting period while the active molecule

becomes concentrated in tissues of interest; then the
subject is placed in the imaging scanner.

o The molecule most commonly used for this purpose is fluorodeoxyglucose

(FDG), a sugar, for which the waiting period is typically an hour

o During the scan a record of tissue concentration is made as the tracer decays

o As the radioisotope undergoes positron emission decay, it emits a positron, an

antiparticle of the electron with opposite charge

o The emitted positron travels in tissue for a short distance, during which time it
loses kinetic energy, until it decelerates to a point where it can interact with an
electron

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o The encounter annihilates both electron and positron, producing a pair of

annihilation photons moving in approximately opposite directions

o These are detected when they reach a scintillator in the scanning device,
creating a burst of light which is detected by photomultiplier tubes or silicon
avalanche photodiodes (Si APD)
o The technique depends on simultaneous or coincident detection of the pair of
photons moving in approximately opposite directions
o Photons that do not arrive in temporal "pairs" (i.e. within a timing-window of
a few nanoseconds) are ignored
RADIONUCLIDES & RADIOTRACERS

o Radionuclides used in PET scanning are typically isotopes with short half-
lives such as carbon-11 (~20 min), nitrogen-13 (~10 min), oxygen-15 (~2 min),
fluorine-18 (~110 min)., or rubidium-82(~1.27 min)

o These radionuclides are incorporated either into compounds normally used by

the body such as glucose (or glucose analogues), water or ammonia, or into
molecules that bind to receptors or other sites of drug action

o Such labelled compounds are known as radiotracers

o Due to the short half-lives of most positron-emitting radioisotopes, the

radiotracers have traditionally been produced using a cyclotron in close
proximity to the PET imaging facility

o The half-life of fluorine-18 is long enough that radiotracers labeled with

fluorine-18 can be manufactured commercially at offsite locations and shipped
to imaging centers

o Recently rubidium-82 generators have become commercially available. These

contain strontium-82, which decays by electron capture to produce positron-
emitting rubidium-82

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08: Alternating pressure pads

Alternate’s inflation and deflation of cells to constantly change pressure points and
promote circulation. A single cell slowly deflates, re-inflates, and then the adjacent
cell does the same, slowly, up and down the mattress. The head area of the mattress
does not alternate so the patient remains undisturbed during sleep. In fact, the
patient doesn't really feel the cells alternating at all since the process is slow. The
speed at which the alternating process cycles from one end of the mattress to the
other end is called cycle time and it can be adjusted or set on most mattress systems.
Usually, 10-minute cycle time is sufficient.

Basic features

o Bubble pads provides superior therapeutic treatment

o Mounted easily to bed
o Provides consistent air flow adjustable pressure

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09: Heart Lung Machine

Heart-lung machine (HLM), also called oxygenator pump or cardiopulmonary

bypass (CPB) pump, aims to provide extracorporeal circulation (ECC) with
maintenance of oxygenated blood flow to the body organs when the device is
connected to the arteriovenous system. The HLM is an essential component of open-
heart surgery to bypass the circulatory system of the heart and lungs, termed CPB.
The main principle is to draw the blood from the major veins (venae cavae) to an
oxygenator in the HLM where it is re-oxygenated, and then pumped into the arterial
system (ascending aorta).

Basic components

o Arterial pump
o Backup arterial pump
o One or two suction pumps
o Cardioplegia pump

Disposable components include

• oxygenator/heat exchanger
• a cardiotomy reservoir
• blood filters
• tubing

Basic principles

o During heart-lung bypass, blood that would normally return to the heart
through the venae cavae is diverted by means of plastic cannulae through a
presterilized disposable tubing set to an arterial pump

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o The blood flows to the oxygenator/heat exchanger for oxygenation, carbon

dioxide removal, temperature regulation, and any necessary anesthetic
exchanges

o Blood that pools in the surgical site is suctioned and collected in a cardiotomy
reservoir, where it is filtered, defoamed, and either pumped or drained to the
oxygenator

o The oxygenated blood is then returned to the patient, typically through the
aorta, bypassing the heart and lungs

Extracorporeal perfusion pump

o Roller pumps: -
• Used as suction, vent
• Provide pulsatile flow
o Centrifugal pump: -
• Used for returning arterial blood to the patient
• Uses centrifugal force to move blood through the
system

Oxygenation
o The type of oxygenator used is the membrane oxygenator.
o Have an integral heat exchanger to control the temperature of the blood,
although heat exchangers are also available as separate disposable units
o Must be primed before use, usually with a priming solution such as lactated
Ringer’s solution with 5% dextrose, to displace air pockets and bubbles from
the bypass circuit

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o Consist of a gas-permeable membrane separating a thin layer of blood from

the oxygenating gas
o The gas diffuses across the membrane into the blood, which, because of its
indirect contact with the oxygen, is less likely to transport bubbles into the
patient’s circulatory system
Three major types of membrane oxygenators are
1. Plate
2. Coil
3. hollow fiber

o Plate membrane oxygenators use flat, multi-layered membrane sheets made of

microporous polypropylene and folded like an accordion
o Gas and blood flow on opposite sides of the membrane, typically in a counter
current direction

Perfusion monitoring & peripheral equipment

• Several devices control and monitor various aspects of perfusion

• To maintain the desired temperature in the heat exchanger, a water mixer
regulates delivery of warming and cooling water
• The mixer is typically part of the pump console and includes a thermometer
and a backup pressure-relief valve.
• A separate electric water heater/cooler can be used instead of a mixer.
• Thermistor probes are placed at various points on the patient and in the
extracorporeal circuit, and temperatures are displayed on
dedicated or operating room (OR) monitoring systems
• Blood gases can be monitored from drawn samples, by an
in-line differential oxygen monitor, or by an oxygen-
saturation meter

*****

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10: Autotransfusion unit

Autotransfusion units are designed to collect and process blood lost by a patient to
extract red blood cells (RBCs) for subsequent transfusion into the same patient. They
are particularly intended for use in surgeries that involve substantial volume blood
loss.

Basic components
o Collection reservoir
o Roller pump
o Centrifuge bowl
o Air detector
o Microfilter

Basic principles
o Use of auto transfusion devices requires aspiration of extravascular blood
from the surgical site into the collection reservoir of the unit, where it
undergoes gross filtration

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o To keep the blood from clotting while in the unit, an anticoagulant (heparin) is
added to the aspiration line at a rate proportional to the rate of blood
collection
o From the reservoir, the unit’s roller pump sends the blood into a centrifuge
bowl
o Once the bowl is full, the pump shuts off and the RBCs are spun and washed
with normal saline to remove anticoagulant
o The saline wash is monitored by an air detector
o When a saline bag is depleted during the wash cycle, residual air in the saline
bag is detected by the air detector, triggering an alarm to alert the operator to
replace the bag
o During the wash cycle, the saline flows into a waste bag, leaving the packed
RBCs in the centrifuge bowl
o The RBCs are then pumped into a holding bag for reinfusion and delivered to
the patient through a microfilter
o Operate in an automatic or a manual mode
o The automatic mode is most often used for routine procedures; the operator
simply selects a programmed cycle choice with preset wash volumes and
pumping rates and initiates the cycle
o The system detects when the bowl is full, automatically triggering the
separation and wash cycle
o High-speed processing units can process one unit of packed red cells (250 ±50
mL) in about three minutes; faster cycle times typically yield less efficient
washes
o A manual mode allows operators to control the start of each processing stage
and the saline volume in wash cycles for maximum flexibility in exceptional
cases
o Faster cycle times can be achieved in this mode because wash cycles can be
eliminated if rapid reinfusion is necessary; however, the operator should try
increasing pump speeds before choosing to eliminate wash cycles to avoid
giving patients potentially contaminated blood

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11: Humidifiers

Capable of providing adequate levels of humidification & it has low resistance to

flow and low dead space. It Provides microbiological protection to the patient &
Maintenance of body temperature

Basic principle
o Inhaling dry gases can cause damage to the cells lining the respiratory tract,
impairing ciliary function
o Within a short period of just 10 mint of ventilation with dry gases, cilia
function will be disrupted
o This increases the patient’s susceptibility to respiratory tract infection
o A decrease in body temperature occurs at the respiratory tract humidifies the
dry gases
o Air fully saturated with water vapour has an absolute humidity of about 44
mg/L at 37◦C
o During nasal breathing at rest, inspired gases become heated to 36◦C with a
relativve humidity of about 80-90% by the time they reach the carina, largely
because of heat transfer in the nose

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o Mouth breathing reduces this to 60-70% relative humidity

o The humidifying property of soda lime can achieve an absolute humidity of
29 mg/L when used with the circle breathing system
o The isothermic boundary point is where 37◦C and 100% humidity have been
achieved
o Normally it is a few centimeters distal to the carina
o Insertion of a tracheal or tracheostomy tube bypasses the upper airway and
moves the isothermal boundary distally

Basic components

o Two ports, designed to accept 15 and 22 mm size tubings and connections

o The head which contains a medium with hydrophobic properties in the form
of a mesh with a large surface area
o It can be made of ceramic fibre, corrugated aluminium or paper, cellulose,
metalized polyurethane foam or stainless steel fibres
o Warmed humidified exhaled gases pass through the humidifier, causing water
vapour to condense on the cooler HME medium
o The condensed water is evaporated and returned to the patient with the next
inspiration of dry and cold gases, humidifying them
o There is no addition of water over and above that previously exhaled
o The greater the temperature difference between each side of the HME, the
greater the potential for heat and moisture to be transferred during exhalation
and inspiration
o The HME humidifier requires about 5-20 mint before it reaches its optimal
ability to humidify dry gases
o The performance of the HME is affected by

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• Water vapor content and temperature of the inspired and exhaled gases
• Inspiratory and expiratory flow rates affecting the time the gas is in contact
with the HME medium hence the heat and moisture exchange
• The volume and efficiency of the HME medium- the larger the medium,
the greater the performance

*****

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12: CUSA

Ultrasonic cavitation device is a surgical device using low frequency ultrasound

energy to dissect or fragment tissues with low fibre content. It is basically an
ultrasound probe (acoustic vibrator) combined with an aspirator device.

Intended use
o Innovative tool for dissecting through the liver parenchyma, which can
potentially reduce intraoperative blood loss and perioperative morbidity
o Powerful ultrasonic aspirator and dissector with a wide application not only
in liver surgery but also in other surgical specialties as well
o Used in multiple surgical subspecialties, including neurosurgery,
gastrointestinal, hepatobiliary surgery, gynecology, and urology
o Ultrasonic surgical aspirator, where fragmentation, suction, and irrigation
occur simultaneously, allowing the surgeon to remove tissue with accurate
control
o In liver surgery, it is an invaluable tool, particularly in a situation where the
tumour is closely adjacent to a vital structure that needs to be saved

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o CUSA will enable dissection around any structure that needs to be preserved

Basic components
o Transducer: -
• A device that converts electromagnetic energy into mechanical
vibration
• The transducer is composed of a stack of nickel alloy plates
• A magnetic field is produced by a coil plced around the plates and
causes mechanical motion of approximately 300 microns
o Connecting body: -
• Mechanically conveys the motions of the transducer to the surgical tip
• It also amplifies the vibration motion of the transducer
o Surgical tip: -
• Completes the amplifications of the motion and also contacts the tissue.
• Hence tip is relatively long compared to its diameter and this provides
adequate motion amplification

Basic principle
o Cavitation
• Cavitation is defined as the process of formation of the vapour phase of
a liquid when it is subjected to reduced pressures at constant ambient
temperature
• Thus, it is the process of boiling in a liquid as a result of pressure
reduction rather than heat addition
• Cavitation occurs when, on the negative side of a pressure cycle, such
as when the probe-tip is retracting with sufficient amplitude and
frequency, suspended gas bubbles either within fluid, tissue or trapped
at solid interfaces expand and collapse resuling in the generation of
shockwaves

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o Aspiration

• Aspiration means to draw in or out using a sucking motion.This term

has two meanings depending on how it is used
▪ Aspiration can mean breathing in a foreign object
▪ Aspiration can also refer to a medical procedure that removes harmful
or misplaced substances from an area of the body
▪ Suction is basically aspiration of a gas or fluid by reducing air pressure
over its surface, usually by mechanical means or negative pressure
device

o Ultrasound
▪ Audible Range:-20Hz---------20,000Hz.
▪ Infrasonic waves:-Sound waves with frequencies
<20Hz
▪ Ultrasonic waves:-Sound waves with frequencies
>20,000Hz

• The cavitron ultrasonic Surgical aspirator (CUSA) device generates ultrasonic

waves in the range of 23kHz to produce tissue cavitation’s

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• This mechanical energy is delivered through a hollow 3mm tip that vibrates at
23,000 cycles per second

• The entire device is embedded with an irrigator and aspirator inorder to

dispose of the tissue debris

Piezoelectric transducer

o Used to produce and detect Ultrasonic Waves

o It is a quartz crystal which converts electrical oscillations into mechanical
vibrations(sound) and vice versa
Mechanics of CUSA
• The CUSA console provides alternating current (24 or 35 kHz) to the
handpiece
• In the handpiece, the current passes through a coil, which induces a
magnetic field
• The magnetic field in turn excites a transducer of nickel alloy
laminations, resulting in oscillating motion in the transducer laminated
structure-vibration-along its long axis
• The transducer transmits vibrations
through a metal connecting body to
an attached surgical tip
• When the vibrating tip contacts tissue,
it breaks cells apart(fragmentation)
• The CUSA system supports different
magneto strictive handpieces based
on frequencies, and each supports multiple tip designs
• The CUSA has a self-contained suction capability to remove
fragmented tissue and irrigation fluid

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• The Suction and Irrigation performs three function in CUSA operation:

• It draws tissue toward the vibrating tip, and creates a tip/tissue
coupling effect
• It keeps the surgical site clear of irrigation and fragmentation debris
• Irrigation fluid flows coaxillary around the outside of the vibrating tip
to keep the tip cool

*****

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13: LINAC

A medical linear accelerator (LINAC) is the device most commonly used for external
beam radiation treatments for patients with cancer. It delivers high-energy x-rays or
electrons to the region of the patient's tumour. These treatments can be designed in
such a way that they destroy the cancer cells while sparing the surrounding normal
tissue. The LINAC is used to treat all body sites, using conventional techniques,
Intensity-Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy
(VMAT), Image Guided Radiation Therapy (IGRT), Stereotactic Radiosurgery (SRS)
and Stereotactic Body Radio Therapy (SBRT).

Component

Equipment working
The linear accelerator uses microwave technology (similar to that used for radar) to
accelerate electrons in a part of the accelerator called the "wave guide," then allows
these electrons to collide with a heavy metal target to produce high-energy x-rays.

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These high energy x-rays are shaped as they exit the machine to conform to the shape
of the patient's tumor and the customized beam is directed to the patient's tumor.
The beam is usually shaped by a multileaf collimator that is incorporated into the
head of the machine. The patient lies on a moveable treatment couch and lasers are
used to make sure the patient is in the proper position. The treatment couch can
move in many directions including up, down, right, left, in and out. The beam comes
out of a part of the accelerator called a gantry, which can be rotated around the
patient. Radiation can be delivered to the tumor from many angles by rotating the
gantry and moving the treatment couch.

Six classes
• Injection system;
• RF power generation system;
• Accelerating waveguide;
• Auxiliary system;
• Beam transport system;
• Beam collimation and beam monitoring system.

Magnetron
Device that produces microwaves. It has a cylindrical construction, having a central
cathode and outer cathode. Space between cathode and anode is evacuated. Cathode
is heated by an inner filament and the electrons are generated by thermionic
emission.

o Static magnetic field is applied perpendicular to the plane of cross-section of

cavities and a pulsed dc electric field is applied between cathode and anode.

o Electrons emitted by cathode are accelerated towards anode by the action of

pulsed dc electric field and by the influence of magnetic field electrons move
in complex spirals towards resonant cavities, radiating energy in the form of
microwaves.

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Klysteron

It is a microwave amplifier &The electron produced by the cathode are accelerated by

a negative pulse of voltage into the first cavity called buncher cavity. The
microwaves set up an alternating electric field across the cavity & The velocity of the
electron is altered by the action of this electric field to a varying degree-velocity
modulation
Some electrons are speed up while others slow down and some are unaffected result
and this results in bunching of electrons . As the electron bunch reaches catcher

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cavity they induce charges on the ends of the cavity and there by generate a retarding
electric field.
The electrons suffer deceleration and by the principle of conservation of energy the
K.E of electrons is converted into high power microwaves.

Gantry
o Source of radiation can rotate 360 degree

o As the gantry rotates collimator axis moves in a vertical plane. The point of
intersection of collimator axis and the axis of rotation of the gantry is known
as iso center.

o The gantry consists of: Electron gun, Accelerator Structure, Treatment Head

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Linac treatment head

The important components found in a typical head of a fourth or fifth generation
linac include:
o X ray targets;
o Flattening filters and electron scattering foils (also called scattering filters);
o Primary and adjustable secondary collimators;
o Dual transmission ionization chambers;
o A field defining light
o wedges;
o Optional MLC.

Scattering foil &Flattening filter

o Electron beam exist the window, is a narrow pencil about 3mm in diameter.
o The narrow pencil beam is made to strike an electron scattering foil to spread
the beam and uniformity.
o Made of thin metallic foil, usually lead.
o Flattening filter to make the beam intensity uniform across the field
o Made of lead, aluminum, tungsten, uranium, steel.

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Beam collimation
In a typical modern medical linac, the photon beam collimation is achieved with two
or three collimator devices:
• A primary collimator
• Secondary movable beam defining collimators

Techniques used with Medical Linacs

With the current trend using linear accelerator a variety of treatment techniques are
possible. Some of the techniques as follow,
o 3D conformal radiotherapy
o Intensity Modulated Radiotherapy
o Stereotactic Radiotherapy (SRT)
o Stereotactic Radiosurgery (SRS)
o Dynamic Adoptive Radiotherapy (DART)
o Image guided Radiotherapy (IGRT)

*****

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14: Steam Sterilizer

Steam sterilization is achieved by exposing the items to be sterilized with saturated

steam under pressure. Steam enhances the ability of heat to kill microorganisms by
reducing the time and temperature required to denature or coagulate proteins in the
microorganisms.

Principle
A basic principle is Gay Loussac’s law i.e., when the pressure of a gas increases, the
temperature of the gas increase proportionally. i.e., about 15 pounds of pressure per
square inch (Psi), the temperature rises to 121oC. Increasing the pressure to 20 psi
raises the temperature to 134oC.

Working
o Steam flows through the sterilizer beginning the process of displacing the air.
o Exhaust valve will be closed, causing the interior temperature and pressure to
ramp up to the desired setpoint.
o Desired temperature is maintained until desired time is reached.
o The pressure is released from the chamber through an exhaust valve

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Parts
• Chamber and jacket
• Thermostatic traps
• Vacuum system
• Steam generator

Chamber and jacket

The chamber is the primary component of a steam sterilizer where the materials to be
sterilized is placed and sterilization happens & the jacket is filled with steam,
reducing the time that sterilization cycles take to complete and reducing
condensation within the chamber.

Thermostatic traps
A device designed to allow air and water (condensate) to escape from the chamber.
Steam traps are temperature sensitive valves that close when heated past a certain set
point.

Vacuum system
Forcibly remove air by pulling a vacuum on the chamber before a cycle (also known
as pre-vacuum), it also helps by pulling a vacuum after the cycle (also known as post-
vacuum) to remove the steam remaining in the chamber and dry off the goods inside
the autoclave.

Steam generator
Boilers are typically i.e., underneath the chamber to the steriliser and utilize electric
heating elements to heat water and generate steam.

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➢ 5 Phases of Sterilization

1. Phase conditioning
• Chamber closes with jacket
• Steam loaded
• Jacket pressure and chamber pressure displayed

2. Heating conditioning
• Steam generated

3. Sterilization phase
• 121 C at 10 psi in 20 min
• 134 C at 20 psi in 5 min

4. Dry phase
• Removal of water

5. Aeration/Vent
• Releasing high pressure
• Use vacuum

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*****

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15: Pulmonary function analyser

Pulmonary function analysers measure the performance of a patient’s respiratory

system, especially for outpatient or presurgical screening. These systems measure the
ventilation, diffusion, and distribution of gases in the lungs. They are used to help
assess patients with conditions like chronic obstructive pulmonary disorder (COPD).
Pulmonary function analysers are designed to assess the volume, airflow , and
derived parameters through the respiratory tract of adults and older children. These
devices typically include a spirometry instrument (e.g., pneumotachometer, bellows,
rolling-seal-type spirometer), a computer, a gas analyser, and an electronic unit with
computerized capabilities and appropriate software. In addition to diagnostic
spirometer measurements, they may measure parameters such as functional residual
capacity, diffusing capacity of the lungs for carbon monoxide, and airway resistance.
The analysers are intended to provide a baseline for ventilatory function as well as
identify respiratory impairments. Some systems include a total-body
plethysmograph for measuring lung volume and Raw.

Principles
Spirometry instruments measure the volume of gases exhaled by the patient (i.e.,
volume changes of the lungs) either by volume displacement or flow sensing
methods. Spirometers measure the volume directly; these devices include water-seal
bellows and rolling-seal spirometers, or the flow of gas that is integrated to yield
volume. Such flow sensing instruments can employ a pneumotachometer, a hot-wire
anemometer, or a turbinometer. Some analysers incorporate computers with software
that permits customized reports or the inclusion of specialized predictive equations
for normal function.

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16: Cath Lab

It is Used primarily to locate and identify irregularities within the heart and its
vasculature, the aorta, or the vena cava, as well as to define the size or severity of
lesions and Complete evaluation of a patient with known or suspected heart
disease. It also used in diagnosing disorders such as reduced left ventricular
function, valve incompetence, pulmonary vascular disease, and congenital
anomalies and used for pacemaker lead placement.
Basic components
• C-Arm
• Pressure injector
• Dye injector
• Hemodynamic monitor
• Review station
• Diagnostic catheter
• Guide catheter
• Guide wires
• Stent
• Angioplasty balloon

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Basic principle
➢ The basic cathlab recording system consists of a computer console and a chart
recorder, which typically reside in a control room
➢ A slave scope and patient interface modules reside in the cathlab
➢ All the systems are multichannel and display and record up to 32 traces of
information from the patient
➢ Linking the cathlab monitor/recorder with a computer allows most of the
hemodynamic parameters to be calculated automatically
➢ The parameters that are automatically derived typically include cardiac
output, pressure gradients, valve areas, shunt flows, vascular resistance,
diastolic filling period, systolic ejection period, work, and preejection period
➢ These values are stored chronologically, along with other important events
occurring during catheterization, and can be printed in report form at the
conclusion of the procedure
➢ It is possible to interface with the cathlab imaging system to provide x-ray
image visualization on the physiologic monito
➢ Before catheterization, a full 12-lead electrocardiogram (ECG) is usually
performed to obtain baseline values
➢ This preliminary study can also disclose unsuspected abnormalities. During
the procedure, continuous arterial pressure can be monitored directly
➢ For right-heart catheterization (RHC), the catheter is introduced into a vein in
the arm, the external jugular vein, or the femoral vein in the groin and then
manipulated into the right atrium of the heart under direct observation using
fluoroscopy
➢ The catheter is then passed through the right ventricle and lodged in the
pulmonary artery
➢ In left-heart catheterization, which is less common, the catheter is introduced
into an artery in the arm or into the femoral artery and maneuvered through
the aortic valve and into the left ventricle

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➢ Pressure measurements from the pulmonary artery, including pulmonary

artery wedge pressure, provide one reliable index of left-ventricular function
➢ Pressure-gradient recordings can be made by drawing the catheter back
through the heart chambers; gradients from one chamber to another indicate
the site of stenosis or obstruction
➢ Pressure measurements taken in the right atrium determine central venous
pressure
➢ Intracardiac pressure measurements are taken by one of two methods
• Fluid-filled catheter
• Blood pressure transducer

➢ The fluid-filled lumen of the catheter transfers pressure fluctuations from the
open distal end of the catheter inside the patient to a transducer at the
proximal end outside the patient, which converts the mechanical force of the
applied pressure into electrical signals that are proportional to that pressure
➢ These signals are then transmitted to a pressure amplifier in the recording
system
➢ Generally, a larger lumen allows for a better pressure reading

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➢ The second method uses a transducer in the catheter tip to measure pressure
fluctuations
➢ The status of the myocardium can be evaluated by measuring pulmonary and
systemic blood flows to determine cardiac output
➢ The most widely used method is the thermal dilution technique in which a
chilled or room-temperature saline solution is injected through the catheter
into the right atrium; its temperature is measured by a thermistor at the distal
end of the catheter, located in the pulmonary artery
➢ The temperature change correlates with the blood flow through the heart
➢ ECG/His amplifiers receive signals from electrode catheters placed inside the
various chambers of the heart and from electrodes on the chest
➢ Studies of the bundle of His provide an assessment of the heart’s electrical
conduction system

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17: Ophthalmoscope

It is used for performing ophthalmoscopy and used to see inside the fundus of an eye
and other structures using an ophthalmoscope. Usually used to check the retina and
vitreous humour.
Basic Principle
If patient and observer are both
emmetropic, the rays emitting from a
point in the patient’s fundus will emerge
as a parallel beam and will be focused
on the observer’s retina.
Basic components

Patient side User side

• Lens * Light

• Eye rest * Vertical dial

• Vertical dial * Horizontal dial

• Red button

• Power base

• Number settings

• Lens

• Eye rest

• Vertical dial

• Red button

• Power base

• Number settings

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Types
➢ Direct ophthalmoscope
➢ Indirect ophthalmoscope

Direct ophthalmoscope

• Image produced will be upright, or unreversed

• Approximately 15 times magnification

Indirect ophthalmoscope

• Image produced will be inversed, or reversed

• Approximately 2 to 5 times magnification

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Features

Direct ophthalmoscope Indirect ophthalmoscope

• Good magnification *Good for peripheral retina assessment

• Good macular assessment *Good for various retinal procedures
• Light and portable
• Easy to use
• Size compactable

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18: Centrifuge

A centrifuge is a laboratory device that is used for the separation of fluids, gas or
liquid, based on density. These are high- or low-speed centrifuges capable of
spinning a large volume of specimen.

Basic components
➢ Basic centrifuge components include
• electric motor
• Shaft
• rotor heads (often interchangeable) on which the
centrifuge head turns
• motor-drive assembly.
➢ The entire system is housed within a chamber
➢ The centrifuge head contains the cups or shields that cover the rotor and turns
on a spindle

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Basic Principle

➢ Centrifuges apply centrifugal force to separate suspended particles from a

liquid or to separate liquids of different densities
➢ These liquids include body fluids (e.g., blood, serum, urine), commercial
reagents, or combinations of the two with other additives
➢ In the blood bank, centrifugation is used in many procedures, including
enhancing immediate agglutination for blood-grouping tests, manual cell
washing, and anti-globulin testing
➢ In its simplest form, a centrifuge is a metal rotor with holes to accommodate
vessels of liquid, spun at selected speeds by a motor
➢ Low-speed centrifuges generally operate at up to 10,000 revolutions per
minute (rpm)
➢ High-speed centrifuges, which operate at 10,000 to 30,000 rpm, are used for
most preparative applications, and some are refrigerated to cool the rotor
chamber
➢ Some centrifuge microprocessors permit the user to program a set or sequence
of operating parameters that are frequently used in laboratory procedures,
such as acceleration rate, rotational speed, temperature, total time, and
braking rate

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19: Lithotripters

It is used to locate, view, fragment and remove urinary tract or renal calculi found in
the kidney, ureter and bladder and also disintegrate difficult-to-treat bile direct
stones and salivary stones.

Basic Principles
➢ Based on the principal of operation lithotripters can be classified into
• Electro hydraulic lithotripsy
• Laser lithotripsy
• Ultrasonic Impact lithotripsy
• Electromechanical and pneumatic lithotripsy
• Percutaneous lithotripsy
• Transurethral lithotripsy

Electro hydraulic lithotripsy

➢ Use plasma induced shock waves to fracture stones

➢ Using a nephroscope or ureteroscope, the stone is located and
the probe is placed against it
➢ A generator enables the probe to deliver energy in single pulse
or timed pulse bursts

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• With the stone in view, the operator fires these pulses at the stone while
the probe is irrigated with saline solution
• Firing the probe produces a plasma bubble causes a hydraulic shock
that fragments the stone, that can subsequently be removed using a
grasper or stone basket

Laser lithotripsy

➢ Lithotripsy lasers use either a crystalline solid or an organic dye

solution as their laser medium to produce coherent monochromatic
light energy
➢ It delivers energy through quartz fibers, which are placed in contact
with the stone through the working channel in the ureteroscope
➢ The aiming beam of the laser highlights the area for energy delivery
➢ When a pulsed dye is activated, the energy released produces a
differential thermal expansion that fragments the stone and easily
passes through urinary tract

Ultrasonic impact lithotripsy

➢ The probe is attached to an external generator and transducer

➢ The external generator stimulates the piezoelectric elements in the
transducer to produce high frequency mechanical vibrations that
propagates along the hollow tube to a movable impact tip
➢ When the oscillating tip touches the stone, the vibration causes the
stone to fragment
➢ A suction pump connected to the probe aspirates stone fragments
through the probe channel

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Electromechanical & pneumatic impact lithotripsy

➢ It can be reliable and cost-effective method for fragmenting calculi in

both the mid ureter and lower ureter as well as in kidney
➢ A rigid tip at the end of the probe is placed directly on the stone and
oscillates to fragment the stone
➢ The electromechanical impact lithotripter is driven electromagnetically
➢ The pneumatic impact lithotripter is driven by compressed air

Percutaneous lithotripsy

➢ In this, a needle is inserted into the patients flank and guided into the
renal pelvis with the help of fluoroscopic visualization, a guide wire is
inserted through the needle and the needle is removed

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➢ A second guide wire is introduced down the ureter in the same manner
to maintain access throughout the procedure in case the nephroscope
becomes dislodged
➢ Dilation of the tract can then be performed using a balloon catheter
➢ Following dilation, the nephroscopic sheath is inserted over the guide
wire and positioned near the calculus
➢ The nephroscope and lithotripter probe or laser fiber are placed inside
the sheath and activated to disintegrate the stone
➢ The resulting fragments are evacuated by suction through the probe

Transurethral lithotripsy
➢ Transurethral ureteroscopic lithotripsy approaches the calculus in an
ascending direction through the urinary tract
➢ A sheath and then a ureterorenoscope are passed into the ureter usually
following ureteral dilation where the lithotripsy probe fragments the
stone

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20: Cryosurgical unit

A cryosurgical unit is a device that employs extreme cold or freezing temperature in

surgery to treat diseased or abnormal tissue by involving surgical application of
cryoablation technique. It also called as cryoextractors, cryosurgical systems,
cryotherapy units. Cryosurgery is an accepted treatment modality within the fields of
dermatology, oral surgery, gynecology, urology, otolaryngology, proctology, and
ophthalmology. it is used to treat malignant and benign tumors, acne, warts,
hemorrhoids.

Basic components

➢ Cryosurgical units(CSUs) are available as consoles or as stand-alone or hand

held units
➢ Consoles are freestanding units that typically contain
• Cryogen gas cylinders
• Pressure regulators
• Indicators
• Operating controls
➢ Stand-alone unit consist of
• Tank
• Pressure regulator
• Probe

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Basic principles
➢ All CSUs employ either a closed or an open system
➢ In a closed-system CSU, the cryogen flows through an insulated shaft in the
hollow probe, cools the tip, and is exhausted back through the probe
➢ For e.g. in ophthalmic surgery, closed systems are used for cryonecrosis,
cryoadhesion, and cryoinflammation because they afford greater control over
both the rate of cooling and the area of freezing than do open systems
➢ Open-system CSUs apply cryogen directly to the target tissue; they are
generally limited to cryonecrosis and are rarely used for ophthalmic surgery
➢ CSUs using N2O or CO2 are not usually suitable for use as open systems
because cryogen “snow” would build up on the target tissue and insulate the
lesion from the cryogen spray
➢ The mechanisms of cooling differ among cryogens
➢ Liquid nitrogen CSUs deliver the cryogen to the tip as a liquid, where its rapid
vaporization cools the probe
➢ In closed-system N2O and CO2 units, cooling occurs through the Joule-
Thomson effect, in which a compressed gas is allowed to expand suddenly
through a small aperture inside the probe tip, causing a considerable drop in
gas temperature and liquefaction of some of the cryogen
➢ The vaporization of the liquefied cryogen from
the interior of the tip, combined with the drop in
gas temperature caused by expansion, lowers the
tip temperature to near the boiling point of the
cryogen
➢ When a cryoprobe or spray of liquid nitrogen is
placed on the target tissue, an adhesive bond of
ice crystals forms between the probe and the
moist tissue, and a cryolesion forms within the
tissue surface

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➢ Within the cryolesion, the lowest temperature is closest to the cryoprobe; the
temperature increases with distance
➢ Internal cryoprobes, such as those used for prostate cryosurgery, develop an
iceball that surrounds the entire probe tip
➢ Regardless of the freezing method, the cryolesion must extend beyond the
target tissue to ensure that the cryobiologically lethal temperature (-20° to -
40°C) is reached in the desired area

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About Author

Name: Akhil S
Working Status:
➢ Biomedical Technician under Sur MOH
Hospital. Oman
Previously worked institution:
➢ KIMS Health. Trivandrum, Kerala
➢ Aster DM WIMS. Wayanad, Kerala
➢ Sree Gokulam Medical. Trivandrum, Kerala

I have gained 5+ years of experience in biomedical engineering from

Kerala. India. I am interested to gain knowledge and share my
knowledge in Biomedical engineering field and also interested in R& D
field. I always ready to acquire new skills and new experiences.
Thanking you

Akhil S

Mail ID: engr.akhil@hotmail.com

Mob: +91-9747144464 (WhatsApp)

Linked in: www.linkedin.com/in/engrakhil

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