CHAPTER 1

OVERVIEW OF HOSPITAL

1.1 INTRODUCTION

A hospital is a health care institution providing patient treatment with specialized staff and
equipment. It is the place where the sick and the injured are treated with care. A hospital is different
from a dispensary. The main purpose of dispensary is distribution of medicine while in the hospital
treatment is being done. A modern hospital is an institution which possesses adequate
accommodation, well qualified and experienced personnel particularly required for efficacious
medical care and hospital service which conducts research assisting the advancement of medical
services and hospital service which organizes programs in health and education. A hospital is an
institution which is scientifically and economically organized for prevention, diagnosis and
treatment of diseases. The teaching and training of medical and paramedical students and trainers,
hospitals may be operated by government or private agencies (Ariponnammal S and Natarajan S,
1994).

1.2 CLASSIFICATION OF HOSPITAL

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave
(“outpatients”) without staying overnight; while others are “admitted” and stay overnight or for
several days or weeks or months (“inpatients”). Hospitals usually are distinguished from other
types of medical facilities by their ability to admit and care for inpatients whilst the others, which
are smaller, are often described as clinic.

1.2.1 GENERAL HOSPITAL

The best-known type of hospital is the general hospital, which is set up to deal with many
kinds of disease and injury, and normally has an emergency department to deal with immediate

1
and urgent threats to health. Larger cities may have several hospitals of varying sizes and
facilities.

1.2.2 SPECIALIZED HOSPITAL

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's

hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such
as psychiatric problems, certain disease categories such as cardiac, oncology, or orthopedic
problems, and so forth. Worldwide, most hospitals run on a non-profit basis by governments or
charities. Specialized hospitals can help reduce health care costs compared to general hospitals.

1.2.3 TEACHING HOSPITAL

A teaching hospital combines assistance to people with teaching to medical students and
nurses and often is linked to a medical school, nursing school or university .

1.2.4 CLINIC

The medical facility smaller than a hospital is generally called a clinic and often is run by
a government agency for health services or a private partnership of physicians. Clinics generally
provide only outpatient services.

2
 CHAPTER 2

DEPARTMENTS IN HOSPITAL

2.1 LIST OF DEPARTMENTS

• Casuality department
• Radiology department
• Neonatal Intensive Care Unit
• Microbiology
• Dialysis
• Intensive Critical Care Unit
• Trauma
• Biomedical department

2.1.1 CASUALITY DEPARTMENT

An emergency department (ED), also known as an accident and emergency department

(A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical
treatment facility specializing in emergency medicine, the acute care of patients who present
without prior appointment; either by their own means or by that of an ambulance. The emergency
department is usually found in a hospital or other primary care center. Due to the unplanned nature
of patient attendance, the department must provide initial treatment for a broad spectrum of
illnesses and injuries, some of which may be life-threatening and require immediate attention. In
some countries, emergency departments have become important entry points for those without
other means of access to medical care. The emergency departments of most hospitals operate 24
hours a day, although staffing levels may be varied in an attempt to reflect patient volume.

3
2.1.2 RADIOLOGY

Radiology is an imaging technique using X-rays to view the internal structure of an object.
To create the image, a beam of X-rays, a form of electromagnetic radiation, is produced by an X-
ray generator and is projected toward the object. The modern practice of radiology involves several
different healthcare professions working as a team. The radiologist is a medical doctor who has
completed the appropriate post-graduate training and interprets medical images, communicates
these findings to other physicians by means of a report or verbally, and uses imaging to perform
minimally invasive medical procedures

2.1.3 NEONATAL INTENSIVE CARE UNIT (NICU)

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is
an intensive care unit specializing in the care of ill or premature newborn infants. NICU is typically
directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists,
physician assistants, resident physicians, respiratory therapists, and dieticians. Many other
ancillary disciplines and specialists are available at larger units.

2.1.4 MICROBIOLOGY

Microbiology The Department of Microbiology is well equipped to diagnose most of the

infectious diseases prevalent in society. It offers diagnostic services to the hospital and also carries
out bacteriological analysis of water, operation theatre sterility checks, in house disinfectant testing
and hospital environmental surveillance.

2.1.5 DIALYSIS

Dialysis is a procedure to remove waste products and excess fluid from the blood when the
kidneys stop working properly. It is a treatment that does some of the things done by the healthy
kidneys. Dialysis Technicians, is a specialized healthcare profession. They are responsible for
operation, cleaning, sterilization of the dialysis machines. Dialysis Technicians give patients
important medical, technical, social, and emotional support and also provide vital information on
patient conditions to doctors, and other medical staff.

4
2.1.6 INTENSIVE CRITICAL CARE UNIT

Intensive care unit is also known as critical care unit (CCU), intensive treatment unit (ITU)
or intensive therapy unit. Intensive care unit deals with life-threatening or severe injuries and
illnesses that require close monitoring from life support devices, constant care. In ICU, patients
are monitored and staffed by highly trained physicians, nurses and respiratory therapists. Common
equipment in an intensive care unit includes a mechanical ventilator, cardiac monitor, defibrillator,
high flow nasal cannula, endotracheal tube, arterial line, infusion pumps, central line, nasogastric
tube, nasogastric feed pump, urinary catheter.

2.1.7 TRAUMA DEPARTMENT

Trauma centers are typically located within hospitals, often in the emergency department.
Emergency rooms provide care to people with injuries ranging from a sprained ankle to a heart
attack — and they are staffed with doctors, nurses, and medical experts who handle a variety of
conditions.

2.1.8 BIOMEDICAL DEPARTMENT

In a hospital, biomedical engineer may provide advice on the selection and use of
medical equipment, as well as supervising its performance testing and maintenance. They may
also build customized devices for special health care or research needs. Biomedical sciences are a
set of sciences applying portions of natural science or formal science, or both, to develop
knowledge, interventions, or technology that are of use in healthcare or public health.[1] Such
disciplines as medical microbiology, clinical virology, clinical epidemiology, genetic
epidemiology, and biomedical engineering are medical sciences. In explaining physiological
mechanisms operating in pathological processes, however, pathophysiology can be regarded as
basic science.

5
 CHAPTER 3

HOSPITAL MANAGEMENT

3.1 INTRODUCTION

Health administration, healthcare administration, healthcare management or hospital

management is the field relating to leadership, management, and administration of public health
systems, health care systems, hospitals, and hospital networks in all the primary, secondary, and
tertiary sectors. Health systems management or health care systems management describes the
leadership and general management of hospitals, hospital networks, and/or health care systems. In
international use, the term refers to management at all levels. In the United States, management of
a single institution (e.g. a hospital) is also referred to as "medical and health services management",
"healthcare management", or "health administration". Health systems management ensures that
specific outcomes are attained, that departments within a health facility are running smoothly, that
the right people are in the right jobs, that people know what is expected of them, that resources are
used efficiently and that all departments are working towards a common goal for mutual
development and growth .

3.2 NEED FOR MANAGEMENT AND THEIR PERSPECTIVE

Healthcare organizations are complex and dynamic. The nature of organizations requires
that managers provide leadership, as well as the supervision and coordination of employees.
Organizations were created to achieve goals that were beyond the capacity of any single individual.
In healthcare organizations, the scope and complexity of tasks carried out in provision of services
are so great that individual staff operating on their own couldn’t get the job done. Moreover, the
necessary tasks in producing services in healthcare organizations require the coordination of many
highly specialized disciplines that must work together seamlessly. The external domain refers to
the influences, resources, and activities that exist outside the boundary of the organization but
which significantly affect the organization. These factors include community needs, population
characteristics, and reimbursement from commercial insurers and Medicare and Medicaid.

6
 The internal domain refers to those areas of focus that managers need to address on a daily
basis, such as ensuring the appropriate number and types of staff, financial performance, and
quality of care.

External Internal

Community demographics Staffing

Licensure Budgeting

Accreditation Quality services

Regulations Patient satisfactions

Stakeholders Demands Physician relations

Competitors Financial performances

Medicare and Medicaid Technology acquisition

Managed care organizations New service development

Table 3.1 Domains of Health Service Administration

3.3 HIERARCHY

Hospital management is also referred to as healthcare administration or healthcare system

management. This is an exquisite management field that involves management, administration and
leadership of hospital and its work. The hospital management professionals are termed as the
Healthcare Management professionals.

7
 Figure 3.1 Hierarchy of management

3.3.1 TOP LEVEL OF HOSPITAL MANAGEMENT HIERARCHY

This is the highest level of the management group. This is the administrative level of the
hospital management hierarchy.

DEAN OF HOSPITAL

The highest authority holder management official in the hospital management hierarchy is
the dean of the hospital. The dean carries out the leadership duties for the hospital in an exquisite
and amorous manner.

HOSPITAL ADMINISTRATORS

These are the group of the people who help dean ardently in carrying out the management
of the hospital with a great ease and taking care of the profit loss statements along with managing
and handling the smooth administration of the hospital. These are specialized professionals who
are great at enforcing and mediating hospital ethics along with the knowledge and efficiency to
excel at what they do.

8
SPECIALISTS SURGEONS

These professionals are also an important part of the hospital management hierarchy.
These are specialized surgeons with years of practice and vital experience. Some surgeons after
serving a hospital for several years with dedication also get promoted to the hospital administration
level and become a part of the administrative team.
3.3.2 MIDDLE LEVEL OF HOSPITAL MANAGEMENT HIERARCHY

This is the executive level in the hospital management hierarchy. It includes following
groups

NORMAL SPECIALISTS

These are those doctors who specialize in a certain type of medicine, like urologists,
cardiologists, and oncologist.

THE SILENT DOCTORS

This group of hospital professionals includes doctors such like anesthesiologists,

pathologists, and radiologists.

NURSING

Nurses play a vital role in the hospital management hierarchy since all the assisting work
of a doctor is handled by the nurses. Nurses are further of two types – the registered practical
nurses and the licensed nurses.

3.3.3 LOWER LEVEL OF HOSPITAL MANAGEMENT HIERARCHY

This is the lowest level in the hospital management hierarchy. This group responds to the
operational level.

PHYSICIAN ASSISTANT

A physician assistant is practically a doctor. He is a commendable and trustable

professional who is responsible for the testing, treatment and examination of the medical

9
conditions of the patients in the hospital. They have extensive training, do the day-to-day functions
of doctors and have the ability to prescribe medicine.

MEDICAL STUDENTS

Well these are the individuals seeking medical degree but not employee of the hospital yet
doing practice in the hospital. This can be considered as the lowest level of the hierarchy and can
be termed as a trainee or practitioner.(Haddock, Cynthia Carter, 2002) .

3.4 MANAGEMENT: DEFINITION, FUNCTIONS & COMPETENCIES

Management is needed to support and coordinate the services that are provided
within healthcare organizations. Management has been defined as the process, comprising social
and technical functions and activities, occurring within organizations for the purpose of
accomplishing predetermined objectives through humans and other resources.

Implicit in the definition is that managers work through and with other people, carrying
out technical and interpersonal activities, in order to achieve desired objectives of the organization.
Others have stated that a manager is anyone in the organization who supports and is responsible
for the work performance of one or more other persons.

Organizational settings Managerial positions

Physician practice Practice manager, Director of medical records

Nursing home Administrator, Business office, Food service

Hospital CEO, Vice president, supervisor,

Maintenance, Marketing manager

Table 3.2 Managerial positions by organizational setting

Planning: This function requires the manager to set a direction and determine what needs
to be accomplished. It means setting priorities and determining performance targets.
Organizing: This management function refers to the overall design of the organization
or the specific division, unit, or service for which the manager is responsible. Further, it
means designating reporting relationships and intentional patterns of interaction.

10
 Determining positions, teamwork assignments, and distribution of authority and
responsibility are critical components of this function.
Controlling: This function refers to monitoring staff activities and performance, and
taking the appropriate actions for corrective action to increase performance.
Directing: The focus in this function is on initiating action in the organization through
effective leadership and motivation of, and communication with, subordinates.
Decision making: This function is critical to all of the aforementioned management
functions and means making effective decisions based on consideration of benefits and
the drawbacks of alternatives. In order to effectively carry out these functions, the
manager needs to possess several key competencies. Katz identified several key
competencies of the effective manager, including conceptual, technical, and
interpersonal skills. The term competency refers to a state in which an individual has
the requisite or adequate ability or qualities to perform certain functions (Ross, Wenzel,
& Mitlying, 2002). These are defined as follows:
Conceptual skills: They are those skills that involve the ability to analyze critically and
solve complex problems. Examples: a manager conducts an analysis of the best way to
provide a service, or determines a strategy to reduce patient complaints regarding food
service.
Technical skills: They are those skills that reflect expertise or ability to perform a
specific work task. Examples: a manager develops and implements a new incentive
compensation program for staff or designs and implements modifications to a computer-
based staffing model.
Interpersonal skills: They are those skills that enable a manager to communicate with
and work well with other individuals, regardless of whether they are peers, supervisors,
or subordinates. Examples: a manager counsels an employee whose performance is
below expectation, or communicates to subordinates the desired performance level for
a service for the next fiscal year.

3.5 PROCESS OF EQUIPMENT MAINTENANCE & FUNCTION

Equipment maintenance is any process used to keep a business’s equipment in reliable

working order. It may include routine upkeep as well as corrective repair work. Equipment may

11
include mechanical assets, tools, heavy off-road vehicles, and computer systems. The resources
needed to keep it all in good repair will vary by type. For instance, repairs made on heavy
construction equipment won’t look the same as those performed on automated food processing
machines. The types of equipment maintenance workers may include technicians, supervisors, and
managers.

3.5.1 MAINTENANCE TECHNICIANS

Equipment maintenance technicians handle general upkeep and repair work on a

business’s equipment. They may also be involved in diagnostic testing and routine inspections as
directed by their supervisors. Individual technicians may specialize in working on specific types
of equipment, or they might provide general maintenance services.

3.5.2 MAINTENANCE MANAGERS

An equipment maintenance manager handles high level planning and oversees

maintenance supervisors. Their planning is centered around meeting the department’s long-term
goals rather than day-to-day requirements, though their tasks may overlap somewhat with those of
supervisors.

12
 CHAPTER 4

SPECIALIZED EQUIPMENT

4.1 STUDY OF PATIENT MONITORING SYSTEM

4.1.1 INTRODUCTION

A patient monitoring system is a set of systems and/or processes that enable medical
professionals to monitor a patient’s health. These systems are often used for remote patient
monitoring and are also referred to as remote physiologic monitoring. They use digital
technologies to capture and monitor health data from patients and transmit it electronically to
health care providers to aid in assessing, diagnosing, and ultimately treating health conditions.
This technology is revolutionizing the way health care is delivered in the United States by reducing
costs and improving outcomes for patients.

Figure 4.1 Patient monitoring system

4.1.2 COMPONENTS

4.1.2.1 PATIENT MONITORING DEVICE

While this term can also refer to the system in its entirety, more specifically it is the part
of the device that comes in contact with or is inserted into the patient. It usually includes a sensor

13
that digitizes the information and a processing device that collects the data and prepares it for
analysis.

4.1.2.2 USER ACCESS PORTAL

The data collected by the patient monitoring device would be useless if it can’t be viewed.
As the patient monitoring device collects patient health data it is sent to either a local data
collection device, or a remote cloud, to be compiled into useful information to be used by health
care professionals. In the case of local user access, it usually consists of a complex interconnect
system with connectors, wire harnesses, printed circuit boards (PCB), and an LCD screen where
the data can be viewed. With a cloud-based system the user interface is normally accessed using a
PC or laptop.

4.1.2.3 SOFTWARE

Both the patient monitoring device and user access portals utilize software. While the
device hardware is extremely important, the software is what translates the information so it can
be understood and used by medical professionals.

4.1.2.4 HEARTBEAT SENSOR

The heartbeat sensor is based on the principle of photo plethysmography. It measures the
change in volume of blood through any organ of the body which causes a change in the light
intensity through that organ (a vascular region). In case of applications where heart pulse rate is
to be monitored, the timing of the pulses is more important. The flow of blood volume is decided
by the rate of heart pulses and since light is absorbed by blood, the signal pulses are equivalent to
the heart beat pulses. There are two types of photo plethysmography:

Transmission: Light emitted from the light emitting device is transmitted through any vascular
region of the body like earlobe and received by the detector.

14
 Figure 4.2 Heartbeat Sensor

4.1.2.5 TEMPERATURE SENSOR

The LM35 series are precision integrated-circuit temperature devices with an output
voltage linearly-proportional to the Centigrade temperature. The LM35 device has an advantage
over linear temperature sensors calibrated in Kelvin, as the user is not required to subtract a large
constant voltage from the output to obtain convenient Centigrade scaling.

Figure 4.3 Temperature Probe

4.1.3 PHYSIOLOGICAL PARAMETERS

1.ECG monitoring

15
 2.Blood pressure monitoring

3.Respiration

4.Blood pressure

4.1.4 MANUFACTURERS

1.Philips
2.GE
3.Nihon
4.Welch
5.Spacelabs Healthcare

4.2 STUDY OF ELECTROCARDIOGRAPHY

4.2.1 INTRODUCTION

Electrocardiography is the process of producing an electrocardiogram (ECG or EKG[a]),

a recording of the heart's electrical activity.[4] It is an electrogram of the heart which is a graph of
voltage versus time of the electrical activity of the heart using electrodes placed on the skin. These
electrodes detect the small electrical changes that are a consequence of cardiac muscle
depolarization followed by repolarization during each cardiac cycle (heartbeat). Changes in the
normal ECG pattern occur in numerous cardiac abnormalities, including cardiac rhythm
disturbances. There are three main components to an ECG: the P wave, which represents
depolarization of the atria; the QRS complex, which represents depolarization of the ventricles;
and the T wave, which represents repolarization of the ventricles.

4.2.2 ELECTROCARDIOGRAPH MACHINE

Electrocardiograms are recorded by machines that consist of a set of electrodes connected

to a central unit.[26] Early ECG machines were constructed with analog electronics, where the
signal drove a motor to print out the signal onto paper. Today, electrocardiographs use analog-to-
digital converters to convert the electrical activity of the heart to a digital signal.

16
 Figure 4.4 Electrocardiograph Machine

4.2.3 CARDIAC MONITORS

Implantable devices such as the artificial cardiac pacemaker and implantable cardioverter-
defibrillator are capable of measuring a "far field" signal between the leads in the heart and the
implanted battery/generator that resembles an ECG signal (technically, the signal recorded in the
heart is called an electrogram, which is interpreted differently). Advancement of the Holter
monitor became the implantable loop recorder that performs the same function but in an
implantable device with batteries that last on the order of years.

Figure 4.5 Cardiac Monitors

4.2.4 ELECTRODES AND LEADS

Electrodes are the actual conductive pads attached to the body surface.[32] Any pair of
electrodes can measure the electrical potential difference between the two corresponding locations
of attachment. Such a pair forms a lead. The 12-lead ECG has a total of three limb leads and three
augmented limb leads arranged like spokes of a wheel in the coronal plane (vertical), and six
precordial leads or chest leads that lie on the perpendicular transverse plane.

17
 Figure 4.6 Lead Placement

ELECTRODE ELECTRODE PLACEMENT

RA On the right arm, avoiding thick muscle.
LA In the same location where RA was placed, but on the left arm.
RL On the right leg, lower end of inner aspect of calf muscle
LL In the same location where RL was placed, but on the left leg.
V1 In the fourth intercostal space just to the right of the sternum
V2 In the fourth intercostal space just to the left of the sternum.
V3 Between leads V2 and V4.
V4 In the fifth intercostal space in the mid-clavicular line.
V5 Horizontally even with V4, in the left anterior axillary line.
V6 Horizontally even with V4 and V5 in the mid-axillary line.
Table 4.1 Placements of Leads

4.2.5 MEDICAL USES

The overall goal of performing an ECG is to obtain information about the electrical
functioning of the heart. Medical uses for this information are varied and often need to be
combined with knowledge of the structure of the heart and physical examination signs to be
interpreted. Some indications for performing an ECG include the following:

➢ Chest pain or suspected myocardial infarction (heart attack), such as ST elevated

myocardial infarction (STEMI) or non-ST elevated myocardial infarction (NSTEMI)

18
 ➢ Symptoms such as shortness of breath, murmurs, fainting, seizures, funny turns, or
arrhythmias including new onset palpitations or monitoring of known cardiac arrhythmias
➢ Medication monitoring (e.g., drug-induced QT prolongation, Digoxin toxicity) and
management of overdose (e.g., tricyclic overdose)
➢ Electrolyte abnormalities, such as hyperkalemia
➢ Perioperative monitoring in which any form of anesthesia is involved (e.g., monitored
anesthesia care, general anesthesia). This includes preoperative assessment and
intraoperative and postoperative monitoring.
➢ Cardiac stress testing
➢ Computed tomography angiography (CTA) and magnetic resonance angiography (MRA)
of the heart (ECG is used to "gate" the scanning so that the anatomical position of the heart
is steady)
➢ Clinical cardiac electrophysiology, in which a catheter is inserted through the femoral vein
and can have several electrodes along its length to record the direction of electrical activity
from within the heart.

4.3 STUDY OF LARYNGOSCOPE

4.3.1 INTRODUCTION

Laryngoscopy is endoscopy of the larynx, a part of the throat. It is a medical procedure

that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may
be performed to facilitate tracheal intubation during general anaesthesia or cardiopulmonary
resuscitation or for surgical procedures on the larynx or other parts of the upper tracheobronchial
tree.

Figure 4.7 Laryngoscopes

19
4.3.2 WORKING PRINCIPLE

A laryngoscopy is a procedure in which a tube is inserted through the mouth in order to

visualize the larynx (the voice box). This method can detect abnormalities in the voice box
ranging from polyps to laryngeal cancer.

4.3.3 APPLICATIONS

➢ Helps in intubation during the administration of general anaesthesia or for mechanical

ventilation.
➢ Detects causes of voice problems, such as breathing voice, hoarse voice, weak voice, or
no voice.
➢ Detects causes of throat and ear pain.
➢ Evaluates difficulty in swallowing : a persistent sensation of lump in the throat, or
mucous with blood.
➢ Detects strictures or injury to the throat, or obstructive masses in the airway.

4.3.4 COMPLICATIONS

Cases of mild or severe injury caused by rough and inexperienced use of laryngoscopes
have been reported. These include minor damage to the soft tissues within the throat which
causes a sore throat after the operation to major injuries to the larynx and pharynx causing
permanent scarring, ulceration and abscesses if left untreated. Additionally, there is a risk of
causing tooth damage.

4.4 DEFIBRILLATOR

4.4.1 INTRODUCTION

Defibrillators are devices that send an electric pulse or shock to the heart to restore a
normal heartbeat. They are used to prevent or correct an arrhythmia, an uneven heartbeat that is
too slow or too fast. If the heart suddenly stops, defibrillators can also help it beat again.

20
 Figure 4.8 Defibrillator

4.4.2 WORKING PRINCIPLE

The heart is able to perform the important function of blood pumping only through the
synchronized of the heart muscle fibers is lost. A method to return the fibers to its normal
synchronized working is called defibrillation. It consists of delivering a therapeutic dose of
electric energy to the affected heart with a device called defibrillator. Defibrillators can be
external, transvenous or implanted based on the nature of device used. Depending on this
fibrillation is classified into atrial fibrillation of atrial muscles and the fibrillation of ventricles is
called ventricular fibrillation. The early defibrillators used the alternating current which is
transformed from normal line voltage up to 300-1000 volts from a power socket to the exposed
heart by way of paddle type electrodes.

4.4.3 DC DEFIBRILATOR

The defibrillator is designed in such a way that the capacitor is rapidly discharged
through electrodes across the chest of the patient. AC fibrillators cannot be used to correct atrial
fibrillation effectively. But DC defibrillator can correct both atrial and ventricular defibrillation.
This is an important advantage of DC defibrillators over the AC defibrillators. The DC method
requires fewer repetitions and most importantly, it is less likely to harm the patient. The circuit
representation of a DC defibrillator is shown below (Figure 4.1).

21
 Figure 4.9 DC Defibrillator Block Diagram

The electrodes are the components through which the defibrillator for delivers energy to
the patient's heart. Many types of electrodes such as hand-held paddles, internal paddles, pre-
gelled disposable electrodes etc. ln general disposable electrodes are used in emergency
conditions because they have the advantages such as increasing the speed of shock and
improving defibrillation technique. Larger paddles create a lower resistance and allows more
current to reach the heart .So larger paddles are desirable.

4.4.4 TROUBLESHOOTING

➢ Inspect the defibrillator for external cracks, broken switches, knobs and indicators.
➢ Examine the cover, pad, and cable of the defibrillator properly for gel and dirt. To clean
the defibrillator see the BTA skill set to Cleaning. If necessary, detect damage to the
casing with the BTA skill on the casing
➢ Power the device from the AC line and turn it on.
➢ Check the power supply using a multimeter as well as inspect the wiring and connections
from the circuit board to the other boards. See the BTA skill set on Connections to
identify and fix broken wires and bad connections.
➢ Check the fuse and if the fuse is defective, replace it as per the rating.
➢ Most defibrillators can draw power from the battery and AC power mains.
➢ Disconnect the defibrillator from the AC power line. Turn on the device.
➢ If the battery/status indicator is red, the battery needs to be charged or replaced (non-
rechargeable).
➢ If the defibrillator does not turn on, the battery is completely exhausted or damaged

22
 ➢ To replace and identify damaged batteries, replace the serial number and model specified
on the batteries.
➢ To troubleshoot the charging circuit, check the transformer and the regulator.
➢ Power the device from the AC line and turn it on. The device will run an automatic self-
test.
➢ The result of the self-test will be displayed (on the screen) or the status indicator will turn
red/green.
➢ Its pedals should be clean and dry. Inspect pad cables and connectors for cut and broken
wires.
➢ The pedal electrode should have a metal paddle with an insulated handle.
➢ These paddle electrodes are reusable and must be cleaned after each use. Connections and
connectors must be replaced to identify and replace damaged cables.
➢ Self-adhesive electrodes should be replaced after each use.

4.5 HEMODIALYSIS

4.5.1 INTRODUCTION

The machine filters your blood through a dialyzer, also known as an artificial kidney, with
built-in safety checks to be sure the process is safe and effective. Dialysis may need to be initiated
when there is a sudden rapid loss of kidney function, known as acute kidney injury (previously
called acute renal failure), or when a gradual decline in kidney function -chronic kidney disease
reaches stage 5. Dialysis is used as a temporary measure in either acute kidney injury or in those
awaiting kidney transplant and as a permanent measure in those for whom a transplant is not
indicated or not possible.

23
 Figure 4.10 Hemodialysis

4.5.2 PRINCIPLE

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across
a semi-permeable membrane. Diffusion is a property of substances in water; substances in water
tend to move from an area of high concentration to an area of low concentration.[9] Blood flows
by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the
opposite side. A semipermeable membrane is a thin layer of material that contains holes of various
sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the
passage of larger substances (for example, red blood cells and large proteins). This replicates the
filtering process that takes place in the kidneys when the blood enters the kidneys and the larger
substances are separated from the smaller ones in the glomerulus.

The two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes and
excess water from the blood in different ways.[2] Hemodialysis removes wastes and water by
circulating blood outside the body through an external filter, called a dialyzer, that contains a
semipermeable membrane. The blood flows in one direction and the dialysate flows in the
opposite. The counter-current flow of the blood and dialysate maximizes the concentration
gradient of solutes between the blood and dialysate, which helps to remove more urea and
creatinine from the blood.

24
 Figure 4.11 Block Diagram of dialyzing

4.5.3 COMPLICATIONS OF DIALYSIS

Some complications occur mainly at the first use of a dialyzer: a new cellophane or
cuprophane membrane may activate the complement system, or a noxious agent may be introduced
to the dialyzer during production or generated during storage. These agents may not be completely
removed during the routine rinsing procedure.

4.6 VENTILATORS

4.6.1 INTRODUCTION

A ventilator is a device that supports or recreates the process of breathing by pumping air
into the lungs. Sometimes, people refer to it as a vent or breathing machine. Doctors use ventilators
if a person cannot breathe adequately on their own. This may be because they are undergoing
general anesthesia or have an illness that affects their breathing.

4.6.2 NEED OF VENTILATOR

There are many injuries and conditions that can cause respiratory failure, including Trusted
Source:

● Head injury
● Stroke
● Lung disease
● Spinal cord injury

25
 ● Polio
● Sudden cardiac arrest
4.6.3 WORKING PRINCIPLE

A ventilator uses pressure to blow air into the lungs. This pressure is known as positive
pressure. A patient usually exhales the air on their own, but sometimes the ventilator does it
for them too. The amount of oxygen the patient receives can be controlled through a monitor
connected to the ventilator. If the patient’s condition is particularly fragile, the monitor will be
set up to send an alarm to the caregiver, indicating an increase in air pressure.

4.6.4 MODERN VENTILATOR

Modern ventilators are electronically controlled by a small embedded system to allow exact
adaptation of pressure and flow characteristics to an individual patient's needs. Fine-tuned
ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In
Canada and the United States, respiratory therapists are responsible for tuning these settings, while
biomedical technologists are responsible for the maintenance. In the United Kingdom and Europe
the management of the patient's interaction with the ventilator is done by critical care nurses.The
patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by
function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation
needed, the patient-end of the circuit may be either noninvasive or invasive. Noninvasive methods,
such as continuous positive airway pressure (CPAP) and non-invasive ventilation, which are
adequate for patients who require a ventilator only while sleeping and resting, mainly employ a
nasal mask. Invasive methods require intubation, which for long-term ventilator dependence will
normally be a tracheotomy cannula, as this is much more comfortable and practical for long-term
care than is larynx or nasal intubation

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 CHAPTER 5

RADIOLOGY AND DIAGNOSTIC IMAGING

5.1 INTRODUCTION

Radiology is the medical discipline that uses medical imaging to diagnose and treat
diseases within the bodies of animals and humans. A variety of imaging techniques such as X-ray
radiography, ultrasound, computed tomography (CT), nuclear medicine including positron
emission tomography (PET), fluoroscopy, and magnetic resonance imaging (MRI) are used to
diagnose or treat diseases. Interventional radiology is the performance of usually minimally
invasive medical procedures with the guidance of imaging technologies such as those mentioned
above.

5.2 CT SCANNER

5.2.1 INTRODUCTION

A CT scan or computed tomography scan is a medical imaging technique used in

radiology to get detailed images of the body noninvasively for diagnostic purposes. The
personnel that perform CT scans are called radiographers or radiology technologists. Medical
professionals use computed tomography, also known as CT scan, to examine structures inside
your body. A CT scan uses X-rays and computers to produce images of a cross-section of your
body. It takes pictures that show very thin “slices” of your bones, muscles, organs and blood
vessels so that healthcare providers can see your body in great detail.

27
 Figure 5.1 CT Scan

5.2.2 COMPONENTS OF CT SCANNER

➢ CT Scanner Gantry Data Acquisition System Operating Console

➢ The gantry assembly is the largest of these systems. ...
➢ High Voltage Generator X-ray tube Pre Patient Collimator Patient Post Patient Collimator
Detector X ray source Pre Patient Collimation Post Patient Collimation X-ray Detector

5.2.2.1 THE GANTRY

The gantry is the ring-shaped part of the CT Scanner, housing many of the components
necessary to produce and detect x-rays. The components are mounted on the rotating scan frame.
The diameter of the opening or aperture varies in size, as does the gantry as a whole. The aperture
range size is usually 70-90 cm.

5.2.2.2 SLIP RINGS

Today’s newer systems use electromagnetic devices called slip rings, which use a brush-
like apparatus that provides continuous electrical power and electronic communication across a
rotating surface. Slip rings allow the gantry frame to rotate continuously. This eliminates the need
to straighten system cables that would get twisted. By allowing the gantry frame to continuously
rotate, helical scan modes are made possible.

28
 Figure 5.2 Slip Rings

5.2.2.3 THE COOLING SYSTEM

Cooling mechanisms are located in the gantry. They keep other components from being
affected by temperature fluctuations. However, they can take different forms, including filters,
blowers or devices that perform oil-to-heat exchange.

5.2.2.4 THE GENERATOR

CT Scanners currently use high frequency generators. They’re designed to be small enough
to fit within the gantry. In the past, highly stable three-phase generators were used. These stand-
alone units were located near the gantry and required cables.The source collimation looks like
small shutters with an adjustable opening that determines slice thickness. In MDCT systems, slice
thickness is also influenced by the detector element configuration, with choices ranging from 0.5-
10mm.

5.2.3 WORKING

● A motorized table moves the patient (Figure 3) through a circular opening in the CT
imaging system.
● As the patient passes through the CT imaging system, a source of x rays rotates around
the inside of the circular opening. A single rotation takes about 1 second. The x-ray
source produces a narrow, fan-shaped beam of x rays used to irradiate a section of the
patient's body.

29
 ● The data are sent to a computer to reconstruct all of the individual "snapshots" into a
cross-sectional image (slice) of the internal organs and tissues for each complete rotation
of the source of x-rays.

5.2.4 ADVANTAGES

● Diagnose muscle and bone disorders, such as bone tumors and fractures.
● Pinpoint the location of a tumor, infection or blood clot.
● Guide procedures such as surgery, biopsy and radiation therapy.
● Detects and monitors diseases and conditions such as cancer, heart disease, lung nodules
and liver masses.
● Cardiac CT, Denta Scan, Multiphasic Liver scan, Angiographies, 3 D imaging of
bones,High resolution scan of thorax.
● CT scanning is painless, noninvasive, and accurate.
● A major advantage of CT is its ability to image bone, soft tissue, and blood vessels all at
the same time.
● Unlike conventional x-rays, CT scanning provides very detailed images of many types of
tissue as well as the lungs, bones, and blood vessels.

5.2.5 DISADVANTAGES

● Requires breath holding which some patients cannot manage. Artifact is common -
eg, metal clips. Computerized tomography scans of the brain can be affected by bone
nearby.
● It cannot be used to assess individual renal function or degree of obstruction.
● CT scan costs in India can range from INR 1000 to INR 3500, which typically varies
from public and private healthcare facilities.
● Pregnant women should not undergo PET/CT scans because the radiations may be
dangerous to the baby while pregnant or breastfeeding
● A misleading result can incur more costs and emotional pain, and in the worst-case
scenario, can lead to serious health problems.
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5.3 MAGNETIC RESONANCE IMAGING

5.3.1 INTRODUCTION

Magnetic Resonance Imaging (MRI) is a medical imaging technique used in radiology to

form pictures of the anatomy and the physiological process of the body. MRI scanners use strong
magnetic fields, magnetic field gradients and radio waves to generate images of the organs in the
body. MRI is a medical application of nuclear magnetic resonance (NMR) which can also be used
for imaging in other NMR applications , such as NMR spectroscopy .The scanner itself typically
resembles a large tube with a table in the middle , allowing the patient to slide in. An MRI scan
differs from CT scans and x-rays , as it does not use potentially harmful ionizing radiation.

Figure 5.3 Magnetic Resonance Imaging

5.3.2.WORKING

MRIs employ powerful magnets which produce a strong magnetic field that forces protons
in the body to align with that field. When a radiofrequency current is then pulsed through the
patient, the protons are stimulated, and spin out of equilibrium, straining against the pull of the
magnetic field. When the radiofrequency field is turned off, the MRI sensors are able to detect the
energy released as the protons realign with the magnetic field. The time it takes for the protons to
realign with the magnetic field, as well as the amount of energy released, changes depending on
the environment and the chemical nature of the molecules. Physicians are able to tell the difference
between various types of tissues based on these magnetic properties.

31
5.3.3.TYPES OF MRI

● Extremity MRI
● Open MRI
● 3 Tesla MRI

EXTREMITY MRI:

This is a diagnostic imaging procedure that uses a closed MRI machine to look at the tissues
in the arms and legs. Unlike a traditional MRI procedure that uses a large tube-shaped device, an
extremity MRI uses a smaller scanner designed specifically for the body's extremities.

OPEN MRI:

Open MRI machines also stray from the traditional design of the full-body MRI, which
makes some patients feel anxious due to the "closed-in" nature of the machine. An open MRI is
open on the sides or features wider openings, still requiring the patient to lie on a sliding table.

3 TESLA MRI:

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

5.3.4.MRI RESULT:

Magnetic resonance imaging helps identify tumors by magnifying the differences in water
content and blood flow between tissues. Malignant tumors grow their own network of blood
vessels via angiogenesis; this gives them a larger blood supply than the surrounding tissue.
Contrast material highlights this concentration of blood vessels to help pinpoint malignant
growths.When contrast agent is not used an MRI can show:

● The shape, size, appearance, and location of organs, bones, and joints

32
 ● The presence of abnormal growths
● Signs of inflammation or infection

When contrast agent is used MRI can show:

● size and location of benign or malignant growths

● enlarged lymph nodes
● changes in blood flow
● extracellular volume

Figure 5.4 MRI Result

5.3.5. DISADVANTAGES:

● MRI is expensive ($1000-$1500)

● MRI will not be able to find all cancers (i.e. breast cancers indicated by microcalcifications)
● MRI cannot always distinguish between malignant tumors or benign disease (such as
breast fibroadenomas), which could lead to a false positive results
● MRI is not painful, but the patient must remain still in an enclosed machine, which may be
a problem for claustrophobic patients.
5.4 XRAY

5.4.1 INTRODUCTION

X-rays make up X-radiation, a form of high-energy electromagnetic radiation. Most X-rays

have a wavelength ranging from 0.01 to 10 nanometers, corresponding to frequencies in the range
30petahertz to 30exahertz (3×1016 Hz to 3×1019 Hz) and energies in the range 100eV to 100keV.
33
 X-ray wavelengths are shorter than those of UV rays and typically longer than those of
gamma rays. In many languages, X-radiation is referred to as Rontgen radiation, after the German
scientist Wilhelm Rontgen, who discovered it on November 8, 1895. He named it X-radiation to
signify an unknown type of radiation. Spelling of X-ray(s) in the English language includes the
variants x-ray(s), x-ray(s). X-ray imaging begins with a beam of high energy electrons crashing
into a metal target and x-rays are produced.A filter near the x-ray source blocks these low energy
rays, which means only the high energy rays pass through a patient toward a sheet of photographic
film. X-ray can penetrate liquids, gas and solids. The point of penetration is based on the intensity,
quality and wavelength of the Xray beams. The stronger the beam of X-ray the more it will material
it can penetrate, and vice versa. These electromagnetic radiations or X-ray work on the absorption
of low level radiation by parts of our body with higher density, making the radiation not absorbed
hit the photographic 'plate' to form a 'negative image'. This means the waves of X-ray can penetrate
through materials of light atoms, such as flesh that is why flesh is not seen during imaging with
X-rays.Bones, which are heavier atoms than flesh (due to the calcium in them), absorb the X-rays.
The absorbed X-rays by the bones then glow on the photographic film. Meaning the higher the
density of the material the brighter it will be imaged on the photographic film.

Figure 5.5 X Ray

5.4.2 ENERGY RANGES

X-rays with high photon energies above 5–10 keV (below 0.2–0.1 nm wavelength) are
called hard X-rays, while those with lower energy (and longer wavelength) are called soft X-
rays.[68] The intermediate range with photon energies of several keV is often referred to as tender
X-rays. Due to their penetrating ability, hard X-rays are widely used to image the inside of objects,
e.g., in medical radiography and airport security. The term X-ray is metonymically used to refer
34
to a radiographic image produced using this method, in addition to the method itself. Since the
wavelengths of hard X-rays are similar to the size of atoms, they are also useful for determining
crystal structures by X-ray crystallography. By contrast, soft X-rays are easily absorbed in air; the
attenuation length of 600 eV (~2 nm) X-rays in water is less than 1 micrometer.

5.4.2.1GAMMA RAYS

There is no consensus for a definition distinguishing between X-rays and gamma rays. One
common practice is to distinguish between the two types of radiation based on their source: X-rays
are emitted by electrons, while gamma rays are emitted by the atomic nucleus.[70][71][72][73]
This definition has several problems: other processes can also generate these high-energy photons,
or sometimes the method of generation is not known. One common alternative is to distinguish X-
and gamma radiation on the basis of wavelength (or, equivalently, frequency or photon energy),
with radiation shorter than some arbitrary wavelength, such as 10−11 m (0.1 Å), defined as gamma
radiation.

Figure 5.6 Energy Ranges

5.4.3 INTERACTION WITH MATTER

X-rays interact with matter in three main ways, through photo absorption, Compton
scattering, and Rayleigh scattering. The strength of these interactions depends on the energy of the
X-rays and the elemental composition of the material, but not much on chemical properties, since
the X-ray photon energy is much higher than chemical binding energies. Photo absorption or

35
photoelectric absorption is the dominant interaction mechanism in the soft X-ray regime and for
the lower hard X-ray energies. At higher energies, Compton scattering dominates.

5.4.4 DETECTORS

X-ray detectors vary in shape and function depending on their purpose. Imaging detectors
such as those used for radiography were originally based on photographic plates and later
photographic film, but are now mostly replaced by various digital detector types such as image
plates and flat panel detectors. For radiation protection direct exposure hazard is often evaluated
using ionization chambers, while dosimeters are used to measure the radiation dose a person has
been exposed to. X-ray spectra can be measured either by energy dispersive or wavelength
dispersive spectrometers. For X-ray diffraction applications, such as X-ray crystallography, hybrid
photon counting detectors are widely used.

5.4.5 APPLICATIONS

➢ X-ray crystallography in which the pattern produced by the diffraction of X-rays through
the closely spaced lattice of atoms in a crystal is recorded and then analysed to reveal the
nature of that lattice. A related technique, fiber diffraction, was used by Rosalind Franklin
to discover the double helical structure of DNA.[135]
➢ X-ray astronomy, which is an observational branch of astronomy, which deals with the
study of X-ray emission from celestial objects.
➢ X-ray microscopic analysis, which uses electromagnetic radiation in the soft X-ray band to
produce images of very small objects.
➢ X-ray fluorescence, a technique in which X-rays are generated within a specimen and
detected. The outgoing energy of the X-ray can be used to identify the composition of the
sample.
➢ Industrial radiography uses X-rays for inspection of industrial parts, particularly welds.
➢ Radiography of cultural objects, most often x-rays of paintings to reveal underdrawing,
pentimenti alterations in the course of painting or by later restorers, and sometimes
previous paintings on the support. Many pigments such as lead white show well in
radiographs.

36
 ➢ X-ray spectromicroscopy has been used to analyse the reactions of pigments in paintings.
For example, in analysing colour degradation in the paintings of van Gogh.[136]

5.4.6 UNITS OF MEASURE AND DOSES

➢ The measure of X-rays ionizing ability is called the exposure:

➢ The coulomb per kilogram (C/kg) is the SI unit of ionizing radiation exposure, and it is the
amount of radiation required to create one coulomb of charge of each polarity in one
kilogram of matter.
➢ The roentgen (R) is an obsolete traditional unit of exposure, which represented the amount
of radiation required to create one electrostatic unit of charge of each polarity in one cubic
centimeter of dry air. 1 roentgen = 2.58×10−4 C/kg.
➢ However, the effect of ionizing radiation on matter (especially living tissue) is more closely
related to the amount of energy deposited into them rather than the charge generated. This
measure of energy absorbed is called the absorbed dose:
➢ The gray (Gy), which has units of (joules/kilogram), is the SI unit of absorbed dose, and it
is the amount of radiation required to deposit one joule of energy in one kilogram of any
kind of matter.
➢ The rad is the (obsolete) corresponding traditional unit, equal to 10 millijoules of energy
deposited per kilogram. 100 rad = 1 gray.
➢ The equivalent dose is the measure of the biological effect of radiation on human tissue.
For X-rays it is equal to the absorbed dose.
➢ The Roentgen equivalent man (rem) is the traditional unit of equivalent dose. For X-rays
it is equal to the rad, or, in other words, 10 millijoules of energy deposited per kilogram.
100 rem = 1 Sv.
➢ The sievert (Sv) is the SI unit of equivalent dose, and also of effective dose. For X-rays the
"equivalent dose" is numerically equal to a Gray (Gy). 1 Sv = 1 Gy. For the "effective
dose" of X-rays, it is usually not equal to the Gray (Gy).

5.5 STUDY OF ULTRASOUND MACHINE

5.5.1 INTRODUCTION

37
 Ultrasound Machine is a very useful test to visualize the structure of the heart and achieve
the study of its hemodynamic functioning. It is possible to accurately diagnose cardiac, acquired
or congenital conditions. For Ultrasound the Doppler technique is basic, which allows, in addition
to seeing the cardiac structure, the precise speed of blood flow within the heart.

5.5.2 PARTS OF ULTRASOUND MACHINE

A basic ultrasound machine has the following parts:

1. Transducer probe – probe that sends and receives the sound waves
2. Central processing unit (CPU) – computer that does all of the calculations and contains the
electrical power supplies for itself and the transducer probe
3. Transducer pulse controls – changes the amplitude, frequency and duration of the pulses
emitted from the transducer probe
4. Display – displays the image from the ultrasound data processed by the CPU
5. Keyboard/cursor – inputs data and takes measurements from the display
6. Disk storage device – stores the acquired images
7. Printer – prints the image from the displayed data

5.5.2.1 TRANSDUCER PROBE

The transducer probe is the main part of the ultrasound machine. The transducer probe
makes the sound waves and receives the echoes. It is, so to speak, the mouth and ears of the
ultrasound machine. The transducer probe generates and receives sound waves using a principle
called the piezoelectric effect, which was discovered by Pierre and Jacques Curie in 1880. In the
probe, there are one or more quartz crystals called piezoelectric crystals. When an electric current
is applied to these crystals, they change shape rapidly.

Figure 5.7 Parts of an Ultrasound machine

38
5.5.2.2 CENTRAL PROCESSING UNIT (CPU)

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

5.5.2.3 TRANSDUCER PULSE CONTROLS

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

5.5.2.4 DISPLAY

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

5.5.2.5 KEYBOARD/CURSOR

Ultrasound machines have a keyboard and a cursor, such as a trackball, built in. These
devices allow the operator to add notes to and take measurements from the data.

5.5.2.6 DISK STORAGE

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

5.5.2.7 PRINTERS

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

39
5.5.3 WORKING PRINCIPLE

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

sound waves and their echoes. The technique is similar to the echolocation used by bats, whales
and dolphins, as well as SONAR used by submarines. In ultrasound, the following events happen:

1. The ultrasound machine transmits high-frequency (1 to 5 megahertz) sound pulses into

your body using a probe.
2. The sound waves travel into your body and hit a boundary between tissues (e.g. between
fluid and soft tissue, soft tissue and bone).
3. Some of the sound waves get reflected back to the probe, while some travel on further until
they reach another boundary and get reflected.
4. The reflected waves are picked up by the probe and relayed to the machine.
5. The machine calculates the distance from the probe to the tissue or organ (boundaries)
using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of each echo’s
return (usually on the order of millionths of a second).
6. The machine displays the distances and intensities of the echoes on the screen, forming a
two dimensional image like the one shown below.

Figure 5.8 Ultrasound scan image

Ultrasound image of a growing fetus (approximately 12 weeks old) inside a mother's uterus.
This is a side view of the baby, showing (right to left) the head, neck, torso and legs. In a typical
ultrasound, millions of pulses and echoes are sent and received each second. The probe can be
moved along the surface of the body and angled to obtain various views.

40
5.5.4 USES OF ULTRASOUND

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

Here is a short list of some uses for ultrasound:

● Obstetrics and Gynecology

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

41
5.5.5 DANGERS OF ULTRASOUND

There have been some reports of low birth weight babies being born to mothers who had
frequent ultrasound examinations during pregnancy.The two major possibilities with ultrasound
are as follows:

● Development of heat - tissues or water absorb the ultrasound energy which increases their
temperature locally
● Formation of bubbles (cavitation) - when dissolved gasses come out of solution due to local
heat caused by ultrasound However, there have been no substantiated ill-effects of
ultrasound documented in studies in either humans or animals. This being said, ultrasound
should still be used only when necessary (i.e. better to be cautious).

5.5.6 MANUFACTURERS

● GE Ultrasound Machine
● Philips Ultrasound Machine
● Samsung Ultrasound Machine
● Mindray Ultrasound Machine
● Hitachi Ultrasound Machine
● Sonoscape Ultrasound Machine
● Toshiba Ultrasound Machine
● Sonosite Ultrasound Machine
● Siemens Ultrasound Machine

5.5.6.1 GE HEALTHCARE

Built on GE’s powerful Voluson Core Architecture, the Voluson S10 provides exceptional
image quality and advanced capabilities across a wide range of applications helping you make
critical clinical decisions with confidence and help you stay at the forefront of women’s health
imaging. HDlive –helps provide 3D and 4D images with exceptional anatomical realism advanced
VCI with OmniView provides exceptional clarity in an image plane, even when viewing
irregularly shaped structures A 23-inch widescreen LED monitor-This high-definition monitor
delivers 98% more image information than our previous Signature Series monitor.

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 CHAPTER 6

SOFTWARE AND REPORTS

6.1 INTRODUCTION

Medical software is any software item or system used within a medical

context, such as:

● standalone software used for diagnostic or therapeutic purposes;

● software embedded in a medical device (often referred to as "medical device
software");
● software that drives a medical device or determines how it is used;
● software that acts as an accessory to a medical device;
● software used in the design, production, and testing of a medical device; or
● software that provides quality control management of a medical device.

6.2 MEDICAL DEVICE

The global IEC 62304 standard on the software life cycle processes of medical
device software states it's a "software system that has been developed for the purpose of being
incorporated into the medical device being developed or that is intended for use as a medical device
in its own right. In the U.S., the FDA states that "any software that meets the legal definition of a
[medical] device" is considered medical device software.

6.2.1 SOFTWARE AS A MEDICAL DEVICE

The dramatic increase in smartphone usage in the twenty-first century triggered the
emergence of thousands of stand-alone health- and medical-related software apps, many falling
into a gray or borderline area in terms of regulation.Thirteen of the most popular types of
healthcare software are:

43
1. Electronic Health Record (EHR) Software

EHR software is one of the most popular (if not the single most popular) type of software
used by hospitals and clinics. In many ways, it’s similar to a CRM, only adjusted to the medical
industry. EHR software collects information on patients – for example, the medication they take,
doctors’ recommendations, and the procedures that they have undergone in the past.Many
programs also include a financial module for invoicing and payment, and a separate portal for the
patient, which allows patients to access their consultation history, medical records, and
prescriptions. The two most popular types of EHR software are:

● Electronic patient record software (EPR) – used internally by hospitals to store

and process their patient information.
● Electronic medical record software (EMR) – used to store data like medication
types and dosage, past and planned procedures, and data on the patient’s recovery
course.

2. Medical database software

Similarly to Electronic Health Record software, medical database software stores patients’
histories and treatment plans. However, unlike in EHRs, the database is categorized by disease,
not patients’ profiles.

3. Medical research software

Medical research software is used for two primary purposes: education and sharing
research with the medical community. This type of software is commonly used to train medical
personnel and to support diagnoses if no similar clinical cases among patients can be referenced
internally.

4. Medical diagnosis software

Medical diagnosis software for doctors allows them to exchange anonymized patient
records so that they can fill any informational gaps preventing them from providing an accurate
diagnosis. This type of software often leverages artificial intelligence (AI) to analyze all available
patient data and generate probable diagnoses.

44
5. Medical imaging software

Medical imaging and visualization software is used primarily for processing MRI/CT/PET
scans and designing 3D models . Human anatomy 3D modeling. Such programs let medical
technicians create tailored models for individual patients. For example, 3D modeling software is
used to generate and print out a real-life model of a patient’s teeth before a planned orthodontic
treatment.

6. E-prescribing software

More and more countries around the world are switching to electronic prescriptions, which
also means e-prescribing software is becoming a must-have for doctors. The software lets medical
professionals track, renew, and cancel prescriptions for their patients. It’s also integrated with
national drug reference databases

7. Telemedicine software

Telemedicine is truly a booming industry, with a market value expected to reach $64 billion
by the year 2025 – and that’s just the data for the United States alone! What makes it so successful
is its convenience for doctors and patients alike.

8. Appointment scheduling (booking) software

Booking software helps hospitals, clinics, and medical practices manage their appointment
systems online. Typically, the software features a patient panel that lets individuals schedule
appointments via an app or website.

9. Medical billing software

This software helps hospital accounting departments keep track of patient invoices,
payments, and any other financial operations. It’s often integrated into bigger systems, such as
EHR or hospital management software.

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 CHAPTER 7

TROUBLESHOOTING ,MAINTANANCE AND SERVICING OF

MEDICAL EQUIPMENT

7.1 TROUBLESHOOTING

Troubleshooting is a systematic approach to problem solving that is often used to find

and correct issues with complex machines, electronics and software systems.

7.1.1 BASIC TROUBLESHOOTING PROBLEMS

7.1.1.1 DEVICE POWER

Power is not just electricity; some devices require compressed gasses, vacuum, or water to
work. To check these parameters in correct levels.The signs that a device is powered up include
indicator lamps, the screen is lit, you can hear a fan or motor running, and the pressure/flow
indicators do not register zero In most modern equipment, there is more than one power supply in
an instrument, so you need to determine which of the power supplies is defective.

7.1.1.2 PROCESSOR

It is a rare failure point, where it can get into serious expenses. These problems can be
found by self-test on the device. . If that comes out OK, the problem is probably not in the
processor. If the self-test comes back with an error code, then correct that before going any further.
On some devices you cannot do a reset from the panel but have to do a full shutdown to reset the
program that controls the processor.

7.1.1.3 OUTPUT

The output of a device is its final product. In many cases it is a delivered energy, a graph,
or a set of alpha/numeric characters. In some cases it may be more than one.

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 The most common devices with graphs are recorders; ECG, EEG, and fetal heart rate are
the most common of those. Problems with graphs often involve the paper not being installed
correctly or the paper is not moving at a constant speed. Other problems involve dirt or wax buildup
on the print head or stylus.

7.1.1.4 MEMORY OR PROGRAM

This type of fault generally affects both the processor and the output. Sometimes, it can
confuse you as to exactly what the problem is. With straight memory problems, the installed
parameters may be wrong for the patient, they may be for another application of the device, or
someone might be playing with the unit and has changed the default settings. It is a good idea to
keep the default settings on a device on the inside cover of the service manual.

7.2 EQUIPMENT MAINTENANCE

Proper maintenance of medical equipment is essential to obtain sustained benefits and to

preserve capital investment. Medical equipment must be maintained in working order and
periodically calibrated for effectiveness and accuracy of the results.

The Maintenance consists of:

● Planned Preventive Maintenance

● Breakdown Maintenance

7.2.1 PLANNED PREVENTIVE MAINTENANCE (PPM)

Planned Preventive Maintenance involves maintenance performed to extend the life of the
equipment and prevent its failure. Planned Preventive Maintenance is usually scheduled at specific
intervals and includes specific maintenance activities such as lubrication, calibration, cleaning (e.g.
filters) or replacing parts that are expected to wear (e.g. bearings) or which have a finite life (e.g.
tubing).

7.2.2 BREAKDOWN MAINTENANCE

Breakdown Maintenance is a task performed to identify, isolate, and rectify a fault so that
the out of order equipment, machine, or system can be restored to an operational condition. All

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medical equipment in use should be free from any fault or defect and all repair work should be
carried out to accepted standards by competent person(s).

7.2.3 CONDITION-BASED MAINTENANCE

Condition-based maintenance (CBM) is at the core of predictive maintenance but, on its

own, does not rely on technology to determine the condition of an asset like PdM does.

7.3 SERVICING

Medical equipment repairers, also known as biomedical equipment technicians (BMETs),

repair a wide range of electronic, electromechanical, and hydraulic equipment used in hospitals
and health practitioners’ offices. They may work on patient monitors, defibrillators, ventilators,
anesthesia machines, and other life-supporting equipment. They also may work on medical
imaging equipment (x rays, CAT scanners, and ultrasound equipment), voice-controlled operating
tables, and electric wheelchairs.

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 CHAPTER 8

CONCLUSION

The hospitals are classified based on Ownership/ control basis, Length of stay of patients
and Clinical basis. A multi-specialty hospital must have more than one specialty but they can be
the broad specialties like medicine, surgery, Pediatrics etc. MMCH hospital has also provided the
working descriptions of various department equipment’s such as ICU, Radiology, and operation
theater. The hospital training program is an excellent opportunity for me to get to the ground level
and experience things. It has been a good opportunity to identify, observe and the practice of
engineering applications in the real hospital environment. It is not only to get experience on the
technical practices but also to observe management practice and to interact with fellow workers.
Apart from maintenance of equipment, this training provides clear ideas about organization of
work order and essential teamwork. Biomedical engineers in the hospital gave ideas on
organization of tasks and assignments. Because servicing some equipment in the hospital requires
higher priority than other department equipment, for example operation theater equipment. An
effective time management allows us to do assignment efficiently within the schedules. Also I
learn the way of work in an organization, the importance of being punctual, the importance of
maximum commitment, and the importance of team spirit. It provided the knowledge and
experience needed to be successful in the health care sector.

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