الريبورت Aziz

Higher College of Technology
Department of Engineering
Biomedical Section
ON THE JOB TRAINING

My training in Armed Forces Hospital in
FBEW EME (Forces Biomedical Workshop
Engineering)
:Done by
Mishal Juma AL-Siyabi (12J09301)
Graduation requirements for a diploma degree in

biomedical engineering
( )
Advisor Name: Mr.Ekram
:Date of submission
Table of contents
Title Pages
.No
Title page 1
Table of contents 2
Table of figures 4
Company data 7
Brief description of the training program 8
Introduction to FBEW EME 10
The sections in the Armed Force Hospital 11
Workshop safety 12
Acceptance procedures 19
Introduction to multimeters 23
Classification and types of medical equipment 27
Introduction to safety electrical and analyzers 29
Dental units 33
Dental hand pieces 35
Autoclave 39
ECG machine 45
Defibrillator machine 53
Infusion pumps 57
Patient monitor 63
X-rays 64
Blood cell counters basics 66
Biochemistry auto analyzer 68
Oxygen concentrator 70
Sphygmomanometer 73
Ultrasound 76
CTG machine 79
( )
CT scan 80
MRI machine 84
Lithotripsy 88
Water distiller 90
Personal evaluation of the training program 91
Recommendations 92
( )
Table of Figures
Figures Pages
.No
Figure 1 (stores spare parts demand) 19
Figure 2 (Medical equipment acceptance form) 20
Figure 3 (Medical equipment work order form) 21
Figure 4 (Periodical Preventive Maintenance) 22
Figure 5 (Digital Multimeter) 23
Figure 6 (Test Leads) 23
Figure 7 (Voltage Meter and Test Lead Connections Voltage) 24
Figure 8 (Ohmmeter Test Lead Connections Resistance) 24
Figure 9 (Ammeter and Test Lead Connections Current) 25
Figure 10 (Special Functions) 26
Figure 11 (Class/Type Definitions) 28
Figure 12 (Single phase and three phase power supply) 29
Figure 13 (connected of Electrical cables & plugs) 30
Figure 14 (connected of Electrical cables & plugs) 30
Figure 15 (safety test analyzer ) 32
Figure 16 (unit section overview) 33
Figure 17 (unit section components) 34
Figure 18 (low speed and high speed hand piece) 35
Figure 19 (hand piece overview) 36
Figure 20 (laboratory hand piece) 37
38
Figure 21 (ultrasonic machine)
38
Figure 22 (maintenance spray)
39
Figure 23 (the process of autoclave)
40
Figure 24 (SES 2000 autoclave)
( )
41
Figure 25 (Lisa 300 autoclave)
42
Figure 26 (Air and water cycle in Lisa300)
43
Figure 27 (sterilization cycles for different loads in lisa300)
Figure 28 (main cycle phases in lisa300) 44
Figure 29 (Lisa300 and ESE200) 44
Figure 30 (ECG machine) 45
Figure 31 (ECG Waveforms and intervals) 46
Figure 32 (Blocks of ECG) 47
Figure 33 (ECG Waveforms in the graph paper) 48
Figure 34 (bipolar limb leads) 49
Figure 35 (Einthovan triangle) 50
Figure 36 (Unipolar Limb Leads) 51
Figure 37 (Unipolar Chest Leads) 51
Figure 38 (colour coded leads of ECG) 52
Figure 39 (types of defibrillator) 53
Figure 40 (fully automatic and semi automatic) 55
Figure 41 (Implantable Cardioverter Defibrillator) 55
Figure 42 (Defibrillator Paddles) 56
Figure 43 (Basic Infusion System) 57
Figure 44 (Syringe Pump) 59
Figure 45 (Syringe Pump) 59
Figure 46 (Volumetric Pumps) 60
Figure 49 (Bedside Monitor) 63
Figure 50 (Vital sign monitor) 63
Figure 51 (X-ray generation) 65
Figure 52 (Block diagram of an x-ray machine) 65
Figure 53 (Blood Cell Counter) 67
Figure 54 (Typical auto analyser) 69
Figure 55 (Oxygen Concentrators) 70
Figure 56 (Overview of Oxygen Concentrators) 71
Figure 57 (Mechanics of Oxygen Concentrators) 72
Figure 58 (Mechanics of Oxygen Concentrators) 72
Figure 59 (blood pressure measured) 74
Figure 60 (manometric sphygmomanometer) 75
( )
Figure 61 (digital sphygmomanometer) 75
Figure 62 (Ultrasound machine) 76
Figure 63 (The parts of an ultrasound machine) 78
Figure 64 (different between Ultrasound probes) 78
Figure 65 (CTG machine and probe) 79
Figure 66 (CT scan machine) 83
Figure 67 (MRI machine) 87
Figure 68 (MRI machine) 87
Figure 69 (lithotripsy machine) 89
Figure 70 (How Does a Water Distiller Work) 90
( )
Company data
Armed Forces Hospital of the most important hospitals in the
Sultanate of Oman. A hospital affiliated to the Ministry of Defense
and located in Alkhod area in Seeb. This hospital provides medical
services to all the people who work in the armed forces and their
.families
There are in this hospital a lot of diverse medical departments and I
.will mention to you later in this report
For biomedical engineering, There is a large workshop for medical
equipment belonging to the hospital was opened on 09/03/2003. The
workshop is Responsible for all medical equipment in the Ministry of
Defence inside and outside the hospital. Where the maintenance and
repair of all medical equipment and the acceptance and registration
.of new medical equipment and other acts
The training began at the Armed Forces Hospital on 06/30/2013 and
finished training on 12/09/2013
There are a lot of people who I worked with them and take
.advantage of their expertise in the work
. Engineer: Ali Almosalhi
Engineer: Salem
Engineer: Syed Ahamed (supervisor)
Technician: Saeed Alameri
Technician: Soliman Alrahbi
Technician: Ahmed Alraisi
Technician: Nayef
Technician: Adnan
Technician: Basma
Technician: Mona
Technician: Moaz Alzadjali
( )
Technician: Jaber
Technician: Jassim
Brief description of the training program

Dates Areas of training Objectives or Activites
30/6/201 FBEW EME (Forces Biomedical Workshop Introduction to FBEW EME
3 Engineering) outside hospital (Forces Biomedical Workshop
Engineering)
1/7/2013 FBEW EME (Forces Biomedical Workshop Workshop safety
Engineering) outside hospital
2/7/2013 FBEW EME (Forces Biomedical Workshop Acceptance procedures
3/7/2013 FBEW EME (Forces Biomedical Workshop Introduction to multimeters
Engineering) outside hospital (test on voltage, current,
resistance)
4/7/2013 FBEW EME (Forces Biomedical Workshop Classification and types of
Engineering) outside hospital medical equipment
7/7/2013 FBEW EME (Forces Biomedical Workshop Autoclaves machines
Engineering) outside hospital (Introduction)
8/7/2013 FBEW EME (Forces Biomedical Workshop Autoclaves machines (dealing
Engineering) outside hospital with the device and try to
repair it)
9/7/2013 FBEW EME (Forces Biomedical Workshop Autoclaves machines (dealing
Engineering) outside hospital with the device and try to
repair it)
10/7/201 FBEW EME (Forces Biomedical Workshop Hand pieces (maintenance and
3 Engineering) outside hospital repair)
11/7/201 FBEW EME (Forces Biomedical Workshop Hand pieces and dental units
3 Engineering) outside hospital (maintenance and repair)
14/7/201 FBEW EME (Forces Biomedical Workshop Introduction to safety electrical
3 Engineering) inside hospital and anslysers used for medical
equipment (safety test)
15/7/201 FBEW EME (Forces Biomedical Workshop Lithotripsy machines
3 Engineering) inside hospital (Introduction more information
about it)
16/7/201 Lithotripsy room in X-Ray department in Lithotripsy machines (show
3 inside hospital how it works in a practical
way)
17/7/201 FBEW EME (Forces Biomedical Workshop CTG machines (Introduction
3 Engineering) inside hospital more information about it)
18/7/201 FBEW EME (Forces Biomedical Workshop ECG machines (Introduction
3 Engineering) inside hospital more information about it)
21/7/201 Accident and Emergency department ECG machines(show how it
( )
3 inside hospital works in a practical way and
maintenance)
22/7/201 FBEW EME (Forces Biomedical Workshop X-Rays machines (Introduction)
3 Engineering) inside hospital
23/7/201 X-Ray room in X-Ray department in X-Rays machines (show how it
3 inside hospital works in a practical way and
some information about it)
24/7/201 FBEW EME (Forces Biomedical Workshop Defibrillators machines (show
3 Engineering) inside hospital how it works in practical and
some information about it)
25/7/201 FBEW EME (Forces Biomedical Workshop Infusion pumps machines
3 Engineering) inside hospital (show how it works and some
information about it)
28/7/201 Medical Dental Canter Dental units (maintenance and
3 repair)
31/7/201 FBEW EME (Forces Biomedical Workshop Other dental equipment
3 Engineering) outside hospital
1/8/2013 FBEW EME (Forces Biomedical Workshop Other dental equipment
4/8/2013 Medical Laboratory Water distillers
5/8/2013 Medical Laboratory Bio-chemistry analyzer
6/8/2013 Medical Laboratory Blood cell counters
13/8/201 FBEW EME (Forces Biomedical Workshop Autoclaves (maintenance and
19/8/201 FBEW EME (Forces Biomedical Workshop Oxygen concentrator
3 Engineering) outside hospital (Introduction)
22/8/201 FBEW EME (Forces Biomedical Workshop Sphygmomanometer
25/8/201 FBEW EME (Forces Biomedical Workshop C.T scan machines
3 Engineering) inside hospital (Introduction)
26/8/201 C.T scan room in X-Rays department in C.T scan machines (show how
3 inside hospital it works in a practical way)
27/8/201 FBEW EME (Forces Biomedical Workshop Ultrasound machines
3 Engineering) inside hospital (Introduction)
28/8/201 Maternity department in inside hospital Ultrasound machines (show
( )
3 how it works in a practical
way)
29/8/201 FBEW EME (Forces Biomedical Workshop X-Rays machines (more
3 Engineering) inside hospital information about it)
1/9/2013 FBEW EME (Forces Biomedical Workshop MRI machines (Introduction)
Engineering) inside hospital
2/9/2013 MRI room in X-Rays department in inside MRI machines (show how it
hospital works in a practical way)
Engineering) outside hospital repair)
8/9/2013 FBEW EME (Forces Biomedical Workshop Other equipment
Introduction to FBEW EME

(Forces Biomedical Workshop Engineering )
There are two workshops and one located outside the hospital and
the second located inside the hospital and the workshop of Foreign
Affairs is the workshop basicis that Responsible for medical
equipment in all medical departments of the Ministry of Defense
within the hospital and outside the hospital, such as the Armed
Forces Hospital and the Centre for dental and laboratory medical and
medical complex and all the medical centers of Foreign Affairs of the
Ministry of defense..The workshop biomedical engineering
acceptance and registration of all medical equipment purchased by
the Department of Defense. And also the maintenance and repair of
.all medical equipment that need maintenance and repair
( )
The sections in the Armed Forces Hospital
Ground floor
Accident and Emergency
Blood tests
Blue ward
Dispensary
Endoscopy
Fracture clinic
Green ward
Gold ward
Mortuary
Occupational therapy
Out patients department
( )
Physiotherapy
X-ray department
First floor
Administration
Coral ward
Diamond ward
Intensive care unit
Laboratory
Operating theatres
Pearl ward
Red ward
Ruby ward
White ward
Lithotripsy
Outside AFH
MDC Medical Dental Center
Medical laboratory
Workshop safety
1. Preface
This is a summary of some of the design considerations and safety
requirements for an all-purpose workshop. For detailed specifications, readers
are advised to consult with the applicable statutory requirements in their
respective jurisdictions, with the installation and operating specifications
provided by the manufacturers and suppliers of shop machines, and with the
materials safety data provided by the suppliers of workshop chemicals.
2. Spatial Arrangements
The space between machines, installations, or piles of
materials or goods shall be a minimum of 600
millimeters (approx. 2 ft.).
Walkways shall be clearly marked. Yellow lines are
recommended to separate walkways from designated
work areas.
( )
Walkways shall be 1100 millimeters (3.6 ft.) in width if
considered as direct access to exits.
Walkways shall not be slippery even through wear or

humidity.
Walkways shall be kept in good condition and free

from obstructions.
3. Ventilation
1. Dilution
Dilution ventilation systems shall provide a minimum
of 3 fresh air exchanges per hour and a minimum of
7.1 litres per second per person.
2. Local Exhausts
All processes involving the release of toxic, flammable,
or corrosive gases, vapours, dusts, mists, or fumes
shall be equipped with a local exhaust system capable
of capturing contaminants at the source. Design
requirements are specified in the Industrial Ventilation
Manual - A manual of recommended practice,
American Conference of Governmental Industrial
Hygienists.
The outlets from local exhausts should be located at

the roof level, and a minimum of 25 ft. distance from
the nearest air intake.
4. Fire Prevention
1. Storage of Flammables
All flammable liquids shall be stored in NFPA or UL
approved flammable liquid storage cabinets.
Quantities of flammable liquids kept on hand shall not

exceed the limits established by the NFPA (see McGill
University Safety Manual for table).
Flammable liquids shall be handled and stored away

from sources of heat, spark, or open flame.
2. Fire extinguishers
Fire extinguishers shall be available for the three
classes of fires common to workshops:
Class A Combustibles (paper, wood, cardboard)
( )
Class B Liquid fuels (solvents, oil based paints,
gasoline)
Class C Electrical fires
A-B-C dry chemical extinguishers are suitable for all

three types
CO2 extinguishers are suitable for electrical fires and

moderately effective for Class B fires.
Water is suitable for Class A fires only.
Consult FPO for other fire prevention issues
5. Emergency Wash Devices
An emergency eye wash meeting ANSI standards shall

be within 50 feet of any work station where toxic,
corrosive, or oxidizing substances are handled, or
where dusts or projectiles are likely to be released.
A drench hose or emergency shower meeting ANSI

standards shall be within 50 feet of any work station
where toxic, corrosive, or oxidizing substances are
handled, or where there is a significant risk of clothing
fires.
6. Gas Cylinders
Gas cylinders shall be securely affixed to a wall or

bench using appropriate chains or clamps.
Gas cylinders shall be transported in the upright

position and be securely affixed to the transport
device.
When not in use or during transport, the regulator

shall be removed and the protective cap shall be
attached.
Regulators for use on gas cylinders shall be CGA

approved for the type of gas used, and the pressure
gauge range shall be appropriate for the pressures
being delivered.
( )
Empty cylinders should be stored separate from full
ones.
Cylinders of oxygen or other oxidizers shall be stored a

safe distance (20 ft.) away from fuels (hydrogen,
acetylene, propane, etc).
All gas delivery components shall be leak-tested

weekly.
Lubrication shall never be applied to the high pressure

side of an oxygen or oxidizer regulator. Teflon tape is
preferred.
7. First Aid
A first aid kit shall be readily accessible to all shop users at all times of shop
occupancy.
Each first aid kit shall contain the minimum contents, as prescribed by the
provincial first aid regulations:
1. a first aid manual
2. 1 pair scissors
3. 1 pair splinter forceps
4. 12 safety pins
5. 25 sterile dressings (25 mm x 75 mm), individually

wrapped
6. 25 sterile gauze squares (101.6 mm x 101.6 mm),

individually wrapped
7. 4 rolls sterile gauze bandage (50 mm x 9 m),

8. 4 rolls sterile gauze bandage (101.6 mm x 9 m),

9. 6 triangular bandages
10. 4 sterile bandage compresses (101.6 mm x

101.6 mm), individually wrapped
11. 1 roll adhesive tape (25 mm x 9 mm)
12. 25 alcohol swabs, individually wrapped

8. Training
( )
Provincial first aid regulations call for a minimum number of staff members to
be certified in first aid and CPR. Using formulas, the Commission de la Sant et
de la securit du travail, determines the minimum number of trainees for each
building and then provides subsidies to cover the costs for such training. Using
this training allocation, the Building Director of each building then identifies
the staff members to be trained. It is highly recommended that persons
supervising workshop operations be certified.
9. Personal Protection
Eye protection shall be mandatory for all workshop

occupants whenever any operations likely to involve
the release of dust or projectiles is being conducted,
and whenever any corrosive, toxic or oxidizing
chemicals are being employed.
UV eye protection shall be worn during welding

operations.
Steel-toed protective shoes shall be worn by anyone

handling or moving heavy pieces of apparatus.
A workshop gown or coat should be worn whenever

working with chemical products.
Long hair must be tied back or otherwise restrained

whenever in the workshop. The same applies to ties,
scarves or other loose items of clothing.
Rings, bracelets (including watches), or other loose

jewelry shall not be worn in the workshop.
10. Respiratory Protection
Respiratory protection should be considered as a last resort when engineering
(ventilation) controls are inadequate. Where suitable local exhausts are not
available and when work involving the release of toxic dusts, mists, vapours,
gases, or fumes at a concentration believed to be hazardous is performed,
respirators shall be worn.
Respirator requirements to be met include:
1. The respirator and the filter cartridge must be NIOSH

approved for the concentration of contaminants being
generated.
( )
2. Individuals required to wear respirators must be
medically fit (ie. no pulmonary ailments) to be able to
work comfortably with the added breathing resistance.
3. Individuals required to wear respirators must undergo

a qualitative fit test to ensure that the mask shape
and person's face are compatible and that the
individuals are trained in their use.
4. Individuals required to wear respirators must undergo

training in the correct selection, care and use of
respirators.
5. A maintenance program shall be in place to ensure

that respirators are properly sanitized, gaskets and
seals are functional, filters are replaced when
required, and that respirators are packaged and sealed
when not in use.
11. Administrative Controls
All persons using the workshop shall receive training in

the safety precautions, the safe operation of all tools,
and the relevant emergency procedures (fire, first aid,
chemical spills or leaks, etc.) before starting work.
All workshop users and visitors shall be made aware of

the aforementioned safety requirements. General
safety rules should be explained, distributed, and
posted.
Inexperienced persons shall be supervised at all times.
Regular inspections shall be conducted by the

department or its designated safety committee. The
performance of one inspection per semester and one
during the summer is recommended.
Maintenance problems should be reported

immediately to the supervisor who shall lock out the
power supply if a machine cannot be operated safely.
12. Lock-Out Procedures
Before commencing any maintenance procedures, energized equipment shall
be deactivated and the power supply locked-out with a suitable padlock. It is
( )
recommended that the shop supervisor be responsible for performing the lock-
out procedure prior to maintenance work.
13. Machine Guarding
It is strictly forbidden to disable safety interlocks,

machine guards, or emergency stop (e-stop) devices.
Machine guards shall never be removed or altered

except for maintenance procedures, during which the
machine shall be locked out.
Shop machines shall be equipped with emergency cut

off switches, readily accessible to the user. If there is
no means of emergency stopping a machine then a
second person must remain present in the workshop
while the machine is in use.
The START switch shall never be altered or impeded. A

vertical surface is the preferred location for the START
switch, to prevent accidental activation in the event
that an object is placed upon the switch. Two-handed
START switches are preferred for machines operated in
the hands free mode.
When machines are not in use, the guards should

remain in place.
Machine guarding requirements are provided in more

detail in the Quebec regulation respecting
occupational health and safety (S-2-1, r.19.01).
14. Electrical Safety
All electrical outlets shall carry a ground connection

requiring a 3-pronged plug.
The grounding pin of a 3-pronged plug shall not be

removed.
All wiring operations shall be conducted by a licensed

electrician.
In the event that equipment becomes wet, or in the

event of a water flood in the shop, power should be
disconnected at the breaker, and a lock applied.
( )
All frayed or damaged wires or plugs should be
replaced. In the interim, the electrical equipment
involved should be taken out of service.
Electrical potential shall be discharged before

conducting work on equipment containing high voltage
power supplies or capacitors.
Use only CO2 or dry chemical extinguishers on

electrical fires.
The use of extension cords should be avoided and they

shall never be placed across areas of pedestrian
traffic.
15. Housekeeping
All walkways, work stations, access to emergency

equipment and exits shall be free from obstruction at
all times.
Liquid spills shall be cleaned up immediately.
Heaps or stacks of equipment shall be stable and shall

not obstruct lines of view necessary for supervision of
shop users.
Wood and metal dusts shall be collected at the end of

each operation. Dry sweeping is not recommended
and the use of air hoses is not permitted.
Flammable and combustible materials shall not be

allowed to accumulate in open areas of the workshop.
Below you will find 8 must have rules for your workshop safety.
1. The workshop should always be kept clean.

Workshops can easily become cluttered so the onus is
on your to ensure that you do a cleanup each and
every day. Make sure that all tools and equipment is
returned to its proper place at the end of the day or
after use.
2. All combustible material should be kept away from any

equipment or tools that produce sparks. You should
always have a place to store your gas can other
flammable items. If you use welding equipment or
have a grinder you need to make sure that all paint
( )
and glass items are kept away from where these items
are used.
3. Safety goggles are a must no matter how careful you

think you are. Safety goggles are used to protect your
eyes and if you are using a grinder or any other
cutting tools you should make sure to have a face
shield too. These are essential safety precautions and
no equipment should be used until these are put in
place. They can prevent serious injuries and by
ensuring that you make it a point of wearing these
items you should be able to avoid any unnecessary
trips to the emergency room.
4. All the equipment in your workshop should be properly

supported. This is to ensure that objects do not fall
down or fall over causing injuries.
5. All keep in mind sudden interruptions especially if you

have a home workshop. You never know when
children or friends will come bursting in. You should
always have safety arrangements in place even if this
means something as simple as putting a sign on the
outside of your door when you are using cutting
materials or doing something where you cannot be
interrupted. If you plan ahead you can avoid
accidents.
6. Always keep your tools in proper working order. If you

use cutting equipment you need to make sure that it is
always kept sharp and up to standard. Regular
maintenance of your equipment can help to prevent
accidents.
7. Concentration is essential in a workshop environment

and if you are not feeling 100% you should leave the
job for another day. Accidents are often caused
because of lack of concentration.
8. It goes without saying that alcohol and workshop

activities do not mix. Workshop safety should always
be paramount and if you are feeling under the weather
or emotionally unstable then you should avoid any
workshop activities until you are in full control of your
body and mind.
( )
Acceptance procedures
.Acceptance paper divided into two sections A and B
In the first section must be written equipment type, model, serial No,
Manufacturer, agent, lpo No and cost. Also date of warranty and list of
.accessories and FMED job NO
:In the second section must be written
GENERAL (packaging satisfactory, equipment complete, accessories complete, -1

documentation complete)
ELECTRICAL SAFETY TEST (mains cable supplied , fuse ratings correct , plug -2
connection good , safety test printout attached , class 1 or 2 , type B or BF or
CF)
OPERATION (function check performed, user tests performed , calefaction -3

check performed)
FORMAL ACCEPTANCE (equipment accepted, FMED informed) -4
Also there are some forms that help to work in the workshop like Medical
equipment work order form and stores spare parts demand and PPM(Periodical
.Preventive Maintenance)
The following three images is a sample of the forms used in a workshop
( )
Figure 1 (stores spare parts demand)
( )
Figure 2 (Medical equipment acceptance form)
( )
Figure 3 (Medical equipment work order form)
( )
Figure 4 (Periodical Preventive Maintenance)
( )
Introduction to multimeters (test on voltage, current,
resistance)
?What is a Digital Multimeter
A digital multimeter measures AC / DC voltage, resistance, and current in

an electric circuit. It is highly accurate and displays an LCD number
.readout
Figure 5 (Digital Multimeter)
:Test Leads
.Test leads are used to connect the multimeter to the circuit to be tested
( )
Figure 6 (Test Leads)
:Voltage Meter and Test Lead Connections Voltage
The voltmeter is used to measure the voltage potential across a component in

-.an active circuit
.It can be used to measure either DC or AC voltages-
.AC voltage can ONLY measure sinusoidal (SINE) waveforms -
Plug the RED test lead into the jack labeled V/ and the BLACK test lead-
.into the jack labeled COM (common)
Figure 7 (Voltage Meter and Test Lead Connections Voltage)
:Ohmmeter and Test Lead Connections Resistance
.The ohmmeter is used to measure the resistance of a component -
.POWER CANNOT be applied to the component being tested-
The ohmmeter actually applies a small voltage and uses Ohms law to calculate -
.the resistance from the measured current
( )
Figure 8 (Ohmmeter Test Lead Connections Resistance)
:Ammeter and Test Lead Connections Current
The ammeter is used to measure the current through a component in an

-.active circuit
.It can be used to measure only DC current-
.Some multimeters can also measure AC current-
Plug the RED test lead into the jack labeled mA for milliamps or into the -
jack labeled 10A for circuits with high current levels. Plug the BLACK test
.lead into the jack labeled COM
.Be certain to select the range according to the test lead connections -
.Observe proper polarity-
Figure 9 (Ammeter and Test Lead Connections Current)
:Basic Instructions
( )
Be sure the test leads are connected appropriately for the intended
-.measurement
Turn the meters Function/Range switch to the function (ACV, DCV, DCA or ) to
-.be measured
.Select a range which is higher than the expected value-
Connect the test leads to the circuit/component being tested. Observe

-.proper polarity
Turn the meters Function/Range switch to reduce the range and increase the
-.accuracy
-.Record results
-.Remember to turn the power OFF when finished
Special Functions
Continuity Tester (Used to test the continuity between two points. Will produce
-an audio tone)
Diode Tester (Used to test the resistance in a diode for forward bias and reverse
-bias)
-Battery Tester (Used to test 9 volt and 1.5 volt (AAA, AA, C, D) batteries)
Figure 10 (Special Functions)
( )
:If the Meter Malfunctions
.Check meters battery-
Review instructions to make sure all the meters settings are accurate for the -
.type of testing being conducted
-.Check to see if test leads are broken or not connected properly
-.Inspect and test the fuse
Classification and types of medical equipment

Medical equipment used for two purposes diagnosis (Diagnostic equipment) and
.treatment (Therapeutic equipment)
Diagnostic equipment use to create a picture of the health status of patients

..at a single point in time
Therapeutic equipment use to change the health status of the patient over a
..period of time
And these equipments are divided into classes and types. So, each equipment
has class and type
- .Equipment Class {I,II,III} method of protection against electric shock
-.Equipment Type {B,BF,CF} degree of protection
All electrical equipment is categorized into classes according to the method of -

protection against electric shock that is used. For mains powered electrical
equipment there are usually two levels of protection used, called "basic" and
"supplementary" protection. The supplementary protection is intended to come
.into play in the event of failure of the basic protection
Class I
( )
Class I equipment has a protective earth. The basic means of protection is the
insulation between live parts and exposed conductive parts such as the metal
.enclosure
In the event of a fault that would otherwise cause an exposed conductive part to
become live, the supplementary protection (i.e. the protective earth) comes into
effect. A large fault current flows from the mains part to earth via the protective
earth conductor, which causes a protective device (usually a fuse) in the mains
.circuit to disconnect the equipment from the supply
term referring to electrical equipment in which protection against electric shock

does not rely on BASIC INSULATION only, but which includes an additional safety
precaution in that means are provided for ACCESSIBLE PARTS of metal or
internal parts of metal to be PROTECTIVELY EARTHED
Class II
term referring to electrical equipment in which protection against electric shock

does not rely on BASIC INSULATION only, but in which additional safety
precautions such as DOUBLE INSULATION or REINFORCED INSULATION are
provided, there being no provision for protective earthing or reliance upon
.installation conditions
Class III
Class III equipment is defined in some equipment standards as that in which

protection against electric shock relies on the fact that no voltages higher than
safety extra low voltage (SELV) are present. SELV is defined in turn in the
relevant standard as a voltage not exceeding 25V ac or 60V dc. In practice such
.equipment is either battery operated or supplied by a SELV transformer
If battery operated equipment is capable of being operated when connected to

the mains (for example, for battery charging) then it must be safety tested as
either class I or class II equipment. Similarly, equipment powered from a SELV
transformer should be tested in conjunction with the transformer as class I or
.class II equipment as appropriate
It is interesting to note that the current IEC standards relating to safety of

medical electrical equipment do not recognize Class III equipment since
limitation of voltage is not deemed sufficient to ensure safety of the patient. All
medical electrical equipment that is capable of mains connection must be
classified as class I or class II. Medical electrical equipment having no mains
."connection is simply referred to as "internally powered
Equipments Types
Different pieces of medical electrical equipment {APPLIED PARTS}
( )
Have different areas of application and therefore different electrical safety
requirements. For example, it would not be necessary to make a particular piece
medical electrical equipment safe enough for direct cardiac connection if there is
.no possibility of this situation arising
Figure 11 (Class/Type Definitions)
Introduction to safety electrical and analyzers used

for medical equipment (safety test)
General information about electric power
The standards voltages in Oman is 430V for three phase power supply and 240V
for single phase power supply (with 50 Hz frequency). So, some equipment use
single phase power supply like X-Ray machines and MRI machines. And some
equipment use three phase power supply like ECG machines, autoclaves
.machines and a lot of equipment
( )
We know the Ohm's Law is voltage=currentresistance (V=IR) so, the
.power=voltagecurrent (P=VI)
For single phase power supply
.P=VI so P=240v13A(mix) so P=3120watt(mix)
For three phase power supply
P=VI so P=430(more then 13A) so P=(more than 3120watt)
Figure 12 (Single phase and three phase power supply)
Electrical cables & plugs
The cable must be connected to the electrical plugs properly and also put the
fuse in the right place and that shown in the pictures below. In order to make
sure that the electricity up to the device safely and avoid getting any problems
.in the electrical conductivity
( )
Figure 13 (connected of Electrical cables & plugs)
Figure 14 (connected of Electrical cables & plugs)
Safety test
.Test-shortcut keys and can be used to initiate manual tests
Volts In single lead mode, displays mains voltage. In dual lead mode, 0
.displays, voltage between RED and BLACK test leads
( )
current Measures the current consumption (in amperes) of the device under 1
.test
Insulation Tests insulation resistance (mains to case or applied parts to 2

.case)
Protective Earth Resistance Measures the earth resistance using a 1A test 3

.current (unless 10A or 25A is selected)
Earth Leakage Is measured between the DUT "protective Earth" terminal 4

.and the "protective Earth" terminal of the 601PRO
Enclosure Leakage In single-lead mode, measures the enclosure leakage 5

.(RED test lead to DUT protective earth on the 601PRO)
Measures the patient leakage current (applied part to earth). 6 patient

Leakage
Mains on Applied Part Leakage Applies 110% mains voltage to selected 7

applied part and measures leakage to earth in both normal and reverse polarity.
.Dose not apply to patient auxiliary selections
Patient Auxiliary Current Measures the leakage and biasing current 8

.between applied parts
IEC 1010 Accessible Voltage/Leakage Selects the IEC 1010 test load. 9
Measures accessible voltage through the RED jack to 601PRO earth. Allows
.access to the accessible leakage test
VDE Equivalent Device Leakage Selects the IEC 601 test load. Applies /
.110% of mains voltage between L1/L2 and earth
VDE Equivalent Patient Leakage Selects the IEC 601 tests load. Applies -
.110% of mains voltage to the selected applied part and measures the leakage
Safety test analyzer
use it for electrical safety test for medical electrical equipment that to make -
sure that the medical equipment is safe for use. For example, it will check if
.there is leakage current and check the insulation of equipment
use it for simulator test to analysis of the medical equipment and make sure it -
is working properly and make sure it is giving us correct reading in diagnostic
.and therapeutic equipment
( )
?How we do the electric safety test
we must know the type and the machine before we do the test and select the-1
.type and class in the safety test analyzer
if the machine is class I (connect the plug of the machine to the safety test -2
analyzer, and connect the red wire (for earth) to the earth position and start
.checking
if the protective earth resistance is more than .2 tray to change the earth -3
.position in the machine and tray test again
if the machine is class II jest connect the plug of the machine to the safety -4
.test analyzer and start the test
Figure 15 (safety test analyzer )
( )
Dental units
Dental chair
( )
Figure 16 (unit section overview)
Figure 17 (unit section components)
.There are three main company for dental chair Sirona, KaVO, EDK
And all of this will use it for same function because all they have about same
things like 1 scalar, 2 coupling for high speed hand pieces, motor for low speed
,hand pieces,2 three way syringe, high suction and low suction
And also they have assistant, curing light(LED), foot switch(operate hand
pieces), spittoon(control the water that patient use), control pox power(consist
.of filters), separator and compressor
( )
Dental Hand pieces
There are main two type of hand pieces High speed and low speed(W&H
.company)
High speed and low speed dental hand pieces are both essential pieces of
?dentistry equipment. But what exactly are the differences between the two
High speed low speed

This product is a power-driven tool- Low Speed Hand pieces, on the other-
with rotary speeds of 400,000 RPM hand, rotate at reduced speeds
and higher. They are used to remove between 0- 5,000 rpm, or 80,000 rpm
cavities and decaying teeth, drill holes in some models. The head of tool
for fillings, and help with other attaches with a latch-type chuck or
restorations. Dentists also use high .friction-grip chuck
speed hand pieces to cut and polish
.dental trays for dentures A speed control ring is used on the-
slow speed hand pieces that allows
These devises use -inch-long- the user to control the speed, which
smooth shank burs. Most bur rotates, and the direction of
manufacturers models work the .rotation
same: air is pushed through ports into
the head of the hand piece, causing it -.Connecting by use coupling
.to rotate
.use motor-
-.Connecting by use coupling
Some have (LT) light turbine and-
Some have (LT) light turbine and- .some don't have
.some don't have
.Use high pressure (3.2-3.5par) -
.Use low pressure (2.2-2.5par)-
.Short-
-.Long
Include (head, rotor or turbine, head-
Include (head, rotor or turbine,- .shift, gear shift or external shift)
.coupling or cylinder)
controlled by air motor or electrical-
.controlled by air- motor
( )
Figure 18 (low speed and high speed hand piece)
( )
Figure 19 (hand piece overview)
( )
Laboratory hand piece
Found in the laboratories of the dental clinic in the drilling process for the
.formation of dentures (SF-Handstck)
Figure 20 (laboratory hand piece)
Hand piece Maintenance Procedures

Almost all manufacturers are currently recommending that you clean and
.lubricate the hand piece before every autoclave cycle
Flush or purge the hand piece before removal from the air supply tubing.
A brush and warm water may be used to clean the outside of a hand piece
before sterilization.
Never wash, spray, or immerse any hand piece in cold sterilant or

chemical disinfectants. This may damage or corrode some metals.
The hand piece turbine should never be removed for cleaning.
The quick disconnect connections may be cleaned with alcohol and a

cotton applicator. Do not use cold sterilants as they may damage O rings.
The fiber optic surfaces may be cleaned using isopropyl alcohol on a

cotton applicator.
( )
Cleaner/lubricant should be sprayed or dropped ONLY into the drive air
tube at the base of the hand piece, which leads to the turbine. The
exhaust hole does not connect to the turbine. The drive air tube is the
smaller of the two larger tubes, and is usually the shorter one.
Always run the headpiece with a bur in place for 20 seconds after
lubrication to expel any excess lubricant.
Contra angles should be detached and taken apart for lubrication about
once a week.
Ultrasonic machine
Use it for cleaning some part of hand pieces like rotor by high frequency (sound
waves).
Figure 21 (ultrasonic machine)
Maintenance spray
Use to clean the hand pieces and make it work smoothly.
( )
Figure 22 (maintenance spray)
Autoclave
Autoclave is a pressurized device designed to heat aqueous solutions above
their boiling point at normal atmospheric pressure to achieve sterilization. Or
device used to sterilized equipment's by them to high pressure saturated steam.
How Des it Works?
Liquid H2O cannot be heated above 100C in an open vessel
At 100C boils
H2O heated in a sealed vessel
Pressure rises
Boiling point of H2O is raised
The Process
Air removal
Downward displacement
Steam pulsing
Vacuums pumps
( )
Super atmospheric
Sub atmospheric
Autoclave Usage
Microbiology
Medicine
Body piercing
Veterinary science
Dentistry
Podiatry
Metallurgy
Figure 23 (the process of autoclave)
There is two type of autoclave: SES 2000 (old model) and Lisa 300 (new
model).
SES 2000 autoclave
( )
Figure 24 (SES 2000 autoclave)
Lisa 300 autoclave
( )
Figure 25 (Lisa 300 autoclave)
The functions of some of the important parts in Lisa 300 autoclave:
( )
Sterilization chamber: They are made of special materials bear temperature and
high pressure and be resistant torust.(Stainless Steel).
Water pump: Used to introduce distilled water into the chamber for ways special
slot.
Vacuum pump: Used to empty the chamber of the air after closing the door.
Sterilization process in order to be optimally.
Distilled and used water tanks: Distilled water tank water is used by sterilized
during the sterilization cycle and water used is the resulting water which is
contaminated with bacteria dead after the end of the sterilization cycle.
Electro valve: Is used to control the flow of air and water to and from the
chamber.
Radiator or condenser: Used to cool the water before entering the reservoir that
the water temperature up to134 degrees Celsius.
Bacteriology filter: It is the filter through which the introduction of air into the
chamber during the sterilization cycle (lawful to raise pressure) and at the end of
the session (to balance the pressure between the inside and outside the room).
Safety valve: It opens in the case of the arrival of the pressure inside the
chamber to the upper limit of the allowable.
Steam generator: Is used to heat water and convert it into steam which is
Responsible for raising and lowering the heat.
Figure 26 (Air and water cycle in Lisa300)
( )
Lisa 300 has three different sterilization cycles for different loads
B-universal 134.
B-prion 134.
B-universal 121.
Figure 27 (sterilization cycles for different loads in lisa300)
( )
Figure 28 (main cycle phases in lisa300)
???The different between SES2000 autoclave and Lisa300 autoclave
There is water inside the chamber of ESE2000 but there steam only in Lisa300,
that because the Lisa300 has steam generator and vacuum pump but there is
.no vacuum pump and steam generator in ESE2000
Figure 29 (Lisa300 and ESE200)
( )
ECG machine
Figure 30 (ECG machine)
Electrocardiography
It deals with the recording and study of electrical activity of heart muscles.
The potentials originated in the individual fibre of heart muscles are added
to produce ECG waveform.
The ECG wave form reflects the rhythmic electrical depolarization and
repolarization of the heart muscles associated with the contractions and
relaxation of the atrium and ventricles.
The shape, time interval and amplitude of the ECG give details of the state
of the heart.
Any form of disturbance in the heart rhythm (arrthymia) can be easily
diagnosed using electrocardiogram.
The typical ECG wave form consist of P wave, QRS complex and T wave.
The electrical potentials of the heart are measured by placing suitable
electrodes.
( )
Either surface electrodes with proper electrode paste or needle electrode
can be used.
The shape, time interval and amplitude of the ECG give details of the state
of the heart
Electrical Activity Of Heart
Each action potential in the heart originates at the sinoatrial(SA) node which is
situated in the wall of the right atrium. It is also called Cardiac pacemaker and
generates impulses at the normal rate of heart beat , about 72beats per minute
.at rest for a normal person
ECG WAVEFORMS AND INTERVALS
Figure 31 (ECG Waveforms and intervals)
The ECG waveforms are labeled alphabetically, beginning with the P wave,
which represents atrial depolarization. The QRS complex represents ventricular
.depolarization, and the T wave represents ventricular repolarization
Physical Nature of ECG Waveform
Duration ses Amplitude Origin

mv
to 0.22 0.12 0.25 Atrial depolarization or P Wave

contraction
(P-R interval)
( )
to 0.1 0.07 1.6 Repolarization of atria and the R Wave
Depolarization of ventricle QRS)

(Complex
to 0.15 0.05 to 0.5 0.1 Ventricular repolarization T Wave
(S-T interval)
Functional Blocks of the Electrocardiogram
Figure 32 (Blocks of ECG)
( )
The connecting wires for the patient electrode originate at the end of a
patient cable.
The wires from the electrodes connect to the lead selector switch.
From the lead selector switch the ECG signal goes to a pre-amplifier,
which is a differential amplifier with high common mode rejection ratio,
high gain factor.
The pre amplifier is followed by a dc pen amplifier or power amplifier,
which provides the power to drive the pen motor that records the actual
ECG trace.
ECG recorders use heat sensitive paper, and the pen is an electrically
heated stylus, the temperature of it is controlled by stylus heat control for
optimal recording trace.
Normally ECG are recorded at a paper speed of 25mm/s.
The complete wave form is called electrocardiogram with labels PQRST
indicating important diagnostic features.
The instrumental setup for recording is called Electrocardiograph.
Figure 33 (ECG Waveforms in the graph paper)
ECG LEAD CONFIGURATION
The potentials generated in the heart are conducted to the body surface. The
potential distribution changes in a regular and complex manner during each
( )
cardiac cycle. Therefore to record electrocardiogram, we must choose
:standardized electrode positions. There are three types of electrode systems
1) Bipolar Limb leads or Standard leads

2) Augmented unipolar limb leads
3) Unipolar chest leads or precordial leads
Bipolar limb leads-Standards leads I, II and III
In bipolar limb leads system ECG is recorded with two electrodes at a

time. The final trace is due to difference in potential of two electrodes kept at
two different locations on the body. For this system, the potentials are tapped
.from four locations of the body
Right arm 2) Left arm 3)Right leg 4)(1

Left leg
.The right leg electrode is used as the reference electrode
The three different leads of the system are
Lead I will gives the voltage drop(VI) from the left arm (LA) to the right (a)
.arm(RA)
.Lead II will gives the voltage drop(VII) from left leg (LL) to the right arm(RA) (b)
Lead III will gives the voltage drop(VIII) from the left leg (LL) to the left (c)
.arm(LA)
( )
Figure 34 (bipolar limb leads)
In defining bipolar leads, Einthovan has postulated that at any given instant of
the cardiac cycle, the electrical axis of the heart can be represented as a two
dimensional vector. The ECG measured from any of the three basic limb leads is
a time variant single dimensional component of the vector. He proposed that the
electric field of the heart could be represented diagrammatically as a triangle,
with heart the heart ideally located at the centre. The triangle is known as
Einthovan Triangle. The sides of the triangle represent the lines along which
.the three projections of the ECG vector are measured. Also VII=VI+VIII
( )
Figure 35 (Einthovan triangle)
Augmented Unipolar Limb Leads
In the augmented unipolar limb leads system the electrocardiogram is recorded

between a single exploratory electrode and the central terminal which has the
potential corresponding to the centre of the body. Thus two equal and large
resistors are connected to a pair of limb electrodes and the center of this
resistive network acts as the central terminal and the remaining limb electrode
act as the exploratory electrode. By means of augmented ECG a small increase
in ECG voltage can be realized. The augmented lead connections are augmented
voltage Right arm(aVR), augmented voltage Foot(aVF)and augmented voltage
.Left arm(aVL) as shown in figure
( )
Figure 36 (Unipolar Limb Leads)
Unipolar Chest Leads
In the case of unipolar chest leads, the exploratory electrode is obtained from
one of the chest electrodes. The chest electrodes are placed on the six different
points on the chest closed to the heart as shown in figure. This lead system is
.known as Wilson system
Figure 37 (Unipolar Chest Leads)
( )
.Unipolar Chest leads V1 Fourth intercostals space at right sterna margin
.V2 Fourth intercostals space at left sterna margin
V3 Midway between V2 and V4
.V4 Fifth intercostals space at mid clavicular line
.V5 Same level as V4 on anterior axillary line
.V6 Same level as V4 on mid axillary line
The ECG potentials are measured with colour coded leads according to the
:convention
White- Right Arm Black Left arm Green- Right leg
Red - Left Leg Brown- Chest
Figure 38 (colour coded leads of ECG)
( )
Defibrillator machine
Principle
A high voltage electric current is applied to the heart muscle either directly
(Internal defibrillator) through the open chest or indirectly (External Defibrillator)
.through the chest wall to terminate ventricular fibrillation
Application
.Emergency department-
.Anesthesiology-
.Cardiology-
.Operation theatre-
.Intensive care areas-
.Ambulance services-
Types
( )
Figure 39 (types of defibrillator)
Manual
Clinical expertise is needed to interpret the heart rhythm and decide whether to
charge the defibrillator and deliver the shock to patient. Energy selection and
.delivery is given to the patient manually
Automatic
These defibrillators are small, safe, simple and lightweight with two pads that
can be applied to the patient. The defibrillator guides the operator step-by-step
through a programmed protocol. It records and analyses the rhythm and
instructs the user to deliver the shock using clear voice prompts, reinforced by
.displayed messages
External
External defibrillator is the device which delivers the high energy shock to
patients heart externally on patient's chest by using a defibrillator paddle. The
maximum energy deliver to the patient is about 360 Joules in Monophasic & 200
.Joules in Biphasic defibrillator
Internal
Internal defibrillator consist of sterilized internal Handle/Paddle through which

.shock is delivered directly to the heart
AED (Automatic External Defibrillator)
.AED can be classified as either fully automatic or semi automatic
In fully automatic models disposable paddles are kept connected to the patient
whilst the AED analyzes the ECG rhythm, decides and determines whether a
defibrillation counter-shock is needed. Then the device automatically charges
.and discharges
Semi Automatic AED analyze the patient's ECG and notify the operator when
defibrillation is indicated. The operator then activates defibrillator and
.discharge
( )
ICD (Implantable Cardioverter Defibrillator)
If it detects an abnormally fast heart rhythm, it either electrically paces the

heart very fast or delivers a small electrical shock to the heart to convert the
heart rhythm back to normal. The rapid pacing is not felt by the patient but the
electrical shock, if used, is felt as a strong jolt in the chest. The ICD is used to
.treat life-threatening heart rhythms that lead to sudden death
Figure 40 (fully automatic and semi automatic)
( )
Figure 41 (Implantable Cardioverter Defibrillator)
Joule
It's the unit of energy delivered by the defibrillator. The energy released in one
second by a current of one ampere through a resistance of one ohm. Also called
.as watt-second
Operating principle
Monophasic defibrillator
.Delivers its current in one forward direction (positive) -
Requires higher escalating energy levels (200-300J) to convert VF/ pulse-less -

.VT
Biphasic defibrillator
The biphasic waveform type defibrillator delivers the current in one direction -
.during the first phase and in opposite direction during the second phase
Biphasic waveform shocks of 200J are safe, equivalent or higher efficiency than -
.damped sinusoidal waveform shocks of 360J
Defibrillator Paddles
( )
:There is two paddles for defibrillator
Sternum and Apex
Figure 42 (Defibrillator Paddles)
INFUSION PUMPS
Basic Infusion System
.Flow by gravity-
.Flow controlled by roller clamp-
.Difficult to set and control infusion rate-
( )
Figure 43 (Basic Infusion System)
?What are they
.Usually electrically powered infusion devices -
?What do they do
-.Use pumping action to infuse fluids, medication or nutrients into patient
.Suitable for intravenous, subcutaneous, enteral and epidural infusions -
?Why are they used
( )
To provide accurate and controllable flow over a prescribed period or on -
.demand
?What are they used for
Wide range of drugs and therapies including
-Chemotherapy
-Pain management
-Total parental nutrition
-Anaesthesia/sedation
- .Etc. etc
TWO BASIC TYPES
.Syringe Pumps-
.Volumetric Pumps-
Syringe Pump
-.Generally used for low volume, low flow rate infusions
.Good short term accuracy-
-.Long start up time at low flow rates
.Prime and purge line before connecting to patient *
-.Alarms: End/near end of infusion; drive disengaged, occlusion, battery low
- .Specialised syringe pumps for ambulatory use, PCA, sedation, insulin etc
.parameter: rate ml/hr-
( )
Figure 44 (Syringe Pump)
Figure 45 (Syringe Pump)
( )
Volumetric Pumps
-.Preferred for medium and high flow rates and large volumes
.Generally not suitable for rates < 5ml/h -
-.Variable short term accuracy
-.Alarms: Latch/door open, set out, occlusion, battery low, air-in-line
- .Specialised volumetric pumps for ambulatory use, epidural infusions etc
.parameter: volume ml and rate ml/hr-
Figure 46 (Volumetric Pumps)
( )
( )
Occlusion alarm (all pumps)
Occurs when pump is unable to sustain set flow rate and pressure in line
-.increases
Caused by partial or complete blockage in delivery tubing (kinked tube, clamp -

.or tap closed) or cannula (clotted off, position changed)
Time to alarm
-Dependent on occlusion pressure level (usually variable) and flow rate
Low pressure, high flow rate 45 seconds*
High pressure, low flow rate 45 minutes*
Hazards
-.Interruption to therapy
Problem with critical, fast acting drugs e.g. inotropes*
-.Post occlusion bolus
KVO in infusion pump
KVO is a medical term that is related to an infusion syringe pump,

which is a type of medical device. The acronym KVO stands for Keep
Vein Open. Many pumps have a KVO mode that can be used on a
patient. When this mode is selected, small amounts of drugs continue
to be infused after the end of the process of infusion. These small
amounts of drugs continue to be administered because they help
.prevent the forming of blood clots in the patient
( )
Patient Monitor
(Bedside Monitor)
Figure 49 (Bedside Monitor)
:Parameter Measured in Patient Monitor
ECG, SpO2(saturation), BP [IBP(Invasive Blood Pressure) ,NIBP(IBP(Non

. Invasive Blood Pressure)], R-R, HR, Temperature, Co2 Concentration
Vital sign monitor
Without ECG
( )
Figure 50 (Vital sign monitor)
X-Rays
X-rays is a form of electromagnetic radiation. X-rays have a wavelength in the

.range of 0.01 to 10 nanometers and energies in the range 100 eV to 100 keV
Properties X-rays
Short wavelength
Extremely high energy
Able to penetrate through materials
Absorbed when passing through matter
Extent of absorption depends upon the density of matter
Produce secondary radiation in all matter through which they pass
There are two main uses for X-Ray energy. One is for diagnostic
.reasons and the second is for therapeutic uses
Diagnostic: Methods used to determine the source or cause of a disease,

.disorder, or traumatic injury
Therapeutic: Methods used to treat and rehabilitate a disease, disorder,

.or traumatic injury
Generation of X-rays
X-rays are produced when fast moving electrons are stopped by a target. An X-
ray tube is fundamentally a high vaccum diode with heated cathode located
.opposite a target anode
The collimator in X-Ray machine used to limit the radiation or adjust the size of
.radiation and heat the radiation in cathode and remove out
There are three type of X-ray
Conventional X-ray has conventional film and conventional processor to wash -

.the film to get the images
Computerized Radiography (CR) used electronic processor to get the images-

.and send it to computer system
( )
Digital Radiography used detectors and this detectors connect to computer -
.system to get images
Figure 51 (X-ray generation)
( )
Figure 52 (Block diagram of an x-ray machine)
Blood Cell Counters Basics
?What does it do
.Counts the number of each type of cell found in whole blood
Physiology
Blood is made up of white blood cells (WBC), Red blood cells (RBC), Platelets
.(PLT) and Haemoglobin (Hb)
How it works
Blood is collected from the patient and put into a test tube. The test tube is bar
coded and put into the analyser for measurement. The WBC, RBC and PLTs are
counted using the Coulter principle where the resistance of a circuit changes
as the cells pass through a narrow aperture. RBCs, WBCs and PLTs are different
( )
sizes. The number of resistance changes and the amount of each change
determine the number and size (hence type) of cells. The Hb is measured using
a photometer at a wavelength specific for Hb. Results are transmitted to the
.Laboratory Information System or may be printed out
Units of measurement
RBC, WBC, PLT are expressed in counts per micro litre (L) Hb may be grams per
litre (g/L)
Typical values
WBC 10.0 x 10^9/L RBC 4.00 x 10^12/L PLT 200 x 10^9/L Hb 130g/L
Figure 53 (Blood Cell Counter)
( )
Biochemistry Auto Analyzer
?What does Biochemistry Auto Analyzer mean
Bio - pertaining to life or the body
Chemistry pertaining to chemicals
Auto automatic, self moving
Analyzer machine which performs the chemistry test or analysis Machine

.which can conduct chemical tests on samples from humans or animals
?What does it do
Performs up to 50 different tests on a test tube of patient serum sample and

reports the results to a Laboratory Information System. Modern analysers are
capable of 1200 tests per hour. The analyser requires between 2 and 35 micro
litres (uL) of sample per test. (One drop of whole blood is about 10uL)
Physiology
( )
Healthy people have biochemistry test results that fall within normal ranges.
.Results outside normal ranges may indicate a disease condition
How it works
Biochemistry analysers are constructed with an automated sample holder and

changer, automated dilutors, calibration systems, temperature controlled
analyser chambers and an output device with computer communications. They
may take the raw specimen as it is collected or usually require some pre-
processing, like centrifuging or filtering. Most analysers use light passing
through the sample to make a colorimetric measurement. (colori meaning colour
and metry meaning measurement). The diluted, clear sample with the necessary
reagent chemicals is pumped into an optically clear sample tube (cuvette). A
light beam is passed through the sample and cuvette and the intensity
measured by a photo detector at the other side. The greater the distance from
one side of the sample to the other (path length) and the darker the colour, the
more Absorbance that occurs. The light beam has a single wavelength, or
colour, determined by the chemistry to be analysed. Some chemistries
(electrolytes eg Sodium, Potassium, Chloride) are tested using ion specific
.electrodes
Units of measurement
milli mol per litre (mmol/l) micro litre (uL)
Typical values
Calcium: 2.00 2.50 mmol/l Chloride: 96 112 mmol/l Glucose: 3.0 5.5mmol/l
( )
Figure 54 (Typical auto analyser)
Oxygen Concentrator
An oxygen concentrator is an electrically operated device that draws in room air,
separates the oxygen from the other gases in the air and delivers the
concentrated oxygen to you. At 2 liters per minute, the air that you receive from
your concentrator is more than 90% oxygen. Oxygen concentrators are available
in different sizes and models. However, all models have the same basic parts: a
power switch to turn the unit on and off, a flow selector that regulates the
amount of oxygen you receive, an alarm system that alerts you if the power is
interrupted and, if recommended, a humidifier bottle. The oxygen in delivered to
you through a nasal cannula. The tubing on the cannula is attached to the outlet
on the unit. Sometimes, an extra length of tubing may be provided. This will
allow you to move a farther distance from your concentrator.
Overview of Oxygen Concentrators

An oxygen concentrator is a medical instrument that provides oxygen therapy to
patients with respiratory illnesses. Oxygen concentrators administer oxygen that
is purer than the oxygen in the ambient air. Oxygen concentrators have become
( )
significantly more popular than compressed oxygen tanks. Unlike oxygen tanks,
oxygen concentrators do not run the risk of leaking and causing explosions or
fires. For this reason, oxygen concentrators are safer for use in emergency and
military situations, where the probability of accidents is high. Oxygen
concentrators also are used in some industrial applications, though their primary
use is for medical treatment.
Figure 55 (Oxygen Concentrators)
( )
Figure 56 (Overview of Oxygen Concentrators)
Mechanics of Oxygen Concentrators
Ambient air consists of approximately 21 percent oxygen and 78

percent nitrogen. Oxygen concentrators suck in ambient air and filter
out the nitrogen, leaving pure oxygen. Oxygen concentrators contain
two Zeolite towers that are filled with aluminum silicate. Room air is
compressed and pumped into these towers, where the aluminum
silicate absorbs the nitrogen. The nitrogen is subsequently vented out
of the Zeolite towers, and the pure oxygen is pumped into a storage
tank where it is held until needed by the patient. There are stationary
and mobile oxygen concentrators, both of which run off of conventional
power sources as well as batteries. Oxygen concentrators typically cost
around $800, although many individuals and medical practices lease
.the devices from manufacturers
Pulse-Dose Technology
Pulse-dose technology is a new development in oxygen therapy that is

incorporated into most new oxygen concentrators. Traditionally, oxygen
concentrators have provided a continuous supply of oxygen to a patient
regardless of whether the patient was inhaling or exhaling. A pulse-
dose system delivers oxygen in fixed increments that correspond to the
inhalation component of a patient's breathing cycle. In doing so, pulse-
dose technology prevents oxygen from being wasted, and increases the
( )
efficiency of an oxygen concentrator. Pulse-dose technology is
particularly important in portable oxygen concentrators, which have
.limited storage
Figure 57 (Mechanics of Oxygen Concentrators)
( )
Figure 58 (Mechanics of Oxygen Concentrators)
Sphygmomanometer
You can measure blood pressure by using a device called a sphygmomanometer.
There are two types of this device, manometric and digital. When using the
manometric variety, a stethoscope is used to hear the sound of blood rushing
back through the artery. This "old-fashioned" type is more accurate than the
.digital type. With a digital device, the stethoscope is not used
Parts of the Device

A sphygmomanometer usually consists of a:
Pump
Dial
Cuff
Valve
What is measured?
The doctor measures the maximum pressure (systolic) and the lowest pressure
.(diastolic) made by the beating of the heart
( )
The systolic pressure is the maximum pressure in an artery at the
moment when the heart is beating and pumping blood through the body.
The diastolic pressure is the lowest pressure in an artery in the

moments between beats when the heart is resting.
Both the systolic and diastolic pressure measurements are important if either
.one is raised, it means you have high blood pressure (hypertension)
How is blood pressure measured?

To take a blood pressure reading, you need to be relaxed and comfortably seated, with your arm well
.supported. Alternatively, you can lie on an examination couch
A cuff that inflates is wrapped around your upper arm and kept in place
with Velcro. A tube leads out of the cuff to a rubber bulb.
Another tube leads from the cuff to a reservoir of mercury at the bottom of
a vertical glass column. Whatever pressure is in the cuff is shown on the
mercury column. The mercury is held within a sealed system only air
travels in the rubber tubing and the cuff.
Air is then blown into the cuff and increasing pressure and tightening is
felt on the upper arm.
The doctor puts a stethoscope to your arm and listens to the pulse while
the air is slowly let out again.
The systolic pressure is measured when the doctor first hears the pulse.
This sound will slowly become more distant and finally disappear.
The diastolic pressure is measured from the moment the doctor is unable
to hear the sound of the pulse.
The blood pressure is measured in terms of millimetres of mercury

(mmHg).
Blood pressure can be measured in other ways, such as using an automatic blood pressure gauge that
.can also be used at home
( )
Figure 59 (blood pressure measured)
digital sphygmomanometer
Electronic blood pressure measuring devices are becoming the norm now
.mercury is being phased out because of its hazardous nature
Most of these are now accurate enough for routine clinical use and are relatively
.inexpensive
They eliminate many of the errors in blood pressure measurement that human
.beings can generate
( )
Figure 60 (manometric sphygmomanometer)
( )
Figure 61 (digital sphygmomanometer)
Ultrasound or ultrasonography
is a medical imaging technique that uses high frequency sound waves and their
echoes. The technique is similar to the echolocation used by bats, whales and
.dolphins, as well as SONAR used by submarines
( )
Figure 62 (Ultrasound machine)
:In ultrasound, the following events happen
1. The ultrasound machine transmits high-frequency (1 to 5 megahertz)

sound pulses into your body using a probe.
2. The sound waves travel into your body and hit a boundary between
tissues (e.g. between fluid and soft tissue, soft tissue and bone).
3. Some of the sound waves get reflected back to the probe, while some
travel on further until they reach another boundary and get reflected.
4. The reflected waves are picked up by the probe and relayed to the
machine.
5. The machine calculates the distance from the probe to the tissue or organ
(boundaries) using the speed of sound in tissue (5,005 ft/s or1,540 m/s)
and the time of the each echo's return (usually on the order of millionths
of a second).
6. The machine displays the distances and intensities of the echoes on the
screen, forming a two dimensional image like the one shown below.
( )
In a typical ultrasound, millions of pulses and echoes are sent and received each
second. The probe can be moved along the surface of the body and angled to
.obtain various views
:A basic ultrasound machine has the following parts
Transducer probe - probe that sends and receives the sound waves
Central processing unit (CPU) - computer that does all of the

calculations and contains the electrical power supplies for itself and the
transducer probe
Transducer pulse controls - changes the amplitude, frequency and

duration of the pulses emitted from the transducer probe
Display - displays the image from the ultrasound data processed by the
CPU
Keyboard/cursor - inputs data and takes measurements from the display
Disk storage device (hard, floppy, CD) - stores the acquired images
Printer - prints the image from the displayed data
The transducer probe is the main part of the ultrasound machine. The
transducer probe makes the sound waves and receives the echoes. It is, so to
speak, the mouth and ears of the ultrasound machine. The transducer probe
generates and receives sound waves using a principle called the piezoelectric
(pressure electricity) effect, which was discovered by Pierre and Jacques
Curie in 1880. In the probe, there are one or more quartz crystals called
piezoelectric crystals. When an electric current is applied to these crystals,
they change shape rapidly. The rapid shape changes, or vibrations, of the
crystals produce sound waves that travel outward. Conversely, when sound or
pressure waves hit the crystals, they emit electrical currents. Therefore, the
same crystals can be used to send and receive sound waves. The probe also has
a sound absorbing substance to eliminate back reflections from the probe itself,
.and an acoustic lens to help focus the emitted sound waves
Transducer probes come in many shapes and sizes, as shown in the photo
above. The shape of the probe determines its field of view, and the frequency of
emitted sound waves determines how deep the sound waves penetrate and the
resolution of the image. Transducer probes may contain one or more crystal
elements; in multiple-element probes, each crystal has its own circuit. Multiple-
element probes have the advantage that the ultrasounc beam can be "steered"
by changing the timing in which each element gets pulsed; steering the beam is
especially important for cardiac ultrasound (see Basic Principles of Ultrasound
for details on transducers). In addition to probes that can be moved across the
( )
surface of the body, some probes are designed to be inserted through various
openings of the body (vagina, rectum, esophagus) so that they can get closer to
the organ being examined (uterus, prostate gland, stomach); getting closer to
.the organ can allow for more detailed views
The CPU is the brain of the ultrasound machine. The CPU is basically a computer
that contains the microprocessor, memory, amplifiers and power supplies for the
microprocessor and transducer probe. The CPU sends electrical currents to the
transducer probe to emit sound waves, and also receives the electrical pulses
from the probes that were created from the returning echoes. The CPU does all
of the calculations involved in processing the data. Once the raw data are
processed, the CPU forms the image on the monitor. The CPU can also store the
.processed data and/or image on disk
The transducer pulse controls allow the operator, called the

ultrasonographer, to set and change the frequency and duration of the
ultrasound pulses, as well as the scan mode of the machine. The commands
from the operator are translated into changing electric currents that are applied
.to the piezoelectric crystals in the transducer probe
Important Note: if the frequency of the probe is high, it will take the picture from
.deep place inside the body
( )
Figure 63 (The parts of an ultrasound machine)
Figure 64 (different between Ultrasound probes)
( )
CTG machine
What is Cardiotocography?
Cardiotocography (CTG) is used in pregnancy to monitor both the foetal heart as well as the
contractions of the uterus. It is usually only used in the 3rd trimester. Its purpose is to monitor foetal
well-being & allow early detection of foetal distress. An abnormal CTG indicates the need for more
invasive investigations & ultimately may lead to emergency caesarian section.
How it works
The device used in cardiotocography is known as a cardiotocograph.
It involves the placement of 2 transducers on the abdomen of a pregnant women.
One transducer records the foetal heart rate using ultrasound.
The other transducer monitors the contractions of the uterus.
It does this by measuring the tension of the maternal abdominal wall.
This provides an indirect indication of intrauterine pressure.
The CTG is then assessed by the midwife & obstetric medical team.
Figure 65 (CTG machine and probe)
( )
CT scan
?What is a CT scanner
.A CT (computerised tomography) scanner is a special kind of X-ray machine
Instead of sending out a single X-ray through your body as with ordinary X-rays,
.several beams are sent simultaneously from different angles
This allows more detailed images from within the body to be constructed, and
.these images are then interpreted by a doctor
CT scanners may also be referred to as CAT scans (computerised axial

.tomography)
Unlike an MRI scanner, where you are placed within a tunnel, a CT scanner
consists of a doughnut shaped machine and therefore you should not feel
.claustrophobic
How does a CT scanner work?

The X-rays from the beams are detected after they have passed through the
.body and their strength is measured
Beams that have passed through less dense tissue such as the lungs will be
stronger, whereas beams that have passed through denser tissue such as bone
.will be weaker
A computer can use this information to work out the relative density of the
tissues examined. Each set of measurements made by the scanner is, in effect,
.a cross-section through the body
The computer processes the results, displaying them as a two-dimensional

picture shown on a monitor. The technique of CT scanning was developed by the
British inventor Sir Godfrey Hounsfield, who was awarded the Nobel Prize for his
.work
What are CT scans used for?

.CT scans are far more detailed than ordinary X-rays
The information from the two-dimensional computer images can be

reconstructed to produce three-dimensional images by some modern CT
.scanners
The CT scanner was originally designed to take pictures of the brain. Now it is
much more advanced and is used for taking pictures of virtually any part of the
.body
( )
They can be used to produce virtual images that show what a surgeon would see
during an operation. They are used for a variety of different reasons, mainly
because CT imaging is one of the best and fastest tools for examining the chest,
abdomen and pelvis, and because it can provide cross-sectional views and
.highly detailed images
Some of the most common uses of CT imaging include detecting different types
of cancer (for example in the lung, bowel, liver and kidney), examining patients
with severe injuries and finding the cause for sudden rapid onset symptoms
.(such as breathlessness, abdominal pain)
CT is also used for the detection, diagnosis and treatment of a number of

vascular disease, which may ultimately lead to stroke, kidney failure or blood
.clots in the lungs
This also includes abdominal aortic anueryms (AAAs), which is where the large
main artery running downwards in the abdomen becomes enlarged and
.therefore may be prone to spontaneously rupture
CT is also used to diagnosing and analysing many spinal problems and injuries
.which may occur to the hands, feet and other skeletal structures
This is because CT is good, not just for looking at soft tissue structures, but also
.in providing detailed images of even very small bones
CT scans also allows doctors to inspect the inside of the body without having to
.operate or perform unpleasant examinations
It allows surgeons to plan surgery prior to starting a procedure, and allows

.assessment of the results after a procedure has been performed
CT scanning has also proven invaluable in pinpointing exactly where a tumour is

.and planning treatment with radiotherapy
The scanner is particularly good at testing for bleeding in the brain, for
aneurysms (when the wall of an artery swells up), brain tumours and brain
damage. It can also find tumours and abscesses throughout the body and is
.used to assess types of lung disease
In addition, the CT scanner is used to look at internal injuries such as a torn

kidney, spleen or liver; or bony injury, particularly in the spine. CT scanning can
.also be used to guide biopsies and therapeutic pain relieving procedures
How is a CT scan prepared for?
( )
Patients should always be asked about any recent illnesses or medical conditions
they may have, and whether there is a history of heart disease, asthma,
.diabetes, kidney disease or thyroid problems
Any of these may increase the risk of the patient having an adverse reaction
.during the scan procedure
Prior to starting the procedure, the patient will usually be given a gown to
hospital gown to wear. It is important that metal objects, such as jewellery,
eyeglasses, dentures and hairpins, are removed before starting the procedure,
.since these will affect the quality of the images
The patient may also be asked to remove hearing aids and dental work, and
women will be asked to remove bras containing metal underwire. Where
.possible, piercings should also be removed
If the patient is receiving an abdomen scan, for example, they will be asked not
to eat for six hours before the test. They will be given a drink containing
.gastrografin, an aniseed flavoured X-ray dye, 45 minutes before the procedure
This makes the intestines easier to see on the pictures. Sometimes a liquid X-ray
dye is injected into the veins during the test. This also makes it easier to see the
.organs, blood vessels or, for example, a tumour
The injection might be a little uncomfortable, and some people also experience
a feeling of warmth in their arm. It's important the patient inform their doctor
prior to the administration of a contrast agent, if they have had a known allergy
.'to contrast material, or 'dye
How is a CT scan carried out?

The scan is a non-invasive, painless medical procedure. It usually takes
approximately 10 to 30 minutes to perform, depending on the part of the body
that is being scanned, the number of pictures taken and the different angles
.required
.The scanner itself looks like a large doughnut, with a bed passing through it
During the scan the patient lies on a bed, with the body part under examination
.placed in the round tunnel or opening of the scanner
If contrast material is to be used it will either be swallowed, injected via an

.intravenous line (IV) or administered by enema
How contrast is given depends on the type of examination to be carried out. The
patient will usually be asked to hold their breath during the scan. This is because
any kind of motion, such as breathing or body movement, can lead to
( )
degradation of the resulting image and so make it harder to analyse and
.interpret
The bed then moves slowly backwards and forwards to allow the scanner to take
.pictures of the body, although it does not touch the patient
During the scan, only the patient will be in the exam room during the time the
scan is carried out, unless there are special circumstances, such as a parent
needing to stay in the room with their child, in which case they are required to
.wear a lead apron to minimise the radiation exposure
During the scan, the technician will communicate with the patient via a speaker
.in the scan room, and they will be able to hear and see the patient at all times
Does a CT scan hurt?

The examination does not hurt but some people find it uncomfortable to lie
.within the scanner itself
Although the scanner is not tunnel shaped like an MRI scanner, people who
suffer from severe claustrophobia sometimes have problems with CT scans. Let
.the doctors and radiographers know if this might be a problem
Other people get slightly nervous because of the whirring noise the machine
.makes while working
If the patient feels this might be the case, then this should be discussed prior to
the procedure being carried out, since the patient may be unable to lie still
during the scan therefore giving pictures of such poor quality they could not be
.interpreted anyway
Is a CT scan dangerous?
Far more X-rays are involved in a CT scan than in ordinary X-rays, so doctors do
.not recommend CT scans without a good medical reason
However, the amount of radiation a patient is exposed to is small, and therefore

.are unlikely to cause any long term harm
The risk is greatest to those who are pregnant, as radiation exposure can cause
harm to the fetus, and therefore CT sans are contraindicated in pregnant
.women, unless the benefits of performing the scan far outweigh the risks
Risks are also greater in children, when compared to adults, and therefore a CT
is only recommended if a child has a serious condition that puts them at greater
.risk
Some patients may experience side-effects due to allergic reactions to the liquid
.dye injected into the veins
( )
In very rare cases, this dye has been known to damage already weakened
.kidneys
It is important to let the X-ray doctors or technicians know if you have any
.allergies, asthma or kidney trouble, prior to having the X-ray dye injected
Figure 66 (CT scan machine)
MRI machine
?What is an MRI scan
MRI (magnetic resonance imaging) is a fairly new technique that has been used
.since the beginning of the 1980s
( )
The MRI scaner uses magnetic and radio waves to create pictures of tissues,
organs and other structures within the body, which can then be viewed on a
.computer
This means that, unlike some other modes of medical imaging, there is no
.exposure to X-rays or any other damaging forms of radiation
The pictures produced by an MRI scan, when compared to other imaging

modalities, are much more detailed and therefore are of higher diagnostic
.quality when compared to more frequently used X-ray scanners for example
How does an MRI scanner work?

.The patient lies inside a large, cylinder-shaped magnet
Radio waves 10,000 to 30,000 times stronger than the magnetic field of the
earth are then sent through the body. This strong magnetic field causes the
alignment of particles, called protons which are found naturally within the body,
.mostly in hydrogen atoms
Hydrogen, together with oxygen and carbon, make up 99 per cent of the
average human body, and therefore almost all the protons found within the body
.are affected by the strong magnetic field
This allows detailed MRI images to be created Once the magnetic field is
switched off, the protons begin to lose their alignment, and go back to the
.position they were in before the magnetic field was applied
As they move back into their original positions, they send out radio waves of
their own. The scanner picks up these signals and a computer turns them into a
picture. These pictures are based on the location and strength of the incoming
.signals
Different protons send out different signals, depending on which tissue the
proton can be found in. For example, a proton found in bone will emit a very
.different radio wave signal when compared to a proton found in blood
It is these signal differences which allow a picture to be created, and allow

.different tissues or structures to be distinguished from one another
What does an MRI scan show?

Using an MRI scanner, it is possible to make pictures of almost all the tissue in
.the body
The tissue that has the least hydrogen atoms (such as bones) turns out dark,
while the tissue that has many hydrogen atoms (such as fatty tissue) looks
.much brighter
( )
By changing the timing of the radiowave pulses it is possible to gain information
.about the different types of tissues that are present
An MRI of the brain and spinal cord can be done to look at a multitude of
different abnormalities, as it can provide clear pictures of these structures even
.though they are surrounded by bone tissue
Changes within the tissues of the brain, whether subtle or gross, can help with a
.diagnosis and so determine treatment
For example, an MRI of the brain can be done to look for the changes associated
.with bleeding or when the brain has been starved of oxygen after a stroke
It can be used to investigate a traumatic brain injury, and also help diagnose
.developmental abnormalities
It can be used to characterise tumours (benign or malignant abnormal growths)

and check their progression, for example if they have changed in size and
.whether there has been spread to nearby tissues
Within the heart, an MRI scan can give very detailed imaging of the thickness
and size of the chamber walls. Damage occurring to the heart tissue after a
.heart attack or in association with valvular disease can also be assessed
Other structures, such as the large blood vessels within the surrounding tissue
can also be examined, for example to check for the build up of plaques, which
.can predispose the patient to having a heart attack in the future
Congenital cardiovascular conditions can more accurately be assessed with MRI,

along with changes to the heart which have occurred as a consequence of these
.conditions
MRI is the imaging modality of choice for assessing joint problems. This is
because joints are typically made up of a number of very different tissues, for
example muscle, bone and ligaments, and MRI is very effective at giving clear
.images of these individual tissues
The method can also sometimes be used to image other parts of your body such
.as the liver, kidneys, spleen and breasts
How is an MRI scan performed?

The scan is usually done as an outpatient procedure, which means that the patient can go home after
the test. During the scan it is important to lie completely still. For this reason it might be necessary to
.give a child an anaesthetic before they are tested
Since you are exposed to a powerful magnetic field during the MRI scan, it is important not to wear
.jewellery or any other metal objects
( )
An MRI scan is not suitable for the patient if they have electrical appliances, such an a ear implant,
implantable cardioverter defibrillator or pacemaker, or have any metal in their body such as surgical
.clips
.But orthopaedic metal ware, such as artificial hips or bone screws, are not normally a problem
How does an MRI scan differ from a CT scan?

There's no ionizing radiation (X-rays) involved in producing an MRI scan. MRI
.scans are generally more detailed, too
This is because they are more capable of illustrating all soft tissues and higher
.density tissues, such as bone
For this reason an MRI is preferred over a CT scan for imaging structures such as
joints, the brain, and the spinal cord, where clearer and more anatomically
detailed images are required. CT scans should therefore not be used if fine detail
.of soft tissues is needed
The difference between normal and abnormal tissue is often clearer on the MRI
scan than on the CT scan, because the anatomical differences between these
.types of tissues is seen more clearly
It is also possible to differentiate cystic lesions from malignant tumours, to

identify areas of infection and inflammation and for assessment of joint tendon
.tears
MRI scans are also more costly than CT scans, and take longer to complete. The
length of the MRI scan depends on the region of the body being imaged. MRI
.scans may be indicated in those patients who are not able to have a CT scan
For example patients with surgical clips, metallic fragments, cardiac

.pacemarkers, and for female patients who are pregnant
It is also possible to produce images in any plane without having to move the
patient when using an MRI scan
Is an MRI scan dangerous?

There are no known dangers or side effects connected to an MRI scan. The test is not painful; you
cannot feel it. Since radiation is not used, the procedure can be repeated without problems. There is a
small theoretical risk to the foetus in the first 12 weeks of pregnancy, and therefore scans are not
.performed on pregnant women during this time
Because patients have to lie inside a large cylinder while the scans are being made some people get
claustrophobic during the test. Patients who are afraid this might happen should talk to the doctor
.beforehand, who may give them some medication to help them relax
.The machine also makes a banging noise while it is working, which might be unpleasant
( )
Figure 67 (MRI machine)
Figure 68 (MRI machine)
( )
Lithotripsy
Overview
Lithotripsy is a medical procedure used to treat kidney stones. It may also be
used to treat stones in other organs, such as the gall bladder or the liver. Kidney
stones are collections of solid minerals that sometimes form in the kidneys.
Healthy kidneys do not have these stone-like formations. Most stones pass out
of the body naturally during urination.
Stones may consist of small, sharp-edged crystals, or smoother, heavier
formations that resemble polished river rocks. Sometimes these larger
formations do not pass in the urine. These stones can cause kidney damage.
People with kidney stones may experience bleeding, pain, or urinary tract
infections. When stones begin to cause these types of problems, your doctor
may suggest lithotripsy in order to break up the stones.
Consist of
-C arm X-ray (used to locate the stone clearly).
-Ultrasound (used to locate the stone clearly).
-Basic unit (consist of control panel, patient table and therapy head).
-There is coil inside the therapy head that make the shock wave.
-It is filled with water to prevent reflection or scattering waves.
-Used distilled water.
-There is water circuit to make sure there is no air inside therapy head.
How lithotripsy work
Lithotripsy uses sound waves to break stones apart. These sound waves are also
called high-energy shock waves. The most common form of lithotripsy is
extracorporeal shock wave lithotripsy (ESWL). Extracorporeal means outside
the body, and in this case refers to the source of the shock waves applied from
outside the body using a special machine.
ESWL was introduced in the early 1980s. It quickly replaced surgery as the
treatment of choice for most stones. ESWL is a noninvasive procedure, because
it does not require a surgical procedure. Noninvasive procedures are generally
safer and easier to recover from than invasive procedures.
After lithotripsy, stone debris is removed from the kidney (s) or the tubes leading
from the kidney to the bladder through urination. The lithotripsy procedure takes
about 45 minutes to one hour to perform. Usually, the patient will be put to
sleep with general anesthesia. Because of this, patients usually do not
experience pain. Sometimes patients will be allowed to remain awake during the
procedure and may even be allowed to follow the progress of the procedure on
an ultrasound or X-ray monitor.
How to prepare for a lithotripsy
( )
Its important to tell your doctor about any drugs, over-the-counter supplements,
or herbs that you may be taking. Drugs such as aspirin, ibuprofen, or blood
thinners (such as warfarin) can interfere with the bloods ability to clot properly.
You will probably be asked to stop taking these types of drugs well before the
procedure.
Do not stop taking any drugs you may have been prescribed unless the doctor
tells you to do so.
You will likely be advised not to drink or eat anything at all for at least six hours
and asked to arrive one to two hours before your procedure begins.
What to expect during the lithotripsy procedure

Lithotripsy is usually done on an outpatient basis. This means you will report to
the hospital or clinic on the day of the procedure, and probably leave the same
day. After arriving for your appointment, you will be given drugs to sedate you
and will receive antibiotics to fight infection. You will dress in a hospital gown
and be asked to lie on an exam table on top of a water-filled cushion where you
will remain while the lithotripsy procedure is performed.
Afterward, you will spend about two hours in recovery before being sent home,
but some patients may be hospitalized overnight. You should plan to have a
friend or family member drive you. Plan to spend one to two days resting at
home after the procedure. It will be helpful if you drink plenty of water for
several weeks after lithotripsy. This will help the kidneys flush out any remaining
stone fragments.
Long-term outlook
Kidney stones can occur in the kidneys or in the ureters (the tubes leading from
the kidneys to the urinary bladder). Stones can vary in size and what theyre
made of. In most cases, lithotripsy completely removes the stones. Some
patients may need more treatments, however. While lithotripsy works very well
for most patients, stones may eventually recur.
Risks of lithotripsy
Like most procedures, there are some risks involved in lithotripsy. Some patients
may experience internal bleeding that will make a blood transfusion necessary.
Some patients develop infections, while others may experience pain or even
kidney damage from a stone fragment blocking the flow of urine out of the
kidneys. The kidneys can suffer damage, and may not work as well after the
procedure. Possible secondary complications may include high blood pressure or
kidney failure.
( )
Figure 69 (lithotripsy machine)
Water Distiller
Water distillation has three basic steps. Water is heated to boiling. The steam is
collected and condenses into water droplets on a surface as it cools. The
droplets are collected in a storage container.
How Does a Water Distiller Work?
The water is cleansed of heavier elements and impurities such as bacteria that
are not carried by water in vapor form.
What a Home Distiller Adds to the Process
In a water distiller unit designed for home use, some added features help purify
the end product. During the water vapor or steam phase, a baffle vent allows
the discharge of gasses other than H2O. The steam is trapped in a coiled tube,
cooled by either a fan or cool water, and condensed into liquid form. An
activated carbon filter may be present in the condenser to remove any
remaining gasses from the water as it becomes liquid, before it goes to the
storage tank. This will also re-oxygenate the water.
Usefulness in the Home
Water distillers are best used with already potable water. Impurities can still
remain in distilled water if the water used contains certain contaminates. With
municipal water or safety-tested well water, the distiller is used to remove
minerals. In areas with hard water, using a water-softener system prior to
( )
distilling the water is recommended but can leave a salty taste in the finished
product. Distillers without a carbon filter may leave the water tasting "flat" due
to the lack of oxygenation. Chilling the finished product in a refrigerator can help
the taste. Since gases such as chlorine can be released during the distillation
process, adequate venting around the distiller is a must. The home distillation
system can be hooked directly to your refrigerator's water and ice unit, a
furnace humidifier or run to a special faucet at your kitchen sink.
Figure 70 (How Does a Water Distiller Work)
Personal evaluation of the training

program
After completing the training period in the hospital, I can say I have
achieved a lot of important accomplishments such as I got the
opportunity to work with medical equipment and try to understand
and try to fix it. And also, gained a lot of electrical skills Such as,
electricity connections to medical equipment and measuring
electrical power, voltage, resistance and current intensity and
learned important skills to work in a safe working environment inside
and outside the workshop. And I also learned how to record and
acceptance of any new medical equipment at the hospital and all
medical units of the Ministry of Defence. I learned a lot of important
skills at work and this is mentioned in detail in this report. I have
benefited greatly from the expertise of a lot of staff within the
hospital and medical equipment workshop, especially some of the
staff who have experience in working with medical equipment to
( )
more than 10 to 20 years old and more. There are some strong
points in the training period is that there are a lot of different
medical equipment at the hospital and this increases the possibility
of teaching in a practical way and also there is a test at the end of
the training period in order to make sure that I benefited from the
training well. And weak points, A few hours of work per day in the
engineering department of medical equipment in the hospital and
therefore increased the training period for more than two months to
finish the 300 hours and I suggested calculates working days, not
.hours of work in the training period
Recommendations
I would advise all the students of biomedical engineering in the
Higher College of Technology to training in the Armed Forces Hospital
because it has a large workshop for biomedical engineering and
there are a lot of tools that help to work to improve the skills of the
student. There is also an internal workshop inside the hospital and
close to various medical departments within the hospital to be able
to go to any medical device within the hospital easily. I also advise
them to train there in the hospital. Due to the presence of staff
( )
collaborators and have considerable experience in medical
equipment and provide all the support for the trainees so, the
trainees can benefit from their experiences dramatically. I also
propose to increase the training period because it is insufficient or
that there will be internships for students before going to external
.training
:Other tips for trainees
Advise them to choose the place of training for themselves and not
.wait for college in order to send them to any institution for training
Recommend to biomedical engineering students training in hospitals
and not to go for training in companies that provide services for
medical equipment because in hospitals having a large number of
medical equipment either company specializes certain types of
.medical equipment
( )

الريبورت Aziz

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الريبورت Aziz

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Higher College of Technology

ON THE JOB TRAINING

Graduation requirements for a diploma degree in

Engineer: Syed Ahamed (supervisor)

Technician: Saeed Alameri

Technician: Soliman Alrahbi

Technician: Ahmed Alraisi

Technician: Moaz Alzadjali

Brief description of the training program

Introduction to FBEW EME

Walkways shall not be slippery even through wear or

Walkways shall be kept in good condition and free

The outlets from local exhausts should be located at

Quantities of flammable liquids kept on hand shall not

Flammable liquids shall be handled and stored away

Class A Combustibles (paper, wood, cardboard)

Class C Electrical fires

A-B-C dry chemical extinguishers are suitable for all

CO2 extinguishers are suitable for electrical fires and

Water is suitable for Class A fires only.

Consult FPO for other fire prevention issues

5. Emergency Wash Devices

An emergency eye wash meeting ANSI standards shall

A drench hose or emergency shower meeting ANSI

Gas cylinders shall be securely affixed to a wall or

Gas cylinders shall be transported in the upright

When not in use or during transport, the regulator

Regulators for use on gas cylinders shall be CGA

Cylinders of oxygen or other oxidizers shall be stored a

All gas delivery components shall be leak-tested

Lubrication shall never be applied to the high pressure

1. a first aid manual

3. 1 pair splinter forceps

5. 25 sterile dressings (25 mm x 75 mm), individually

6. 25 sterile gauze squares (101.6 mm x 101.6 mm),

7. 4 rolls sterile gauze bandage (50 mm x 9 m),

8. 4 rolls sterile gauze bandage (101.6 mm x 9 m),

10. 4 sterile bandage compresses (101.6 mm x

11. 1 roll adhesive tape (25 mm x 9 mm)

12. 25 alcohol swabs, individually wrapped

Eye protection shall be mandatory for all workshop

UV eye protection shall be worn during welding

Steel-toed protective shoes shall be worn by anyone

A workshop gown or coat should be worn whenever

Long hair must be tied back or otherwise restrained

Rings, bracelets (including watches), or other loose

Respirator requirements to be met include:

1. The respirator and the filter cartridge must be NIOSH

3. Individuals required to wear respirators must undergo

4. Individuals required to wear respirators must undergo

5. A maintenance program shall be in place to ensure

All persons using the workshop shall receive training in

All workshop users and visitors shall be made aware of

Inexperienced persons shall be supervised at all times.

Regular inspections shall be conducted by the

Maintenance problems should be reported

13. Machine Guarding

It is strictly forbidden to disable safety interlocks,

Machine guards shall never be removed or altered

Shop machines shall be equipped with emergency cut

The START switch shall never be altered or impeded. A

When machines are not in use, the guards should

Machine guarding requirements are provided in more