X-Ray tube :Principle Of Operation

X-Rays are generated when fast-moving electrons are suddenly decelerated by impinging on a target The intensity of X-Ray depends on the current through the tube The wavelength of the X-Ray depends on the target material and the velocity of electrons hitting the target For Diagnostic purposes, Target voltages are in the range 30 to 100KV,while the current is several hundred milliamperes

Mobile X-Ray

Limitation of X-Ray
Super-imposition of the three-dimensional information onto a single plane makes diagnosis confusing and often more difficult Photographic film usually used for making radiographs has a limited dynamic range

X-Ray Computed Tomography

Computed tomography was originally known as the "EMI scan" as it was developed at a research branch of EMI, a company best known today for its music and recording business It was introduced on a commercial scale in 1972

 The Early CT scanners were designed for neuro-radiological investigation. CT enabled radiologists to distinguish ,for the first time, Types of Brain Tissue and even between normal and coagulated blood. To visualize the ventricles of Brain and repositories of the Cerebro0spinal fluid

 In CT, the picture is made by viewing the patient via XRay imaging from numerous angles, by mathematically reconstructing image on a video-monitor In computed tomography, a three-dimensional image is generated by rotating the object in very small steps (<1) 360 around a single axis of rotation while taking a series of two-dimensional X-ray images. Afterwards, the final three-dimensional image is numerically reconstructed based on the two- dimensional images and is displayed either as a series of sectional images or a threedimensional image There are two conditions essential to precise reconstruction of volume data. Firstly, the sample must remain within the beam cone at all times so that each projection image shows the complete sample. Secondly, at all times during the 360 rotation, the entire sample geometry must be 100% irradiated and imaged at the set X-ray parameters.

Block Diagram

Principle
X-Rays from finely collimated source are made to pass through a slice of the object or patient from a variety of directions. In principle ,CT involves the determination of attenuation characteristics for each small volume of tissue in the patient slice, which constitute the transmitted radiation intensity recorded from varying directions

 For a monochromatic X-Ray beam, the tissue attenuation characteristics can be describes by It = Io e-x Incident Radiation Intensity Transmitted Radiation Intensity Thickness of Tissue Characteristic attenuation coefficient of tissue

 Again the slice is divided into volume elements or voxels with each voxel having its own attenuation coefficient i.e Water has 0.205 cm-1 Whole blood has 0.214cm-1

CT

GANTRY GEOMETRY
The CT gantry, which looks like a doughnut, contains X-ray tube, detection system and other associated mechanism The patient support table allows for insertion of the patient into the doughnut hole, which is approximately 60-72 cm in diameter. Most gantries can be tilted in order to obtain oblique slices

 A narrow visible light field is used to indicate where CT slice will be taken An intercom system is generally available near the inside of the gantry opening. The top of the table on which the patient is lied is made of carbon fiber for maximum strength and radio-transparency The table provides longitudinal movement over a range of 150 cm ,which enables uninterrupted scanning without repositioning the patient.

 Pacemaker implantation is a procedure to put a small, battery-operated device called a pacemaker into your chest, to help your heart beat regularly. This is a minor surgical procedure that is usually performed under a local anaesthetic (the area is numbed but you are awake during the operation). About 25,000 pacemakers are implanted every year in the UK.

Why is it necessary?
The heart has its own natural pacemaker, called the sinoatrial (SA) node (see box, below left). The SA node is a small clump of cells in your heart that generates electrical impulses that spread throughout your heart, causing it to beat. If this process stops working properly, you may need an artificial pacemaker. The main reasons for needing an artificial pacemaker are: Heart block: a condition where your heart beats irregularly or more slowly than normal because the electrical signals that control your heartbeat are not being transmitted properly. Bradycardia: a heart condition featuring episodes of an abnormally slow heart rate (less than 60 beats a minute). This is sometimes caused by sinus node disease, where your natural pacemaker does not function properly, which can happen as a result of age, heart disease or medication.

 Heart failure: when your heart is not pumping blood around your body very efficiently. Pacemakers can be implanted in patients of any age, although the average age of those who received a pacemaker in 2003 was 76. Outlook Having a pacemaker fitted is very straightforward and the risk of complications is low. After the procedure, you should feel back to normal, or even better, very quickly

Flow meter bellow

ventilator

vaporizer

Corrugated tube

APL valve

Soda lime

Scavenging system

The Anesthesia Machine

High Intermediate Low Pressure Circuit

High Pressure System

Receives gasses from the high pressure E cylinders attached to the back of the anesthesia machine (2200 psig for O2, 745 psig for N2O) Consists of:
Hanger Yolk (reserve gas cylinder holder) Check valve (prevent reverse flow of gas) Cylinder Pressure Indicator (Gauge) Pressure Reducing Device (Regulator)

Usually not used, unless pipeline gas supply is off

E Size Compressed Gas Cylinders

Cylinder Characteristics Color State Contents (L) Empty Weight (kg) Full Weight (kg) Pressure Full (psig) Oxygen White (green) Gas 625 5.90 6.76 2000 Nitrous Oxide Blue Carbon Dioxide Air Gray Black/White (yellow) Gas 625 5.90

Liquid and gas Liquid and gas 1590 5.90 8.80 750 1590 5.90 8.90 838

1800

Hanger Yolk
Hanger Yolk: orients and supports the cylinder, providing a gas-tight seal and ensuring a unidirectional gas flow into the machine Index pins: Pin Index Safety System (PISS) is gas specificprevents accidental rearrangement of cylinders (e.g.. switching O2 and N2O)

Pressure Reducing Device

Reduces the high and variable pressures found in a cylinder to a lower and more constant pressure found in the anesthesia machine (45 psig) Reducing devices are preset so that the machine uses only gas from the pipeline (wall gas), when the pipeline inlet pressure is 50 psig.

This prevents gas use from the cylinder even if the cylinder is left open (i.e. saves the cylinder for backup if the wall gas pipeline fails)

Pressure Reducing Device

Cylinders should be kept closed routinely. Otherwise, if the wall gas fails, the machine will automatically switch to the cylinder supply without the anesthetist being aware that the wall supply has failed (until the cylinder is empty too).

Intermediate Pressure System

Receives gasses from the regulator or the hospital pipeline at pressures of 40-55 psig Consists of:
Pipeline inlet connections Pipeline pressure indicators Piping Gas power outlet Master switch Oxygen pressure failure devices Oxygen flush Additional reducing devices Flow control valves

Pipeline Inlet Connections

Mandatory N2O and O2, usually have air and suction too Inlets are noninterchangeable due to specific threading as per the Diameter Index Safety System (DISS) Each inlet must contain a check valve to prevent reverse flow (similar to the cylinder yolk)

Oxygen Pressure Failure Devices

A Fail-Safe valve is present in the gas line supplying each of the flowmeters except O2. This valve is controlled by the O2 supply pressure and shuts off or proportionately decreases the supply pressure of all other gasses as the O2 supply pressure decreases Historically there are 2 kinds of fail-safe valves
Pressure sensor shut-off valve (Ohmeda) Oxygen failure protection device (Drager)

Oxygen Failure Protection Device (OFPD)

Based on a proportioning principle rather than a shut-off principle The pressure of all gases controlled by the OFPD will decrease proportionately with the oxygen pressure

Oxygen Supply Failure Alarm

The machine standard specifies that whenever the oxygen supply pressure falls below a manufacturer-specified threshold (usually 30 psig) a medium priority alarm shall blow within 5 seconds.

Limitations of Fail-Safe Devices/Alarms

Fail-safe valves do not prevent administration of a hypoxic mixture because they depend on pressure and not flow. These devices do not prevent hypoxia from accidents such as pipeline crossovers or a cylinder containing the wrong gas

Oxygen Flush Valve (O2+)

Receives O2 from pipeline inlet or cylinder reducing device and directs high, unmetered flow directly to the common gas outlet (downstream of the vaporizer) Machine standard requires that the flow be between 35 and 75 L/min The ability to provide jet ventilation Hazards
May cause barotrauma Dilution of inhaled anesthetic

Vaporizers
A vaporizer is an instrument designed to change a liquid anesthetic agent into its vapor and add a controlled amount of this vapor to the fresh gas flow

The Adjustable Pressure Limiting (APL) Valve

User adjustable valve that releases gases to the scavenging system and is intended to provide control of the pressure in the breathing system Bag-mask Ventilation: Valve is usually left partially open. During inspiration the bag is squeezed pushing gas into the inspiratory limb

Scavenging Systems
Protects the breathing circuit or ventilator from excessive positive or negative pressure.

Checking Anesthesia Machines

8 Categories of check: Emergency ventilation equipment High-Pressure system Low-Pressure system Scavenging system Breathing system Manual and automatic ventilation system Monitors Final Position