FORCE Biomedical

Short Learning Topics

Biomedical Equipment’s and IEC 60601

Author
Akhil. S

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

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Introduction to Biomedical Engineering

What Is Biomedical Engineering?

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

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

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

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

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

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What Biomedical Engineers do?

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

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Introduction to IEC Standards – 60601

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

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

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

COMMONLY USED DEFINITIONS WITHIN IEC 60601

Equipment Under Test

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

Device Under Test

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

Applied Part

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

Patient Connection

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

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Patient Environment

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

F-Type Applied Part

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

Type B Applied Part

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

Type BF Applied Part

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

Type CF Applied Part

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

Medical Electrical Equipment

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

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

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Medical Electrical System

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

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

Class I

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

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

Class II

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

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

Symbols and Markings

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Introduction to Biomedical Equipment’s

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

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

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

mounted on a stand or cart for mobility

Principles of operation

Various pump configurations include rotary-

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

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

Digital Thermometer

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

Digital Thermometer

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

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

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

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

Types

• ANEROID SPHYGMOMANOMETERS

• DIGITAL SPYGMOMANOMETERS

ANEROID DIGITAL

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

Basic components

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

Weighing scale Block diagram

OPERATIONAL ISSUES

➢ Pressure sensor sensitivity issues

➢ Error reading

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Glucometer

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

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

Glucometer Block diagram

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

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

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

Parts of oxygen flowmeter

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Safe use of medical oxygen regulator

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

Type of safety system is used when connecting the regulator

• Pin Index Safety System

• Diameter index safety system

Pin Index Safety System

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

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

Diameter index safety system

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

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

SpO2 – Saturation of Peripheral Oxygen

HR - Heart Rate (BPM- Beats Per Minute)

Waveform: Plethysmograph (Pleth)

Fingertip pulse oximeter Block diagram

Types based on Methods

• Transmittance

• Reflectance

Response of Blood to IR and Red Light

Oxygenated Blood: Absorbs IR and Allow Red Light to Pass

De Oxygenated Blood: Allows IR and Absorbs More Red Light

Types of Spo2 Probes (Based on Application)

▪ Finger Probe Foot

▪ Ear lobe Forehead

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

TYPES

➢ Vibrating mesh technology

➢ Jet nebulizer

➢ Ultrasonic wave nebulizer

Vibrating mesh nebulizers

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

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Jet nebulizer

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

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Ultrasonic nebulizers

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

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

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

Breast pump

Electrical wheelchair

A motorized wheelchair, powerchair, electric

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

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

BASIC PRINCIPLES

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

• High pressure intake phase

• Depressurizing exhaust phase

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

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

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

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

Principle

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

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

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

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

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

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

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

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Bronchoscope

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

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

Principles

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

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Flexible bronchoscope

Rigid bronchoscope

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

These filtered cabinets are primarily designed to protect against exposure to

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

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

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

Classification

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

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CLASS I CLASS II

CLASS III

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

Mobile C-arm working

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

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

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C ARM PARTS

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Capnography

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

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

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

Measurement methods

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

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

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

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

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

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

Sidestream Mainstream

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CT Machine

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

Non-invasive radiographic technique that involves the reconstruction of a

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

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

mathematically manipulated to produce sagittal or coronal image slices

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Basic components

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

BASIC PRINCIPLES

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

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

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

IMAGE MANIPULATION

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

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

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

CT IMAGE RECONSTRUCTION

RADIATION DOSE

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

******

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

BASIC PRINCIPLE

o An anesthesia system comprises three basic subsystems

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

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CIRCUIT DIAGRAM

GAS SUPPLY & CONTROL

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

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VENTILATION

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

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

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

Different types of defibrillators work in different ways. Automated external

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

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

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Types of Defibrillators

• Monophasic Defibrillator
• Biphasic Defibrillator

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

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

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

to the heart via two vectors

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

Different Types of Dental Chairs

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

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

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

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

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Dental chair controls

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

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

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

cancer and to evaluate palpable masses and nonpalpable breast lesions.

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

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

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

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

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

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

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

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

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

Principle

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

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

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

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

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

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

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

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

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

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

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

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

heart function. Multichannel electrocardiographs record signals from two or more

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

electrocardiographs can perform automatic measurement and interpretation of the

ECG as a selectable or optional feature.

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

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

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

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

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

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

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

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

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

electrocardiographs acquire and analyze the electrical signals.

Principles

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

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

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

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

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

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

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

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

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

midsternum and left midaxillary electrodes, and the left leg.

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Electro surgical unit

Health problem addressed Devices intended for surgical cutting and for controlling

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

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

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

well as certain dental procedures.

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

generator) and a handpiece including one or several electrodes.

Principles

o High frequency electrosurgical unit devices transfer electrical energy to human

tissue via a treatment electrode that remains cool

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

o The electrical resistance of

human tissue helps to convert

this electrical energy in

molecular energy, which causes

denaturation of intracellular

and extracellular proteins,

resulting in coagulation or

desiccation effects

o Raising intracellular water

above boiling point causes cell

membrane rupture to produce

a cutting effect

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MAJOR MODALITIES IN ESU

o Electro-desiccation

o Fulguration

o Electrocoagulation

o Electro section

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

produce tissue destruction

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

shallow tissue destruction

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

superficial surgery

▪ In electrosection, the electrode is used to cut tissues

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

nearly bloodless surgery and decreasing treatment time

▪ The blend mode combines both cutting and coagulation characteristics with

various combinations of cutting and coagulation

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

depth of coagulation to major bleeding sites

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

achieve congealed tissue.

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

of achieving the desired electrosurgical effect

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▪ COAGULATION MODES

I. soft coagulation
II. Forced coagulation

III. Spray coagulation

TECHNIQUES

MONOPOLAR SURGERY

BIPOLAR TECHNIQUE

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

BASIC COMPONENTS

▪ Control module
▪ Electrodes
▪ EEG Cable

TYPES OF ECT

o Bilateral ECT – bitemporal

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

o Bilateral ECT – bifrontal

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

o Unilateral ECT

The Unilateral electrodes placed over the right hemisphere

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BASIC PRINCIPLES

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

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

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

o An decrease in dose may be indicated either

I. If the person is experiencing adverse cognitive side effects

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

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

Vein Detector Hardware parts

Fetal Monitor

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

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

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

Principles

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

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

o External fetal heart monitoring

o Internal fetal heart monitoring
External fetal heart monitoring

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

External fetal heart monitoring

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Internal fetal heart monitoring

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

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

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

Internal fetal heart monitoring

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

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

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

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

and the dialyzer.

Principles

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

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

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

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

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

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

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

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

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

clearance, takes place

BASIC COMPONENTS

Dialyzer Roller pump

Heparin pump Blood leak detector

Air detector Dialysate pump

Heater Proportioning pump

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BASIC PRINCIPLES

DIALYSATE DELIVERY SYSTEM

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

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

dialyzer

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

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

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

buffering agent

o Additional water is mixed into the dialysate to approximate normal

bicarbonate ion blood concentrations

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

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

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

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

achieve the standard acceptable level of contaminants

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

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

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

concentrate

• Fixed-ratio controllers mix specific amounts of each

• Servo-controlled systems monitor the conductivity of the dialysate

and regulate the delivery of concentrate to satisfy specified

conductivity and pH limits

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

excessive cooling or heating of the blood

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

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

within specified limits

EXTRACORPOREAL BLOOD CIRCUIT

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

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

patient.

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

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

o Bypassing capillary beds, where arterial blood pressure is markedly

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

diameter of the vein to expand greatly

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

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

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

arterial lines

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

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

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

tight

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

and prevent it from being pumped into the patient

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

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

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

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

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

arterial side of the blood circuit

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

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

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

the patient

DIALYZER

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

clearance, takes place

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

fiber

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

semipermeable membrane into a flowing stream of dialysate solution

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

exchanged between the blood and the dialysate

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

diffuse across the membrane from the blood to the dialysate

o Electrolytes move in both directions to maintain equilibrium

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

in the membrane

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

from the blood through the semipermeable membrane

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

hydrostatic pressure—the primary UF mechanism in haemodialysis

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

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

gradual waste removal than intermittent treatment

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

loss associated with intermittent therapy; in hemodynamically unstable

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

cardiac surgery

o Some conventional haemodialysis machines are now offering some CRRT

modalities as an option.

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

pump blood.

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

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

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

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

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

machine during this procedure to help accurately position the IABP.

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

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

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

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

body

BASIC PRINCIPLES

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

supply blood and oxygen to the heart

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

coronary perfusion

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

stage (diastole)

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

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

developed

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

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

through the femoral artery into the aorta

Basic principle of counterpulsation

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

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

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

blood flow and potential improvements in systemic perfusion by augmentation of

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

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

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Baby Incubators

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

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

Types of Incubators

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

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

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Incubator

Parts of incubator

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

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

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

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

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

antibiotics, chemotherapy drugs, and pain relievers.

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

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

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

These include:

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

patient’s digestive tract.

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

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

administer a controlled amount of medication, as needed.

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

diabetes. Insulin pumps are frequently used in the home.

BASIC COMPONENTS

o Drop sensor Clamp

o Air detector Door

o Housing Keyboards & labels

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BASIC PRINCIPLES

Two types of working

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

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

tubings

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

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

patient

Alarms includes

• Air in line

• Upstream/downstream occlusion

• Empty fluid container

• Set disengagement

• Flow error

Sensors includes

• Pressure / ultrasonic transducers

• Optical sensors

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Parts of infusion pump

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PCA pump

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

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

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

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

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

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

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

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

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

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

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

alarm lets the nursing staff know

PCA pump

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Enteral Feeding pump

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

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

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

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

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

condition that affects the normal ingestion and digestion process in the

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

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

Enteral Feeding pump

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Multipara Monitor

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

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

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

oxygen saturation (SpO2) and temperature (TEMP).

Application of Patient Monitors

o Acquisition and Display of Physiological Parameters

o Detection of Unexpected Life threatening conditions

o Recording of Parameter values and Trend

o Guiding in clinical decision making and Treatment

Monitoring Parameters

o Saturation of Peripheral Oxygen

o Non-Invasive Blood Pressure

o ECG

o Respiration

o Temperature

o End Tidal Carbon dioxide

o Invasive Blood Pressure

o Cardiac Output (CO)

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Block diagram

Multipara Monitor Display parameter view

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NIBP

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

Principle

Instead of recording the readings acoustically (Ausculatory Method) the

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

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Block Diagram of NIBP

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

Terminology and measurements

• Lux (lx)

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

• Central illuminance (Ec)

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

• Light field centre

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

• Depth of illumination

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

• Shadow dilution

The lights’ ability to minimise the effect of obstructions.

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• Light field diameter (D10)

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

• D50

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

Scientific principles

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

lux).

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

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

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

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

Parts of surgical light

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OT table

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

Requirements

o Height
o Tilting
o Adjustable segments
o Radiolucent surface

Components and Models

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

o Table top
o Operating table column
o The transporter

Types

o Fixed/Stationary
o Mobile unit

Fixed operating table

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

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Mobile operating table

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

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

Types of Surgical OT Table

o General Surgery Tables

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

❖ General Surgery Table

o Accessibility
o Stability
o Imaging Support
o weight support

General Surgery Table

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❖ Imaging Table

o Fluoroscopy, Vascular procedures

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

Imaging Table

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❖ Neurology Table

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

Neurology Table

Urology and CystoTables

o Perform Lithotripsy procedures

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

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❖ Orthopaedics Table

Operating table for orthopaedic surgery and traumatology.

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

Orthopaedics Table

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OT Table positions

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Radiant warmer

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

Principles

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

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

Function

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

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

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

• water loss through breathing out

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Modes

• Servo Mode
• Manual Mode

Servo Mode

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

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

Manual Mode

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

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

• Record baby temperature every 2-4 hourly.

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

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

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

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Principles

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

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

Phototherapy units fall into two general categories

I. Overhead phototherapy lamps

II. Fibre optic phototherapy pads system

Overhead phototherapy lamps

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

Fibre optic phototherapy pads system

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

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

Uses

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

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

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

Types

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

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

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

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

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

BASIC PRINCIPLE

o Image-guided neuronavigation utilizes the principle of stereotaxis

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

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

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

o Neuronavigation provides a precise surgical guidance by referencing this

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

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

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

o The spatial accuracy of the modern neuronavigation system is further

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

o MRI guided neuronavigation was effective for accurately placing the

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

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

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Ultrasound machine

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

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

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

BASIC PRINCIPLES

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

human hearing

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

used

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

for transmission; because they exhibit the normal wave properties of

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

and reflected

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

inserted into a body cavity

o Ultrasonic probes contain one or more elements made of piezoelectric

materials

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

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

into electrical signals

o These signals are processed and converted into an image

o Lower sound frequencies provide decreased resolution but greater tissue

penetration, while higher frequencies improve resolution when deep

penetration is not necessary

Types of transducer

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MODES

Various modes are available for displaying the returning echoes

o A MODE

o B MODE

o M MODE

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

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

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

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

accurate focus of the destructive wave energy.

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

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

two-dimensional image on screen.

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

scans whose images follow each other in sequence on screen enables

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

that produce reflections move relative to the probe.

BASIC COMPONENTS

• Pulser (Voltage generator, Transmitter, Output gain)

• Beam former (Master Synchronizer)

• Transducer

• Receiver (signal processor)

• Memory (image processor, Scan converter)

• Display (Cathode ray tube, CRT)

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Ventilator

Ventilators provide temporary ventilatory support or respiratory assistance to

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

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

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

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

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

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

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

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

or a battery.

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BASIC COMPONENTS

o Expiratory valve

o Patient circuit

o Flow sensor

o Blender

o Control circuits

o Humidifier

BASIC PRINCIPLES

❖ SPONTANEOUS BREATHING

Inspiration: -

o Contraction of the diaphragm and the intercostal muscles

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

o Expansion of the chest

o Increase in lung volume

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

pressure compensation to the atmosphere

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SPONTANEOUS BREATHING

Inspiration

Expiration: -

o relaxation of the diaphragm and the inter-costal muscles

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

o Reduction of the chest

o Decrease in lung volume

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

compensation to the atmosphere

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Expiration

VOCABULARY OF VENTILATION

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

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

o f breathing frequency 10 - 15 / min

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

MV = f * Vt

o I: E inspiration - expiration ratio 1: 1.5

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

pressure - is increasing the end expiratory lung volume

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

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

mmHg

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

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

the arterial blood

o AaDO2 = pAO2 - paO2

o at FiO2 = 0,2  10 - 20 mmHg

o at FiO2 = 1,0  25 - 65 mmHg

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o paO2/ FiO2 value with information about the transpulmonary oxygen

transport normal > 450

MANDATORY VENTILATION

o Inspiration started by the ventilator

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

into the lung

o Lung will be stretched

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

pressure inside the thorax

Modes of ventilation

❖ Volume modes

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

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

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

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

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

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

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

❖ Synchronized Intermittent-Mandatory Ventilation (SIMV)

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

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

breaths are synchronized to coincide with spontaneous respirations. Disadvantages

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

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

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

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

❖ ACV vs. SIMV

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

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

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

Pressure Modes

❖ Pressure-Controlled Ventilation (PCV)

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

initiated breaths. The inspiratory flow pattern decreases exponentially, reducing

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

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

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

with neuromuscular disease but otherwise normal lungs

❖ Pressure Support Ventilation (PSV)

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

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

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

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

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

through specialized face masks.

❖ Pressure Controlled Inverse Ratio Ventilation (PCIRV)

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

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

PEEP and hemodynamic deterioration due to the decreased expiratory time and

increased mean airway pressure generally outweight the small potential for

improved oxygenation

❖ Airway Pressure Release Ventilation (APRV)

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

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

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

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

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

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

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

typically requires increased sedation

Block diagram

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

Kerala. Now I am working in Sur

Hospital Oman as Biomedical Technician

and I have gained 5 years of experience in

biomedical engineering from Kerala.

Previously I worked in Sree Gokulam

medical college. Trivandrum, Aster DM

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

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

always ready to acquire new skills and new experiences.

Thanking you

Akhil S

Mail ID: engr.akhil@hotmail.com

Mob: +91-9747144464

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

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