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MODULE 4
Modern Imaging Systems: Basic X-ray machines - CAT scanner- Principle of operation
- scanning components - Ultrasonic Imaging principle - types of Ultrasound Imaging –
MRI and PET scanning (Principle only).Therapeutic equipment: Cardiac Pacemakers –
De-fibrillators - Hemodialysis machines -Artificial kidney – Lithotripsy - Short wave
and Micro wave Diathermy machines

X-rays

 An X-ray is a quick, painless test that produces images of the structures inside your body
— particularly your bones.

 X-rays are electromagnetic radiations with a much shorter wavelength.

 X-rays normally move in a straight line like light .

 These are used for both diagnostic as well as therapeutic purposes.

 When they travel through the body of the patient, a portion of them will be either
absorbed or scattered.

 The image of intensity distribution of the X-rays that have passed through the body of a
patient help to visualize the internal structures of the body

X-ray machine

Principle of Operation

 An x-ray machine consists of an X-ray generator and an X-ray detector.

 An X-ray generator is a device that produces X-rays

 X-ray detectors are devices used to measure the flux, spatial distribution, spectrum, and
other properties of X-rays.

 An X-ray imaging system consists of an X-ray source or generator (X-ray tube) and an
image detection system. The X-ray tube (high vacuum diode) operates by emitting
electrons from a heated cathode tungsten filament toward a rotating high voltage anode
disc. The point where the electrons (beam) strike the target is called the focal spot.

 The beam is projected on the object. Some of the beams will pass through the object and
some are absorbed. The resulting pattern of radiation is detected in a photographic film.

 In an X-ray tube, the rotating anode is used to overcome the overheat problem. Also the
anode is made of tungsten alloy which helps in avoiding over heat.

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Components of X-Ray Machine

High Voltage Source

The main purpose of using a high voltage source control to power an x-ray machine is to allow
the proper operation of the x-ray tube. The voltage value typically ranges from 30 to 150
kilovolts (kV).

High Voltage Transformer

The high voltage produced by the high voltage source on the input side of the machine is coupled
to a step-up transformer. The transformer tends to uplift the voltage and produce a signal at its
output whose magnitude usually lies between the voltage range of 20-200 kV.

High Voltage Rectifier

The AC supply cannot be used to operate the x-ray machine, hence a high voltage rectifier is
attached to the circuit that mainly performs the task of converting AC supply into DC supply.

X-ray Tube

X-ray tube is a simple vacuum tube to produce the X-rays. The DC supply voltage produced by
the rectifier circuit is coupled to the anode terminal of the x-ray tube, while the cathode terminal
of the x-ray tube is connected to the filament current control. The input signal received by the x-
ray tube is then used to generate multiple beams of high power x-rays that can be used for
imaging and detection purposes.

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Collimator

The x-rays produced by the x-ray tube are desired to be highly directional in nature as the
excessive exposure of the healthy body cells to the high power x-rays may encounter serious side
effects. This measured exposure of the radiations is mainly controlled with the help of a
collimator. The collimator is generally placed between the patient and the filter.

Aluminium Filter

The unwanted frequencies contained by the X-rays tend to cause side effects and serious health
problems. Also, these frequencies tend to disrupt the image quality by lowering down the
contrast value. To minimize these effects to a certain level, Aluminium filters are attached to the
internal circuitry of the device.

Rotor Control

A rotor control present in the x-ray machine is used to limit the beam power according to the
usage and helps to cool down the anode. Also, an induction motor is attached to the machine that
is used to control the rotation of the anode terminal of the x-ray tube via the rotor control
mechanism.

Pulse Control Mechanism

The main purpose of the pulse control mechanism is to protect the patient and the surroundings
from uncontrollable heat. The excessive heat produced by the machine may cause health
problems, improper diagnosis, and the production of a distorted image.

Thermal Overload Detection

The main purpose of a thermal overload detection mechanism attached to the X-ray machine is
to turn off the machine in case the heat level surpasses a certain threshold value.

Diaphragm

When the x-rays produced by the x-ray tube cross the patient‘s body completely or partially, they
get scattered. The scattered radiations tend to disrupt the detection and may cause the burning of
the output image. To reduce the negative effects caused due to the scattering of x-rays, a
diaphragm is used..

Film and Lead Shield

After passing through the diaphragm, the radiations tend to fall on the surface of the film and the
lead shield. The main purpose of the film is to translate the signal and information contained by
the radiations into an image; whereas, the main purpose of the lead shield is to collect the x-rays
after they strike the film.

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USES OF X-RAYS

 In the fields of medicine and dentistry.

 Observations of the broken bones and torn ligaments of football players.
 The discovery of cavities in teeth.
 X-rays can be used to kill the affected cells like cancer cells.
 Show detailed images of bone structure.
 Used in fluoroscopy to obtain the moving images

Biomedical imaging technologies

 Biomedical imaging concentrates on the capture of images for both diagnostic and
therapeutic purposes.
 Snapshots of in vivo physiology and physiological processes can be garnered through
advanced sensors and computer technology.
 Biomedical imaging technologies utilize either x-rays (CT scans), sound (ultrasound),
magnetism (MRI), radioactive pharmaceuticals (nuclear medicine: SPECT, PET) or light
(endoscopy, OCT) to assess the current condition of an organ or tissue and can monitor a
patient over time over time for diagnostic and treatment evaluation
1. CT or CAT Scan (Computerized axial tomography)
 A computerized tomography (CT) or computerized axial tomography (CAT) scan
combines data from several X-rays to produce a detailed image of structures inside the
body.
 CT scans produce 2-dimensional images of a ―slice‖ or section of the body, but the data
can also be used to construct 3-dimensional images.
 CT scans are used in hospitals worldwide.
 CT scan can detect abnormalities in the soft tissue.
 CT enables radiologist to distinguish between different types of brain tissues , between
normal & coagulated blood etc.

Principle of operation

 CT is based on the fundamental principle that the density of the tissue passed by the x-ray
beam can be measured from the calculation of the attenuation coefficient.

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 Using this principle , CT allows the reconstruction of the density of the body.
 The CT X-ray tube emits N photons per unit of time.
 For monochromatic x-ray beam, the tissue attenuation characteristics can be described by
It=I0.e(^−μx)

It : Transmitted radiation intensity

I0 : Incident radiation intensity
µ : linear attenuation coefficient.
x : Thickness of tissue

Computer tomography – system components

 CT scanners are composed of three important elements: an X-ray tube, a gantry with a
ring of X-ray sensitive detectors, and a computer

 Scanning system : Include x-ray source and detectors .This system takes suitable
readings for the picture to be reconstructed.

 Processing unit : This converts these readings into picture information

 Viewing part : It presents this information in visual form

 Storage unit : This enables the information to be stored for future analysis

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Working of CT system

 A motorized table moves the patient through a circular opening in the CT imaging
system.
 As the patient passes through the CT imaging system, a source of x rays rotates around
the inside of the circular opening. A single rotation takes about 1 second. The x-ray
source produces a narrow, fan-shaped beam of x rays used to irradiate a section of the
patient's body. The thickness of the fan beam may be as small as 1 millimeter or as large
as 10 millimeters. In typical examinations there are several phases; each made up of 10 to
50 rotations of the x-ray tube around the patient in coordination with the table moving
through the circular opening. The patient may receive an injection of a "contrast material"
to facilitate visualization of vascular structure.

 Detectors on the exit side of the patient record the x rays exiting the section of the
patient's body being irradiated as an x-ray "snapshot" at one position (angle) of the source
of x rays. Many different "snapshots" (angles) are collected during one complete rotation.

 The data are sent to a computer to reconstruct all of the individual "snapshots" into a
cross-sectional image (slice) of the internal organs and tissues for each complete rotation
of the source of x rays

Advantages of Computerized Axial Tomography

➨The CT technique eliminates superimposition of images of undesired structures completely.

➨It offers higher contrast resolution. Hence it can distinguish tissues having differences of less
than 1% in their physical densities.

➨Multiplanar reformatted imaging is possible due to multiple contiguous or single helical scan.

➨It provides more detail compare to ultra sonography.

➨Motion artifacts are of less concern in CT scan than MRI.

Dis advantages of Computerized Axial Tomography

➨It is time consuming.

➨It is expensive for routine clinical use.

➨The patient is exposed to higher radiation.

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➨It requires expensive equipment and hence it is not always accessible at all levels of people.

➨There is risk of ionizing radiation and iodinated contrast agents.

Applications

 X-ray machines are used in healthcare for Visualizing bone structures and other dense
tissues such as tumors.

 The two main fields which use X-ray machines are radiography and dentistry.

 Radiography is used for fast and highly penetrating images.

 By using X-rays cancer cells can be treated in radiotherapy

ULTRASONIC IMAGING SYSTEMS

 Ultrasound waves have very high frequency above the range of human hearing.

 Most biomedical applications of ultrasound employ frequencies in the range 1to15 MHz.

 Characteristics

o Ultrasonic waves can be easily be focused.

o They are inaudible and are suitable for applications where it is not advantageous to
employ audible frequencies.

o Ultrasonic waves which are associated with shorter wavelengths,it is investigate the
properties of very small structures.

 Use of ultrasonic in Medical field

 Ultrasonic diagnostic aids are based on the echo aspect

 Ultrasonic therapeutic aids are based on the thermal effects developed during the
irradiation of ultrasound on the body.

 Ultrasonography is a technique by which ultrasonic energy is used to detect the state of

the internal body organs.

 Ultrasonic energy is transmitted from piezoelectric transducer through the skin and into
internal anatomy

 When this energy strikes the tissues of different acoustical impedance, reflections
(echoes) are returned to the transducer.

 The transducer converts these reflections to an electrical signal.

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 This electrical signal is amplified and displayed on an oscilloscope at a distance

proportional to the depth of the interface.

 Ultrasonic imaging is safe since ultrasonography uses mechanical energy at a level which
is not harmful to human tissues.

 Pulse Repetition Frequency Generator(PRF):

 This unit produces a train of pulses which control the sequence of events in the rest of the
equipment.

 The frequency of the pulse is determined by the Pulse Repetition Frequency (PRF)
generater.The PRF is usually kept between 500 Hz to 3 KHz.

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 Transmitter

 The transmitter transmits a train of short duration pulses.

 These pulses are converted into pulses of ultrasonic waves by a piezoelectric crystal
acting as the transmitting transducer.

 The echoes from the target are picked up by the same transducer(piezoelectric crystal)

 These are amplified suitably for display on a cathode ray tube.

 Probe

 These are required to transmit the acoustic energy efficiently into the patient.

 A material with an acoustic impedance between tissue and piezo-electric ceramic is

selected.

 Wide band amplifier

 The echo-signals received at the receiving transducer are as small as few microvolts.

 These signals are amplified by wide-band amplifier before being fed to a detector circuit .

 Swept gain control

 Used to adjust the gain of amplifier

 Detector

 After the amplification, the echo signals are rectified in the detector circuit.

 The detector employed is a conventional diode-capacitor type with an inductive filter .

 This is followed by a demodulation circuit.

 The output of the demodulator circuit is in the form of an envelope of the echo signal
which contains the desired information

 Video amplifier

 The signal requires further amplification after its demodulation in the detector circuit
before giving it to the CRT.

 The output of the detector circuit is typically around 1V, but for display on the CRT, the
signal must be amplified to about 100 to 150 V.

 The most commonly used video amplifier is the RC coupled type amplifier.

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 Time delay unit

 The time delay unit is sometimes required for special applications.

 In special cases, if desired, the start of the trace can be delayed by the time delay unit
Time marker

 Display

 After amplification in the video amplifier, the signal is given to the Y plates of the CRT.

 CRT gives a clear presentation of the received echo signals

Ultrasonography Applications

 In neurology to find any brain tumour

 In ophthalmology to find any foreign objects in eye

 In cardiology to determine the cross-section of the heart and to determine heart rate.

 In gynaecology to monitor the foetus growth and to indicate the presence of twins

Types of Ultrasonic Imaging System

Ultrasonic Imaging can be operated in three modes depending upon the application. They are:

 A -Mode(amplitude mode)

 B -Mode (brightness mode)

 M-Mode(motion mode)

A-mode

 Simplest form of ultrasonic imaging which is based on the pulse – echo principle.
 A scans can be used to measure distances.
 A scans only give one dimensional information.

 Not so useful for imaging.

 Used for echo-encephalography and echo-ophthalmoscopy.
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(NOTE:Echo encephalography is the detailing of interfaces in the brain by means of ultrasonic

waves & Echo-ophthalmoscopy is a test that allows a health professional to see inside the of the
eye)

B-mode

 B-Mode is a two-dimensional ultrasound image display composed of bright dots

representing the ultrasound echoes.

 The brightness of each dot is determined by the amplitude of the returned echo signal.

 B Mode gives two dimensional information about the cross section.

 Generally used to measure cardiac chambers dimensions ,assess valvular structure and
function.

M- mode

 M stands for motion.

 This represents movements of structures overtime.

 M mode is commonly used for measuring chamber dimensions.

 This is analogous to recording a video in ultrasound.

 Used for Echocardiograph

(NOTE :An echocardiogram checks how your heart's chambers and valves are pumping
blood through your heart. An echocardiogram uses electrodes to check your heart rhythm
and ultrasound technology to see how blood moves through your heart. An
echocardiogram can help your doctor diagnose heart conditions)

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MRI-MAGNETIC RESONANCE IMAGING

 Type of scan that uses strong magnetic fields and radio waves to produce detailed images
of the inside of the body.

 MRI does not involve x-rays, which distinguishes it from computed tomography

 Also known as nuclear magnetic resonance imaging.

 An MRI scan can be used to examine almost any part of the body including: brain and
spinal cord, bones and joints, heart and blood vessels, internal organs, such as the liver

 During an MRI scan, the patient lie on a flat bed that's moved into the scanner.

 Depending on the part of your body being scanned, you'll be moved into the scanner
either head first or feet first

 An MRI scanner is a large tube that contains powerful magnets. Patient lie inside the tube
during the scan.

Main components of scanner

– Static magnetic field coils: Produces a magnetic field of about 1.5 Tesla

– Gradient coils: are used to produce deliberate variations in the main magnetic field

– RF (radiofrequency) coils: RF coils are the "antenna" of the MRI system. They transmit the RF
signal and receives the return signal.

 The scanner is controlled using a computer, kept in a different room, away from the
magnetic field generated by the scanner

 At certain times during the scan, the scanner will make loud tapping noises. This is due
to the electric current in the scanner coils being turned on and off.

 Earplugs are given to the patient to wear.

 The scan lasts 15 to 90 minutes, depending on the size of the area being scanned and how
many images are taken

PRINCIPLE OF MRI

 70% of human body is water composed of hydrogen and oxygen atoms

 H nucleus is composed of a single proton

 Protons are like tiny magnets and are very sensitive to magnetic fields.

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 In the absence of a magnetic field, these protons are randomly arranged.

 In the presence of a strong magnetic field, they allign in a direction parallel or anti-
parallel to the magnetic field

 Short pulses of radio waves are sent from RF coil to certain areas of the body, knocking
the protons out of alignment. When the radio waves are turned off, the protons realign by
sending out radio signals, which are picked up by receivers.

 These received signals provide information about the exact location of the protons in the
body.

 They also help to distinguish between the various types of tissue in the body, because the
protons in different types of tissue realign at different speeds and produce distinct signals

Advantages
 No ionizing radiation
 Better resolution

Disadvantages
 Very expensive
 Dangerous for patients with metallic devices placed within the body
 Difficult to be performed on claustrophobic patients
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 Movement during scanning may cause blurry images

PET SCAN

 Positron emission tomography (PET) scans detect early signs of cancer, heart disease and
brain disorders.

 PET scan produces images of your organs and tissues at work.

 The test uses a safe injectable radioactive chemical called a radiotracer and a device
called a PET scanner.

 The scanner detects diseased cells that absorb large amounts of the radiotracer, which
indicates a potential health problem.

A PET scan can:

 Measure vital functions, such as blood flow, oxygen use and blood sugar (glucose)
metabolism.

 Identify organs and tissues that aren‘t working as they should.

 Detect cancerous tumor cells to help gauge cancer spread (metastasis).

 Evaluate how well a treatment plan is working and help your healthcare provider adjust
treatment, if needed.

Principle

 The technique is based on the detection of radioactivity emitted after a small amount of a
radioactive tracer is injected into a peripheral vein.

 The tracer is administered as an intravenous injection usually labelled with oxygen-15,

fluorine-18, carbon-11, or nitrogen-13. The total radioactive dose is similar to the dose
used in computed tomography.

Positron emission

 Positron emission occurs when the isotope decays and a proton decays to a neutron ,a
positron

 After travelling a short distance ,the positron emitted encounters an electron from the
surrounding environment.

 The two particles combine and ―annihilate‖each other,resulting in the emission of two
gamma rays in opposite directions

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Emission Detection

 As positron annihilation occurs ,the detector detects the isotopes location and
concentratation

 The resultant light photons are converted to electrical signals that are registeredby the
system electronics almost instsntly.

 The reconstruction software then takes the coincidence events measured at all angular
and linear positions to reconstruct an image

How does the PET scan compare to other tests?

 PET scans show metabolic changes occurring at the cellular level in an organ or tissue.
This is important because diseases often begin at the cellular level. CT scans and MRIs
cannot reveal problems at the cellular level.

 PET scans can detect very early changes in your cells. CT scans and MRIs can only
detect changes later, as a disease alters the structure of your organs or tissues.

 Detection of illness at the cellular level gives your doctor the best view of complex
systemic diseases, such as:

 coronary artery disease (CAD)

 brain tumors
 memory disorders
 seizure disorders

Advantages

 Shows all the organs of the body in one image.

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 May show changes before CT or MRI scans.

 Can show if you have cancer and how far it has spread.
 Can be used to look at the response of your cancer treatment.
 Generally painless.

Disadvantages

 Even though the radioactive elements used in these scans are short lived it might cause
some complications especially to pregnant patients.

 Since it is a new procedure, it is quiet expensive compared to other forms of medical

imaging

 Sensitivity of this diagnostic tool is too high. In case a patient was suffering from
chemical imbalance for instance those who are diabetic or just ate something before
undergoing the procedure, the likelihood of PET imaging false results is high.

CARDIAC PACEMAKERS

 The beating of heart is due to the pulses that originate in the SA node of heart.
 In abnormal situations, if this natural pacemaker stops to function, the normal functioning
of heart gets disturbed.
 This results in a decrease in the heart rate and changes in the electrocardiogram (ECG)
waveform.
 By giving external electrical stimulation impulses to the heart muscle, it is possible to
regulate the heart rate.
 These impulses are given by an electronic instrument called a 'pacemaker'.
 A pacemaker basically consists of two parts:
a. An electronic unit which generates stimulating impulses of controlled rate
and amplitude, known as pulse generator.
b. The lead which carries the electrical pulses from the pulse generator to the
heart.

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 A pacemaker is a small, battery-operated device. This device senses when your heart is
beating irregularly or too slowly. It sends a signal to your heart that makes your heart
beat at the correct pace

(i) Internal Pacemakers

 In this, entire pacemaker system is inside the body.

 Permanently implanted into the body of patient whose SA node has failed to function
properly

 The pulse generator is placed surgically below the right or left clavicle

 The electrical impulses are applied through electrodes placed on the surface of
myocardium.

 Pulse generator is powered by small batteries capable of continuously operating the unit
for a period of years.

 The pacemaker circuit should be covered with a biologically inert material

 The pacemaker unit should be covered such that the body fluids do not find a way inside
the circuit.

ii) External Pacemakers

 Employed to restart normal rhythm of heart in case of cardiac standstill.

 An external pacemaker usually consists of an externally worn pulse generator connected

to electrodes located on or within the myocardium .

 Used on patients with temporary heart irregularities

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 In this the pulse generator is located outside the body and connected to ventricle using a
long thin tube called catheter

 The pacing impulse(80 mA) is applied through metal electrodes placed on the surface of
the body.

DEFIBRILLATORS

 CARDIAC FIBRILLATION is a condition of irregular cardiac rhythm .

 It must be corrected as soon as possible to avoid brain damage to the patient and death

 Electric shock to the heart can be used to re-establish a normal cardiac rhythm.

 Electric machines that produce the energy to carry out this function are known as
defibrillators.

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 Defibrillator consists of an electric supply unit and two metal electrodes called ―Paddles‖.

 Paddles are pressed very firmly to the patient‟s chest using insulating plastic handles. So
the person using them does not get a shock too.

 The important thing is that current should flow through the heart so where the paddles are
applied is crucial.

 For getting good electrical contact solid or liquid conducting gel is used .

Types :
1. AC Defibrillator. 2. Capacitive Discharge DC Defibrillator

AC Defibrillator

 An AC defibrillator is the oldest and simplest type.

 Applying brief 0.25 -1 second burst of 60 Hz AC act as intensity of around 6A.
 The procedure of applying electric shock to resynchronize heart is known as Counter
shock.
 External defibrillation voltage range: 250 – 750V
 Internal defibrillation voltage range: 60 – 250V
 Large currents are required in external defibrillation to produce uniform and
simultaneous contraction of the heart muscle fibers

 An AC defibrillator consists of a step-up transformer with primary and secondary

winding, and two switches
 A.C supply is given through switches and fuse to primary winding of the transformer.
 The timing circuit is connected with switch, which is used to preset the time for the
defibrillator to deliver shock to the patient

Capacitive discharge dc defibrillator

• DC defibrillator does not produce side effects and produces normal heartbeat.

• Ventricular fibrillation is avoided when high-energy shock is passed through discharging

capacitor that is exposed to heart or chest of the patient.

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• The output of this is fed to step up transformer to produce a high voltage

• A half wave rectifier rectifies this high AC voltage to obtain high DC voltage.
• This DC voltage charges the capacitor C
• A series resistance Rs limits the charging current to protect the circuit components.
• With electrodes firmly placed at appropriate position on chest, the clinician discharges
the capacitor by changing the switch S from position 1 to 2.
• The capacitor is discharged through electrodes and patient is represented by a resistive
load and inductor L .

HAEMODIALYSIS
 Main function of the kidney is to form urine out of blood plasma, which basically
consists of two process:
1. The removal of waste products from blood plasma
2. The regulation of the composition of blood plasma
 Kidney performs these functions through a process involving filtration, reabsorption,
excretion.

FIGURE: Section of Kidney

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Human body has two kidneys. Each kidney consists of about a million individual units which are
all having similar structure and function.
These tiny units are called nephrons.
Its main functions include regulating the concentration of sodium salts and water by filtering the
kidney's blood, excreting any excess in the urine and reabsorbing the necessary amounts.
Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make
substances that keep your body healthy. Dialysis replaces some of these functions when your kidneys
no longer work.
One of the most important prosthetic (artificial body part) device in modern is the artificial
kidney, which is periodically connected to the circulatory systems of uremic patients to remove
metabolic waste products from their body.

In uremic patients,

Amino acids + proteins urea, creatinine
Excess of these products in blood cause kidney failure.
Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes
(sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).
In hemodialysis, blood is removed from the body and filtered through a man-made membrane
called a dialyzer, or artificial kidney, and then the filtered blood is returned to the body.

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The dialysis machine is like a big computer and a pump. It keeps track of blood flow, blood
pressure, how much fluid is removed and other vital information.
It mixes the dialysate, or dialysis solution, which is the fluid bath that goes into the dialyzer.
This fluid helps pull toxins from the blood, and then the bath goes down the drain.
The dialysis machine has a blood pump that keeps the blood flowing by creating a pumping
action on the blood tubes that carry the blood from the body to the dialyzer and back to the body.
Block Diagram Details of Hemodialysis

How does hemodialysis work?

The dialyzer is the key to hemodialysis. The dialyzer is called the artificial kidney because it
filters the blood — a job the kidneys used to do.
The dialyzer is a hollow plastic tube about a foot long and three inches in diameter that contains
many tiny filters.
There are two sections in the dialyzer; the section for dialysate and the section for the blood.
The two sections are divided by a semipermeable membrane so that they don‗t mix together.
A semipermeable membrane has microscopic holes that allow only some substances to cross the
membrane.
Because it is semipermeable, the membrane allows water and waste to pass through, but does not
allow blood cells to pass through.
Dialysate, also called dialysis fluid, dialysis solution or bath, is a solution of pure water,
electrolytes and salts, such as bicarbonate and sodium.

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The purpose of dialysate is to pull toxins from the blood into the dialysate.
The way this works is through a process called diffusion.
In the blood of the hemodialysis patient, there is a high concentration of waste, while the
dialysate has a low concentration of waste.
Due to the difference in concentration, the waste will move through the semipermeable
membrane to create an equal amount on both sides.
The dialysis solution is then flushed down the drain along with the waste
LITHOTRIPSY

FIGURE: Percutaneous Lithotripsy

SARATH KUMAR S, AP,EEE ,SNIT ADOOR

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DITHERMY

SARATH KUMAR S, AP,EEE ,SNIT ADOOR

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SARATH KUMAR S, AP,EEE ,SNIT ADOOR