2010 International Conference on Industrial Electronics, Control and Robotics

Power Quality Issues With Medical

Electronics Equipment In Hospitals
Uma Rao, S.N.Singh Chandan Kumar Thakur
Department of Electronics and Communication Engineering
National Institute of Technology, Jamshedpur (India) - 831014
imumarao@gmail.com , snsnitjsr@gmail.com ex.chandu@gmail.com

Abstract- This paper describes power quality audits
conducted at hospitals in India. Voltage ,current and
power measured at various points were used to assess
the quality of the power. The main power quality
problems found in hospitals were voltage flicker,
neutral currents , and harmonic distortion (THD
)value . Measurement, analysis and conditioning of
power quality has been studied in few different
hospitals as a case study. Recommendation have been
made to mitigate the issue
. connected to the same power supply, are considered
Keywords - Power quality, harmonic distortion, voltage
disturbances, Flickering, Neutral Current, Total
Harmonic Distortions.
1. INTRODUCTION
Power quality is the term used for overall voltage
quality, current quality and nature of output
waveform which directly or indirectly affect the
loads as well as source. Power quality has been a
major issue in todays industrial, commercial,
residential and military and medical environments.
Poor power quality may lead to disastrous
consequences like break-downs, production
interruptions, excess energy consumptions etc. In
this paper power quality issues have been discussed
in the hospitals where these issues are becoming
more important due to greater impact on sensitive
medical equipment which utilizes microprocessor
controls and switched DC power supplies. Medical
devices driven by electric power have come to be
commonly used in hospitals and rapid changes of
voltage or current can easily cause them to fail or
does not respond as per the desired control action.
Externally and internally induced power surges and
harmonics can have a dramatic effect on equipment
performance. A stable and high quality power
supply is indispensable in order to maintain safety in
the modern clinical setting. The widespread use of
sensitive, microprocessor /microcontroller based
equipment at hospitals requires that the power
delivered to such sensitive facilities be of a higher
quality [1]. Power quality problems may be caused
by generation of harmonics by equipment itself,
external sources like lightning or internal sources
like interaction of loads.
Common sources of power quality problems found
in hospitals include : inadequate wiring and
grounding, high wattage operating equipment,
testing of emergency generators, physical plant
renovation. Some equipment such as X-ray,
computerized axial tomography and magnetic
resonance imaging are considered as polluting ones
due to their high amount of harmonics and voltage
transients produced on the electrical power supply
when in operation, while other equipment,
sensitive or victim ones, presenting failure or
producing wrong. In order to deal with these
problems, the electrical system should be improved
as the number of sensitive, nonlinear loads at a
hospital increases. However, many buildings were
not required to implement system improvements
suggested in new or revised regulations.
Compounding the problem is the fact that many
codes or regulations deal with safety issues, but
they do not address power quality concerns .
Frequently, large-demand devices as x-ray machies
are installed without a complete power quality
survey. Since power quality problems are
cumulative; small power quality events (detectable
in an audit) can lead to loss-of-life and eventually
premature equipment failure.
DESCRIPTION OF THE SYSTEM
The first step of the power quality audit was an
inspection of the hospitals electrical system. Most
of the Hospitals receive their electric power from:
Normal Supply (NS) is a direct utility
(Western Power) supply for non-essential
areas such.
Essential Supply (ES) is used for areas of
medical importance that are not critical to
patients in the case of supply interruption.
The essential supply is backed up by an
emergency generator.
Uninterruptible Power Supply (UPS) is
used for emergency lighting, operating
theatres, patient monitoring and other
equipment that is important to the well
being and safety of patients.

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2. POWER QUALITY
The definition of power quality given in the IEEE
dictionary [5] originates in IEEE Std 1100 (better
known as the Emerald Book) [78]: Power quality is
the concept of powering and grounding sensitive
equipment in a matter that is suitable to the
operation of that equipment. High power qualities
implies safety, reliable service and lower initial and
operational costs. Power quality is concerned with
deviations of the voltage from its ideal waveform
(voltage quality) and deviations of the current from
its ideal waveform (current quality). Such a
deviation is called a "power quality phenomenon" or
a "power quality disturbance." Some of the power
quality disturbance are
(A)Transients
Transients or surges are defined as a transient wave
of current, voltage or power in an electric circuit.
Voltage transients may cause a microprocessor to
read voltage levels incorrectly, resulting in incorrect
data processing (ones being read like zeros) or
altered stored data/setting. This can also cause loss
(or corruption) of data , Physical damage of
Electronic equipments like PCB cards, SMPS and
system halts .
(B) Interruption
Interruption is complete loss of supply voltage or
load current, depending on its duration. This may
cause equipment damage, ruination of product, the
cost associated with downtime, cleanup, and restart.
(C) Sag/Swell
Sag is a reduction of AC voltage at a given
frequency for the duration of 0.5 cycles to 1
minutes time. Swell is the reverse form of sag,
having an increase in AC voltage for duration of 0.5
cycles to 1 minutes time. They can cause equipment
damage, data corruption, errors in industrial
processing, data errors, flickering of lights,
degradation of electrical contacts, semiconductor
damage in electronics, Insulation degradation.
(D) Harmonics
Harmonics are sinusoidal voltages or currents
having frequencies that are integer multiples of the
frequency at which the supply system is designed to
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operate (termed as the fundamental frequency;
usually 50 Hz or 60 Hz).They can cause overheating
of rotating equipment, transformers, and current-
carrying conductors, premature failure or operation
of protective devices (such as fuses), harmonic
resonance, blinking of incandescent lights,
Transformer Saturation, Capacitor Fai lure
Harmonic Resonance, Circuit Breakers Tripping
Inductive Heating and Overload, Computer
Malfunction or Lockup - Voltage Distortion .
(D. Voltage Fluctuations
Voltage fluctuations are systematic variations of the
voltage envelope or a series of random voltage
changes.
This may cause Flickering of incandescent lamps,
System halts.
(E). Frequency Fluctuations
The power system frequency is directly related to
the rotational speed of the generators on the system.
At any instant, the frequency depends on the balance
between the load and the capacity of the available
generation. When this dynamic balance changes,
small changes in frequency occur. This may cause
synchronous equipment failure.
3. MATERIALS AND METHODOLOGY
The existing standards do not consider the voltage
harmonic and sags in the medical electrical
equipment.
The methodology applied consisted of taking
measurements of parameters regarding of electrical
power quality in health care facilities. Particular
attention was paid to the voltage harmonic content
and to momentary voltage transients, especially
sags. The electrical current flow needed to operate
three types of medical equipment usually found at
typical health care facilities are measured during
their operations. The purpose is to show the
polluting characteristics of X-ray, Computerized
Axial Tomography and Magnetic Resonance
Imaging equipments.
4. CASE STUDY
Study was carried out on power quality of few
instruments commonly used in nursing home and
hospital.
X-ray equipment current consumption
measurements
The X-ray equipment in the operating theatres at the
hospital is supposed to be normally run from the
UPS system. However, due to light flickering while
being supplied by the UPS, the X-ray machine was
supplied by an essential power supply instead.
Hence in a blackout situation the X-ray equipment
would loose power until the start-up of the diesel
generator. During the two minute change over the
operating theatre staffs are unable to monitor
 2010 International Conference on Industrial Electronics, Control and Robotics
patients condition. The neutral current on the
essential supply is found to be large and have very
high total harmonic distortions. The X-ray machine
operates on two modes:
- Screening: This mode is a continuous mode of
operation for patient monitoring purposes. This
mode produces relatively small amount of X-raying
energy compared to the next mode.
- Snapshots: This mode is monitoring and produces
high levels of X-raying energy but for a period of up
to 20-30 seconds so there is a high demand for
electrical power and temporary voltage sags can
occur, compromising the performance of sensitive
equipment connected to the power supply. Longer
periods could cause excessive heating and damage
the X-ray tube.
For both modes, the X-raying energy is adjustable.
This is an important observation as it is crucial to
maintain similar conditions between different
measurements for valid comparisons. 
The use of X-ray fluoroscopy has increased
dramatically in recent years and is spreading beyond
the radiology department where users traditionally
have extensive fluoroscopy training. Figure 2 shows
potential for excessive radiation exposure to
personnel and patients.
Fig.2: Peaks caused by X-ray equipment during its
operation.
Computerized axial tomography current
consumption measurements
It is one of the most reliable and safe methods of
examination in modern electrical signals are emitted
by the atomic nuclei of body tissues. A circular
antenna surrounding the patient intercepts these
signs. The intensity of the signal varies according to
the kind of tissue. A computer assigns each signal to
a point corresponding to the body area being
examined and turns them into an image on the
screen. The current peak during its employment is
shown in figure
36
Fig. 3: Current peak caused by magnetic resonance
imaging during its operation.
Heart monitor test results: The heart monitor is
used for continual monitoring of a patient in surgical
centres and intensive care units producing
electrocardiograms as well as for monitoring
temperature, breathing and other patient data. In
addition to the waveform in the electrocardiogram, it
can indicate the heart rate and provide important
information like oxygen saturation levels in arterial
blood (SpO2) and arterial pressure. The equipment
used in the tests performs those measurements in a
non-invasive manner. A patient simulator was used
to generate voltage pulses on a steady and regular
basis, similar to those generated by a heart. The
equipment tested has an internal battery for
operation in cases of energy outages. In all tests, an
110 V voltage powered it. The maximum value
obtained for the third harmonic voltage during
measurements in several hospitals was 3%, thus the
values used during tests were far superior, with the
objective to verify the behaviour of the equipment
under conditions that can be far more critical. This
equipment keeps a steady operation when subjected
to voltages with high harmonic content and critical
momentary voltage sags.
Pulmonary ventilator test results: The ventilator
type tested is completely microprocessor based and
designed to be employed in respiratory insufficiency
in pediatric and adult patients, with a body mass
between 6 and 150kg. It is very practical equipment,
with direct digital controls for the main ventilator
parameters. The ventilation cycle starts by means of
pressure and since it incorporates a ventilation
monitor, it allows for an extensive monitoring of
patients conditions, increasing safety. Besides, an
audiovisual alarm system with written messages on
the control screen gives quick alarm identification.
The presence of lungs was simulated through the use
of a rubber balloon, provided by the manufacturer
for this purpose. alteration in current waveform
between sine voltage and the supply with completely
distorted voltage, no alterations in the regularity of
the equipments ventilation cycles could be noticed.

Fig 4: Voltage sag sequence generation to simulate
test conditions of the Table 4
5. OBSERVATIONS
There is a lack of standard related to test cases
considering the effects of high harmonic and voltage
sags. The quality of electrical installation in health
care facilities needs to be improved to reduce risks
to the patients and to provide better health treatment.
Figure 5 shows the lamp r.m.s voltage over a 4
minute interval. In this period two x-raying
snapshots were taken as shown in the Figure. The
variation of peak voltage was measured to be equal
to 40 V between two successive period. Figure 5
clearly indicates severe voltage fluctuations while x-
raying using the UPS system. However, with the ES
supply no voltage fluctuations were found.
Surgery suits equipment includes the surgery
luminaries. These luminaries were experiencing
frequent burn out. This problem was identified
thorough the audit. The solution was to use a circuit
with less harmonic distortion. The current distortion
resembles a step square wave. The steps follow a
sinusoidal wave. This behaviour agree with the way
this machine operates, were continuous x-ray
"shoots" draw high current in steps. As with idle
operation, there is minimal voltage distortion. The
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amplitude of current is almost twice in this case, but
the distortion is very different. The current
magnitude of the third harmonic is slightly reduced
as compared to idle operation, and its percentage in
the spectrum is significantly reduced since the total
current magnitude has doubled.
Total harmonic distortion THD is the most
frequently used power quality index. Most of this
equipment produces large third harmonic current
and hence the violation of the third harmonic limit.
This also explains why the process of x-raying did
not have much effect on the THD of the neutral
current[4]. The THDIs
on the ES and UPS supply were measured and found
to be 4.1% and 3.3% respectively. The r.m.s
voltage of the ES supply is also 4 to 5 V higher than
the UPS supply. Figure 5 shows the neutral current
and its spectrum. The current waveform is severely
distorted with a THD of 38.16% without x-raying
from the ES supply.
Another important outcome of the power quality
audit is in regard to the condition of the electrical
system. Installation of new equipment did not go in-
hand with improvements in infrastructure. As in
most facilities changes occur at a fast pace, new
equipment is added almost daily, e.g., office
equipment, diagnosis equipment, and patient
treatment equipment. In the past a single power
outlet per bed in patient rooms was more than
enough. Today two or three outlets are insufficient.
Unfortunately, services are added most of the time
without improving feeders, panel board capacity,
circuit protection and infrastructure in general.
Therefore, a system that was once stiff is now
operating near its limits. This change in operating
point has already caused malfunctions in equipment
such as patients intravenous pumps (used to
administer serum and other medicines to patients).
Overall system efficiency may be improved,
resulting on less repairs, reduced loss-of-life and
better maintenance records. This kind of study
would give an ability to identify and prevent power
quality events. This study will also serve as a guide
for installations of new equipment and future
expansions in the hospital. The study is especially
important for the BVH since its electrical installation
is not suited to deal with many power quality events.
Further analytical investigation of harmonic
propagation and unbalance conditions is required.
As a first step, the grounding bonding in the
facilities is being studied so that existing and future
problems are mitigated.
In most hospitals, the latest equipment is controlled
by computers, which require uninterrupted power
supply for proper functioning. Even though hospitals
rely on the power supplied by the government, they
do have generators as back up during power-cuts.
The generators use diesel, which is costlier than
electricity. Hence UPS have to be used to their
maximum capacity to control wastage. With the
conventional resources depleting day-by-day, the
need to bank on alternate energy sources is
unavoidable. The common resource of all is solar
 2010 International Conference on Industrial Electronics, Control and Robotics

energy, which is in abundance in a tropical country

like India.

6. RECOMENDATIONS
Design of an additional low cost filter unit and use
of intelligent UPS system with its implementation at
various power supply outlets will ensures power
quality enhancements, RMS/power current level
reduction, efficient power/energy utilization and
effective demand side management. Source current
harmonic will also be reduced by the dynamic
controller power quality enhancement. This
translates into improved power factor and energy
saving. The quality of electrical installation in health
care facilities needs to be improved to reduce risks
to the patients and to provide better health treatment.
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1998, pp. 71 76.
[2] Power Quality Analyzer-Applications Guide, Rev. 2, Fluke
Corporation, Everett, WA, June 1998.
[3] G. T. Heydt, Electric Power Quality, 2nd ed., Stars in a Circle
Publications, Scottsdale, 1994.
[4] Recommended Practices and Requirements for Harmonic
Control in Electrical Power Systems, IEEE Standard 519, NY,
1992.
[5] Dougherty, J.G. and W.L. Stebbins, 1997. Power quality: A
utility and industry perspective. Proceeding of the Conference on
Textile, Fiber Film Industry Technical, May 6-8, IEEE Computer
Society, Washington DC., USA., pp: 1-10. DOI:
10.1109/TEXCON.1997.598528
[6] Sersen, E. and J. Vorsic, 2008. Quality of Electricity Supply
as a Service. The Energy Agency of the Republic of Slovenia.
IEC Std. 60601, 2008. Electrical safety testing for medical
equipment.
[7] Hoevenaars , T. et al., 2003. Interpreting IEEE Std
519 and meeting its harmonic limits in VFD applications.

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