SRI SHAKTHI INSTITUTE OF ENGINEERING AND

TECHNOLOGY
COIMBATORE 641062

DEPARTMENT OF BIOMEDICAL ENGINEERING

SRI SHAKTHI INSTITUTE OF ENGINEERING AND
TECHNOLOGY
COIMBATORE 641062

DEPARTMENT OF BIOMEDICAL ENGINEERING

INDUSTRIAL VISIT
 INDEX
S.NO INDUSTRIAL CONTENT PAGE.NO
VISIT

I INTRODUCTION

II A)MUSEUM OF 1)MUSCULOSKELETAL
ANATOMY SYSTEM
AND
PATHOLOGY 2)CARDIOVASCULAR
SYSTEM

3)RESPIRATORY SYSTEM

4)DIGESTIVE SYSTEM

5)URINARY SYSTEM

6)REPRODUCTIVE SYSTEM

7)EMBROLOGY

B)MUSEUM OF
PHARMACOLOGY

C)MUSEUM OF FORENSIC
MEDICINE

D)COMMUNITY MEDICINE
MUSEUM

E)GENERAL SURGERY
MUSEUM

F)ORTHOPAEDIC MUSEUM

III KASTURBA 1)OPD

HOSPITAL
2)DIALYSIS

3)VENTILATOR
 4)ELECTROCARDIOGRAPHY

5)ENDOSCOPY

IV MANIPAL 1) X-RAY
INSTITUTE OF
MEDICAL 2)COMPUTED
SCIENCE TOMOGRAPHY

3)ULTRASOUND

4)POSITRONEMISSION
TOMOGRAGHY

5) MAGNETIC RESONANCE
IMAGING

6) C – ARM

7) GAMMA CAMERA

8) MAMMOGRAM

V SHEKHAR 1) NEBULIZER
HOSPITAL
2)DEFIBRILLATOR

3) ANGIOGRAM

4) NERVE STIMULATOR
I)INTRODUCTION

Industrial visit has its own place of importance in a career of a student who is
pursuing a professional degree course like Biomedical Engineering. In fact, it
constitutes a part of core course curriculum taught at the college. The objective of an
industrial visit is to provide the students an insight regarding the internal working of
companies. Today, we all perfectly understand that theoretical knowledge is just not
enough for a successful professional career. It is here that by going beyond
academics, industrial visit provides students a much relevant practical perspective of
the actual work place and the larger world of business. Industrial visits provide the
students with an opportunity to learn practically through interaction, working methods
and employment practices.It gives the students an exposure to current work practices
as opposed to theoretical knowledge being taught at their college
classrooms.Industrial visits grant the students a great opportunity to interact with
industries and know more about industrial environment.
II.A)Manipal Museum of Anatomy and Pathology (MAP)

For Biomedical Engineering students, it is a wonderful learning aid , MAP is a storehouse

of knowledge. The specimens have been there for close to 40 years. The renovated museum
with its new magnificent ambiance will be an added attraction for hundreds and thousands of
visitors Billed as one of the largest in Asia, the museum boasts of over 3,000 specimens and
samples of things anatomical, including the skulls of elephant and a whale, and the long
skeleton of King Cobra.
1)MUSCULOSKELETAL SYSTEM

Dr.SSGodbole, the first Anatomy Professor of Kasturba Medical College, had a passion for
preservation. His techniques of careful dissection, processing, and mounting anatomical
specimens are followed even today. It was under his watch that the museum opened its doors
to the public in 1954, with over 650 specimens from his collection.
2)CARDIOVASCULAR SYSTEM

Revamped and renamed as the Manipal Museum of Anatomy and Pathology in November
2012, the sprawling Anatomy section houses well-preserved specimens of the human body
from head to toe, and everything in between. A section on comparative anatomy houses the
skeletons of various other animals, and carefully crafted models and charts augment the entire
experience.

3)RESPIRATORY SYSTEM
The Pathology Museum, which displays diseased body parts and organs, has a popular
section on life-style related diseases, and their impact on the human body. Work to convert it
into a digital or virtual museum is completed and is available on the intranet.

4)DIGESTIVE SYSTEM

5)URINARY SYSTEM

6)REPRODUCTIVE SYSTEM
The museum is divided into two main sections: Anatomy and Pathology. The anatomy
section displays specimens of normal human body parts and organs in a manner that makes
them easy to understand. Each organ system of the human body can be explored as a separate
entity. Every bit of the body is displayed from head to toe from different sections. There is a
section on comparative anatomy, where a large collection of animals, their skeleton, and
bones are displayed. The museum of Pathology displays diseased body parts and organs. The
section on life-style related diseases displays specimens of diseases that occur in humans.

7)EMBROYOLOGY
B)Museum of Pharmacology

The museum has a display of specimens, charts, models, and a section on "History of
medicine" in addition to a computer and seating area for students.

C)Museum of Forensic Medicine

Department museum is set up over an area of 225 sqm2 which contains mounted specimens
in glass jars depicting various conditions of forensic importance. It also contains flow charts,
photographs, and wax models of various aspects of forensic medicine. Prototypes of firearms
and toxicological specimens are also part of the department museum. Important cases which
were milestones in the history of Forensic medicine is also depicted with photographs and
description. All the specimens are arranged in serial rows with supporting catalogs which
give details of the specimen. There are arrangements to seat 80 students at a time.
D)Community Medicine Museum
The department has a museum of 175 sq. mt. with an extensive collection of 54 exhibits &
128 Charts. These exhibits involve the evolution of community medicine, concepts of health,
epidemiology, communicable & noncommunicable diseases, maternal & child health, and
health legislation. There are specimens of various common diseases in the local community
and slides related to those. There are Photographs of eminent scientists of public health
importance used for undergraduate and postgraduate teaching.

E)General Surgery Museum

The surgery museum houses numerous historical surgical specimens ranging from common
to rare surgical diseases as well as historical devices and instruments with detailed
descriptions, catering to young surgeons, keeping in mind that surgical training begins with
an appreciation of its history. Integrating these specimens in teaching programs aids in
nurturing young minds by providing a holistic learning environment blending history with
current surgical progress. We believe that is paramount that both medical students and
surgical trainees have access to these facilities to inspire and aid their academic progress.

F)Orthopaedic Museum
The department of Orthopaedics boasts of having a museum. The museum, established in

2015, showcases a photographic depiction of the history and evolution of the department,
along with archives of scientific papers and research articles published in various national
and international journals by our esteemed faculty. The museum walls are decorated with
posters describing the works of some of the finest Orthopaedic surgeons across the globe.

III)KASTURBA HOSPITAL
1.OPD [Out Patient Department]
OPD is the first intermediary between a patient and the hospital staff . It stands as a crucial
component of contemporary healthcare, providing a comprehensive array of services to
patients. With primary care consultations, diagnostic tests, minor surgical procedures, and
rehabilitation services, OPD caters to diverse medical needs.
2)Dialyzer

INTRODUCTION

The dialyzer provides controllable transfer of solutes and water across the semipermeable
membrane. The flows of dialysate and blood are separated and countercurrent. The dialyzer
has four ports, one inlet and one outlet port each for blood and dialysate. Dialyzer is often
referred to as an “artificial kidney.” Its function is to remove the excess wastes and fluid from
the blood, when the patient’s kidneys can no longer perform that task.

HISTORY

The early days of dialysis. The first historical description of this type of procedure was
published in 1913. Abel, Rowntree, and Turner “dialyzed” anesthetized animals by directing
their blood outside the body and through tubes of semipermeable membranes made from
Collodion, a material based on cellulose. It is impossible to say for sure whether Abel and
his colleagues intended to use this procedure to treat kidney failure from the start.There is no
doubt, however, that dialysis treatment today continues to use major elements of Abel’s
vividiffusion machine. Before the blood could be routed through the “dialyzer,” its ability to
clot or coagulate had to be at least temporarily inhibited. Abel and his colleagues used a
substance known as hirudin, which had been identified as the anticoagulant element in the
saliva of leeches in 1880.

INTRODUCTION

The dialyzer provides controllable transfer of solutes and water across the semipermeable
membrane. The flows of dialysate and blood are separated and countercurrent. The dialyzer
has four ports, one inlet and one outlet port each for blood and dialysate. Dialyzer is often
referred to as an “artificial kidney.” Its function is to remove the excess wastes and fluid from
the blood, when the patient’s kidneys can no longer perform that task.

HISTORY

The early days of dialysis. The first historical description of this type of procedure was
published in 1913. Abel, Rowntree, and Turner “dialyzed” anesthetized animals by directing
their blood outside the body and through tubes of semipermeable membranes made from
Collodion, a material based on cellulose. It is impossible to say for sure whether Abel and
his colleagues intended to use this procedure to treat kidney failure from the start.There is no
doubt, however, that dialysis treatment today continues to use major elements of Abel’s
vividiffusion machine. Before the blood could be routed through the “dialyzer,” its ability to
clot or coagulate had to be at least temporarily inhibited. Abel and his colleagues used a
substance known as hirudin, which had been identified as the anticoagulant element in the
saliva of leeches in 1880.

BLOCK DIAGRAM
WORKING & OUTPUT
The hemodialysis machine performs five basic functions. It mixes the dialysate, monitors the
dialysate, pumps the blood and controls administration of anticoagulants, monitors the blood for
the presence of air and drip chamber pressure, and monitors the ultrafiltration rate.A pump in the
hemodialysis machine slowly draws out your blood, then sends it through another machine called
a dialyzer.

This works like a kidney and filters out extra salt, waste, and fluid. Your cleaned blood is sent
back into your body through the second needle in your arm.
COIL DIALYZER

WORKING & OUTPUT

The hemodialysis machine performs five basic functions. It mixes the dialysate, monitors
the dialysate, pumps the blood and controls administration of anticoagulants, monitors the
blood for the presence of air and drip chamber pressure, and monitors the ultrafiltration
rate.
A pump in the hemodialysis machine slowly draws out your blood, then sends it through
another machine called a dialyzer.
This works like a kidney and filters out extra salt, waste, and fluid. Your cleaned blood is
sent back into your body through the second needle in your arm.

It consist of sheets of membranes separated by a spacer in rectangular compartments that are

placed in parallel. This arrangement allows for low blood flow resistance and controlled UF.
Sheets of membrane are placed between supporting plates. The plates have ridges and
grooves to support the membrane and allow flow of dialysis along it. Resistance to blood
flow is low.
HOLLOW FIBER DIALYZER

A hollow fiber dialyzer bundle comprises 7–17 x 103 semipermeable hollow fibers that allow
solute and fluid transfer between blood and dialysate. Typical fibers have an internal diameter
of 180–200 microns and wall thickness of 30–40 microns, yielding 1.0–2.5 m2 of surface
area. Hollow fiber are tiny it’s diameter 150-250 um Number of fiber 2000 or more,
depending upon length ,kind of membrane and surface area of Dialyzer.

APPLICATION IN BIOMEDICAL FIELD

Dialysis is used as a temporary measure in either acute kidney injury or in those awaiting
kidney transplant and as a permanent measure in those for whom a transplant is not indicated
or not possible. The most common application of dialysis is for the removal of unwanted
small molecules such as salts, reducing agents, or dyes from larger macromolecules such as
proteins, DNA, or polysaccharides.
 COMPLICATIONS
The most common side effects of hemodialysis include low blood pressure, access site
infection, muscle cramps, itchy skin, and blood clots. The most common side effects of
peritoneal dialysis include peritonitis, hernia, blood sugar changes, potassium imbalances,
and weight gain.
Complications include

 Breach of sterility
 Ineffective dialysis
 Alterations in membrane permeability
 Loss of structural integrity,
 Exposure to minute amount of sterilizing agents, 13 and increased risk of infection
with higher morbidity and mortality 14 if reprocessing and reuse does not follow the
standard

CONCLUSION
Our goal for hemodialysis patients should be a healthy lifestyle that can be maintained in the
long run, rather than a short- term diet. We concluded that the benefits of dialyzer reuse
included safety in our center and reduction in cost during a 12-month period. Dialyzer
reuse may be a safe alternative. Dialyzer reuse has been in practice in the United States for
more than three decades.

3)VENTILATOR

INTRODUCTION
Intubation, with subsequent mechanical ventilation, is a common life-saving intervention in
the emergency department (ED). Given the increasing length of stay of ventilated patients in
EDs, it is necessary for emergency practitioners to have a good understanding of techniques
to optimize mechanical ventilation and minimize complications.
Many different strategies of positive-pressure ventilation are available; these are based on
various permutations of triggered volume-cycled and pressure-cycled ventilations and are
delivered at a range of rates, volumes, and pressures. Poor ventilatory management can inflict
serious pulmonary and extrapulmonary damage that may not be immediately apparent.
HISTORY
Mechanical ventilators, in the form of negative-pressure ventilation, first appeared in the
early 1800s. Positive-pressure devices started to become available around 1900 and today's
typical intensive care unit (ICU) ventilator did not begin to be developed until the 1940s
ROLE OF VENTILATOR

Ventilators help a patient breathe by assisting the lungs to inhale and exhale air. These
machines are used to treat patients suffering from conditions including pneumonia, brain
injury and stroke.The SARS-CoV-2 virus (which causes the COVID-19 disease) attacks the
respiratory system. When infected, a patient’s ability to breathe is compromised. In mild
cases, breathing or respiratory support can be provided using noninvasive means, such as
delivering oxygen-rich air through a face mask.In more severe cases, when a patient suffers
acute respiratory distress, an invasive form of respiratory support is required. This is provided
through an artificial airway. A tube attached to a ventilator is inserted into the patient’s mouth
or nose (and down the windpipe), or via a surgically-made hole in the neck.
BLOCK DIAGRAM

WORKING
The need for mechanical ventilation is one of the most common causes of admission to the
intensive care unit.It is imperative to understand some basic terms to understand mechanical
ventilation.
Ventilation: Exchange of air between the lungs and the air (ambient or delivered by a
ventilator), in other words, it is the process of moving air in and out of the lungs. Its most
important effect is the removal of carbon dioxide (CO2) from the body, not on increasing
blood oxygen content. Ventilation is measured as minute ventilation in the clinical setting,
and it is calculated as respiratory rate (RR) times tidal volume (Vt). In a mechanically
ventilated patient, the CO2 content of the blood can be modified by changing the tidal
volume or the respiratory rate.
 Oxygenation: Interventions that provide greater oxygen supply to the lungs, thus the
circulation. In a mechanically ventilated patient, this can be achieved by increasing the
fraction of inspired oxygen (FiO 2%) or the positive end-expiratory pressure (PEEP).
PEEP: The positive pressure that will remain in the airways at the end of the respiratory cycle
(end of exhalation) is greater than the atmospheric pressure in mechanically ventilated
patients. For a full description of the use of PEEP, please review the article titled “Positive
End-Expiratory Pressure (PEEP).”
Tidal volume: Volume of air moved in and outside the lungs in each respiratory cycle.
FiO2: Percentage of oxygen in the air mixture that is delivered to the patient. Flow:
Speed in liters per minute at which the ventilator delivers breaths.
Compliance: Change in volume divided by change in pressure. In respiratory physiology,
total compliance is a mix of lung and chest wall compliance as these two factors cannot be
separated in a patient.

APPLICATION IN BIOMEDICAL FIELD

Biomedical equipment technology has made some enormous strides over the course of the
20th century. It wasn’t that long ago when we were putting Polio victims in iron lungs in
order to enable their continued breathing throughout the rest of their lives. But advances in
positive pressure ventilation have made past treatments look almost archaic. Now it’s
common for recipients of ventilator treatment to live active lifestyles instead of being
confined to a chair or bed.
TROUBLESHOOTING OF VENTILATOR
The differential diagnosis of the clinically deteriorating, mechanically ventilated patient is
wide and includes endotracheal tube or ventilator dysfunction, improper ventilator settings,
pain, anxiety, and pulmonary or extrapulmonary disease processes. [10] The complications
most commonly encountered in the ED include hypoxia, hypotension, high-pressure
alarms, and low exhaled–volume alarms.Intubated patients who develop hemodynamic
instability with respiratory compromise should immediately be disconnected from the
ventilator and manually ventilated with 100% FiO2.One of the first diagnoses that should be
considered in any hemodynamically unstable patient undergoing positive- pressure
ventilation is tension pneumothorax. This is a clinical diagnosis and should be detected and
treated with needle decompression prior to obtaining a chest radiograph.A second diagnosis
to exclude, particularly in patients with asthma or COPD, is intrinsic PEEP. As discussed,
intrinsic PEEP occurs as a result of incomplete exhalation, which subsequently leads to
hyperinflation, increased intrathoracic pressure, decreased venous return, and decreased
preload. The diagnosis of intrinsic PEEP may be made by performing an end-expiratory hold
or by detecting a non-zero end-expiratory flow on the ventilator. The treatment for intrinsic
PEEP is to allow for lung deflation, then to alter mechanical ventilation settings to allow for
longer expiratory times by decreasing the respiratory rate, decreasing the tidal volume, or
changing the inspiratory-to- expiratory ratio

MONITORING OF VENTILATOR SUPPORT

Cardiac monitor, blood pressure, and pulse oximetry (SaO2) are recommended. The authors’
practice with stable patients is to titrate down FiO2 to the minimum value necessary to
maintain maximal SaO2. An arterial blood gas (ABG) measurement is frequently obtained
10-15 minutes after the institution of mechanical ventilation. The measured arterial PaO2
should verify the transcutaneous pulse oximetry readings and direct the reduction of FiO2 to
a value less than 0.5. The measured PaCO2 can suggest adjustments of minute ventilation but
should be interpreted in light of the patient’s overall acid-base status. For example, full
correction of PaCO2 in a chronically hypercarbic COPD patient will lead to unopposed
metabolic alkalosi
INITIAL VENTILATORNTILATOR SETTING
In the ED setting, patients frequently require full respiratory support. For most ED patients
who are paralyzed as a component of rapid-sequence induction, CMV and A/C are good
choices as an initial ventilatory mode. SIMV may be better tolerated in nonparalyzed patients
with obstructive airway disease and an intact respiratory effort. PSV can be used when
respiratory effort is intact and respiratory failure is not severe.
Noninvasive ventilation (CPAP, BiPAP) can be used effectively in many cases of severe
COPD and CHF to avoid tracheal intubation. Initial ventilator settings are guided by the
patient’s pulmonary pathophysiology and clinical status. Adjustments can then be made to
limit barotrauma, volutrauma, and oxygen toxicity. CPAP and BiPAP require alert,
cooperative patients capable of independently maintaining their airways and are
contraindicated in the presence of facial trauma.

ADVANTAGES OF VENTILATOR
 Decreases the work of breathing
 Increases functional residual capacity
 Improves gas exchange
 Improves general pulmonary function
 Reduces venous return to the heart (may be a disadvantage in a setting of
hypotension)
 Avoids intubation complications and costs
 Decreased mortality in properly selected patients

DISADVANTAGES OF VENTILATOR
 Patient discomfort
 Facial skin necrosis
 Increased aspiration risk
 Reduces venous return to the heart (may be an advantage in volume overload)
CONCLUSION
Novel physiological approaches, combined with new biological insights and engineering
approaches, will undoubtedly continue to improve the delivery of mechanical ventilation as
we move further into the 21st century. Such advances will certainly be welcome as the
number of patients requiring mechanical ventilation is expected to increase substantially (47).
Reviewing the history of the progress of mechanical ventilation is enlightening in a number
of respects. First, it’s humbling to consider how many discoveries, such as the usefulness of
positive pressure ventilation or the iatrogenic consequences of ventilatory support, took
literally centuries to change practice, despite convincing evidence. Second, it is intriguing to
sit back and think what ventilatory approaches we are currently using that in the future will
be viewed at best as somewhat naïve and at worst as harmful. Perhaps viewing our current
practices critically using a “future historical lens” will allow us to identify these harmful
practices earlier rather than later and hence to accelerate the future history of mechanical
ventilation.

4) ELECTROCARDIOGRAM(ECG)

INTRODUCTION
An electrocardiogram is a picture of the electrical conduction of the heart. By examining
changes from normal on the ECG, clinicians can identify a multitude of cardiac disease
processes.There are two ways to learn ECG interpretation — pattern recognition (the most
common) and understanding the exact electrical vectors recorded by an ECG as they relate to
cardiac electrophysiology — and most people learn a combination of both. This tutorial pairs
the approaches, as basing ECG interpretation on pattern recognition alone is often not
sufficient.
ROLE OF ECG
The ECG machine is designed to recognise and record any electrical activity within the
heart. It prints out this information on ECG paper made up of small squares 1mm
squared.Diagram of the ecg paper displaying scale and relationship of time and
amplitudeEach electrical stimulus takes the form of a wave and so patterns emerge made up
of a number of connected waves. A standard ECG is printed at 25mm per second or 25 small
squares per second (see above). In this way it is possible to calculate the duration of
individual waves.10 small squares vertically is equal to 1 millivolt. So it is possible to
calculate the amount of voltage being released within the heart. If the line is flat at any time
in the duration of a series of waves, it indicates no electrical activity at that particular
moment.The direction in which the waves point indicates whether electricity is moving
towards or away from a particular lead.The general direction in which electricity normally
travels through the heart is a downward diagonal line from the right shoulder to the left
lower abdomen. This is because the electrical stimulus originates in the SA node (upper right
side of the heart), travels through the AV node and bundle of His, and finishes mainly in the
left ventricle. (remember that there is more conduction in the left ventricle).
BLOCK DIAGRAM

WORKING
It works on the principle that a contracting muscle generates a small electric current that can be
detected and measured through electrodes suitably placed on the body.For a resting
electrocardiogram, a person is made to lie in the resting position and electrodes are placed on
arms, legs and at six places on the chest over the area of the heart. The electrodes are attached to
the person’s skin with the help of a special jelly.The electrode picks up the current and transmit
them to an amplifier inside the electrocardiograph. Then electrocardiograph amplifies the current
and records them on a paper as a wavy line.In an electrocardiograph, a sensitive lever traces the
changes in current on a moving sheet of paper.A modern electrocardiograph may also be
connected to an oscilloscope, an instrument that display the current on a screen
TYPES OF WAVE FORM
A normal ECG makes a specific pattern of three recognizable waves in a cardiac cycle. These
wave are- P wave, QRS wave and T-wave, P-R interval, S-T segment
P-wave:It is a small upward wave that appears first.It indicates atrial depolarization (systole),
during which excitation s node to all over atrium About
0.1 second after P-wave begins, atria contracts. Hence P-wave represents atrial systole
QRS wave: It is the second wave that begins as a little downward wave but continues as a
large upright triangular wave and ends as downward waveIt represents the ventricular
depolarization (systole)Just after QRS wave begins, ventricles starts to contracts. Hence QRS
wave represents ventricular systole
T- wave: It is third small wave in the form of a dome-shaped upward deflection.It indicates
ventricular repolarization (diastole)It also represents the beginning of ventricular diastole**
ATRIAL DIASTOLE MERGES WITH QRS-WAVEP-R interval:It represents the time
required for an impulse to travel through the atria, AV node and bundle of his to reach
ventricles.
S-T segment:It is measured from the end of S to the beginning of T- waveIt represents the
time when ventricular fibres are fully depolarized.
APPLICATION IN BIOMEDICAL FIELD
Electrocardiography (ECG) is a graphical representation of the electrical activity of the
heart over a period of time which is recorded by the electrodes connected to the body either
using three leads or twelve leads attached to the surface of the skin.

TROUBLESHOOTING OF ECG
The most common problem with ECG systems is user error. Modern ECG recorders have
many buttons and controls and can be quite confusing.
Therefore, if the machine turns on, the first thing to suspect is usererror

 Poor electrode cleaning

 Poor electrode placement
 Poor skin preparation

ADVANTAGES OF ECG
 Arrhythmias – where the heart beats too slowly, too quickly, or irregularly.Coronary heart
disease – where the heart’s blood supply is blocked or interrupted by a build-up of fatty
substances.Heart attacks – where the supply of blood to the heart is suddenly blocked.

DISADVANTAGES OF ECG
It does not provide underlying heart problems for patients not having any symptoms.It does
not always provide help in accurate diagnosis. More tests are needed to trace serious heart
problems undetected by normal ECG curve.

CONCLUSION
Electrocardiogram (ECG) supervising is the most important and efficient way for preventing
heart attacks. Our work presents an integrated classification method, which combinesthe
Support Vector Machine (SVM) with either the Principal Component Analysis (PCA) or the
Kernel PCA (KPCA) for classification of different types of cardiac abnormalities.Our
experiments show that binary SVM combined withfeature extraction using PCA or KPCA
greatly improves the quality of classification than that without feature extraction.
5)ENDOSCOPY
INTRODUCTION:
An endoscopy is a procedure used in medicine to look inside the body. The endoscopy
procedure uses an endoscope to examine the interior of a hollow organ or cavity of the
body. Unlike many other medical imaging techniques, endoscopes are inserted directly
into the organ.
There are many types of endoscopies. Depending on the site in the body and type of
procedure, an endoscopy may be performed by either a doctor ora surgeon. A patient may
be fully conscious or anaesthetized during the procedure. Most often, the term endoscopy is
used to refer to an examination of the upper part of the gastrointestinal tract , known as
an esophagogastroduodenoscopy .

HISTORY:
The first endoscope was developed in 1806 by Philipp Bozzini in Mainz with his
introduction of a "Lichtleiter" (light conductor) "for the examinations of the canals and
cavities of the human body".However, the College of Physicians in Vienna disapproved of
such curiosity. The first to use an endoscope in a successful operation was Antonin Jean
Desormeaux whose invention was the state of the art before the invention of electricity.The
use of electric light was a major step in the improvement of endoscopy. The first such lights
were external although sufficiently capable of illumination to allow cystoscopy,
hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic)
cavities as was being performed routinely in human patients by Sir Francis Cruise (using his
own commercially available endoscope) by 1865 in the Mater Misericordiae Hospital in
Dublin, Ireland.Later, smaller bulbs became available making internal light possible, for
instance in a hysteroscope by Charles David in 1908.Hans Christian Jacobaeus has been
given credit for the first large published series of endoscopic explorations of the abdomen
and the thorax,
With laparoscopy (1912)and thoracoscopy (1910) although the first reported thoracoscopic
examination in a human was also by Cruise.Laparoscopy was used in the diagnosis of liver
and gallbladder disease by Heinz Kalk in the 1930s. Hope reported in 1937 on the use of
laparoscopy to diagnose ectopic pregnancy. In 1944, Raoul Palmer placed his patients in
the Trendelenburg position after gaseous distention of the abdomen and thus was able to
reliably perform gynecologic laparoscopy.

ROLE OF INSTRUMENT:
Endoscopy is a nonsurgical procedure used to examine a person's digestive tract. Using an
endoscope, a flexible tube with a light and camera attached to it, your doctor can view
pictures of your digestive tract on a color TV monitor. During an upper endoscopy , an
endoscope is easily passed through the mouth and throat and into the esophagus, allowing the
doctor to view the esophagus, stomach, and
upper part of the small intestine.Similarly, endoscopes can be passed into the large intestine
through the rectum to examine this area of the intestine. This procedure is called
sigmoidoscopy or colonoscopy depending on how far up the colon is examined.A special
form of endoscopy called endoscopic retrograde cholangiopancreaticography, or ERCP,
allows pictures of
the pancreas, gallbladder, and related structures to be taken. ERCP is also used for stent
placement and biopsies.Endoscopic ultrasound or EUS combines upper endoscopy and
ultrasound examination to obtain images and information about various parts of the
digestive tract.
BLOCK DIAGRAM:

WORKING & OUTPUT:

1. One of the two main endoscope cables carries light from a bright lamp in the
operating room into the body, illuminating the cavity where the endoscope has been
inserted.
2. The light bounces along the walls of the cable into the patient's body cavity.
3. The diseased or injured part of the patient's body is illuminated by the light
shining in.
4. Light reflected off the body part travels back up a separate fiber-optic cable,
bouncing off the glass walls as it goes.
5. The light shines into the physician's eyepiece so he or she can see what's happening
inside the patient's body. Sometimes the fiber-optic cable is directed into a video
camera (which displays what's happening on
a television monitor) or a CCD (which can capture images like a digital camera or
feed them into a computer for various kinds of image enhancement).
APPLICATION IN MEDICAL FIELD:
1. During pregnancy. The amnion (amnioscopy)
2. Plastic surgery.
3. Panendoscopy (or triple endoscopy) Combines laryngoscopy, esophagoscopy,
and bronchoscopy.
4. Orthopedic surgery. ...
5. Endodontic surgery. ...
6. Endoscopic endonasal surgery.
7. Endoscopic spinal surgery.

CONCLUSION:
Endoscopy plays a key role in the diagnosis and management
of gastroparesis. In a conventional sense, endoscopy is required to both establish and
confirm the diagnosis of gastroparesis. Postpyloric feeding may be required to stabilize
patients nutritionally while diagnostic studies and therapy proceed. Recent reports have
highlighted the identification of a subset of patients with prominent pyloric dysfunction, and
endoscopy plays a role in both the identification of this subset and the treatment of these
patients. Impedance planimetry has emerged as a novel tool for assessing pyloric
distensibility and compliance, and could potentially be used to identify a subgroup of patients
in whom endoscopic techniques for pyloric disruption can be utilized. Advances in
endoscopic techniques have led to the development of numerous methods by which full-
thickness gastric biopsy can be obtained and clear histopathologic subsets can be identified,
with the hope of identifying subgroups for which treatment decisions can be based on these
histologic features. Finally, endoscopy may play a role in placing both temporary and
permanent electrical stimulation devices, and certainly in facilitating electrical recording of
gastric smooth muscle. We predict that the role for endoscopy should only continue to
expand in the future, and that a revolution in this area is clearly underway.
IV)MANIPAL INSTITUTE OF MEDICAL SCIENCE

1) XRAY
INTRODUCTION

An X-ray, or, much less commonly, X-radiation, is a penetrating form of highenergy electromagnetic
radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers,
corresponding to frequencies in the range 30 petahertz to 30 exahertz (30×1015 Hz to 30×1018 Hz) and
energies in the range 124 eV to 124 keV. X-ray wavelengths are shorter than those of UV rays and
typically longer than those of gamma rays. In many languages, X-radiation is referred to as
Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it on
November 8, 1895.
HISTORY

Before their discovery in 1895, X-rays were just a type of unidentified radiation emanating
from experimental discharge tubes. They were noticed by scientists investigating cathode
rays produced by such tubes, which are energetic electron beams that were first observed in
1869. Many of the early Crookes tubes (invented around 1875) undoubtedly radiated X-rays,
because early researchers noticed effects that were attributable to them, as detailed below.
 Crookes tubes created free electrons by ionization of the residual air in the tube by a high DC
voltage of anywhere between a few kilovolts and 100 kV. This voltage accelerated the
electrons coming from the cathode to a high enough velocity that they created X-rays when
they struck the anode or the glass wall of the tube.[4]
The earliest experimenter thought to have (unknowingly) produced X-rays was actuary
William Morgan. In 1785 he presented a paper to the Royal Society of London describing the
effects of passing electrical currents through a partially evacuated glass tube, producing a
glow created by X-rays.[5][6] This work was further explored by Humphry Davy and his
assistant Michael Faraday.
ROLE OF THE MACHINE
An X-ray is a common imaging test that’s been used for decades. It can help your doctor
view the inside of your body without having to make an incision. This can help them
diagnose, monitor, and treat many medical conditions.
Different types of X-rays are used for different purposes. For example, your doctor may order
a mammogram to examine your breasts. Or they may order an X-ray with a barium enema to
get a closer look at your gastrointestinal tract.

BLOCK DIAGRAM
WORKING & OUTPUT
Functioning of an X-Ray generator:

 X-RAY Tube
 High Voltage Generator
 Cooling System
 Control Console

X-Ray tube

The tube cathode (filament) is heated with a low-voltage current of a few amps. The filament
heats up and the electrons in the wire start breaking free. To kick off the flow of electrons, a
strong electrical potential is created between the cathode and the anode by the generator.
Electrons that break free of the cathode are strongly attracted to the anode disc. The electron
flow between the cathode and the anode is called the tube current. The tube current is
measured in milliamps (mA) and is controlled by regulating the low-voltage, heating current
applied to the cathode. Higher the temperature of the filament, the larger the number of
electrons that leave the cathode and travel to the anode. The mA or current setting on the
control console regulates the filament temperature and hence the intensity of the X-ray
output.
 High Voltage generator:

The high-voltage between the cathode and the anode affects the speed at which the electrons
travel and strike the anode. The higher the voltage (kV), the higher the speed and, therefore,
energy the electrons have when they strike the anode. Higher the energy of the electrons
striking the anode, better the X-rays penetration. The high-voltage potential is measured in
kilovolts (kV) which is controlled using the kV control on the console

Cooling System:

A focusing cup is used to concentrate the stream of electrons to a small area on the anode,
called the focal spot. The focal spot size is an important factor in the system’s ability to
produce a sharp image. Most of the energy (nearly 98%) applied to the tube is transformed
into heat at the focal spot of the anode. Therefore, it is necessary to cool the anode. Tubes are
 cooled using a water or oil recirculating system.Vacuum is maintained inside the tube, in
order to prevent the cathode from burning up and to prevent arcing between the anode

Control Console:
The other important component of an X-ray generating system is the control console. There
are three main adjustable controls that regulate the 1) tube voltage in kilovolts, 2) the tube
amperage in milliamps, and the 3) exposure time in minutes and seconds. Some systems also
have a switch to change the focal spot size of the tube.
HF X-Ray machines today have digital console with settings for procedure being done (e.g
AP Lumbar) and the patient thickness, rather than the Voltage, Current and Exposure time,
making it easier for the technician.

APPLICATION IN BIOMEDICAL FIELD

X-rays are a form of electromagnetic radiation, similar to visible light. Unlike light, however,
x-rays have higher energy and can pass through most objects, including the body. Medical x-
rays are used to generate images of tissues and structures inside the body. If x-rays travelling
through the body also pass through an x-ray detector on the other side of the patient, an image
will be formed that represents the “shadows” formed by the objects inside the body.

Safety Mechanism:
Radiation protection and safety procedures have been established to ensure the protection &
safety of the staff, patients and their relatives during their stay in department and to ensure
that fertile and pregnant women are not exposed to radiation accidentally or unintentionally.
Radiation safety is enforced to ensure that both patients and radiation health workers are not
 exposed to unnecessary radiation through the use of proper techniques, equipment and
shielding materials

CONCLUSION
Doses from X-ray scanners pose no short-term risks such as tissue damage. The long-term
effects such as cancer risks, cannot be entirely excluded but if they exist, they are orders of
magnitude below the cancer risk due to other factors. The annual dose limit for the general
public is 1mSv. The radiation dose from a single backscatter scanner is tiny and even if
someone was scanned 3 times a day, every working day, he would receive an annual dose
well below the set limit. The dose from transmission scanners is at least 10 times higher than
that from backscatter scanners but is still safe, even for vulnerable individuals.

working day, he would receive an annual dose well below the set limit. The dose from
transmission scanners is at least 10 times higher than that from backscatter scanners but is
still safe, even for vulnerable individuals

2)COMPUTED TOMOGRAPHY SCAN

INTRODUCTION:

Medical professionals use computed tomography, also known as CT scan, to examine

structures inside your body. A CT scan uses X-rays and computers to produce images of a
cross-section of your body. It takes pictures that show very thin “slices” of your bones,
muscles, organs and blood vessels so that healthcare providers can see your body in great
detail.
HISTORY:

The first commercially available CT scanner was created by British engineer Godfrey
Hounsfield of EMI Laboratories in 1972. He co-invented the technology with physicist Dr.
Allan Cormack. Both researchers were later on jointly awarded the 1979 Nobel Prize in
Physiology and Medicine. By 1981, Hounsfield was knighted and became Sir Godfrey
Hounsfield.Godfrey Hounsfield with CT scanAbove: Godfrey Hounsfield with the first
commercial CT scanner.However, it was the mathematical theory of Johann Radon way back
in 1917, called “Radon transform,” that brought the technology to life. Another mathematical
advancement that Hounsfield built on is the “Algebraic Reconstruction Technique,” which
was formulated by Polish mathematician Stefan Kaczmarz in 1937. Both theories were
adopted by Hounsfield to create one of the greatest advancements in medical
history.Interestingly, Hounsfield had no qualifications as he quit school at the tender age of
16. Hence, all the degrees bestowed upon him were honorary. He also never got married and
claimed to have not established any “permanent residence” until he reached 60 years old.
Although he later invented the CT scan, Hounsfield’s initial work with EMI focused on radar
and guided weaponry. Despite his brilliance, Hounsfield’s peers described the Nobel winner
as a “crank.” He passed away in 2004 at the age of 84.

ROLE OF EQUIPMENT:

CT scans can be used to identify disease or injury within various regions of the body. For
example, CT has become a useful screening tool for detecting possible tumors or lesions
within the abdomen. A CT scan of the heart may be ordered when various types of heart
disease or abnormalities are suspected. CT can also be used to image the head in order to
locate injuries, tumors, clots leading to stroke, hemorrhage, and other conditions. It can
image the lungs in order to reveal the presence of tumors, pulmonary embolisms (blood
clots), excess fluid, and other conditions such as emphysema or pneumonia. A CT scan is
particularly useful when imaging complex bone fractures, severely eroded joints, or bone
tumors since it usually produces more detail than would be possible with a conventional x-
ray.
BLOCK DIAGRAM:

WORKING:
In many ways, a CT scan works like other x-ray exams. Different body parts absorb x-rays in
different amounts. This difference allows the doctor to distinguish body parts from one
another on an x-ray or CT image.
A conventional x-ray exam directs a small amount of radiation through the body part under
examination. A special electronic image recording plate captures the image. Bones appear
white on the x-ray. Soft tissue, such as the heart or liver, shows up in shades of gray. Air
appears black.
 With CT scanning, several x-ray beams and electronic x-ray detectors rotate around you.
These measure the amount of radiation being absorbed throughout your body. Sometimes, the
exam table will move during the scan. A special computer program processes this large
volume of data to create two-dimensional cross-sectional images of your body. The system
displays the images on a computer monitor. CT imaging is sometimes compared to looking
into a loaf of bread by cutting the loaf into thin slices. When the computer software
reassembles the image slices, the result is a very detailed multidimensional view of the body's
interior.
Nearly all CT scanners can obtain multiple slices in a single rotation. These multi-slice
(multidetector) CT scanners obtain thinner slices in less time. This results in more detail.
Modern CT scanners can image large sections of the body in just a few seconds, and even
faster in small children. Such speed is beneficial for all patients. Speed is especially
beneficial for children, the elderly, and critically ill – anyone who finds it difficult to stay
still, even for the brief time necessary to obtain images.
For children, the radiologist will adjust the CT scanner technique to their size and the area of
interest to reduce the radiation dose.Some CT exams use a contrast material to enhance
visibility in the body area under examination.

OUTPUT:
The technologist begins by positioning you on the CT exam table, usually lying flat on your
back. They may use straps and pillows to help you maintain the correct position and remain
still during the exam.Many scanners are fast enough to scan children without sedation. In
special cases, children who cannot hold still may need sedation. Motion may cause blurring
of the images and degrade image quality the same way that it affects photographs.The exam
may use contrast material, depending on the type of exam. If so, it will be swallowed,
injected through an intravenous line (IV) or, rarely, administered by enema.Next, the table
will move quickly through the scanner to determine the correct starting position for the
scans. Then, the table will move slowly through the machine for the actual CT scan.
Depending on the type of CT scan, the machine may make several passes.The technologist
 may ask you to hold your breath during the scanning. Any motion, including breathing and
body movements, can lead to artifacts on the images. This loss of image quality can resemble
the blurring seen on a photograph taken of a moving object.When the exam is complete, the
technologist will ask you to wait until they verify that the images are of high enough quality
for accurate interpretation by the radiologist.The CT examination is usually completed within
30 minutes. The portion requiring intravenous contrast injection usually lasts only 10 to 30
seconds.

APPLICATION IN BIOMEDICAL FIELD:

With remarkable growth in its applications and use, evolution of MDCT technology has
resulted in significant changes in the scanning parameters, hardware, and radiation exposure
associated with CT scanning. In comparison with single-detector CT, conventional MDCT
allows acquisition of different image slabs from the same dataset by using helical
reconstruction, weighting algorithms, and interpolation of adjacent helical datasets.
Salient MDCT characteristics are: a cone-shaped X-ray beam, up to 0.5 seconds of rotation
time (2 Hz of frequency), faster scan coverage, larger z-axis coverage/rotation (18/24/32
mm), isotropic voxel possible, greater temporal resolution and less image noise, beam pitch,
and reduced radiation dose efficiency.
MDCT has multiple detector rows (each consisting of 500–900 detector elements) along the
scanning direction, which create a two-dimensional curved detector array. MDCT acquires
more than one slice in a single X-ray tube rotation with thin isotropic voxels. At a beam pitch
of 1:1, table speed and z-axis coverage from dual-slice CT scanners (20 mm per second)
have steadily increased to 40 mm per second for four-slice, 80 mm per second for eight-slice,
and 160 mm per second for 16-slice MDCT scanners. Currently available MDCT scanners
have as many as 40 rows of detectors in the z-axis, which comprise more than 30,000
individual detector elements with high efficiency and minimal afterglow. In addition to
changes in detector design, evolution of CT technology has resulted in substantial alteration
in the image reconstruction techniques used to accommodate changes in image geometry; the
filtered
 back-projection technique of image reconstruction is used in single-slice axial scanners, and
interpolated filtered back-projection is used in single-detector CT scanners and four-slice
MDCT.
Recent implementation of computer calculation performances has made it possible to
introduce into clinical CT scanners a different image reconstruction model known as the
iterative reconstruction protocol. This protocol is mainly based on comparison of the acquired
CT image with a CT model in order to reduce CT image noise using lower Kv levels or to
improve image quality using the same kV levels.12 Isotropic scanning may be defined as
acquisition of images with equal voxel size in three axes: MDCT scanners permit acquisition
of thin slices with isotropic voxel size.
Images obtained using conventional MDCT provide useful but only limited material-specific
information, because the representation of structures on images depends solely on the linear
attenuation coefficient of each of the constituent materials and is independent of the material
density and mass attenuation coefficient.
The introduction of DECT technology made possible new diagnostic scenarios: two datasets
(80 kVp and 140 kVp) are loaded on the workstation, and virtual non-contrast, iodine map,
and mixed (with adjustable blending of 80 kVp and 140 kVp data) images can be obtained.

CONCLUSION:
Modern CT scanners, by contrast, can perform an entire scan of a patient within 10 seconds,
and the associated computers take about the same amount of time to prepare image from the
data collected. CT scanning is especially useful in discovering the early onset of many
disorders or disease, which in turn leads to early treatment and an improved chance for
complete recovery. Because of it's complexity, the doctors and technicians who use CT
scanner must be professionally trained and their facility accredited.Accreditation is also an
important issue for insurance companies, which often do not reimburse non-accredited
facilities for CT scanning services. ENT Memphis is accredited by ICACTL.
3)ULTRASOUND

INTRODUCTION:
Ultrasound refers to sound waves having frequencies higher than the human hearing
limit. Ultrasound has the same physical qualities as "regular" (audible) sound, except that
human cannot hear it. In healthy young people, this limit varies from person to person and is
around 20 kilohertz (20,000 hertz). Ultrasound machines use frequencies ranging from 20
kHz to several gigahertz.
Ultrasound is utilized in a variety of applications. Objects are detected and distances
are measured using ultrasonic instruments. In medicine, ultrasound imaging, also known as
sonography, is frequently employed. Ultrasound is used to discover defects in products and
structures during nondestructive testing. Ultrasound is utilized in industry for cleaning,
mixing, and speeding up chemical processes. Ultrasound is used by bats and porpoises to
locate prey and barriers.
HISTORY:
Acoustics, or the science of sound, dates back to Pythagoras, who wrote on the
mathematical features of stringed instruments in the 6th century BC. Lazzaro Spallanzani
discovered echolocation in bats in 1794, demonstrating that bats hunted and navigated using
inaudible sound rather than vision. Francis Galton devised the Galton whistle, an adjustable
 whistle that produces ultrasonic, in 1893, and used it to test the hearing ranges of humans and
other animals, revealing that many species could hear noises that humans could not.
Paul Langevin's attempt to detect submarines in 1917 was the first technological
application of ultrasound. In 1880, Jacques and Pierre Curie discovered the piezoelectric
effect, which was used in transducers to generate and detect ultrasonic waves in air and
water.
Many people experimented with the military, scientific, and industrial potential of
ultrasonic technology throughout the next few decades. However, it was not until the early
1940s that it was used as a diagnostic medical tool, thanks to the work of neurologist and
psychiatrist Karl Dussik of the University of Vienna. Dussik used an ultrasound beam to look
for brain tumors and detect the cerebral ventricles, which are cavities in the brain that store
cerebrospinal fluid, with the help of his physicist brother Friedreich.
Other pioneers in America and Europe continued expanding the scope of
diagnostic medical ultrasound throughout the next half century. They used it to detect an
increasing variety of medical conditions and made advances in hardware and imaging quality.
Ian Donald working in Glasgow during the 1950s in particular pioneered the use of
ultrasound in monitoring fatal development.

He also published a seminal diagnostic study in 1958 after working with a team to
develop a prototype ultrasound machine dedicated to medical diagnosis. Over time,
ultrasound machines became smaller and more portable. Ultrasound pictures became sharper,
and the development of two-, three- and four- dimensional images as well as Doppler
imaging enabled medical professionals and patients alike to better understand what
ultrasound test results revealed.

ULTRASOUND:

Ultrasound or ultrasonography is a medical imaging technique that uses high frequency

sound waves and their echoes. The technique is similar to the echolocation used by bats,
whales and dolphins, as well as SONAR used by submarines. In ultrasound, the
following events happen:
1. The ultrasound machine transmits high-frequency (1 to 5 megahertz) sound pulses
into your body using a probe.
2. The sound waves travel into your body and hit a boundary between tissues (e.g.,
between fluid and soft tissue, soft tissue and bone).
3. Some of the sound waves get reflected back to the probe, while some travel on further
until they reach another boundary and get reflected.
4. The reflected waves are picked up by the probe and relayed to the machine.
5. The machine calculates the distance from the probe to the tissue or organ (boundaries)
using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of each echo's
return (usually on the order of millionths of a second).
6. The machine displays the distances and intensities of the echoes on the screen,
forming a two-dimensional image like the one shown below
MACHINE:

A basic ultrasound machine has the following parts:

 transducer probe - probe that sends and receives the sound waves
 central processing unit (CPU) - computer that does all of the calculations and
contains the electrical power supplies for itself and the transducer probe
 transducer pulse controls - changes the amplitude, frequency and duration of the
pulses emitted from the transducer probe
 display - displays the image from the ultrasound data processed by the CPU
 keyboard/cursor - inputs data and takes measurements from the display
 disk storage device (hard, floppy, CD) - stores the acquired images
 printer – prints the image from the displayed data

Transducer Probe

The transducer probe is the main part of the ultrasound machine. The transducer probe
makes the sound waves and receives the echoes. It is, so to speak, the mouth and ears of
the ultrasound machine. The transducer probe generates and receives sound waves using a
principle called the piezoelectric (pressure electricity) effect, which was discovered by
Pierre and Jacques Curie in 1880. In the probe, there are one or more quartz crystals
called piezoelectric crystals. When an electric current is applied to these crystals, they
change shape rapidly. The rapid shape changes, or vibrations, of the crystals produce
sound waves that travel outward. Conversely, when sound or pressure waves hit the
crystals, they emit electrical currents. Therefore, the same crystals can be used to send
and receive sound waves. The probe also has a sound absorbing substance to eliminate
back reflections from the probe itself, and an acoustic lens to help focus the emitted sound
waves.

Transducer probes come in many shapes and sizes, as shown in the photo above. The
shape of the probe determines its field of view, and the frequency of emitted sound waves
determines how deep the sound waves penetrate and the resolution of the image.
Transducer probes may contain one or more crystal elements; in multiple-element probes,
each crystal has its own circuit. Multiple- element probes have the advantage that the
ultrasound beam can be "steered" by changing the timing in which each element gets
 pulsed; steering the beam is especially important for cardiac ultrasound. In addition to
probes that can be moved across the surface of the body, some probes are designed to be
inserted through various openings of the body (vagina, rectum, oesophagus) so that they
can get closer to the organ being examined (uterus, prostate gland, stomach); getting
closer to the organ can allow for more detailed views.

The parts of an ultrasound machine

Central Processing Unit (CPU)

The CPU is the brain of the ultrasound machine. The CPU is basically a computer that
contains the microprocessor, memory, amplifiers and power supplies for the microprocessor
and transducer probe. The CPU sends electrical currents to the transducer probe to emit
sound waves, and also receives the electrical pulses from the probes that were created from
the returning echoes. The CPU does all of the calculations involved in processing the data.
Once the raw data are processed, the CPU forms the image on the monitor. The CPU can also
store the processed data and/or image on disk.

Transducer Pulse Controls

The transducer pulse controls allow the operator, called the ultra- sonographer, to
set and change the frequency and duration of the ultrasound pulses, as well as the scan mode
of the machine. The commands from the operator are translated into changing electric
currents that are applied to the piezoelectric crystals in the transducer probe.

Display

The display is a computer monitor that shows the processed data from the CPU.
Displays can be black-and-white or colour, depending upon the model of the ultrasound
machine.
Disk Storage

The processed data and/ or images can be stored on disk. The disks can be hard disks,
floppy disks, compact discs (CDs) or digital video discs (DVDs). Typically, a patient's
ultrasound scans are stored on a floppy disk and archived with the patient's medical records.

Printers

Many ultrasound machines have thermal printers that can be used to capture a hard
copy of the image from the display.

WORKING PROCEDURE:

 During sonography, the doctor will place a transducer (USG probe) directly on the
skin or inside a body opening (vagina or rectum).
A thin layer of gel is applied to the skin directly above the organ to be scanned.
Ultrasound waves are transmitted from the transducer through the gel into the
body.
 These short bursts of sound energy hit the desired organs and return to the probe as an
echo. The probe diverts them to a biometer present in the system.
 The biometer converts the sound wave data into organ images.
 The image formed depends upon the echoes received and time taken for the sound to
be reflected. In a diseased organ, the echoes reflected are different compared with
those in a healthy organ. Therefore, the image formed is different.

These images can provide valuable information for diagnosing and treating various
diseases and conditions. A special three-dimensional (3D) ultrasound used in pregnancy can
show us some of the facial features of the child inside the
 uterus. Fingers and toes of the foetus may be visible on this kind of scan. The four-
dimensional ultrasound is a 3D ultrasound in motion.

The sonography commonly used in the medical practice uses the B-mode and M-mode
type of imaging. These techniques operate at sound wave frequencies that do not produce
heat energy in the organ due to probe vibrations.

ADVANTAGES:

 The sonography is a non-invasive technique yet a highly accurate scan to view insides
of the body.
 Ultrasound images are captured in real time. They can show the movement of the
body’s internal organs, foetus, and blood flow through the blood vessels.
 Unlike X-ray imaging, there is no ionizing radiation exposure associated with
ultrasound imaging. Hence, it can be used safely in pregnancy.
 Ultrasound can be used in cases where remote diagnosis or teleconsultations are the
only option.
 It can be performed as a bedside investigation.

DISADVANTAGES:

Ultrasound waves can heat up the tissues slightly. In some cases, it can also produce
cavitation (small pockets of gas in the body fluids or tissues). The long- term consequences of
these effects are still unknown.

A USG cannot be used in organs with large amount of air, for example, for the lungs or
a gassy intestine.

Philips HD-11 Digital Ultrasound Machine

The HDII System is a general-purpose, mobile, software-controlled, diagnostic ultrasound
system. Its function is to acquire, process, and display ultrasound data. The HDII system
builds on the Envise architecture and feature set with added
 channels and new software and hardware features. The appearance of the HDII reflects the
Phillips standard colour scheme.
The operator can measure anatomical structures and generate reports for health-care
professionals. The system has a basic set of imaging models and measurement tools.

APPLICATIONS:
The following applications are available on the HD II system:

 Abdominal
 Cardiac
 Gynaecological
 Intraoperative
 Musculoskeletal
 Neonatal Head
 Obstetrical
 Paediatric
 Small Parts
 Transcranial
 Transoesophageal
 Vascular

MODALITIES:
The following imaging modalities are available on the HD II system. Refer to the user
documentation for detailed feature information regarding these modes:

 2D
 M-Mode
 3D/4D
 PW Doppler
 CW Doppler
 Colour Flow
 Colour Power Angio

Physical Description
The HD II physical structure is made of fabricated sheet metal and folded plastic
parts. The system consists of a cart, a user interface (control panel), a visual display (video
monitor), and the ultrasound electronic components. The major ultrasound components are
the PC, the E-box, and the system power supply.
USES:

Ultrasound has been used in a variety of clinical settings, including obstetrics and
gynaecology, cardiology and cancer detection. The main advantage of ultrasound is that
certain structures can be observed without using radiation. Ultrasound can also be done much
faster than X-rays or other radiographic techniques. Here is a short list of some uses for
ultrasound:

 Obstetrics and Gynaecology

 measuring the size of the foetus to determine the due date
 determining the position of the foetus to see if it is in the normal head down
position or breech
 checking the position of the placenta to see if it is improperly developing
over the opening to the uterus (cervix)
 seeing the number of foetuses in the uterus
 checking the sex of the baby (if the genital area can be clearly seen)
 checking the foetus’s growth rate by making many measurements over time
 detecting ectopic pregnancy, the life-threatening situation in which the baby is
implanted in the mother's Fallopian tubes instead of in the uterus
 determining whether there is an appropriate amount of amniotic fluid
cushioning the baby
 monitoring the baby during specialized procedures - ultrasound has been
helpful in seeing and avoiding the baby during amniocentesis (sampling of
the amniotic fluid with a needle for genetic testing). Years ago, doctors use
to perform this procedure blindly; however, with accompanying use of
ultrasound, the risks of this procedure have dropped dramatically.
 seeing tumours of the ovary and breast
 Cardiology
 seeing
the inside of the heart to identify abnormal structures or functions
 measuring blood flow through the heart and major blood vessels
  Urology
 measuring blood flow through the kidney
 seeing kidney stones
 detecting prostate cancer early

CONCLUSION:

As with other computer technology, ultrasound machines will most likely get faster
and have more memory for storing data. Transducer probes may get smaller, and more
insertable probes will be developed to get better images of internal organs. Most likely, 3D
ultrasound will be more highly developed and become more popular. The entire ultrasound
machine will probably get smaller, perhaps even hand-held for use in the field (e.g.,
paramedics, battlefield triage). One exciting new area of research is the development of
ultrasound imaging combined with heads-up/virtual reality-type displays that will allow a
doctor to "see" inside you as he/she is performing a minimally invasive or non-invasive
procedure such as amniocentesis or biopsy.
 1.1 PET (POSITRON EMISSION TOMOGRAPHY):

INTRODUCTION

A positron emission tomography (PET) scan is an imaging test that allows your
doctor to check for diseases in your body.The scan uses a special dye containing radioactive
tracers. These tracers are either swallowed, inhaled, or injected into a vein in your arm
depending on what part of the body is being examined. Certain organs and tissues then
absorb the tracer.When detected by a PET scanner, the tracers help your doctor to see how
well your organs and tissues are working. The PET scan can measure blood flow, oxygen
use, how your body uses sugar, and much more. A PET scan is typically an outpatient
procedure.
HISTORY
HISTORY

The concept of emission and transmission tomography was introduced by David E.

Kuhl, Luke Chapman and Roy Edwards in the late 1950s. Their work later led to the design
and construction of several tomographic instruments at the University of Pennsylvania. In
1975 tomographic imaging techniques were further developed by Michel Ter-Pogossian,
Michael E. Phelps, Edward J. Hoffman and others at Washington University School of
Medicine.
Work by Gordon Brownell, Charles Burnham and their associates at the
Massachusetts General Hospital beginning in the 1950s contributed
significantly to the development of PET technology and included the first demonstration of
annihilation radiation for medical imaging. Their innovations, including the use of light pipes
and volumetric analysis, have been important in the deployment of PET imaging. In 1961,
James Robertson and his associates at Brookhaven National Laboratory built the first single-
plane PET scan, nicknamed the "head-shrinker.
ROLE OF THE MACHINE

In general, PET scans may be used to evaluate organs and/or tissues for the presence of
disease or other conditions. PET may also be used to evaluate the function of organs, such
as the heart or brain. The most common use of PET is in the detection of cancer and the
evaluation of cancer treatment.

To diagnose dementias (conditions that involve deterioration of mental function), such as

Alzheimer's disease, as well as other neurological conditions. To locate the specific surgical
site prior to surgical procedures of the brain. To evaluate the brain after trauma to detect
hematoma (blood clot), bleeding, and/or perfusion (blood and oxygen flow) of the brain
tissue. To detect the spread of cancer to other parts of the body from the original cancer site.
To evaluate the effectiveness of cancer treatment.

To evaluate the perfusion (blood flow) to the myocardium (heart muscle) as an aid in
determining the usefulness of a therapeutic procedure to improve blood flow to the
myocardium. To further identify lung lesions or masses detected on chest X-ray and/or chest
CT. To assist in the management and treatment of lung cancer by staging lesions and
following the progress of lesions after treatment. To detect recurrence of tumors earlier than
with other diagnostic modalities.
BLOCK DIAGRAM
 WORKING & OUTPUT

PET works by using a scanning device (a machine with a large hole at its center) to
detect photons (subatomic particles) emitted by a radionuclide in the organ or tissue being
examined. The radionuclides used in PET scans are made by attaching a radioactive atom to
chemical substances that are used naturally by the particular organ or tissue during its
metabolic process.

Main system components are:

1. Scanner Gantry

 Detector
 Septa
 Coincidence Circuit

2. Table
3. Computer
4. Cyclotron
DETECTOR

- Comprised of an 8 x 8 scintillation, inorganic crystals which emits light

photons after the interaction of photons.

- 4 photomultiplier tubes (PMTs)arranged in a circular pattern around the patient.

SEPTA

- Lead or tungsten circular shield mounted between the detector rings

-Limits scattered radiation from the object reaching the detector(scattered out the
transverse plane).
COINCIDENCE CIRCUIT

-Specific electronic circuits "coincidence" circuits pick up gamma pairs due to

the two gamma rays emitted during the positrons annihilation almost simultaneously.

-This coincidence is a very strong signature that distinguishes them from other
photons.

- On the image it is requested that the signals coming from the scintillators A and B
coincide within 12 billionths of a second.

CYCLOTRON

A machine used to produce the radioisotopes (radioactive chemical elements)

which are used to synthesize the radiopharmaceuticals.

The most frequently used radioisotopes in PET are:

Carbon-11

Nitrogen-13

Oxygen-15

Fluorine-18
TABLE

The bed is capable of moving in and out of the scanner to measure the distribution of
PET radiopharmaceuticals throughout the body,and it adjusts to a very low position for easy
patient access.

COMPUTER

A computer analyzes the gamma rays and uses the information to create an image
map of the organ or tissue being studied.

APPLICATION IN BIOMEDICAL FIELD

PET is used in Following areas:

 Neuro imaging

 Clinical oncology(Medical imaging of tumours)

 Cardiology
 Pharmacology

COMPLICATIONS

A PET scan is painless and poses few risks. The scanner itself does not emit
radiation, and the amount of radiotracer used for the imaging is so small as to not require the
use of standard radiation precautions.

Since the radiotracer is essentially glucose with a radioactive isotope attached, the drug
half-life is extremely short. Some of the agents have a half-life as short as two minutes (such
as oxygen-15), while others may be active for up to two hours (such as with FDG). In most
cases, the drug will be in and out of your system within a day. While the injection itself may
cause localized pain and swelling, allergic reactions are rare, and there are no outright
contraindications to the procedure, including pregnancy.

The only other concern and, in some ways, the most significant is the risk of claustrophobia.
If being placed inside the tube-like device makes you nervous, let your healthcare provider
know in advance. In extreme cases, the healthcare provider may prescribe a mild sedative,
such as low-dose Valium (diazepam) or Ativan (lorazepam), to help reduce anxiety.
SAFETY MECHANISM

 Please let us know if you have any allergies or adverse reactions to

medications.
 If you are pregnant or may be pregnant, please tell your doctor or
technologist.
 Please leave your valuables at home or in your room in the hospital.
 Please let us now if you need interpreting services, this can be arranged for you.
 Bring a list of your current medications with you (out-patient).

CONCLUSION

Conclusion from the various studies - PET is inadequate modality forassessing

the tumor depth. PET cannot distinguish carcinoma in situ from invasive disease. Also
false +ve results may occur d/t chemo,
radiation inducedesophagitis, candidiasis. EUS is a better modality depth assessment
90% sens, 99% specific, but it may not able to pass stenotic tumors - PET-CT may be
usefulhere.
 1.2 MAGNETIC RESONANCE IMAGING (MRI)

DEFINITION:

Magnetic resonance imaging (MRI) is a medical imaging technique used

in radiology to form pictures of the anatomy and the physiological processes of the body.
MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to
generate images of the organs in the body. MRI does not involve X-rays or the use of
ionizing radiation, which distinguishes it
from CT and PET scans. MRI is a medical application of nuclear magnetic resonance (NMR)
which can also be used for imaging in other NMR applications, such as NMR spectroscopy.
MRI is widely used in hospitals and clinics for medical diagnosis, staging and follow-up of
disease. Compared to CT, MRI provides better contrast in images of soft-tissues, e.g. in the
brain or abdomen. However, it may be perceived as less comfortable by patients, due to the
usually longer and louder measurements with the subject in a long, confining tube.
Additionally, implants and other non- removable metal in the body can pose a risk and may
exclude some patients from undergoing an MRI examination safely.
INTRODUCTION:
MRI was originally called NMRI (nuclear magnetic resonance imaging), but "nuclear" was
dropped to avoid negative associations. Certain atomic nuclei are able to absorb radio
frequency energy when placed in an external magnetic field; the resultant evolving spin
polarization can induce a RF signal in a radio frequency coil and thereby be detected. [2] In
clinical and research
MRI, hydrogen atoms are most often used to generate a macroscopic polarization that is
detected by antennae close to the subject being examined. Hydrogen atoms are naturally
abundant in humans and other
biological organisms, particularly in water and fat. For this reason, most MRI scans
essentially map the location of water and fat in the body. Pulses of radio waves excite the
nuclear spin energy transition, and magnetic field gradients localize the polarization in space.
By varying the parameters of the pulse sequence, different contrasts may be generated
between tissues based on
the relaxation properties of the hydrogen atoms therein.
CONSTRUCTION AND PHYSICS:

In most medical applications, hydrogen nuclei, which consist solely of a proton, that are in
tissues create a signal that is processed to form an image of the body in terms of the density
of those nuclei in a specific region. Given that the protons are affected by fields from other
atoms to which they are bonded, it is possible to separate responses from hydrogen in
specific compounds. To perform a study, the person is positioned within an MRI scanner that
forms a strong magnetic field around the area to be imaged. First, energy from
an oscillating magnetic field is temporarily applied to the patient at the appropriate resonance
frequency. Scanning with X and Y gradient coils causes a selected region of the patient to
experience the exact magnetic field required for the energy to be absorbed. The excited
atoms emit a radio frequency (RF) signal, which is measured by a receiving coil. The RF
signal may be processed to deduce position information by looking at the changes in RF level
and phase caused by varying the local magnetic field using gradient coils. As these coils are
rapidly switched during the excitation and response to perform a moving line scan, they
create the characteristic repetitive noise of an MRI scan as the windings move slightly due to
magnetostriction. The contrast between different tissues is determined by the rate at which
excited atoms return to
the equilibrium state. Exogenous contrast agents may be given to the person to make the
image clearer.

DIAGNOSTIC METHODS:

USAGE BY ORGAN OR SYSTEM:

MRI has a wide range of applications in medical diagnosis and more than 25,000 scanners
are estimated to be in use worldwide. MRI affects diagnosis and treatment in many
specialties although the effect on improved health outcomes is disputed in certain cases.
MRI is the investigation of choice in the
preoperative staging of rectal and prostate cancer and has a role in the diagnosis, staging, and
follow-up of other tumors, as well as for determining areas of tissue for sampling in
biobanking.
NEUROIMAGING:

MRI is the investigative tool of choice for neurological cancers over CT, as it offers better
visualization of the posterior cranial fossa, containing
the brainstem and the cerebellum. The contrast provided
between grey and white matter makes MRI the best choice for many conditions of the central
nervous system, including demyelinating
diseases, dementia, cerebrovascular disease, infectious diseases, Alzheimer's disease and
epilepsy. Since many images are taken milliseconds apart, it shows how the brain responds to
different stimuli, enabling researchers to study both the functional and structural brain
abnormalities in psychological disorders.
MRI also is used in guided stereotactic surgery and radiosurgery for treatment of
intracranial tumors, arteriovenous malformations, and other surgically treatable conditions
using a device known as the N-localizer.

CARDIOVASCULAR:
Cardiac MRI is complementary to other imaging techniques, such
as echocardiography, cardiac CT, and nuclear medicine. It can be used to assess the structure
and the function of the heart. Its applications include assessment of myocardial ischemia
and viability, cardiomyopathies, myocarditis, iron overload, vascular diseases, and
congenital heart disease.

MUSCULOSKELETAL:
Applications in the musculoskeletal system include spinal imaging, assessment of joint
disease, and soft tissue tumors. Also, MRI techniques can be used for diagnostic imaging of
systemic muscle diseases including genetic muscle diseases.
LIVER AND GASTRO INTESTINAL:
Hepatobiliary MR is used to detect and characterize lesions of
the liver, pancreas, and bile ducts. Focal or diffuse disorders of the liver may be evaluated
using diffusion-weighted, opposed-phase imaging and dynamic contrast enhancement
sequences. Extracellular contrast agents are used widely in liver MRI, and newer
hepatobiliary contrast agents also provide the opportunity to perform functional biliary
imaging. Anatomical imaging of the bile ducts is achieved by using a heavily T2-weighted
sequence in magnetic resonance cholangiopancreatography (MRCP). Functional imaging of
the pancreas is performed following administration of secretin. MR enterography provides
non-invasive assessment of inflammatory bowel disease and small bowel tumors. MR-
colonography may play a role in the detection of large polyps in patients at increased risk of
colorectal cancer.
ANGIOGRAPHY:

Magnetic resonance angiography (MRA) generates pictures of the arteries to evaluate them
for stenosis (abnormal narrowing) or aneurysms (vessel wall dilatations, at risk of rupture).
MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal
aorta, the renal arteries, and the legs (called a "run-off"). A variety of techniques can be used
to generate the pictures, such as administration of a paramagnetic contrast agent (gadolinium)
or using a technique known as "flow-related enhancement" (e.g., 2D and 3D time-of-flight
sequences), where most of the signal on an image is due to blood that recently moved into
that plane (see also FLASH MRI).

THREE TYPES OF MRI MACHINES

1. EXTREMITY MRI: This is a diagnostic imaging procedure that uses a closed MRI
machine to look at the tissues in the arms and legs. Unlike a traditional MRI
procedure that uses a large tube-shaped device, an extremity MRI uses a smaller
scanner designed specifically for the body's
 extremities. This eliminates the potential for claustrophobia, which some patients
experience when enclosed in a full-body MRI machine. A traditional MRI requires
you to lie completely still, but an extremity MRI won't limit your body movements
quite as much. One may undergo an extremity MRI to diagnose any of the following
conditions in the arms, legs, hands, and feet:
o Arthritis
o Fractures
o Bone infections
o Tumors of the bone or soft tissue
o Nerve-related issues
o Stress injuries or injuries related to torsion or heavy impact

2. OPEN MRI: Open MRI machines also stray from the traditional design of the full-
body MRI, which makes some patients feel anxious due to the "closed-in" nature of
the machine. An open MRI is open on the sides or features wider openings, still
requiring the patient to lie on a sliding table. Although an Open MRI offers increased
comfortability for patients suffering from anxiety or claustrophobia, it comes at the
cost of producing less detailed images than its closed MRI counterparts because the
open nature of the machine does not provide as strong of a magnetic field.

3. 3 TESLA MRI: This type of closed MRI uses magnetic fields that have double the
strength of a traditional MRI machine, thus producing an even more detailed image
in less time. It is commonly used to identify the signs of stroke, tumors, or aneurysms
in the brain; to examine the heart and circulatory system for damage resulting from a
heart attack or heart disease, or blockages in the blood vessels; to look for conditions
such as arthritis, disc disease, or bone infections in the bones and joints; or to analyze
the state of internal organs like the liver, kidneys, uterus, ovaries, or prostate.

CONCLUSION:
Medical societies issue guidelines for when physicians should use MRI on patients and
recommend against overuse. MRI can detect health problems or confirm a diagnosis, but
medical societies often recommend that MRI not be the first procedure for creating a plan to
diagnose or manage a patient's complaint. A common case is to use MRI to seek a cause of
low back pain; the American College of Physicians, for example, recommends against this
procedure as unlikely to result in a positive outcome for the patient.
3.6.C- Arm X-ray Machine

INTRODUCTION:
A C-arm is an imaging scanner intensifier. The name derives from the C- shaped arm
used to connect the x-ray source and x-ray detector to one another. C-arms have radiographic
capabilities, though they are used primarily for fluoroscopic intraoperative imaging during
surgical, orthopaedic and emergency care procedures.

The devices provide high-resolution X-ray images in real time, thus allowing the
Physician to monitor progress and immediately make any corrections.
History:

The C-arm was introduced in 1955 and the technology is rapidly changing each year. Today,
mobile imaging systems are an crucial part of everyday life.
Specialists in fields Such as surgery, orthopedics, traumatology, vascular surgery and
cardiology use c-arms for imaging during normal procedures.

The devices provide high-resolution x-ray images immediately, allowing the physician To
monitor progress at any point and can make any immediate corrections.

Hospitals, surgical centres, and clinics benefit from cost savings through fewer Follow-up
operations due to this preventative measure
Role of C -Arm :

C-arm machine is a piece of medical imaging equipment that operates on the basic principle
Of X-ray technology.

➔ This fluoroscopy device is used to visualise patient’s anatomy in the operating

room during Surgery.

➔ This is different from most other X-ray equipment that is used for
diagnostics and therefore Generates revenue.

➔ For example: CT scanners, Rad rooms, R/F rooms, or Cath Labs.

Block Diagram
 Working principle :

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.

Components Required:

★X-ray generator

★Imaging System
X Ray Generator:
★Workstation unit
X-ray generator is a device that produces X-rays.
Together with an X-ray detector, it is commonly used In a variety of applications including
medicine, X-ray Fluorescence, electronic assembly inspection, and Measurement of material
thickness in Manufacturing operations.
In medical applications, X-ray generators are used By radiographers to acquire x-ray
images of the Internal structures (e.g., bones) of living organisms, And also in sterilization
Imaging systems :

Imaging allows organizations to capture Paper-based information

and convert it To electronic images that are stored in a Computer electronically.

These technologies enable users to index Or enter “metadata” into the system and Always
utilize some form of storage Technology to save the digital version of the document
Workstation Unit :

The workstation unit is the platform that provides

Extensive customization options for a C-Arm System.
Examples of model-specific stock control features Include various handles for movement
and Positioning, power switches, exposure switches, Cable hangers, brake pedals, controls
for Radiographic and fluoroscopic settings, Interconnect cables, mechanical, optical or
Non-volatile electronic storage drives, optical disk Writers, PACS hardware, and advanced
image Quality enhancement processors capable of noise reduction and zoom control
Safety measures :

➔ Talk to your patient about the radiation risks

➔ Try to reduce the amount of radiation exposure

➔ Adjust distance

➔ Shorten the fluoro times

➔ Unauthorized personnel should not be in the room during

the fluoroscopy

➔ Analyse original radiographs before performing the

fluoroscopic examination

➔ Stand on the image intensifier side of the C-Arm when

performing the procedure

➔ Be sure to step away from the patient during the

fluoroscopy

➔ Shield yourself as much as possible

➔ Install structural shielding to reduce radiation

Application :

C-Arm machines are widely used in:

➔ Orthopaedic

➔ Complicated surgical

➔ Pain management (Anaesthetics)

➔ Emergency procedures

Conclusion :

C-A RM is a new technique for 3D volume imaging guidance

of Interventional procedures of the spine and blood vessels with the Capability to produce
near real time high resolution Image reconstructions in any plane
 3.7 GAMMA CAMERA

1. Introduction

A gamma camera, also called a scintillation camera or Anger camera, is a device 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.
The emission of a single gamma ray is a very small-scale nuclear phenomenon. It is the role
of the gamma-camera head to amplify this microscopic radiation into an electric signal that
can be detected and measured. By exploiting a large number of readings of these electric
signals, one can determine the map of the radioactive nuclei responsible for the emission of
gamma rays.
The light photons emitted by the crystal are detected by hexagonal-shaped (sometimes
square) photomultiplier tubes (PMTs), which are closely coupled to the scintillation crystal
via light pipes. Arrays of 61, 75, or 91 PMTs, each with a diameter between 25 and 30 mm,
are typically used. The output currents of the PMTs pass through a series of low-noise
preamplifiers and are digitized.
The PMTs situated closest to a particular scintillation event produce the largest output
current. By comparing the magnitudes of the currents from all PMTs, the location of
individual scintillations within the crystal can be estimated using an Anger logic circuit.
2. History

The gamma camera was invented and constructed by H. Anger in 1957, improvements being
made from 1958 to 1963. Gamma cameras are being commercially produced and sold since
1962; about ten years later they become widely used, and soon they pushed out the scanner
from visual diagnostics.
COMPUTER: Its use in scintigraphic diagnostics started in 1964 (H. Shepers, D. Wincler,
D. Brown). From 1965 to 1974 various centers developed their own computer programs;
after 1974 computers with incorporated nuclear medicine software packages became
commercially available.

3. Role
The ultimate role of gamma camera is to produce functional scans of the brain, lungs,
thyroid, liver, skeleton, gallbladder and kidneys.
Types of scans involved using gamma camera are :

• Renal scintigraphy
• Lung scintigraphy
• Bone scintigraphy
• Thyroid scintigraphy
• Parathyroid scintigraphy etc..
4. Block Diagram
 5. Working and Output

The imaging process begins when a radiopharmaceutical is administered to a patient, usually

in one of three ways – ingestion, injection or inhalation.
Generally, the injection will be into the elbow or hand (like a blood test), but this may vary
according to the test. The delay following the injection is to give the drug time to get to
where it needs to go in the body (i.e. lung, bone, kidney, heart). The most commonly used
tracer is technetium – 99m, a metastable nuclear isomer chosen for its relatively long half-
life of six hours and its ability to be incorporated into variety of molecules in order to target
different systems within the body. As it travels through the body and emits radiation, its
progress is tracked.

Basic working of Gamma Camera

Once the patient is injected, they are placed onto the gamma camera bed where they are
acquisitioned under the detector for imaging (picture 1).
Picture 1. Gamma camera bed

A gamma camera detector is composed of a collimator, scintillation crystals, a light guide,

photomultiplier tubes (PMT) and preamplifiers (picture 2).
The acquisition process begins when the gamma rays emitted from the patient interact with
the detector collimator. The collimator consists of a thick sheet of lead, typically 25 to 75
millimetres (1 to 3 in) thick, with thousands of adjacent holes through it. They are used as
physical discriminators, only allowing the desired gamma rays to enter the detector. Unlike a
lens, as used in visible light cameras, the collimator attenuates most (>99%) of incident
photons and thus greatly limits the sensitivity of the camera system. Large amounts of
radiation must be present so as to provide enough exposure for the camera system to detect
sufficient scintillation dots to form a picture. To achieve the propagation, the collimator septa
are composed of lead or tungsten to eliminate any undesirable rays. It is important to ensure
no scatter radiation precedes to scintillation crystals, as this can decrease image quality. The
thickness and length of septa varies depending on the type of radiopharmaceutical being
clinically used.
Picture 2. Composition of the gamma camera

After the gamma rays have travelled through the collimator, they interact with the cameras
scintillation crystals.
These crystals are commonly made from sodium iodide (NaI). The crystal thickness should
be approximately 13 mm, to ensure image degradation does not occur when the crystals are
too thick and to prevent poor detection efficiency of gamma rays caused when the crystals
are too thin. Their shape is hexagonal, so they could be positioned to one another, ensuring
there are no gaps and all surfaces are covered.
Scintillation crystals convert the gamma rays to visible light, which is then directed through
a light guide to a photomultiplier tube. The purpose of the light guide is to direct the light to
each PMT to increase the efficiency of the light collection and imaging.
Photomultiplier tubes, also known as PMTs, are stimulated to produce an electrical current
pulse when light signals interact with the photocathode. The photocathode is comprised of a
photo emissive substance that expels an electron when hit by a photon. This expelled
electron becomes known as a photo electron and passes through a focusing grid which
directs it to dynodes. The dynodes are positively charged materials that attract the
photoelectron. As the photoelectron moves from dynode to dynode, the electron is
multiplied until it reaches the anode. The amount of signal amplification is between 3 to 6
times the initial input for each PMT (picture 3). Preamplifiers are also another way to
increase signal output.
Picture 3. PMT process

From this point, the PMT will direct the signal to the system electronics. The signal is
transferred digitally or electronically to a position circuit or energy circuit.
The more modern gamma cameras operate through an Analog-to-Digital Converter system
(or ADC). This means that the PMT output is directly digitalized through the system. These
ADC systems are able to extract the position and energy data simultaneously. This approach
improves errors caused by noise and pulse distortion.
The final step to the image acquisition process comes once the images are generated on a
computer monitor where they can be constructed and altered.
6. Types and their applications

There are two types of gamma camera 1. SPECT and 2. PET

They form 3-dimensional images, and are therefore classified as separate techniques to
scintigraphy, although they also use gamma cameras to detect internal radiation. Scintigraphy
is unlike a diagnostic X-ray where external radiation is passed through the body to form an
image.

6.1 PET scan

The positron emission tomography (PET) scan (picture 4) creates computerized images of
chemical changes, such as sugar metabolism, that take place in tissue. Typically, the patient is
given an injection of a substance that consists of a combination of a sugar and a small amount
of radioactively labelled sugar. The radioactive sugar can help in locating a tumour, because
cancer cells take up or absorb sugar more avidly than other tissues in the body.
After receiving the radioactive sugar, the patient lies still for about 60 minutes while the
radioactively labelled sugar circulates throughout the body. If a tumour is present, the
radioactive sugar will accumulate in the tumour. The patient then lies on a table, which
gradually moves through the PET scanner 6 to 7 times during a 45-60-minute period. The
PET scanner is used to detect the distribution of the sugar in the tumour and in the body. By
the combined matching of a CT scan with PET images, there is an improved capacity to
discriminate normal from abnormal tissues. A computer translates this information into the
images that are interpreted by a radiologist.
PET scans may play a role in determining whether a mass is cancerous. However, PET
scans are more accurate in detecting larger and more aggressive tumours than they are in
locating tumours that are smaller than 8 mm and/or less aggressive. They may also detect
cancer when other imaging techniques show normal results. PET scans may be helpful in
evaluating and staging recurrent disease (cancer that has come back). PET scans are
beginning to be used to check if a treatment is working - if a tumour cells are dying and thus
using less sugar.
 6.2 SPECT scan

Similar to PET, single photon emission computed tomography (SPECT) uses radioactive
tracers and a scanner to record data that a computer constructs into two- or three-
dimensional images (picture 5). A small amount of a radioactive drug is injected into a
vein and a scanner is used to make detailed images of areas inside the body where the
radioactive material is taken up by the cells.
SPECT can give information about blood flow to tissues and chemical reactions (metabolism)
in the body.
In this procedure, antibodies (proteins that recognize and stick to tumour cells) can be linked
to a radioactive substance. If a tumour is present, the antibodies will stick to it. Then a
SPECT scan can be done to detect the radioactive substance and reveal where the tumour is
located.

Picture 4. PET scan in cancer treatment Picture 5.

Scanning brain activity with SPECT
7. Conclusion

Gamma The gamma camera has a limited field of view. Nowadays it is often a rectangular
field of view of about 40 by 55 cm. To be able to record the distribution of activity in an
entire patient in a single image, the detector can be moved in one or more tracks along the
patient’s axis. During this movement, an electronic picture is built up. Older cameras may
have a narrower field of view requiring image construction from multiple tracks.

Most often a parallel collimator which allows for constant spatial resolution and sensitivity
for the entire scan area is used. However, there are also gamma cameras with a collimator
divergent perpendicular to the direction of movement. This enlarges the field of view so a
single track is usually sufficient to depict the entire width of the patient. Spatial resolution
and sensitivity in a divergent collimator depend on the position within the field of view.
Assessment of such images requires the necessary caution and a quality protocol adapted to
the specific camera.
3.8 MAMMOGRAM

INTRODUCTION:
A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look
for early signs of breast cancer. Regular mammograms are the best tests doctors have
to find breast cancer early, sometimes up to three years before it can be felt.
Three recent advances in mammography include digital mammography, computer-
aided detection and breast tomosynthesis :
Digital mammography:
It also called full-field digital mammography (FFDM), is a mammography system
in which the x-ray film is replaced by electronics that convert x-rays into mammographic
pictures of the breast. These systems are similar to those found in digital cameras and their
efficiency enables better pictures with a lower radiation dose. These images of the breast
are transferred to a computer for review by the radiologist and for long term storage. The
patient's experience during a digital mammogram is similar to having a conventional film
mammogram.

Computer-aided detection (CAD):

The systems search digitized mammographic images for abnormal areas of density,
mass, or calcification that may indicate the presence of cancer. The CAD system highlights
these areas on the images, alerting the radiologist to carefully assess this area.

Breast tomosynthesis:
Is also called three-dimensional (3-D) mammography and digital breast tomosynthesis
(DBT), is an advanced form of breast imaging where multiple images of the breast from
different angles are captured and reconstructed ("synthesized") into a three-dimensional
image set. In this way, 3-D breast imaging is similar to computed tomography (CT) imaging
in which a series of thin "slices" are assembled together to create a 3-D reconstruction of the
body.
TYPES OF MAMMOGRAM:

 Screening mammogram : A screening mammogram is an X-ray of the breast used

to detect breast changes in women who have no signs symptoms of breast cancer. It
usually involves 2 X-rays of each breast. Using a mammogram, it is possible to
detect a tumor that cannot be felt.
 Diagnostic mammogram: A diagnostic mammogram is an X-ray of the breast used
to diagnose unusual breast changes, such as a lump, pain, nipple thickening or
discharge, or a change in breast size or shape. A diagnostic mammogram is also
used to evaluate abnormalities detected on a screening mammogram. It is a basic
medical tool and is appropriate in the workup of breast changes, regardless of a
woman's age.

HISTORY:
The History of mammography began in 1913, when a Berliner surgeon, A. Salomon realized
a roentgeno-histological study on 3,000 mastectomies. This work is the basis of
mammography. Until 1938, few articles were published but were of little help to
mammography. From 1947 to 1970, the second period brought the results of roentgenologic
and clinical correlation. R. Leborgne was the first accountable for the wide development of
this method. Since 1951, many American and European radiologists brought their
contribution. Ch. Gros is the best known. He gave this technique an acknowledgment
throughout the world for the diagnosis of breast diseases. Since 1970, the third period
emphasizes the value of mammography as a technique for detection of breast cancer. Some
"Screening working groups" are being set up. The problem is mainly economical.

PATIENT PREPARATIONS:

SCHEDULING : Breasts can be tender the week before and during menstruation, so try to
schedule your mammogram for one to two weeks after your period starts.If you have breast
implants, please notify the office when you schedule the exam.

PRECAUTIONS : If you are pregnant or think you may be pregnant, please check with your
doctor before scheduling the exam. Other options will be discussed with you and your doctor.

BREASTFEEDING : Please notify the technologist if you are currently breast- feeding.

PERSONAL HYGIENE : Do not use any deodorant, powder, lotion or perfume on the day
of your exam.

CLOTHING : You must remove your clothing from the waist up and change into a patient
gown. A locker will be provided to secure your personal belongings. Please remove all
piercings and leave all jewelry and valuables at home.
WORKING AND OUTPUT:
X- rays are a form of radiation like light or radio waves. X-rays pass through most objects,
including the body. The technologist carefully aims the x-ray beam at the area of interest.
The machine produces a small burst of radiation that passes through your body. The
radiation records an image on photographic film or a special detector.Different parts of the
body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while
soft tissue (muscle, fat, and organs) allow more of the x-rays to pass through them. As a
result, bones appear white on the x-ray, soft tissue shows up in shades of gray, and air
appears black.Most x-ray images are electronically stored digital files. Your doctor can
easily access these stored images to diagnose and manage your condition.In conventional
film and digital mammography, a stationery x-ray tube captures an image from the side and
an image from above the compressed breast. In breast tomosynthesis, the x-ray tube moves
in an arc over the breast, capturing multiple images from different angles.

BLOCK DIAGRAM:
BENEFITS:

 Screening mammography reduces the risk of death due to breast cancer. It is useful
for detecting all types of breast cancer, including invasive ductal and invasive lobular
cancer.
 Screening mammography improves a physician's ability to detect small tumors.
When cancers are small, the woman has more treatment options.
 The use of screening mammography increases the detection of small abnormal
tissue growths confined to the milk ducts in the breast, called ductal carcinoma
in situ (DCIS).
 No radiation stays in your body after an x-ray exam.
 X-rays usually have no side effects in the typical diagnostic range for this exam.

RISKS:

 There is always a slight chance of cancer from excessive exposure to radiation.

However, given the small amount of radiation used in medical imaging, the benefit of
an accurate diagnosis far outweighs the associated risk.
 The radiation dose for this procedure varies. See the Radiation Dose in X- Ray and
CT Exams page for more information about radiation dose.
 False Positive Mammograms. Five percent to 15 percent of screening
mammograms require more testing such as additional mammograms or
ultrasound. Most of these tests turn out to be normal. If there is an
abnormal finding, a follow-up or biopsy may have to be performed. Most of the
biopsies confirm that no cancer was present. It is estimated that a woman who has
yearly mammograms between ages 40 and 49 has about a 30 percent chance of
having a false-positive mammogram at some point in that decade and about a 7
percent to 8 percent chance of having a breast biopsy within the 10-year period.
 Women should always tell their doctor and x-ray technologist if they are pregnant.
See the Safety in X-ray, Interventional Radiology and Nuclear Medicine Procedures
page for more information about pregnancy and x- rays.
CONCLUSION:
Mammography, in conjunction with physical examination, is the method of choice for
early detection of breast cancer. Other methods should not be substituted for
mammography in diagnosis or screening, but may be useful adjuncts in specific
diagnostic situations.
KG HOSPITAL

4.1 Nebulizer

INTRODUCTION :

In medicine,a nebulizer or nebuliser is a drug delivery device used to administer

medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for
the treatment of asthma, cystic fibrosis, COPD and other respiratory diseases or
disorders. They use oxygen, compressed air or ultrasonic power to break up
solutions and suspensions into small aerosol droplets that are inhaled from the
mouthpiece of the device. An aerosol is a mixture of gas and solid or liquid particles.

A nebulizer is a small machine that turns liquid medicine into a mist.

You sit with the machine and breathe in through a connected mouthpiece. Medicine goes into
your lungs as you take slow, deep breaths for 10 to 15 minutes. It is easy and pleasant to
breathe the medicine into your lungs this way.
HISTORY:
 The first "powered" or pressurized inhaler was invented in France by Sales-Girons in
1858.This device used pressure to atomize the liquid medication. The pump handle is
operated like a bicycle pump. When the pump is pulled up, it draws liquid from the
reservoir, and upon the force of the user's hand, the liquid is pressurized through an
atomizer, to be sprayed out for inhalation near the user's mouth.

 In 1864, the first steam-driven nebulizer was invented in Germany. This inhaler,
known as "Siegle's steam spray inhaler", used the Venturi principle to atomize liquid
medication, and this was the very beginning of nebulizer therapy.

 As an alternative to the expensive electrical nebulizer, many people in the 1930s

continued to use the much more simple and cheap hand-driven nebulizer, known as
the Parke-Davis Glaseptic.

 In 1964, a new type of electronic nebulizer was introduced: the "ultrasonic wave
nebulizer".Today the nebulizing technology is not only used for medical purposes.
Ultrasonic wave nebulizers are also used in humidifiers, to spray out water aerosols
to moisten dry air in buildings.
ROLE OF THE MACHINE:

• A nebulizer is a piece of medical equipment that a person with asthma or another

respiratory condition can use to administer medication directly and quickly to the
lungs. A nebulizer turns liquid medicine into a very fine mist that a person can inhale
through a face mask or mouthpiece.

• Doctors typically prescribe nebulizers to people with one of the following lung
disorders:

• asthma
• chronic obstructive pulmonary disease (COPD)
• cystic fibrosis
• bronchiectasis
• Sometimes, a doctor will prescribe a nebulizer for a child who has a respiratory
infection, such as bronchiolitis.

• A nebulizer is a small machine that turns liquid medicine into a mist. You sit with
the machine and breathe in through a connected mouthpiece. Medicine goes into your
lungs as you take slow, deep breaths for 10 to 15 minutes. It is easy and pleasant to
breathe the medicine into your lungs this way.
 BLOCK DIAGRAM:

WORKING:

• His concept was based on the fact that the faster water flows through a tube, the less
the lateral pressure will be. A decreased lateral pressure is also referred to as a
negative side stream pressure. If there is a hole in the side of the tube, the negative
pressure will force water into the stream.

• This same concept was used in creating the first nebulizers. only using air. Air is
forced through a tube, and a hole in the tube is connected to a container with a
solution in it that contains the medication. The fluid is basically sucked in due to the
negative sidewall pressure, and turned into a spray or mist.

Components of Nebulizer :

 Compressor.
 Nebuliser chamber.
 Mouthpiece or face mas
COMPRESSOR:

A power source that compresses room air which then breaks the liquid
medication into tiny droplets (an aerosol) which can be breathed in.

Nebuliser chamber:
A plastic cylinder which holds the medication and is attached to the compressor by a
plastic tube.
Mouthpiece or face mask:

Attaches to the nebuliser chamber and is placed on the face or between the teeth
allowing the medication to be breathed into the lungs.

TYPES OF NEBULIZER:

There are three main types of nebulizers:

• Jet. This uses compressed gas to make an aerosol (tiny particles of

medication in the air).

• Ultrasonic. This makes an aerosol through high-frequency vibrations. The

particles are larger than with a jet nebulizer.

• Mesh. Liquid passes through a very fine mesh to form the aerosol.
This kind of nebulizer puts out the smallest particles. It’s also the most expensive.

1. Jet nebulizer:
• A jet nebulizer is a machine that turns certain liquid medicines into a fine mist that
your child simply breathes in through a face mask or mouthpiece. And it delivers the
medicine straight to your child's lungs, where it is needed.
• Jet nebulisers use compressed air or oxygen passing through a narrow orifice at 6–8
L/minute to suck drug solution from a reservoir into a feed tube. There are fine
ligaments in this tube, and the impact of the solution on these ligaments generates
droplets (Venturi principle). Baffles trap the larger droplets.

2. Ultrasonic nebulizer:

• An Ultrasonic nebulizer is a device that uses ultrasonic waves to provide medication

to patients in the form of a mist, which is inhaled into lungs. It is commonly used for
patients with respiratory diseases, and it creates the mist by vibrating a metal plate at
ultrasonic frequencies.

• The principle of an ultrasonic nebulizer is based on the vibrations of a piezoelectric

crystal driven by an alternating electrical field. These periodic vibrations are
characterized by their frequency, their amplitude, and their intensity, which
corresponds to the energy transmitted per surface unit.
3. Mess Nebulizer:
• Mesh nebulizers are the newest innovation of nebulizer product to the market. They
use a mesh cap with tiny holes to help dispense medication into consistent particle
sizes that can be easily and comfortably inhaled.

• Active mesh nebulizers use the vibration of a piezo element to vibrate a mesh
substrate that is in contact with a fluid reservoir so that the movement of the mesh
pushes the liquid through the holes in the mesh.

APPLICATION IN BIOMEDICAL FIELD:

• Nebulizers are commonly used for the treatment of asthma, cystic fibrosis, COPD
and other respiratory diseases or disorders. They use oxygen, compressed air or
ultrasonic power to break up solutions and suspensions into small aerosol droplets that
are inhaled from the mouthpiece of the device.

COMPLICATIONS:

• The most common side effects of nebulizer treatment are rapid heartbeat, jitteriness
and anxiety. Less frequent side effects may include headache, nausea, vomiting or
throat irritation. Serious reactions to nebulizer treatment are also possible and should
be immediately reported to the prescribing physician.
Safety mechanism:

Following these safety guidelines will help reduce possible risks. Refer to the manufacturer
website if you would like further information about your equipment.

• Carefully use the medicine as directed by your healthcare provider.

• Always unplug the device immediately after using.

• To reduce the risk of electrical shock, do not place the compressor in or near liquids.

• Keep it clean. Make sure to wash your hands well and often and clean your nebulizer as
directed

CONCLUSION:

Continuous nebulization therapy is an important means of treating patients with

severe asthma. Dosage criteria can be established based on the operating characteristics of the
nebulizer system, drug solution concentration, and patient respiration.
4.2-DEFIBRILLATOR

INTRODUCTION:
Defibrillation is a process in which an electronic device sends an electric shock to the
heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart
rhythm.
Defibrillation is a common treatment for life threatening cardiac dysrhythmias,
ventricular fibrillation, and pulse less ventricular tachycardia.
The equipment using for the defibrillation process is called ‘DEFIBRILLATOR’.

HISTORY:
Defibrillators were first demonstrated in 1899 by Jean Louis Prévost and Frédéric Batelli,
two physiologists from the University of Geneva, Switzerland. They discovered that small
electrical shocks could induce ventricular fibrillation in dogs, and that larger charges would
reverse the condition.
In 1933, Dr. Albert Hyman, heart specialist at the Beth Davis Hospital of New York City
and C. Henry Hyman, an electrical engineer, looking for an alternative to injecting powerful
drugs directly into the heart, came up with an invention that used an electrical shock in place
of drug injection. This invention
was called the Hyman Otor where a hollow needle is used to pass an insulated wire to the
heart area to deliver the electrical shock. The hollow steel needle acted as one end of the
circuit and the tip of the insulated wire the other end. Whether the Hyman Otor was a success
is unknown.

The external defibrillator, as it is known today, was invented by electrical engineer William
Kouwenhoven in 1930. Kouwenhoven studied the relationship between electric shocks and
their effects on the human heart when he was a student at Johns Hopkins University School
of Engineering. His studies helped him invent a device to externally jump start the heart. He
invented the defibrillator and tested it on a dog, like Prévost and Batelli.

The first use on a human was in 1947 by Claude Beck professor of surgery at Case
Western Reserve University. Beck's theory was that ventricular fibrillation often
occurred in hearts that were fundamentally healthy, in his
terms "Hearts that are too good to die", and that there must be a way of saving them. Beck
first used the technique successfully on a 14-year-old boy who was being operated on for a
congenital chest defect. The boy's chest was surgically opened, and manual cardiac massage
was undertaken for 45 minutes until the arrival of the defibrillator. Beck used internal paddles
on either side of the heart, along with procainamide, an antiarrhythmic drug, and achieved
return of a perfusing cardiac rhythm.

These early defibrillators used the alternating current from a power socket, transformed from
the 110–240 volts available in the line, up to between 300 and 1000 volts, to the exposed
heart by way of "paddle" type electrodes. The technique was often ineffective in reverting VF
while morphological studies showed damage to the cells of the heart muscle post-mortem.
The nature of the AC machine with a large transformer also made these units very hard to
transport, and they tended to be large units on wheels.

Role of equipment:

Defibrillation is often an important step in cardiopulmonary

resuscitation (CPR). CPR is an algorithm-based intervention aimed to restore cardiac and
pulmonary function. Defibrillation is indicated only in certain types of cardiac dysrhythmias,
specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia. If the heart has
completely stopped, as
in asystole or pulseless electrical activity (PEA), defibrillation is not indicated. Defibrillation
is also not indicated if the patient is conscious or has a pulse.
Improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular
fibrillation.

Survival rates for out-of-hospital cardiac arrests are poor, often less than 10%. Outcome for
in-hospital cardiac arrests is higher at 20%. Within the group of people presenting with
cardiac arrest, the specific cardiac rhythm can significantly impact survival rates. Compared
to people presenting with a non- shockable rhythm (such as asystole or PEA), people with a
shockable rhythm (such as VF or pulseless ventricular tachycardia) have improved survival
rates, ranging between 21 and 50%.

Most hospitals and medical clinics employ the use of defibrillators on a routine basis because
they strengthen an individual’s chance of survival. Studies show that when a person suffers a
debilitating sudden cardiac arrest, their chances of survival decrease by as much as 10% for
each minute that passes without a defibrillator or cardiopulmonary resuscitation (CPR).

TYPES OF DEFIBRILLATORS:
 Automated External Defibrillators (AED)
 Implantable Cardioverter Defibrillators (ICD)
 Manual External Defibrillators (MED)

Automated External Defibrillators (AED):

 Invented in 1965 by renowned cardiologist Frank Pentridge, AEDs are portable

devices that are designed to be used by trained or untrained bystanders.
 The device is strong enough to diagnose and treat life-threatening
arrhythmias.
 While sophisticated, AEDs are designed to be easy to use. First, you turn on the
device and attach the device’s pads to the affected person’s bare chest. After you
press the “analyse” button on the machine, the device tells you if a shock is needed.
If a shock is needed, you do so by pressing the “shock” button. You should perform
CPR until an ambulance arrives.
IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD):

 Unlike AEDs, ICDs are surgically implanted inside the body, right below the collar
bone.
 These devices are designed to diagnose and fix cardiac issues such as abnormal
heart rhythms.
 These machines are composed of three different parts: a pacemaker, a pulse
generator, and electrode-tipped wires, which are connected to veins to the heart.
ICDs are only implanted in individuals who have a known cardiac condition.
 According to recent studies, ICDs are effective and can reduce the risk of death by as
much as 60%.

MANUAL EXTERNAL DEFIBRILLATORS (MED):

 MEDs are by far the most advanced than other two.

 The units are primarily used in a clinical setting by physicians and
paramedics.
 MEDs are also unique because they are typically used in tandem with
electrocardiograms.
 These devices test the health of the heart and are useful in diagnosing certain
cardiac conditions.
 Once a healthcare practitioner determines the heart rhythm, he or she will manually
input the voltage necessary for an effective shock.

Waveforms and its importance:

Energy-based defibrillators can deliver energy in a variety of waveforms, broadly

characterized as monophasic, biphasic or triphasic.

Monophasic waveform.

Defibrillators with this type of waveform deliver current in one polarity and were the
first to be introduced. They can be further categorized by the rate at which the current
pulse decreases to zero. If the monophasic waveform falls to zero gradually, the term
damped sinusoidal is used. If the waveform falls instantaneously, the term truncated
exponential is used
 (figure 1). The damped sinusoidal monophasic waveforms have been the mainstay of
external defibrillation for over three decades.

Biphasic waveform.

This type of waveform was developed later. The delivered current flows in a positive
direction for a specified time and then reverses and flows in a negative 4 Cardiac
Defibrillation direction for the remaining duration of the electrical discharge. With
biphasic waveforms there is a lower defibrillation threshold (DFT) that allows reductions
of the energy levels administrated and may cause less myocardial damage [21-24]. The
use of bi‐ phasic waveforms permits a reduction in the size and weight of AEDs.

Triphasic waveform

There are no human studies to support the use of multiphasic waveforms over biphasic.
Investigation in animals suggests that the benefits of biphasic waveform could be
harnessed using a triphasic waveform in which the second phase has the larger strength to
lower the DFT and the third phase the lower strength, to minimize damage

Biphasic Waveform Triphasic Waveform

 HOW IT WORKS?

When you have an irregular heartbeat, a defibrillator may be needed to regulate your heart’s
rhythm and prevent a serious cardiac event. Depending on the problem, a low or high energy
shock may be needed.

For example, implantable cardioverter defibrillators can be programmed to deliver a low-

energy pacing sensation or a Higher-energy shock. If the device detects a minor problem, the
ICD will attempt to regulate the issue using a painless low-energy pacing mechanism. You
will most likely feel nothing.

For more serious rhythm issues, the ICD will use a high-energy shock. These shocks can be
uncomfortable, but they only last for a few seconds.

Typically, one shock is all that is needed to regulate a heart rhythm problem. If the device
detects a more severe problem, multiple shocks may be needed.
Receiving multiple shocks in 24 hours is usually referred as to an electrical storm.

After you experience a multiple shock event, it is best to consult your doctor right away to
perform more extensive tests on the health of your heart. Your doctor can also adjust your
device’s settings to reduce the frequency or intensity of shocks if necessary.

You should also ensure your device is still working properly because some only work
through one actual event.

COMPONENT:

Batteries:

Essentially, they are containers of chemical reactions and one of the most important parts of
the AED system. Initially lead batteries and nickel-cadmium were used but lately non-
rechargeable lithium batteries, smaller in size and with longer duration with ‐ out maintenance
(up to 5 years), are rapidly replacing them. Since extreme temperatures negatively affect the
batteries, defibrillators must be stored in controlled environments. Also, it is important to
dispose of the batteries using designated containers as they contain corrosive and highly toxic
substances.
Capacitor:

The electrical shock delivered to the patient is generated by high voltage circuits from
energy stored in a capacitor which can hold up to 7 kV of electricity. The energy delivered
by this system can be anywhere from 30 to 400 joules.

Electrodes:

These are the components through which the defibrillator collects information for rhythm
analysis and delivers energy to the patient's heart. Many types of electrodes are available
including hand-held paddles, internal paddles, and self- adhesive disposable electrodes. In
general, disposable electrodes are preferred in emergency settings because they increase the
speed of shock and improve defibrillation technique. Principles of External Defibrillators.

Electrical circuit:

AEDs are highly sophisticated, microprocessor-based devices that analyse multiple features
of the surface ECG signal including frequency, amplitude, slope, and wave morphology. It
contains various filters for QRS signals, radio transmission and other interferences, as well as
for loose electrodes and poor contact. Some devices are programmed to detect patient
movement.

Controls:

The typical controls on an AED include a power button, a display screen on which trained
rescuers can check de heart rhythm and a discharge button.
Defibrillators that can be operated manually have also an energy select control and a charge
button. Certain defibrillators have special controls for internal paddles or disposable
electrodes.
ADVANTAGES:
o The biggest advantage of an AED in the workplace is simple.
o Sudden cardiac arrest is the leading cause of death in adults over the age of 40.
Unfortunately, the survival rate from cardiac arrest is currently poor – only around
10% of people survive.
o AEDs are key to increasing the survival rate from sudden cardiac arrest. They deliver
an electrical shock to the heart to restore the normal rhythm. The earlier a
defibrillator is used, the better the chances of survival.
o A workplace AED can be lifesaving as it can be set up and used before the arrival
of Emergency Medical Services.

DISADVANTAGES:

o More complex to use for the untrained responders

o More difficult to synchronize with CPR maneuvers for lay rescuers
o Longer times until shock delivery
o Risk of electrocution for the rescuer if inappropriately used
o No possibility to override the device

RISKS:

 Infection at the implant site

 Swelling, bleeding, or bruising
 Blood vessel damage from ICD leads
 Bleeding around your heart, which can be life-threatening
 Blood leaking through the heart valve (regurgitation) where the ICD
lead is placed
 Collapsed lung (pneumothorax)

These are the risks having an Implantable Cardioverter Defibrillator (ICD).

 PHILIPS HEADSTART XL DEFIBRILLATOR\MONITOR

Philips Medical Systems’ M4735A Heart Start XL offers advanced and basic life-support
clinicians a compact, lightweight, easy-to-use defibrillator/monitor with both Manual and
AED capabilities. Heart Start XL features Philips’ patented SMART Biphasic waveform,
ECG monitoring, synchronized cardioversion, and optional non-invasive pacing and SpO2.

A biphasic waveform is energy delivered in two phases. During the first phase, the electrical
current passes through the heart muscle, reverses direction, and then passes through the heart
a second time. This efficient transmission of energy requires less current than that delivered
by a monophasic waveform.

Manual Mode operation is as easy as 1-2-3: 1 - Select an energy level from 2 to 200 Joules.
2 - Charge the unit. 3 - Deliver the shock. The Heart Start XL charges to its highest energy
level in less than 3 seconds. ALS providers can also perform synchronized cardioversion and
deliver non-invasive pacing therapy.
In AED Mode, the Heart Start XL meets the needs of BLS users by offering a range of
functions from basic AED to AED with monitoring. BLS clinicians will find these intuitive
AED features supported by straightforward voice prompts and displayed text messages. The
Heart Start XL records a patient summary in either mode of operation. Patient data such as
continuous ECG, shocks and alarm violations are stored in the unit's internal memory.
Downloading and reporting data is available by using a data card. The Event Review Pro data
management system allows authorized users to edit, store, and print reports. The Heart Start
XL is designed to meet a wide variety of resuscitation and monitoring needs in one
lightweight, easy-to-use device.

FEATURES:

In manual mode,

Manual Output Energy (Delivered): 2, 3, 5, 7, 10, 20, 30, 50, 70, 100, 150, 200 Joules.
Energy limited to 50 Joules for internal defibrillation. Controls: Manual/AED On/Energy
Select knob, Charge/Disarm, Shock, ECG Lead Select, SpO2 On/Off, SpO2 Alarm, HR
Alarm, Sync On/Off, Pacer, Pacer Start/Stop, Pacer Rate, Pacer Current, Pacer Mode, ECG
Gain, Volume, Strip, Summary Mark. Indicators: LCD display for ECG waveforms and text
prompts, Audio alerts, QRS Beeper, Charging tones (for sync and asynchronous modes), AC
Power LED, Battery Charging LED, Sync LED, Pacer LED. Armed Indicators: Charge Done
tone and available energy indicated on display. Energy Selection: Front panel rotary knob.
Charge Control: Front panel “2” key or buttons on paddles. Shock Control: Front panel “3”
key or buttons on paddles.
Synchronizer: SYNC message appears on the monitor and is annotated on the printer (if
printing while in Sync mode). An audible beep sounds with each detected R-wave while a
tick mark on the monitor and printed strip indicates the discharge points. Synchronizer delay
is less than 60 msec from peak R-wave to peak current of the defibrillation discharge.

In AED mode,

AED Energy Profile: Fixed energy (150 Joules). AED Shock Series: 1, 2, 3, 4
shocks per series. Shock Series Timer: off, 30, 60, 90, 120, 150, 180, or 210 seconds. Text
and Voice Prompts: Extensive text/audible messages guide user through protocol. AED
Controls: On, Off, Pause/Resume, Analyse/Stop
Analysis, Shock, Lead Select, SpO2 On/Off, SpO2 Alarms, HR Alarms, ECG Gain,
Volume, Strip, Summary Mark. Indicators: LCD display for ECG waveforms and text
prompts, Audio alerts, voice prompts, QRS Beeper, charging tones, Charge Done Tone,
Printer, AC Power LED, Battery Charging LED. Armed Indicators: Charge Done tone,
available energy indicated on display; Voice Message. Patient Analysis: Per protocol,
evaluates patient ECG and signal quality to determine if a shock is appropriate and evaluates
connection impedance for proper defibrillation pad contact. Shockable Rhythms: Ventricular
fibrillation with amplitude greater than 100 UV and wide complex ventricular tachycardia
with rates greater than 150 bpm. Sensitivity and Specificity: Meets AAMI guidelines.

CONCLUSION:

Sudden cardiac arrest, frequently due to VF or pulseless VT, is traditionally associated with
poor survival rates. Saving the lives of these patients depends on early cardiac defibrillation
which, with manual defibrillators, is limited only to qualified rescuers who can interpret
ECGs. AEDs solve this problem since they can analyse rhythm and inform the rescuers
whether a shock is indicated. This approach allows lay rescuers to provide effective early
defibrillation which has been shown to significantly improve survival and survival with in‐
tact neurologic function after out-of-hospital cardiac arrest. One limitation is that AED use
requires interruptions in CPR which was proved to be deleterious especially in patients with
non-shockable rhythms. Special efforts are being made to improve rhythm analysis and
‘hands-off’ time during CPR.
 4.3 – Angiogram

INTRODUCTION
Angiogram or angiography is a medical imaging technique used to visualize the inside, or
lumen, of blood vessels and organs of the body, with particular interest in the arteries,
veins, and the heart chambers. This is traditionally done by injecting a radio-opaque
contrast agent into the blood vessel and imaging using X-ray based techniques such as
fluoroscopy. When blood vessels are blocked, damaged or abnormal in any way, chest pain,
heart attack, stroke, or other problems may occur. Angiography helps your physician
determine the source of the problem and the extent of damage to the blood vessel segments
that are being examined.
HISTORY
The technique was first developed in 1927 by the Portuguese physician and neurologist
Egas Moniz at the University of Lisbon to provide contrasted Xray cerebral angiography in
order to diagnose several kinds of nervous diseases, such as tumors, artery disease and
arteriovenous malformations. Moniz is recognized as the pioneer in this field. He performed
the first cerebral angiogram in Lisbon in 1927.
ROLE OF THE MACHINE
This exam typically uses a radiographic, one or two x-ray tubes, and a video monitor.
Fluoroscopy converts x-rays into video images. Doctors use it to watch and guide procedures.
The x-ray machine and a detector suspended over the exam table produce the video. The
catheter used in angiography is a long plastic tube about as thick as a strand of spaghetti

When blood vessels are blocked, damaged or abnormal in any way, chest pain, heart attack,
stroke, or other problems may occur. Angiography helps your physician determine the source
of the problem and the extent of damage to the blood vessel segments that are being
examined.

BLOCK DIAGRAM

WORKING & OUTPUT

Components of Angiogram Machine:

• X-Rays with catheters

• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Contrast material (Dye)
X-Rays with catheters:

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects,
including the body. The technologist carefully aims the x-ray beam at the area of interest.
The machine produces a small burst of radiation that passes through your body. The
radiation records an image on photographic film or a special detector. When a contrast
material is introduced to the bloodstream during the procedure, it clearly defines the blood
vessels being examined.
Computed tomography (CT):
 CT angiography is a type of medical test that combines a CT scan with an injection of a
special dye to produce pictures of blood vessels and tissues in a part of your body. The
dye is injected through an intravenous (IV) line started in your arm or hand. The dye
injected to perform CT angiography is called a contrast material because it "lights up"
blood vessels and tissues that are being studied.
Physicians use CT angiography to diagnose and evaluate many diseases of blood vessels
and related conditions such as:

• aneurysms
• blockages
• blood clots
• congenital (birth-related) abnormalities of the cardiovascular system, including
the heart
• disorganized blood vessels, such as vascular malformations
• injury
• tumours
• vessel rupture or tears
Magnetic Resonance Imaging (MRI):
Magnetic resonance angiography–also called a magnetic resonance angiogram or
MRA–is a type of MRI that looks specifically at the body’s blood vessels. Unlike a
traditional angiogram, which requires inserting a catheter into the body, magnetic
resonance angiography is a far less invasive and less painful test. During magnetic
resonance angiography, you lie flat inside the magnetic resonance imaging scanner.
This is a large, tunnel-like tube. In some cases, a special dye, known as contrast, may
be added to your bloodstream to make your blood vessels easier to see.
In most MRI units, the magnetic field is produced by passing an electric current through
wire coils. Other coils are inside the machine and, in some cases, are placed around the
part of the body being imaged. MRI is often able to tell the difference between diseased
tissue and normal tissue better than xray, CT, and ultrasound.

APPLICATION IN BIOMEDICAL FIELD

They can provide images of the blood vessels in many different organs. They often
help doctors diagnose conditions affecting the heart, brain, arms, or legs. Angiograms
can help doctors detect blood vessel abnormalities, including weakened blood vessels,
plaque deposits, and blood clots. The procedure which helps in treating cardiac blocks
or any other abnormalities related with blocking in vessels can be treated with
angiogram and the name of the procedure is called Angiography.

SAFETY MEASURES

• Don't eat or drink anything after midnight before your angiogram.

• Take all your medications to the hospital with you in their original bottles. Ask
your doctor about whether to take your usual morning medications.
• If you have diabetes, ask your doctor if you should take insulin or other oral
medications before your angiogram.
CONCLUSION
The potentialities and limitations of angiographic and various aspects of it are
discussed. It is concluded that whether there is a normal supply of blood to your heart
and any blockages. An abnormal result may mean that you have one or more blocked
arteries.
 4.4 NERVE STIMULATOR

INTRODUCTION
The concept of nerve stimulation/peripheral nerve stimulation (PNS) is not new and has been
in practice since the early 19 century.
However, clinical studies were done much later in this field. In 1976, Campbell et al.
published the reports of the first set of clinical studies done in the field of pain management
using PNS.Since then, PNS has been actively explored as a treatment of modality for
managing chronic pain conditions. Chronic pain conditions, including low back pain, neck
pain, and neuropathic pain states like chronic regional pain syndrome, causalgia, and diabetic
neuropathy, afflict a large group of population. They pose a substantial economic burden on
society. These pain conditions are the leading cause of disability in the world. Currently,
there is an active opioid crisis in the United States, with over 15,000 deaths involving
prescription opioids reported in 2015. Also, managing these chronic pain conditions with
conventional medical management can lead to multiple drug-drug interactions resulting in
intolerable side effects.PNS offers a relatively safe and effective treatment modality in the
treatment of such chronic pain conditions.
HISTORY
Kierstin M. Lund, M.D., Meg A. Rosenblatt, M.D.Anesthesiology, Mount Sinai School of
Medicine, New York, New YorkPeripheral nerve blockade is based on the concept that the
transmission of pain, conveyed along a nerve fiber, can be inhibited. The theory of nerve
conduction was first described in 1826, by Johannes P. Muller. Regional anesthesia was not
performed until 1855, when Rynd introduced a solution of morphine around a peripheral
nerve. More than half a century past before further advancements in regional anesthesia
were made. In 1912, von Perthes1 was the first to
describe the technique of peripheral nerve stimulation as a means to localize a particular
nerve. Furthering the technique of nerve localization, Pearson2 was able to locate motor
nerves by electrical stimulation with an insulated needle using a transformer, a vacuum- tube
stimulator and an electrophrenic stimulator. In 1962, Greenblatt and Denson3 constructed a
portable nerve stimulator that Wright4 made commercially available in 1969.Although all
prior studies on peripheral nerve stimulation utilized insulated needles, Montgomery5, based
on personal experience, argued that uninsulated needles allowed for better nerve localization.
He stated that insulation could alter the feel of tissues making accurate anatomic location
more difficult. Bashein6 discovered that the zone of depolarization for an insulated needle
has a more favorable geometry for successful nerve block than that of an uninsulated one.
Supporting this Ford7 demonstrated that insulated needles more precisely located peripheral
nerves than uninsulated needles.
ROLE OF NERVE STIMULATOR
A nerve stimulator set at low intensity may be used to monitor the status of relevant nerves to
ensure they still transmit briskly and are not being stretched, kinked, or dried out.
The muscular type of electric stimulation seeks to strengthen the muscles by reducing
muscle spasms. Also known as EMS, this stimulates the skeletal muscle using electric
impulses to cause muscle contraction. TENS is commonly used to help with chronic pain.
BLOCK DIAGRAM

WORKING OF NERVE STIMULATOR

The stimulator itself is implanted under the skin and the small coated wires (leads) are
inserted under the skin to the point where they are either connected to nerves or inserted into
the spinal canal. After this outpatient procedure is complete, you and your doctor determine
the best pulse strength.
Electrical nerve stimulation in regional anesthesia is a method of using a low-intensity (up to
5 mA) and short-duration (0.05 to 1 ms) electrical stimulus (at 1- to 2-Hz repetition rate) to
obtain a defined response (muscle twitch or sensation) to locate a peripheral nerve or nerve
plexus with an (insulated) needle …
PERIPHERAL STIMULATOR

Doctors implant a small wire under the skin close to nerves and place a small battery pack,
which could be internal or external, over this area to power the wire. The device is
programmed to maximize pain relief by disrupting pain signals to the brain.
Peripheral nerve stimulation, frequently referred to as PNS, is a commonly used approach
to treat chronic pain. It involves surgery that places a small electrical device (a wire-like
electrode) next to one of the peripheral nerves. (These are the nerves that are located
beyond the brain or spinal cord).
APPLICATIONS IN BIOMEDICAL FIELD
New TENS patients should undergo a pain assessment and should be given clear, simple
instructions on the safe use of TENS. The patient should be observed using TENS to ensure
competence. Conventional TENS is used in the first instance starting with a continuous pulse
pattern, and ‘mid-range’ pulse frequencies (e.g. 80pps-100pps) and durations (100–200μs).
However, patients should be encouraged to take a trial and error approach on each treatment
session to establish the most comfortable pattern, frequency and duration for their pain at
that moment in time. Maximal pain relief occurs in the presence of a strong but comfortable
electrical paraesthesia so TENS should be delivered as often as needed throughout the day.
OUTPUT OF NERVE STIMULATOR
Action potential, threshold level, and stimulus. Motor fibers have a short chronaxy because of
the relatively low capacitance of their myelinated membrane (only the area of the nodes of
Ranvier count; see Figure 14–1); therefore, it takes only a short time to depolarize the
membrane up to the threshold level. B: Action potential, threshold level, and stimulus. Pain
fibers have a long chronaxy
because of the higher capacitance of their nonmyelinated membrane (the entire area of the
membrane counts); therefore, it takes a longer time to depolarize the membrane up to the
threshold level.
Short impulses (as indicated by the vertical dotted line) would not be able to depolarize the
membrane below the threshold level.

SAFETY FEATURES

Easy and intuitive use.

A large and easy-to-read display.

Limited current range (0–5 mA) because an amplitude that is too high may be painful or
uncomfortable for the patient.
A display of all relevant parameters, such as amplitude (mA) (alternatively stimulus charge
[nC]), stimulus duration (ms), stimulus frequency (Hz), impedance (kΩ), and battery status.
Clear identification of output polarity (negative polarity at the
needle).
HOSPITAL VISIT REPORT
Peripheral nerve stimulation helps up to 70% of the patients
selected for treatment. The rate of reduction in pain varies from
patient to patient. On average, pain scores are reduced by around
50%. For example if a patient had a pain score of 10/10 we would
be able to reduce it to 5/10.
We are particularly successful with getting rid of the burning
sensation aspect of the pain in the majority of patients.
CONCLUSION
Peripheral nerve stimulation was associated with reduced pain
scores, lower opioid utilization, and improved patient function at 6
months. These data support PNS as a potentially effective
nonopioid analgesic modality in chronic pain, though prospective
multicenter evaluation is warranted to evaluate longer-term
outcomes.