CHAPTER 1

INTRODUCTION

1.1 ABOUT THE HOSPITAL

The best super-multispecialty hospital in Chennai, Tamil Nadu, is Meridian

Hospital. They offer top-notch care along with round-the-clock emergency
assistance. Meridian Multi Super Specialty Hospital features a 300-bed, ultra-
modern facility with a 65-bed ICU and sophisticated monitoring. A brand-new,
cutting-edge healthcare facility. Cardiology, cardiothoracic, neurology,
neurosurgery, and obstetrics and gynecologist are a few of the recognised
specialties. Additionally they have expertise in urology, pediatrics, and
neonatology with NICU and PICU. Their goal is to offer the best clinical care
possible while combining the ethics and ideals of the nation's cutting-edge
healthcare system. The multi-specialty hospital Meridian is prepared to continue
offering super specialist services. Their objective is to uphold their vision and
assist as many individuals as they can. They take pleasure in their high
standards, best practices, and efficient care.

Figure 1.1 Meridian Hospital

1
1.2 DEPARTMENTS IN HOSPITAL

Several of the hospital's departments and specialty procedures include:

 Neurology
 Pulmonology
 Cardiology
 Gastroenterology
 Nephrology
 Urology
 Obstetrics and Gynaecology
 Critical care unit
 Surgical Specialities
 Radiology
 Pediatrics
 Physiotherapy
 Orthopaedics
 24/7 Emergency

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1.3 ROLE OF BIOMEDICAL ENGINEERS
A Biomedical Engineer is primarily concerned with solving problems;
thus, specializing in the fields of biology and medicine, biomedical
engineers focus on analysing challenges and designing efficient and
effective solutions to improve quality of patient care. Because healthcare
systems are vast and complex, biomedical engineers can work on any of a
number of necessary tasks, such as developing artificial organs, building
machines to aid in diagnosis, providing technical support for medical
technology, training clinicians in machine use, and even studying the
engineering aspects of biological systems, like the endocrine system, in
humans and animals.
However, most biomedical engineers claim a concentration in specific
professional field. Biomedical engineering studies are broad,
encompassing biology, chemistry, math, physics, computer science, and
more, so biomedical engineers can apply any of this knowledge to benefit
the medical community. For example, one biomedical engineer might
spend a career devoted to developing software to run complicated
medical instruments, while another biomedical engineer applies biology
and chemistry to craft new drug therapies. Some of the newest efforts of
biomedical engineers include using biomaterials (cells and tissues) to
solve problems. Bioprinting is a prime example of biomedical engineers’
successes. Generally, Biomedical Engineers enjoy diverse career
opportunities, but each application of biomedical engineering is vital to
the success of a healthcare facility. From research of bodily systems and
development of medical devices to maintenance of facility networks and
instruction on treatment procedures, biomedical engineers keep hospitals,
clinics, and care facilities running and helping patients.

3
 CHAPTER 2
NEUROLOGY
Neurology is the branch of medicine dealing with the diagnosis and
treatment of all categories of conditions and disease involving the brain,
the spinal cord and the peripheral nerves. Neurological practice relies
heavily on the field of neuroscience, the scientific study of the nervous
system.
A Neurologist is a physician specializing in neurology and trained to
investigate, diagnose and treat neurological disorders. Neurologists treat a
myriad of neurologic conditions, including stroke, seizures, movement
disorders such as Parkinson's disease, autoimmune neurologic disorders
such as multiple sclerosis, headache disorders like migraine and
dementias such as Alzheimer's disease. Neurologists may also be
involved in clinical research, clinical trials, and basic or translational
research. While neurology is a nonsurgical specialty, its corresponding
surgical specialty is neurosurgery.

2.1 NEURODIAGNOSTICS
Neurodiagnostics help doctors determine whether the brain, spinal cord,
and/or peripheral nervous system are functioning properly. The nervous
system relies on tiny electrical signals that travel through the central and
peripheral nervous systems, carrying instructions from the brain to the
rest of the body and also carrying sensory information from the body
back to the brain. An interruption in those signals sometimes results in
loss of function in a limb, sensory deficits, coordination problems, or gait
dysfunction.

4
2.1.1 Diagnostic Procedures

Neurodiagnostic analysis might involve several tests to pinpoint a

condition or rule out others. Depending on the test, the patient can be
awake or asleep during the procedure.
Imaging tests include magnetic resonance imaging (MRI), computed
tomography (CT) scans, X-rays, or positron emission tomography (PET)
scans.
Specific tests include:
 3-D rotational angiography: An X-ray study that looks inside the
veins and arteries to detect cerebral, abdominal, or peripheral
vascular abnormalities such as aneurysms.
 Computed tomography angiography (CTA): Used to visualize the
arteries and veins throughout various parts of the body; often used
with conditions such as strokes.
 Diagnostic and interventional cerebral angiography: Provides
images of the veins and arteries in and around the brain; used with
conditions such as strokes.
 High-field MRI: Assesses brain alterations; used with strokes
 Magnetic resonance perfusion: Uses injected dye to see blood flow
through tissue.
 Transcranial doppler and carotid doppler: Tests blood flow in the
arteries of the brain and neck; used in strokes and cerebral vascular
diseases.

5
2.1.2 Product Specification

Figure 2.1 Magnetoencephalography Figure 2.2 Intracranial pressure

monitor

Magnetoencephalography

Magnetoencephalography (MEG) is a non-invasive medical test that measures

the magnetic fields produced by your brain's electrical currents. It is performed
to map brain function and to identify the exact location of the source of epileptic
seizures.

Intracranial pressure monitor

An intracranial pressure (ICP) monitor is a common neurosurgical procedure

used to monitor raised intracranial pressure. A pressure transducer is inserted in
the brain, usually a frontal lobe, which gives accurate and live pressures. In the
acute setting, the transducer is attached to the monitor that passes through a

6
skull burr hole. These are removed when the patient neurologically improves.
Long term ICP monitors can be inserted such as a wireless device.

2.2 ELECTROENCEPHALOGRAM

An electroencephalogram (EEG) is a test used to evaluate the electrical activity

in your brain. It can help detect potential problems with brain cell
communication.

An EEG tracks and records brain wave patterns. Small flat metal discs called
electrodes are attached to your scalp with wires. The electrodes analyze the
electrical impulses in your brain and send signals to a computer that records the
results.

The electrical impulses in an EEG recording look like wavy lines with peaks
and valleys. These lines allow doctors to quickly assess whether there are
abnormal patterns. Irregularities may be a sign of seizures or other brain
disorders.

EEGs have been used to detect problems in the electrical activity of the brain
that are associated with certain brain disorders. The measurements given by an
EEG are used to confirm or rule out various conditions, including:

 seizure disorders (such as epilepsy)

 head injury
 encephalitis (inflammation of the brain)
 brain tumor
 encephalopathy (disease that causes brain dysfunction)
 sleep disorders
 stroke
 dementia

7
 When someone is in a coma, an EEG may be performed to determine
their level of brain activity. The test can also be used to monitor activity
during brain surgery.

Figure 2.3 EEG Waveforms

2.2.1 Working

The EEG electrodes pick up on electrical activity produced by neurons. EEG

machines use an array of electrodes because the brain produces different signals
from different brain regions. The number of electrodes corresponds with the
number of channels an EEG machine has. The more channels, the higher the
resolution of EEG data captured. A 32 channel EEG machine captures a more
detailed picture of brainwave activity than an 8 channel EEG machine.

EEG signals are typically very small — around 10 microVolts or less. To make
accurate measurements the signals from the electrodes are passed to an
amplifier system that stabilizes the signals and magnifies them to a level that
can be measured accurately using common electronic components that convert
them to digital signals. The amplified signals can be recorded via computer,
mobile device or cloud database.

8
EEG machines measure changes in the electrical activity the brain produces, not
thoughts or feelings. These voltage changes come from ionic current within and
between neurons. EEG machines don’t send any electricity into your brain, they
simply capture electrical signals that naturally occur as your brain absorbs and
processes information.

Figure 2.4 EEG Machine

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2.2.2 Product Specification

Figure 2.5 EEG MACHINE 32CHANNEL

Frequency band: 0-500 Hz

Number of Channels:32
Type: Digital, Portable, Video EEG, Wearable
Uses: Routine EEG, Brain-Computer interfacing, Long term
Monitoring, Neuro Imaging, Neuro Marketing, Pediatric
Neurology, Psychology, Routine EEG, Brain-Computer
interfacing, Long term Monitoring, NeuroImaging,
NeuroMarketing, Pediatric Neurology

10
 CHAPTER 3

PULMONOLOGY

Pneumonology is a medical specialty that deals with diseases involving the

respiratory tract. It is also known as respirology, respiratory medicine, or chest
medicine in some countries and areas. Pulmonology is considered a branch of
internal medicine, and is related to intensive care medicine. Pulmonology often
involves managing patients who need life support and mechanical ventilation.
Pulmonologists are specially trained in diseases and conditions of the chest,
particularly pneumonia, asthma, tuberculosis, emphysema, and complicated
chest infections.

3.1 OXYGEN CONCENTRATOR

An oxygen concentrator is a medical device that provides supplemental or extra

oxygen to a patient with breathing issues. The device consists of a compressor,
sieve bed filter, oxygen tank, pressure valve, and a nasal cannula (or oxygen
mask). Like an oxygen cylinder or tank, a concentrator supplies oxygen to a
patient via a mask or nasal tubes. However, unlike oxygen cylinders, a
concentrator doesn’t require refilling and can provide oxygen 24 hours a day. A
typical oxygen concentrator can supply between 5 to 10 litres per minute (LPM)
of pure oxygen.

3.1.1 Working

An oxygen concentrator works by filtering and concentrating oxygen molecules

from the ambient air to provide patients with 90% to 95% pure oxygen. The
compressor of the oxygen concentrator sucks ambient air and adjusts the
pressure at which it is provided. The sieve bed made of a crystalline material
called Zeolite separates the nitrogen from the air. A concentrator has two sieve

11
beds that work to both release oxygen into a cylinder as well as discharge the
separated nitrogen back into the air. This forms a continuous loop that keeps
producing pure oxygen. The pressure valve helps regulate oxygen supply
ranging from 5 to 10 litres per minute. The compressed oxygen is then
dispensed to the patient through a nasal cannula (or oxygen mask).

Figure 3.1 Oxygen Concentrator model

3.1.2 Product Specification

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 Figure 3.2 Oxygen Concentrator Machine

Description : Oxygen Concentrator 5L

Oxygen flow : 0.5 – 5 LPM

Oxygen Concentration : 93% ± 3%

Functions : Total work hour display, Compressor auto cut off at high
temperature, High & low pressure alarm function. Low oxygen concentration
alarm function. Auto shutdown.

3.2 NEBULIZER

A nebulizer is a small machine that creates a mist out of liquid medication,

allowing for quicker and easier absorption of medication into the lungs.
Typically, nebulizers come in both electric or battery-run versions, and are
either portable (so you can carry with you) or meant to sit on a table and plug
into a wall.

A nebulizer is helpful for a variety of conditions, including:

 chronic obstructive pulmonary disease (COPD)

 asthma
 bronchiectasis
 cystic fibrosis
 pulmonary fibrosis

Nebulizers are also a helpful way to deliver medication during palliative care
and to very young children.

13
3.2.1 Working

A nebulizer delivers liquid medication via pressurized air. While individuals

with asthma typically use both nebulizers and inhalers, occasionally, a nebulizer
may be easier to use especially when it comes to young children who may not
have the proper technique for an inhaler. However, when airways become
narrow -like during an asthma attack an inhaler is most likely the best choice,
because a nebulizer can take some time to set up.

Examples of medications used in nebulizers include:

 Bronchodilators are drugs that help to open up the airway.

 Medical-grade saline (saltwater) solutions are solutions that help break up
mucus in the lungs.
 Antibiotics are used to help treat or prevent infections.

Figure 3.3 Nebulizer model

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3.2.2 Product Specification

Figure 3.4 Nebulizer

Features :

Compressor Nebulizer machine use compressed air to deliver asthma medicine

as a wet aerosol- a fine mist that can be inhaled. Safe-NEB allows the
medication to go directly to a persons airways and lungs and the medication can
be given over a long period of time. Safe-NEB makes inhaling medication
easier for people who are having serious difficulty in breathing or who have
trouble using an inhaler which requires careful timming and control of ones
breathing.

Specification:

 Maximum compressor pressure 2.5 3.0 bar

 Nebulization rate 0.3 ml / min
 Nebulizer cup capacity 6ml
 Particle size( mmad) 0.5m to 5m

15
  Noise level 55 dba

CHAPTER 4

CARDIOLOGY

Cardiology is the study and treatment of disorders of the heart and the blood
vessels. A person with heart disease or cardiovascular disease may be referred
to a cardiologist. Cardiology is a branch of internal medicine. A cardiologist is
not the same as a cardiac surgeon. A cardiac surgeon opens the chest and
performs heart surgery. A cardiologist specializes in diagnosing and treating
diseases of the cardiovascular system. The cardiologist will carry out tests, and
they may perform some procedures, such as heart catheterizations, angioplasty,
or inserting a pacemaker. Heart disease relates specifically to the heart, while
cardiovascular disease affects the heart, the blood vessels, or both.

4.1 ELECTROCARDIOGRAM

An electrocardiogram (ECG) is a graphic record produced by an

electrocardiograph that provides details about one’s heart rate and rhythm and
any other related abnormalities; it depicts if the heart has enlarged due to
hypertension (high blood pressure) or evidence of a myocardial infarction
previously (heart attack if any).

Electrocardiogram (ECG) is one of the most common and effective tests for all
drugs. It is easy to perform, non-invasive, yields outcomes instantly and is
useful to identify hundreds of heart conditions.

ECGs from healthy hearts have a distinct, characteristic shape. Any

inconsistency in the rhythm of the heart or damage to the heart muscle can alter
the heart’s electrical activity thereby changing the shape on the ECG.

16
ECG test can be used to check the rhythm of the heart and the electrical
movement. The electrical signals are detected due to the attachment of the
sensors to the skin which are generated as and when the heart beats. These
signals are recorded by the machine and examined by a medical practitioner for
an unusual signs. An ECG has three main components: the P wave, which
denotes depolarising atria; the QRS complex, denotes the depolarization of the
ventricles; and the T wave represents repolarising ventricles.

During each pulse, a healthy heart has an ordered process of depolarization that
starts with pacemaker cells in the sinoatrial node, extends throughout the
atrium, and moves through the atrioventricular node into its bundle and into the
fibres of Purkinje, spreading throughout the ventricles and to the left.

The electrical activity occurs in a small patch of pacemaker cells called the
sinus node during a regular heartbeat. This produces a small blip called the P
wave when the impulse stimulates the atria. It then activates the main pumping
chambers, the ventricles, and produces the large up-and-down in the middle, the
QRS complex. The last T wave is a time of regeneration as the impulse reverses
over the ventricles and travels back. If the heart is beating normally, it takes
about a second (approximately 60 heartbeats per minute) for the entire cycle.

17
 Figure 4.1 QRS Complex

Normal

In the normal ECG pattern, there is a regular pattern of The P wave, QRS
complex, and T wave. They occur in a sequence.

Angina

When the heart muscle doesn’t get enough blood with oxygen, it causes
discomfort, that feels like putting pressure on the chest. This condition is termed
as Angina pain. It can sometimes be misunderstood as indigestion. As you can
see in the figure above (see arrow), the ST-segment dips, which normally is flat.

18
Serious heart attack

The elevated ST segment of the ECG is an indication of a serious heart attack.

In the medical terminology, it is referred to as “STEMI”, which needs
immediate attention. Generally, the ST segment remains flat.

Atrial fibrillation

Atrial fibrillation is the state when the atria and the ventricles show a lack of
coordination of movement. It results in rapid heartbeat, weakness and shortness
of breath. On ECG, it is represented by jumpy baseline and the P wave
disappears.

4.1.1 Working

 It works on the principle that a contracting muscle generates a small

electric current that can be detected and measured through electrodes
suitably placed on the body.
 For a resting electrocardiogram, a person is made to lie in the resting
position and electrodes are placed on arms, legs and at six places on the
chest over the area of the heart. The electrodes are attached to the
person’s skin with the help of a special jelly.

19
  The electrode picks up the current and transmit them to an amplifier
inside the electrocardiograph. Then electrocardiograph amplifies the
current and records them on a paper as a wavy line.
 In an electrocardiograph, a sensitive lever traces the changes in current on
a moving sheet of paper.
 A modern electrocardiograph may also be connected to an oscilloscope,
an instrument that display the current on a screen.

Figure 4.2 ECG Model

4.1.2 Product Specification

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 Figure 4.3 ECG Machine

 7" TFT, touch screen, led backlight

 Digital isolation technology and signal processing solution, digital filter
 Patient management, name and age and id, Detail analysis report.
 Multi-language options: English, German, French, Italian,
 Built-in lithium rechargeable battery, wide thermal printing system
 USB and LAN socket.
 Memory : Built-in memory or mini SD Memory card. Store more than
1000 pieces of archive.

Technical Features :

Lead: Standard 12 leads

Patient leak current : <10 micro A

Input impedance : ≥50 MΩ

Frequency response : 0.05 ~ 150HZ(-3dB)

4.2 ECHOCARDIOGRAM
21
An echocardiogram, often called a cardiac echo, is a non-invasive ultrasound
imaging test used to observe the heart. Your healthcare provider may order this
test to help diagnose various heart conditions.

A cardiac echo is considered the best way to visualize the movement and
function of the heart muscle and heart valves. You may need a cardiac echo if
you have heart valve disease, heart rhythm irregularities, or cardiac muscle
diseases such as dilated cardiomyopathy or hypertrophic cardiomyopathy.

A cardiac echo is used to identify abnormalities in the heart's structure and

function. A handheld device sends out sound waves that bounce off your heart
and create a moving image of it on a screen. This allows your healthcare
provider to look at the anatomy of your heart from many different angles and to
observe your heart rhythm.

4.2.1 Working

Figure 4.4 Echocardiogram model

A cardiac echo allows your healthcare provider to watch your heart as it beats
so that specific areas of concern can be identified. Some of the heart functions
an echo can detect include:

22
  Problems with the heart valves: For example, mitral valve prolapse can be
detected because the test shows how well your hearts valves are
functioning.
 The velocity, or speed, of blood flow within the heart: A special
microphone called a Doppler can be used during the test to measure this.
This is helpful in measuring problems with blood flow in conditions such
as aortic stenosis.
 Anatomical defects: Congenital heart conditions such as tetralogy of
Fallot and atrial septal defect are conditions that are present from birth in
which the heart does not develop properly.
 Left ventricular ejection fraction: "Ejection fraction" is a term used to
describe how strong the heart is and how well it pumps blood. An echo
can evaluate how well various cardiac treatments are working in people
with conditions such as heart failure.
 Cardiac arrhythmia: An echo can assess your heartbeat. This may help in
determining the exact cause and best treatment if you do have an
arrhythmia, or irregular heart rhythm.

4.2.2 Product Specification

23
 Figure 4.5 Echocardiogram machine

The system should be a color Doppler Echocardiography all digital beam

former system to study the anatomical abnormalities and blood flow in the heart
and associated vessels. Should be a stand alone system integrated on a light
weight mobile cart. Should have 256 gray shades for sharp contrast resolutions..
Should have 2D, M-mode, Anatomical M-mode, Color M-mode, PW and CW
doppler,

Steerable CW doppler. The system should have a very high dynamic range of
at least 200dB to pick up subtle echoes. Should have three active ports. Should
have 2-4 Mhz broadband phased array sector probe for adult cardiac imaging.

CHAPTER 5

GASTROENTEROLOGY

24
 Gastroenterologists diagnose, treat, and care for people with a range of gut-
related illnesses. These include long-term conditions, such as inflammatory
bowel disease (IBD) and celiac disease.

It relates to the study of the function and diseases of the gastrointestinal tract
and the digestive system. Gastroenterology involves a detailed understanding
of:

 The gastrointestinal organs

 The movement of material through the stomach and intestines
 The digestion and absorption of nutrients
 The removal of waste from the body
 The liver

A Gastroenterologist is a medical professional who specializes in conditions

that affect the organs and structures of the digestive system.

5.1 ENDOSCOPY

Endoscopy is a nonsurgical procedure used to examine a person's digestive

tract. Using an endoscope, a flexible tube with a light and camera attached to it,
your doctor can view pictures of your digestive tract on a color TV monitor.
During an upper endoscopy, an endoscope is easily passed through the mouth
and throat and into the esophagus, allowing the doctor to view the esophagus,
stomach, and upper part of the small intestine.

Similarly, endoscopes can be passed into the large intestine (colon) through the
rectum to examine this area of the intestine. This procedure is called
sigmoidoscopy or colonoscopy depending on how far up the colon is examined.

Endoscopic ultrasound or EUS combines upper endoscopy and ultrasound

examination to obtain images and information about various parts of the
digestive tract.

25
5.1.1 Endoscopy procedure

The procedure will depend to some extent on the reason for the endoscopy.
There are three main reasons for carrying out an endoscopy:

 Investigation: If an individual is experiencing vomiting, abdominal pain,

breathing disorders, stomach ulcers, difficulty swallowing, or
gastrointestinal bleeding, for example, an endoscope can be used to
search for a cause.
 Confirmation of a diagnosis: An endoscopy can carry out a biopsy to
confirm a diagnosis of cancer or other diseases.
 Treatment: An endoscope can treat an illness directly; for instance,
endoscopy can be used to cauterize (seal using heat) a bleeding vessel or
remove a polyp.

Sometimes, an endoscopy will be combined with another procedure such as an

ultrasound scan. It can be used to place the ultrasound probe close to organs that
can be difficult to image, such as the pancreas.

Modern endoscopes sometimes come with sensitive lights that use narrow-band
imaging. This type of imaging uses specific blue and green wavelengths that
allow the doctor to spot precancerous conditions more easily. An endoscopy
typically happens while the person is conscious, although sometimes the person
will receive local anesthetic (commonly an anesthetic spray to the back of the
throat). Often, the person is sedated. For endoscopy procedures involving entry
through the mouth, a mouth guard will protect the teeth and lips as the tube is
inserted.

26
 Figure 5.1 Endoscopy model

5.1.2 Product Specification

Figure 5.2 Endoscopy Machine

An examination of upper GI tract using a camera held on to a flexible tube

called endoscope.

 Type: Imaging
 Duration: Usually 20-30 mins
 Results available: Within an hour

27
  Conditions it may diagnose: Gastroesophageal reflux disease , Peptic
ulcer, Stomach cancer, Esophageal cancer , Barrett's esophagus
 Is Invasive: Invasive

5.2 ENTEROSCOPY

Enteroscopy is a procedure that helps your doctor find and treat problems in the
digestive system. During an enteroscopy, your doctor inserts a thin, flexible
tube with an attached camera into your body. This is called an endoscope. There
are usually one or two balloons attached to the endoscope. The balloons can be
inflated to help your doctor get a closer view of your esophagus, stomach, and a
section of the small intestine. Your doctor may use forceps or scissors on the
endoscope to remove a tissue sample for analysis.

Enteroscopy is also known as a:

 double balloon enteroscopy

 double bubble
 capsule enteroscopy
 push-and-pull enteroscopy

The two types of enteroscopy are upper and lower. In an upper enteroscopy, the
endoscope is inserted into the mouth. In a lower enteroscopy, the endoscope is
inserted into the rectum. The type of enteroscopy performed will depend on the
type of problem the doctor is trying to diagnose.

5.2.1 Enteroscopy procedure

An enteroscopy is an outpatient procedure, which means that you can go home

the same day as the procedure. It usually takes between 45 minutes and two
hours to complete. Depending on the type enteroscopy being performed, your

28
doctor will either fully sedate you or give you medicine to help you relax. These
medications will be administered through a vein in your arm.

During the procedure, your doctor will record a video or take pictures. These
can be reviewed in more detail after the procedure is done. Your doctor may
also take tissue samples or remove existing tumors. The removal of any tissue
or tumor won’t cause any pain. Depending on the type of problem you’re
having, your doctor will perform either an upper enteroscopy or a lower
enteroscopy. An upper enteroscopy allows your doctor to view and treat the
upper part of the digestive system. A lower enteroscopy allows your doctor to
view and treat the lower part.

Upper Enteroscopy

After numbing the throat, your doctor will insert an endoscope into your mouth
and gradually ease it through your esophagus and down into your stomach and
upper digestive tract. You may have a feeling of pressure or fullness during this
part of the procedure.

Throughout your upper enteroscopy, you’ll have to remain alert. Your doctor
may need you to swallow or move to help get the tube in place. If any growths
or other abnormalities are found during enteroscopy, your doctor may remove a
sample of tissue for further examination.

Lower Enteroscopy

Once you’re sedated, your doctor will insert an endoscope with a balloon on the
end into your rectum. Once the endoscope reaches the area that your doctor
wants to see or treat, the balloon is inflated. This allows your doctor to get a
better view.

29
 Figure 5.3 Enteroscopy Model

5.2.2 Product Specification

Figure 5.4 Enteroscopy Machine

Area examined: small intestine

scope is inserted: through the mouth or anus

There are several techniques a gastroenterologist may use to gain access deep
into the small intestine, including video capsule endoscopy, double balloon

30
enteroscopy, single balloon enteroscopy and spiral enteroscopy. Balloon
enteroscopy and spiral enteroscopy are collectively known as deep enteroscopy.

Spiral enteroscopy

Both procedures are considered safe and effective for investigating and treating
problems in the small bowel. Spiral enteroscopy uses a special tube with a
rotating spiral placed over the endoscope, which allows the scope to move back
and forth in the small intestine as the spiral rotates.

Figure 5.5 spiral enteroscopy

Balloon enteroscopy

Balloon enteroscopy is a nonsurgical procedure. It’s performed using a long thin

tube with a balloon and a camera at the tip to assess your small intestine. Tiny
instruments can take a biopsy, remove polyps and sometimes stop bleeding.

Figure 5.6 Balloon enteroscopy

31
 CHAPTER 6

NEPHROLOGY
Nephrology is a subfield of medical science dealing with the kidneys; it
involves diseases of the kidneys and the study of normal kidney functioning.
The kidneys are the two small bean-shaped organs below the rib cage that filter
waste products from the blood and produce urine, which is then excreted from
the body. Nephrologists are doctors that specialize in nephrology.

Some of the most common conditions and diseases in nephrology include:

 Acute Kidney Failure/Injury

 Alport Syndrome
 Chronic Kidney Disease (CKD)
 Diabetic Neuropathy
 Fabry Syndrome
 Glomerulonephritis
 Kidney Stones
 Nephrotic Syndrome
 Polycystic Kidney Disease (PKD)

6.1 HEMODIALYSIS

Hemodialysis is a specialized process that uses an artificial kidney machine

called hemodialyzer for extracting extra waste, fluid, and chemicals from the
blood before returning it to the body. After purification blood is returned to the
body through a catheter or port, in leg, arm, or neck.

32
This procedure is usually used for patients who have reached the end stage of
kidney failure. At this stage, 85–90% functioning of kidneys is lost and during
this a patient requires around 4 hours of hemodialysis sessions three times a
week.

6.1.1 Hemodialysis and its principles

Hemodialysis simply refers to the process in which an artificial kidney

(dialyzer) does the function of a kidney when a person's natural kidney fails to
do that. When trying to understand, this definition, keep two things in mind:

 Kidneys not only remove end-products of different metabolic processes

but also produce certain hormones for our body. The artificial kidney
doesn't do that but those hormones are injected into the person's body as a
part of the treatment.
 An artificial kidney or Dialyzer is a machine that is kept outside our body
and is connected through our veins for its functioning.
 Dialyzer, an electric device, would receive the blood from our body. This
blood is filtrated through a filter and after removing the waste products,
the blood is pumped back to the human body. By this process, the waste
and extra fluid in the blood is removed and the blood pressure level is
regulated.

Dialysis works mainly on two principles:

 The principle of diffusion

 The principle of ultrafiltration.

The principle of diffusion works by allowing a solution to pass over a

semipermeable membrane for dialysis. But in the principle of ultrafiltration,
both the solute passing and fluid waste removal are done under a pressure

33
guardian. These principles would be clearer when the procedure of
Hemodialysis is explained.

Figure 6.1 Hemodialysis

6.1.2 Procedure of Hemodialysis

To perform Hemodialysis, we mainly need four things- a Dialyzer (artificial

kidney), dialysate (a solution), a blood delivery system, and access to our blood
vessels. The dialyzer plays the major role of filtering the blood; but let us begin
from where the actual process begins i.e., from the access to the blood vessels.

Access to a human body vessel can be done in three ways- through a fistula,
graft, or rarely through a catheter (a soft tube inserted into a large vein into the
neck or chest). This selection depends on the nature of the patient's body. This
access may be placed as a part of your body, through minor surgery.

34
 Figure 6.2 Hemodialysis process

The access to our blood vessel will be connected to the dialyzer which has two
sides. One side would be for collecting our blood and the other for the dialysate.
These two (blood and dialysate) are passed parallelly through two narrow tubes.
This narrow tube acts as a filter as it is not big enough for substances like urea.
Moreover, dialysate act like a deterging agent that separates the waste from our
blood where diffusion and ultrafiltration happen.

Figure 6.3 Procedure of Hemodialysis

35
The blood flow at a rate of 300-500ml/min, which is regulated by the blood
delivery system. This process is done frequently for 4 hours (or more,
depending on the patient's condition) where the blood flows out of the body,
gets filtrated, and will return to the body. So, dialyzer acts as a kidney kept
outside our body. Hemodialysis is normally done 3 times a week.

6.1.3 Product Specification

Figure 6.4 Hemodialysis Machine

 Should have facility for conventional and High flux dialysis.

 Machine should have two bacterial filter (Pyrogen filters) one at water
inlet and one before water going to dialyser
 Battery back-up for 20-30 minutes to run complete machine with heater
supply Should have Na, Bicarbonate and UF profiling
 Dialysate temperatures selectable between 35 degrees C to 39 deg.
 Should have variable dialysate flow 200-800 ml/mt and should have
increasing facilty to step up by 20 ml

36
 Should have facility to show trends curve of all parameter for 15-20
minutes.
 Heparin pump with syringe sizes 20 to 30 ml with pump flow rate from
1-10 ml/hr( 0.1 ml increments)

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 CHAPTER 7

UROLOGY
Urology is the field of medicine that focuses on diseases of the urinary tract and
the male reproductive tract. Some urologists treat general diseases of the urinary
tract. Others specialize in a particular type of urology, such as:

 Female urology, which focuses on conditions of a woman’s reproductive

and urinary tract.
 male infertility, which focuses on problems that prevent a man from
conceiving a baby with his partner.
 neurourology, which focuses on urinary problems due to conditions of the
nervous system.
 pediatric urology, which focuses on urinary problems in children.
 urologic oncology, which focuses on cancers of the urinary system,
including the bladder, kidneys, prostate, and testicles.
Urologists diagnose and treat diseases of the urinary tract in both men and
women. They also diagnose and treat anything involving the reproductive
tract in men.
The urinary tract is the system that creates, stores, and removes urine
from the body. Urologists can treat any part of this system. This includes
the:
 kidneys, which are the organs that filter waste out of the blood to produce
urine.
 ureters, which are the tubes through which urine flows from the kidneys
to the bladder.
 bladder, which is the hollow sac that stores urine.
 urethra, which is the tube through which urine travels from the bladder
out of the body.

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 adrenal glands, which are the glands located on top of each kidney that
release hormones.
Urologists also treat all parts of the male reproductive system. This
system is made up of the:
 penis, which is the organ that releases urine and carries sperm out of the
body.
 prostate, which is the gland underneath the bladder that adds fluid to
sperm to produce semen.
 testicles, which are the two oval organs inside the scrotum that make the
hormone testosterone and produce sperm.

7.1 CYSTOGRAM
cystourethrogram is a medical examination that entails obtaining images
of your urinary bladder with an X-ray. The examination is mainly used to
diagnose bladder issues and is performed by a radiologist with the
assistance of an X-ray technician.
A cystoscope is a thin tube with a camera and light on the end. During a
cystoscopy, a doctor inserts this tube through your urethra (the tube that
carries urine out of your bladder) and into your bladder so they can
visualize the inside of your bladder. Magnified images from the camera
are displayed on a screen where your doctor can see them.
A voiding cystourethrogram is most commonly used to diagnose urinary
reflux, also known as vesicoureteral reflux or simply reflux. The
condition is often characterized by recurring urinary tract infections
(UTIs). If you complain about that and your healthcare provider suspects
that you may have urinary reflux, he will order a cystogram.
To ensure that your bladder isn’t torn and that there is no structural
damage to it, your healthcare provider may also order this test if you

39
 report having experienced an injury to your pelvic area. Also, having
problems urinating—painful urination, blood in the urine, and frequent
urination—may lead your healthcare provider to suspect you have a
bladder polyp or tumor and they may have you undergo a cystoscopy
with or without a cystogram.

7.1.1 Cytogram procedure

Figure 7.1 cytogram procedure

A cystogram is a radiology procedure to examine the bladder.

The procedure is performed by a radiology doctor with the help of a technician.

The procedure involves placing a catheter into your bladder while you lie on the
X-ray table. The bladder is than filled with contrast. The procedure will
usually take under an hour.

X-ray pictures are than taken as the bladder is filled. Sometimes pictures will
be taken while you empty your bladder as well. The bladder will be filled until

40
it is full. I usually fill the bladder until the patient has to void. I will take
pictures while you turn to both sides and flat. I also take X-ray pictures as you
void.

X-ray pictures are taken, with attention to the bladder and ureters which drain
into the bladder from the kidneys. If the ureters have contrast in them, than this
is called reflux and is abnormal. I also look for anything inside the bladder like
a mass or stone. In some cases, we are looking for leaks. A leak will mean that
the contrast in the bladder will be outside the wall.

Some common reasons to do the test include urinary reflux. This occurs when
urine goes into the ureters. This can happen while filling the bladder, emptying
it, or both. The urine can go as high up as the kidneys. Patients with reflux
may have frequent urinary tract infections, scarring of the kidneys and even loss
of function.

Figure 7.2 Cystogram Machine

7.2 CYSTOSCOPY

Just before the cystoscopy, you need go to the bathroom to empty your bladder.
Then, you change into a surgical gown and lie down on your back on a

41
treatment table. Your feet may be positioned in stirrups. The nurse may provide
you with antibiotics to help prevent a bladder infection.

At this point, you’ll be given anesthesia. If you get general anesthesia, this will
be all that you are conscious of until you wake up. If you get a local or regional
anesthetic, you may also be given a sedative to relax you. Your urethra will be
numbed with an anesthetic spray or gel. You’ll still feel some sensations, but
the gel makes the procedure less painful. The doctor will lubricate the scope
with gel and carefully insert it into the urethra. This may burn slightly, and it
may feel like urinating.

If the procedure is investigatory, your doctor will use a flexible scope. Biopsies
or other surgical procedures require a slightly thicker, rigid scope. The bigger
scope allows surgical instruments to pass through it.

Your doctor looks through a lens as the scope enters your bladder. A sterile
solution also flows through to flood your bladder. This makes it easier for your
doctor to see what’s going on. The fluid might give you an uncomfortable
feeling of needing to urinate.

With local anesthesia, your cystoscopy may take less than five minutes. If
you’re sedated or given general anesthesia, the entire procedure may take 15 to
30 minutes.

7.2.1 Used to Diagnose

Cystoscopy is used to diagnose, monitor and treat conditions affecting the

bladder and urethra.

Investigate causes of signs and symptoms. Those signs and symptoms can
include blood in the urine, incontinence, overactive bladder and painful
urination. Cystoscopy can also help determine the cause of frequent urinary

42
tract infections. However, cystoscopy generally isn't done while you have an
active urinary tract infection.

Diagnose bladder diseases and conditions. Examples include bladder cancer,

bladder stones and bladder inflammation (cystitis).

Treat bladder diseases and conditions. Special tools can be passed through the
cystoscope to treat certain conditions. For example, very small bladder tumors
might be removed during cystoscopy.

Diagnose an enlarged prostate. Cystoscopy can reveal a narrowing of the

urethra where it passes through the prostate gland, indicating an enlarged
prostate (benign prostatic hyperplasia).

Figure 7.3 cystoscope

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 CHAPTER 8

OBSTETRICS AND GYNAECOLOGY

Obstetrics and gynecology are medical specialties that focus on two different
aspects of the female reproductive system. At Virginia Beach OBGYN we
provide care to women in all phases of their lives whether they are having a
baby or are past menopause.

Obstetrics deals with the care of the pregnant women, the unborn baby, labor
and delivery and the immediate period following childbirth. The obstetrician
ensures that mother and child get the best prenatal care to ensure labor and
delivery is accomplished without complications and that should intervention be
needed, it is done quickly and safely.

Gynecology deals with any ailment concerning the reproductive organs; uterus,
fallopian tubes, cervix, ovaries and vagina. A gynecologist may also treat
related problems in the bowel, bladder and urinary system since these are
closely related to female reproductive organs.

8.1 DOPPLER ULTRASOUND

A Doppler ultrasound is a noninvasive test that can be used to estimate the

blood flow through your blood vessels by bouncing high-frequency sound
waves (ultrasound) off circulating red blood cells. A regular ultrasound uses
sound waves to produce images, but can't show blood flow. A Doppler
ultrasound may help diagnose many conditions, including:

 Blood clots

44
  Poorly functioning valves in your leg veins, which can cause blood or
other fluids to pool in your legs (venous insufficiency)
 Heart valve defects and congenital heart disease
 A blocked artery (arterial occlusion)
 Decreased blood circulation into your legs (peripheral artery disease)
 Bulging arteries (aneurysms)
 Narrowing of an artery, such as in your neck (carotid artery stenosis)

A Doppler ultrasound can estimate how fast blood flows by measuring the rate
of change in its pitch (frequency). During a Doppler ultrasound, a technician
trained in ultrasound imaging (sonographer) presses a small hand-held device
(transducer), about the size of a bar of soap, against your skin over the area of
your body being examined, moving from one area to another as necessary.

8.1.1 Doppler ultrasound work

The ultrasound probe sends sound waves into your body. The sound waves
bounce off of moving blood cells in blood vessels and go back to the probe to
be detected. The computer looks at the change in pitch (low or high sounds)
between the sound waves sent into your body and the echo (sound that bounced
back) to figure out the direction of blood flow and how fast the blood is moving.

This information provides information about:

 Your circulation, such as how fast or slow blood is moving.

 If something is stopping blood flow.
 Blood going in the wrong direction or pooling in a blood vessel.

A sonographer, a specialist in ultrasound imaging technology, performs this

test. The test may take 30 to 60 minutes.

45
Depending on the reason for the test, you may lie on your back or side on an
exam table, or you may sit up.

During the test:

 The sonographer applies a small amount of gel to your skin. The gel helps
the sonographer glide a small probe over the skin. It also helps sound
waves travel.
 The transducer sends painless sound waves through your skin into your
body. The sound waves are high frequency and you won’t hear them.
 The sound waves reflect off the moving blood cells, causing the pitch of
the sound waves to change. You may hear a whooshing sound from the
ultrasound machine.
 The transducer detects changes in the sound wave.
 A machine records the sound wave changes and converts them into
images or graphs for your provider to review.
 The sonographer cleans the gel from your skin at the end of the test.

Figure 8.1 Doppler ultrasound report

46
8.1.2 Advantages

Figure 8.2 Doppler ultrasound machine

The Doppler technique is a color ultrasound, which is used to measure and

evaluate the blood flow that circulates through the cavities and valves of the
baby's heart. It allows you to know the amount of blood that is pumped with
each beat, which is essential to determine the proper functioning of your heart,
as well as to analyze the heart valves and the surfaces of the core. This helps to
detect early any anomaly that the baby could have to act in the most convenient
way when it is born.

It detect heart diseases, preeclampsia, and obstructions of the blood vessels,

fetal suffering, and malformations and, if necessary, establish how is the
circulation to be able to carry out surgery.

47
In those cases where there is hypertension of the pregnant woman, they usually
require this color Doppler test in pregnancy to ensure that the baby remains in
excellent condition.

CHAPTER 9

RADIOLOGY

9.1 X-ray

An X-ray is a common imaging test that’s been used for decades. It can help
your doctor view the inside of your body without having to make an incision.
This can help them diagnose, monitor, and treat many medical conditions.

Different types of X-rays are used for different purposes. For example, your
doctor may order a mammogram to examine your breasts. Or they may order an
X-ray with a barium enema to get a closer look at your gastrointestinal tract.

There are some risks involved in getting an X-ray. But for most people, the
potential benefits outweigh the risks. Talk to your doctor to learn more about
what is right for you.

9.1.1 procedure

An X-ray technologist or radiologist can perform an X-ray in a hospital’s

radiology department, a dentist’s office, or a clinic that specializes in diagnostic
procedures. Once you’re fully prepared, your X-ray technician or radiologist
will tell you how to position your body to create clear images. They may ask
you to lie, sit, or stand in several positions during the test. They may take
images while you stand in front of a specialized plate that contains X-ray film or
sensors. In some cases, they may also ask you to lie or sit on a specialized plate
and move a large camera connected to a steel arm over your body to capture X-

48
ray images. It’s important to stay still while the images are being taken. This
will provide the clearest images possible.

Figure 9.1 X-ray

9.1.2 Uses Of X-Ray in Medicine

Chest X-ray:

 Used to identify lung diseases.

 Pneumonia, lung cancer, fluid collection (Pulmonary Odema) in the
lungs.

Abdominal X-ray:

 Detection of obstruction of the intestine (Ileus)

 Presence of air in the abdominal organs through abnormal
communications
 Fluid collection in the abdominal cavity (Ascites)
 Identification of stones in the gallbladder
 Detection of stones in the urinary system .

Real time imaging

49
  Angiography
 Contrast studies of hollow organs (small or large intestine)
 Angioplasty

9.2 CT SCAN

A CT scan uses computers and rotating X-ray machines to create cross-sectional

images of the body. These images provide more detailed information than
typical X-ray images. They can show the soft tissues, blood vessels, and bones
in various parts of the body.

Computed tomography (CT) is an imaging procedure that uses special X-ray

equipment to create detailed images or scans of areas inside the body. It is also
sometimes called computerized tomography or computerized axial tomography
(CAT). Each picture created during this process shows organs, bones, and other
tissues in a thin “slice” of the body while CT is performed. The whole range of
images produced in the whistle is like a loaf of sliced bread.

A CT scan may be used to visualize the:

 head
 shoulders
 spine
 heart
 abdomen
 knee
 chest

During a CT scan, you lie in a tunnel-like machine while the inside of the
machine rotates and takes a series of X-rays from different angles.

50
These pictures are then sent to a computer, where they’re combined to create
images of slices, or cross-sections, of the body. They may also be combined to
produce a 3-D image of a particular area of the body.

Figure 9.2 CT Scan

Working and principle

It relies on target density variation that affect affects the attenuation of high-
frequency waves. CT intern works onto the basic principle of X-rays which
Photo-Electric Effect.

the picture of the patient is viewed thru X-ray imaging from varied angles & are
then the detailed structures are mathematically reconstructed & the formed
image is displayed on a video monitor.

9.2.1 CT Scan working

A CT-scan uses a motorized X-ray source that rotates around the circular
opening of a doughnut-shaped structure called a gantry. During the CT scan the
patient lies down which is slowly passed through the gantry while the X-ray

51
tube moves around the patient. Due to which narrow rays of X-rays come out
through the body. Instead of film, CT scans use special digital X-ray detectors,
which are located directly opposite the X-ray source. As the X-rays leave the
patient, they are detected by detectors and transmitted to a computer.

In this, each time the X-ray source completes one complete rotation, the CT
computer uses sophisticated mathematical techniques to create a two-
dimensional, three-dimensional image slice of the patient. The thickness of the
tissue represented in each image slice can vary depending on the CT machine
used, but typically ranges from 1–10 millimeters.

When a complete slice is completed, the image is stored and the motorized bed
is moved forward sequentially in the gantry. Then the X-ray scanning process is
repeated to produce another image slice. This process continues until the desired
number of slices is collected.

These are stacked together by the computer to generate a three-dimensional

image of the patient that shows the skeleton, organs and tissues as well as any
abnormalities the doctor is trying to identify. This method has several
advantages, including the ability to rotate the 3D image in space or view slices
sequentially, making it easier to locate the exact location of the problem.

52
The test is minimally invasive and can be conducted quickly.

Figure 9.3 CT Scan machine

9.2.2 Use of CT Scan

A CT scan has many uses, but it’s particularly well-suited for diagnosing
diseases and evaluating injuries. The imaging technique can help your doctor:

 Diagnose infections, muscle disorders, and bone fractures

 Pinpoint the location of masses and tumors, including cancer
 Study the blood vessels and other internal structures
 Assess the extent of internal injuries and internal bleeding
 Guide procedures, such as surgeries and biopsies

53
 Monitor the effectiveness of treatments for certain medical conditions,
including cancer and heart disease.

9.3 MRI
Magnetic resonance imaging (MRI) uses a large magnet and radio waves
to look at organs and structures inside your body. Health care
professionals use MRI scans to diagnose a variety of conditions, from
torn ligaments to tumours.
MRIs are very useful for examining the brain and spinal cord. MRI does
not involve X-rays or the use of ionizing radiation, which distinguishes it
from CT and PET scans. MRI is a medical application of nuclear
magnetic resonance (NMR). NMR can also be used for imaging in NMR
other applications such as NMR spectroscopy
9.3.1 Working
MRI machines work by exploiting the interaction of the magnetic field,
hydrogen ions, and radiofrequency (RF) pulse. When you put a patient in
a strong magnetic field, their hydrogen ions align in the direction of the
magnetic field. Applying an RF pulse will change the direction of
alignment of these hydrogen ions.
When the RF pulse is turned off, these ions will attempt to realign with
the magnetic field again and release a signal. The strength of this signal
depends on the type of tissue (fat, muscle, water) that the hydrogen ion .
9.3.2 Uses
Magnetic resonance imaging (MRI) uses a large magnet and radio waves
to look at organs and structures inside your body. Health care
professionals use MRI scans to diagnose a variety of conditions, from
torn ligaments to tumours. MRIs are very useful for examining the brain
and spinal cord.

54
Figure 9.4 MRI machine

9.4 POSITRON EMISSION TOMOGRAPHY(PET)

Positron emission tomography is a functional imaging technique that uses
radioactive substances known as radiotracers to visualize and measure
changes in metabolic processes, and in other physiological activities
including blood flow, regional chemical composition, and absorption
PET is a common imaging technique, a medical scintillography technique
used in nuclear medicine. A radiopharmaceutical — a radioisotope
attached to a drug — is injected into the body as a tracer. Gamma rays are
emitted and detected by gamma cameras to form a three-dimensional
image, in a similar way that an X-ray image is captured.
9.4.1 Working
PET scans detect diseased cells in organs and tissues. You receive an
intravenous (IV) injection of a safe amount of a radioactive drug. This
substance is called radiotracer. Diseased cells in your body absorb more
of the radiotracer than healthy ones do.

55
The PET scanner detects this radiation and produces images of the
affected tissue. A PET/CT scan combines X-ray images from a CT scan
with PET scan images.

Figure 9.5 PET scan

9.4.2 Uses
PET scans are often used with CT or MRI scans to help make a diagnosis
or to get more data about a health condition and the progress of any
treatment. While an MRI or CT scan shows how part of the body looks, a
PET scan can reveal Trusted Source how it is functioning.
PET scans are commonly used to investigate a number of conditions.
Epilepsy: It can reveal which part of the brain the epilepsy is affecting.
This can help doctors decide on the most suitable treatment, and it can be
useful if surgery is necessary.
Alzheimer’s disease: PET scans can help diagnose Trusted Source
Alzheimer’s disease by measuring the uptake of sugar in specific parts of
the brain. Brain cells that are affected by Alzheimer’s tend to use
glucose more slowly than normal cells.
Cancer: PET scans can reveal the presence and stage of a cancer, show
whether and where it has spread, and help doctors decide on treatment.

56
9.5 SINGLE PROTON EMISSION COMPUTED
TOMOGRAPHY(SPECT)
Single-photon emission computed tomography (SPECT, or less
commonly, SPET) is a nuclear medicine tomographic imaging technique
using gamma rays. It is very similar to conventional nuclear medicine
planar imaging using a gamma camera (that is, scintigraphy), but is able
to provide true 3D information.
This information is typically presented as cross-sectional slices through
the patient, but can be freely reformatted or manipulated as required.
The technique needs delivery of a gamma-emitting radioisotope (a
radionuclide) into the patient, normally through injection into the
bloodstream. On occasion, the radioisotope is a simple soluble dissolved
ion, such as an isotope of gallium(III).
Most of the time, though, a marker radioisotope is attached to a specific
ligand to create a radioligand, whose properties bind it to certain types of
tissues. This marriage allows the combination of ligand and
radiopharmaceutical to be carried and bound to a place of interest in the
body, where the ligand concentration is seen by a gamma camera.
9.5.1 Working
SPECT is a nuclear imaging scan that integrates computed tomography
(CT) and a radioactive tracer. The tracer is what allows doctors to see
how blood flows to tissues and organs.
Before the SPECT scan, a tracer is injected into your bloodstream. The
tracer is radio labeled, meaning it emits gamma rays that can be detected
by the CT scanner.
The computer collects the information emitted by the gamma rays and
displays it on the CT cross sections. These cross-sections can be added
back together to form a 3D image of your brain. The radioisotopes

57
typically used in SPECT to label tracers are iodine-123, technetium-99m,
xenon133, thallium-201, and fluorine-18. These radioactive forms of
natural elements will pass through your body and be detected by the
scanner. Various drugs and other chemicals can be lable with these
isotopes.
The type of tracer used depends on what your doctor wants to measure.
For example, if your doctor is looking at a tumour, he or she might use
radio label glucose (FDG) and watch how it is metabolized by the
tumour.
The test differs from a PET scan in that the tracer stays in your blood
stream rather than being absorbed by surrounding tissues, thereby
limiting the images to areas where blood flows. SPECT scans are cheaper
and more readily available than higher resolution PET scans.
9.5.2 Risks
The tracer is radioactive, which means your body is exposed to radiation.
This exposure is limited, however, because the radioactive chemicals
have short half-lives. They breakdown quickly and are removed from the
body through the kidneys.
The long-term risk of radiation exposure is usually worth the benefits of
diagnosing serious medical conditions. Your exposure risk could vary,
however, depending on how many CT or other scans you have had. If you
have concerns about your cumulative radiation exposure, talk to your
doctor. Women who are pregnant or nursing should not undergo a SPECT
scan. Some people may have an allergic reaction to the tracer or the
contrast agent.

58
Figure 9.6 SPECT scan

59
 CHAPTER 10

OPERATION THEATER

An operating theatre (also known as an operating room (OR), operating suite, or

operation suite) is a facility within a hospital where surgical operations are
carried out in an aseptic environment Historically, the term "operating theatre"
referred to a non-sterile, tiered theatre in which students and other spectators
could watch surgeons perform surgery. Contemporary operating rooms are
devoid of a theatre setting, making the term "operating theatre" a misnomer.

10.1 ELECTRO SURGICAL UNIT

Electrosurgical units (ESU) use a high-frequency electrical current to cut tissue

and control bleeding by causing coagulation. Tissue resistance to the high-
density current causes a heating effect which results in tissue destruction.

Electrical current is delivered and received through cables and electrodes. The
electrodes may be activated by either a handpiece switch or a footswitch. The
ESU may use a monopolar or a bipolar mode.

10.1.1 Principles

In monopolar electrosurgery, tissue is cut and coagulated by completion of an

electrical circuit that includes a high frequency oscillator and amplifiers within
the ESU, the patient, the connecting cables, and the electrodes. In most
applications, electric current from the ESU is conducted through the surgical
site with an active cable and electrode.

The electrosurgical current exits the patient through a dispersive electrode

(usually placed on the patient at a site remote from the surgical site) and its
associated cable connected to the neutral side of the generator. In bipolar
electrosurgery, two electrodes (generally, the two tips of a pair of forceps or

60
scissors) serve as the equivalent of the active and return electrodes in the
monopolar mode.

10.1.2 Operating Steps

Electrosurgical procedures may or may not be performed with the patient under
anesthesia. The patient is prepped and electrodes are applied to the affected
areas. Electrical current is delivered to the affected area and the surrounding
tissue is heated to cause desiccation, vaporization, or charring to remove
diseased or damaged tissue

Figure 10.1 Electro surgical unit

10.1.3 Uses

Electrosurgery is used routinely in eye surgery to cut, coagulate, dissect,

fulgurate, ablate and shrink tissue. High frequency (100 kilohertz to 5
megahertz), alternating electric current at various voltages (200–10,000 Volts)
is passed through tissue to generate heat.

10.2 INSUFFLATOR

Insufflation is defined as the act of blowing something such as gas, powder, or

vapor into a body cavity. There are many medical applications, the most
common being surgery, diagnostics, respiratory assistance, critical care and
anesthesia, and administration of drugs via nasal insufflation

61
.

Figure 10.2 Insufflator

10.2.1 Surgery

Endoscopic insufflators are used in laparoscopic surgeries to create space for

the surgeon to work.

A lapraro scopic insufflator inflates a patient’s body using pressurized gas –

commonly carbon dioxide (CO2) rather than ambient air or oxygen (O2)
because CO2 has fewer negative effects on the body. Specifically, CO2 is non-
flammable, colourless, and has a higher blood solubility than air.

The patient is constantly monitored for their safety throughout the surgery.

10.2.2 Diagositics

Insufflating gases into parts of the human body can also improve diagnostics.
Insufflation can enhance radiological imaging, or provide access to parts of the
body that would otherwise be difficult to examine. For example, insufflation
can be used during routine colonoscopies and is often necessary in deeply
sedated patients.

10.2.3 Insufflator testing

Insufflation devices integrate a number of sensors into their design such as

pressure sensors, gas flow sensors, temperature sensors, etc. These sensors are
used to control the pressure, gas flow, and temperature outputs necessary to the

62
function of the insufflator as well as display real-time readings to inform users
during the operation of the equipment. It is essential that these pneumatic
components function accurately so that the insufflator operates correctly and the
patient is not harmed by the process of insufflation.

To ensure the insufflator is operating correctly, devices are serviced and tested
periodically to confirm that they are operating within manufacturer
specifications. Insufflators are tested during the product development and
production processes by manufacturers. The sensors are calibrated or verified at
this time by design engineers, manufacturing engineers, and technicians.

To test the pneumatic components of an insufflator, testing generally involves

measuring the pressures, flow rate, or volume of the device. The typical
pressure range for insufflators is between 10-15 mm Hg and the flow rates are
less than 50 litres per minute. Service and maintenance testing results are
documented and a report or certificate is typically generated.

10.3 ANESTHESIA MACHINE

The anesthesia machine receives medical gases from a gas supply, controls the
flow and reduces the pressure of desired gases to a safe level, vaporizes volatile
anesthetics into the final gas mixture, and delivers the gases to a breathing
circuit that is connected to the patient's airway. An anesthesia machine is the
apparatus used to deliver general anesthesia to patients as they undergo a
medical procedure. The most commonly used device is the continuous-flow
anesthetic machine, which provides a steady flow of air containing a regulated
supply of gas. Modern instruments often include monitors and touch-screen
displays that provide data on heart rate and oxygen saturation level.

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10.3.1 Principles

Medical Anaesthesia Vaporizer firstly reduces the high-pressure gas (air,

oxygen, nitrous oxide, etc.) through a pressure-reducing valve to collateral and
stable gas. The flow meter adjusts to produce a certain amount of gas for the
anesthesia machine; the anesthetic is volatilized. After the canister is converted
to anesthetic vapor, the required amount of anesthetic vapor is adjusted for use
by the surgeon.

The proportion of oxygen or air filled with anesthetic steam, using the negative
suction pressure generated by the human body, the gas is inhaled into the lungs
and exchanged into the human body, and is transported to various organs of the
human body through the blood circulation, so that the organs temporarily lose
consciousness and each time within a certain period of time. Reflexes to achieve
anesthesia purpose

Figure 10.3 Anesthesia machine

10.3.2 Components
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A modern anaesthetic machine includes at minimum the following components:

• Connections to piped oxygen, medical air, and nitrous oxide from a wall
supply in the healthcare facility, or reserve gas cylinders of oxygen, air, and
nitrous oxide attached via a pin index safety system yoke with a Bodok seal

• Pressure gauges, regulators and 'pop-off' valves, to monitor gas pressure

throughout the system and protect the machine components and patient from
excessive rises

• Flowmeters such as rotameters for oxygen, air, and nitrous oxide

• Vaporisers to provide accurate dosage control when using volatile

anaesthetics

• A high-flow oxygen flush, which bypasses the flowmeters and vaporisers

to provide pure oxygen at 30-75 litres/minute.

10.4 ARTHOSCOPY

Arthroscopy is a surgical procedure doctors use to look at, diagnose, and treat
problems inside a joint.

It’s a minor surgery and is done on an outpatient basis, which means you can go
home the same day. Your doctor may recommend it if you have inflammation in
a joint, have injured a joint, or have damaged a joint over time. You can have
arthroscopy on any joint. Most often, it’s done on the knee, shoulder, elbow,
ankle, hip, or wrist.

During the procedure, your doctor will insert a tool called an arthroscope into
your joint through several small cuts to see how much damage is in the joint.
They can also repair many injuries during arthroscopy.

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 Figure 10.4 Arthroscopy

10.4.1 Procedure

Arthroscopy is a procedure for diagnosing and treating joint problems. A

surgeon inserts a narrow tube attached to a fiber-optic video camera through a
small incision — about the size of a button hole. The view inside your joint is
transmitted to a high-definition video monitor.

10.4.2 Benefits

Arthroscopy has many other benefits, including:

• Less pain after surgery

• Smaller incisions

• Quicker recovery time

• Lower risk of infection

• Minimal soft tissue trauma

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10.5 HEART LUNG MACHINE

A heart-lung machine is an apparatus that does the work both of the heart (i.e.,
pumps blood) and the lungs (i.e., oxygenates the blood) during, for example,
open-heart surgery (Galletti and Colton, 1995). The basic function of the
machine is to oxygenate the body's venous supply of blood and then to pump it
back into the arterial system.

Blood returning to the heart is diverted through the machine before returning it
to the arterial circulation. Some of the more important components of these
machines include pumps, oxygenators, temperature regulators, and filters. The
heart-lung machine also provides intracardiac suction, filtration, and
temperature control.

10.5.1 Working

A heart-lung machine—also called a cardiopulmonary bypass machine—is a

device that takes over the function of the body’s heart and lungs during open
heart or traditional surgery. The machine circulates the essential oxygen-rich
blood to the brain and other vital organs during open-heart surgery, allowing the
cardiac surgery team to operate on a heart that is blood-free and still. When the
surgery is complete, the heart is restarted and the heart-lung machine is
disconnected. The heart-lung machine intercepts the blood at the right atrium
(upper heart chamber) before it passes into the heart. Using a pump, the
machine delivers the blood to a reservoir, which adds oxygen to the blood. The
pump then sends the oxygen-rich blood to the aorta and through the rest of the
body. The machine, which is operated by a trained and certified specialist
called a perfusion technologist, also removes carbon dioxide and other waste
products from the blood and delivers anesthesia and medications into the
recirculated blood. Also, in some cases, it cools the blood. Cool blood lowers

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the body’s temperature, which helps to further protect the brain and other vital
organs during surgery.

10.5.2 Components

The components of the CBP machine include the following:

• Venous cannula

• Arterial cannula

• Oxygenator

• Reservoir container

• Pumps

• Tubing

• Heat exchanger

• Cardiotomy suckers

• Cardiac Vents and

• Adjuncts such as the level detector, arterial line pressure meter, arterial
line bubble trap and filter, cardioplegia line pressure meter, gas line filter, gas
flow meter, and one-way valves on cardiac vents.

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 Figure 10.5 Heart lung machine

10.6 C-ARM

A C-arm is an imaging scanner intensifier. The name derives from the C-

shaped arm used to connect the x-ray source and x-ray detector to one
another. C- arms have radiographic capabilities, though they are used primarily
for fluoroscopic intraoperative imaging during surgical, orthopedic and
emergency care procedures. The devices provide highresolution X-ray images
in real time, thus allowing the physician to monitor progress and immediately
make any corrections.

10.6.1 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

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details on the image such as blood vessels, bones, kidney stones and the
position of implants and instruments at any time.

Figure 9.6 C-ARM

10.6.2 Purpose

C-arms have radiographic capabilities, though they are used primarily for
fluoroscopic intraoperative imaging during surgical, orthopedic and emergency
care procedures. The devices provide high-resolution X-ray images in real time,
thus allowing the physician to monitor progress and immediately make any
corrections.

10.7 OT LIGHT

Operation theatre light is a medical device intended to assist medical personnel

during a surgical procedure by illuminating a local area or cavity of the patient.
A combination of several surgical lights is often referred to as a "surgical light
system".

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There are typically three basic types of lamps used in an operating theatre
environment – Incandescent, Gas Discharge and Light Emitting Diodes (LED)
According to the International

Electrotechnical Commission (IEC), the illuminance of the operating cavity

should be within the 40,000 - 160,000 lux range. In contrast, the requirement for
the reading light in the patient's room is 300 lx, for examination light – 1000 lx

Figure 10.7 OT light

10.7.1 Features

Good visibility and the homogeneous illumination of 100000 Lux. Effortless

movement inside calibrated arms ambient light for minimally invasive surgery.
Control Panel to adjust the lux intensity & on/off the light..

10.7.2 Uses

They are used by clinicians, surgeons and proceduralists. A surgical light

illuminates the operative site on a patient for optimal visualization during a
procedure. Surgical lights can provide hours of bright light without excessively
heating the patient or staff.

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10.8 OT TABLE

Depending on the duration and type of procedure, the operating table can be
prepared with a short water mat (e.g. 55x100 cm) with the mat always
connected at the head end so that the C-arm can be moved without any
problems in the scanning area and to provide better access to the patient in
general .

Figure 10.8 OT table

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

operating table column, the table top and the transporter. Modern operating
table systems are available as both stationary and mobile units. There are a wide
range of table tops that can be used for both general surgery and for specialist
disciplines.

In Meridian Hospital, Operation theatre table are imported from palakadu

surgicals. Which is a famous biomedical equipment manufacturing company in
kerala

10.8.1 Uses

A patient lies on the operating table during a surgical procedure. The purpose of
a surgical table is to keep the patient in place while the surgical team operates,

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and may move various parts of the body using surgical table accessories for
easier access to the surgical site.

CHAPTER 11

INTENSIVE CARE UNIT

An ICU is an organized system for the provision of care to critically ill patients
that provides intensive and specialized medical and nursing care, an enhanced
capacity for monitoring, and multiple modalities of physiologic organ support to
sustain life during a period of life-threatening organ system insufficiency.

11.1 VENTILATOR

A medical ventilator is a machine that helps the lungs work. It’s used for
breathing problems that can accompany a variety of conditions. Other names for
a ventilator are: respirator breathing, machine mechanical, ventilation.

11.1.1 Uses

• During surgery. A ventilator can temporarily do the breathing for you

while you’re under general anesthesia.

• Recovering from surgery. Sometimes people need a ventilator to help

them breathe for hours or even days after surgery.

• When breathing on your own is very difficult. A ventilator can help you
breathe if you have lung disease or another condition that makes breathing
difficult or impossible.

11.1.2 Working

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Get oxygen into your lungs; remove carbon dioxide from your body. A
breathing tube connects the ventilator machine to your body. One end of the
tube is placed into your lungs’ airways through your mouth or nose. This is
called intubation.

11.1.3 Risk

The breathing tube in your airway could let in bacteria that infect the tiny air
sacs in the walls of your lungs. Plus, the tube makes it harder to cough away
debris that could irritate your lungs and cause an infection. This type of
infection is called ventilator-associated pneumonia, or VAP. We saw three
kinds of ventilators like Maquet servo-i/ servo-s, Carescape R80, Hamlton-C1
which is used in the Meridian Hospital. These brands are speciallist in
manufacturing ventilators with good quality. Especially, Maquet servo-I is user
friendly equipment. Some of the images of those ventilators are shown below

Figure 11.1 Maquet servo-i ventilator

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Figure 11.2 Carescape R80 Ventilator

11.2 PATIENT MONITOR

Patient Monitoring is one of the awe-inspiring technologies, the brain child of

advanced science that serves as a tool in taking care of millions of lives. Tri
vitron provides patient monitoring device which aids in monitoring the health
conditions of neonates to adults.

11.2.1 Working

Small sensors attached to your body carry information to the monitor. Some
sensors are patches that stick to your skin, while others may be clipped on one
of your fingers. The devices have changed a lot since the first electronic heart
monitor was invented in 1949. Many today have touchscreen technology and
get information wirelessly. The most basic monitors show your heart rate, blood
pressure, and body temperature. More advanced models also show how much
oxygen your blood is carrying or how fast you’re breathing. Some can even
show how much pressure is on your brain or how much carbon dioxide you’re

75
breathing out. The monitor will make certain sounds if any of your vital signs
fall below safe levels.

Vital signs reflect essential body functions, including your heartbeat, breathing
rate, temperature, and blood pressure. Your health care provider may watch,
measure, or monitor your vital signs to check your level of physical functioning.
Normal vital signs change with age, sex, weight, exercise capability, and overall
health. Normal vital sign ranges for the average healthy adult while resting are:

• Blood pressure: 90/60 mm Hg to 120/80 mm Hg

• Breathing: 12 to 18 breaths per minute

• Pulse: 60 to 100 beats per minute

• Temperature: 97.8°F to 99.1°F (36.5°C to 37.3°C); average 98.6°F

(37°C)

We saw Schiller truescope III/ Truescope Q5, Philipa and GE patient monitor in
Meridian hospital. And schiller is the most famous medical equipment
manufacturer company. There make equipment with good quality and user
friendly so preference for this brand is high.

11.2.2 Features

• Up to 7 lead ECG display\

• Total 10 waveform display simultaneously, ST & Arrhythmia analysis

• 168 hours tabular and graphic trends & data storage

• Drug dosage, Hemodynamic, Nephridium, Ventilation & Oxygenation

calculation software

• OXYCRG software

• Pacemaker detection facility.

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• Video Output (VGA)

• Recorder

• Central station connectivity : Wired and Wi-Fi

11.3. SYRINGE PUMP

A syringe driver, also known as a syringe pump, is a small infusion pump, used
to gradually administer small amounts of fluid (with or without medication) to a
patient or for use in chemical and biomedical research. Some syringe drivers
can both infuse and withdraw solutions.

11.3.1 Working

The syringe pump: is composed of a stepping motor and its driver, a screw rod
and a bracket, and has a reciprocating screw and a nut, and is therefore also
called a screw pump. Its nut is connected to the piston in the syringe, and the
inside of the syringe holds the liquid to be injected, achieving high-precision
and smooth and pulsating liquid transfer.

s syringe pump is a device for delivering a controlled amount of fluid (such as

nutrients, blood and drugs) to a patient. They are suitable for in vivo diagnosis,
treatment and research. To ensure the adequate and safe use of the medical
syringe pump, it is equipped with a wide range of optical and acoustic alarms to
prevent injury or even death from air bubbles and other hazards. Only
professional medical personnel can operate or supervise their use.

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Figure 11.3 Fresenius kabi Infusia SP7 Syringe pump.

11.3.2 Uses

Syringe pumps are used to deliver a very small amount of medications,

mechanically moving the piston of a syringe to send medication into IV tubing.

11.3.3 Product features

Flow rate range

50 ml syringe: From 0.1 to 1800.0 ml

30 ml syringe: From 0.1 to 1200.0 ml/h

20ml syringe: From 0.1 to 800.0 ml/h

10ml syringe: From 0.1 to 400.0 ml/h

5 ml syringe: From 0.1 to 200.0 ml/h

Increment: 0.1 ml/h for all syringe types

Syringe capacities: 5 ml, 10 ml, 20 ml (30 ml), 50 ml (60 ml)

Accuracy: ±1% device accuracy (without disposable variability), ±3% total

accuracy

Volume to be infused: From 0.0 to 1999.9 ml, 0.1 ml increment

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Infusion time: From 1.0 min to 1999 min, 1 min increment

Bolus or Purge rate

50 ml syringe: From 0.1 to 1800.0 ml/h

30 ml syringe: From 0.1 to 1200.0 ml/h

20ml syringe: From 0.1 to 800.0 ml/h

10ml syringe: From 0.1 to 400.0 ml/h

5 ml syringe: From 0.1 to 200.0 ml/h

Increment: 0.1 ml/h for all syringe types

Bolus volume From 1.0 to 100.0 ml, 0.1 ml increment

11.4 INFUSION PUMP

An infusion pump is a generic pump (syringe, peristaltic among others) that

delivers fluids in a medical context; usually the nutrients, drugs are controlled
through these devices. The rate of the infusion pump needs to be programmed
by software.

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.

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11.4.1 Principles

Infusion pump use pumping action to infuse fluids, medication or nutrition for
the patients. It is suitable for intravenous, subcutaneous, enteral, epidural
infusions

11.4.2 Working

An infusion pump is operated by a trained user, who programs the rate and
duration of fluid delivery through a built-in software interface. Infusion pumps
offer significant advantages over manual administration of fluids, including the
ability to deliver fluids in very small volumes, and the ability to deliver fluids at
precisely programmed rates or automated intervals. They can deliver nutrients
or medications, such as insulin or other hormones, antibiotics, chemotherapy
drugs, and pain relievers.

We saw Fresenius infusia VP7S infusion pump in Meridian Hospital. As I said

as before Fresenius is the most top company in manufacturing infusion pump,
which is user friendly and they provide best service so leading hospital prefer
this brand.

Figure 11.4 Fresenius infusia VP7S Infusion Pump

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11.4.3 Product features

Flow rate range:1.0 ml/h - 1200 ml/h

1.0 - 99.9 ml/h, 0.1 ml/h increment

100 - 1200 ml/h, 1 ml/h increment

1 - 400 drops/min, 1 drop/min increment

Flow rate accuracy: ± 5 %

Volume to infuse: 0 - 9999 ml, 1 ml increment

Infusion mode: Rate setting mode - ml/h, drops/min

Time setting mode - minutes, ml/h, drops/min

Volumetric setting mode - ml/h

Time of infusion: 1 - 1999 min, 1 min increment minimum

Priming: Manual or by using the purge/bolus function of the pump Bolus

rate: 1 - 1200 ml/h

0.1 - 99.9 ml/h, 0.1 ml/h increment

100 - 1200 ml/h, 1 ml/h increment

Purge rate: 600 ml/h

Free flow protection: Anti-free flow clamp when door is closed

End of infusion: Automatic KVO at the end of infusion: 1 ml/h if < 10 ml/h
infusion rate, otherwise, 3 ml/h

Data log event: 5,000 events

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11.5 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 if the heart suddenly stops. There are three types of
defibrillators: AEDs, ICDs, and WCDs. Each type works by checking for
arrhythmias, or irregular heart rhythms. Once detected, each defibrillator will
send a shock to restore a normal rhythm. Learn more about how the three types
of defibrillators work

11.5.1 Working

A defibrillator is a device that delivers direct electrical current across the

myocardium to cause synchronous depolarization of the cardiac muscle, with
the aim of converting a dysrhythmia into normal sinus rhythm. It is used to treat
ventricular fibrillation (VF), which is one of the main causes of sudden death.

Figure 11.5 Block diagram of working of defibrillator

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11.5.2 Energy supply

The 2015 American Heart Association (AHA) guidelines for defibrillation state
that it is reasonable to use the manufacturer's recommended dose of the first
defibrillation shock. On a biphasic defibrillator, this is usually between 120
joules to 200 joules. On a monophasic defibrillator, this is usually 360 joules.

We saw Nikhon konden branded Defibrilator, model name as Cardiolife

TEC5600 in Meridian Hospital. It is fully automated external defibrillator.
Cardiolife TEC-5600 has a compact, lightweight design and delivers the highest
performance for resuscitation and emergency teams.

To enhance its usability, it has the Smart CableTM System for ECG, SPO2, and
CO2 sensors which can be interchanged with cardiolife TEC-8300 series
defibrillators and Nihon Kohden’s patient monitors – saving precious time
while changing the cables and sensors on the patient.

. Figure 11.6 Nihon khoden Cardiolife TEC 5600 Defibrillator

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11.5.3 Uses

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 if the heart suddenly stops.

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 CHAPTER 12

CONCLUSION
On the whole the hospital training was very useful and informative. I got to

learn new things about different equipments, both theoretical and practical

details. After the training now I have a better understanding about the various

aspects of instruments, its calibration and the work of a biomedical engineer at

hospital. I was also able to analyse the working of devices in real time. This

helped me to define what skills and knowledge I have to improve in the coming

time.

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 REFERENCES
 www.meridianhospitals.in

 www.fda.gov/medical-devices

 www.my.indiamart.com

 www.nhlbi.nih.gov

 www.sciencedirect.com

 www.healthline.com

 www.fda.gov/home

 www.omrom-healthcare.com/eu/health-and-lifestyle

 www.webmd.com

 www.medlineplus.gov

 www.healthdirect.gov.au

 www.ncbi.nlm.nih.gov

 www.medicalexpo.com

 khandpur R.S, “Handbook of biomedical instrumentation”,3 rd

edition,tata McGraw-Hill,New delhi,2014.

 Myer Kutz “Standard Handbook of Biomedical

Engineering&Design”,Mc Graw-Hill publisher,2003.

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