MULTIX Compact K

CO

Adjustment

© Sie mens AG 2001

The reproduction, transmission or
use of this document or its contents
is not permitted without express
written authority. Offenders will be
liable for damages. All rights,
including rights created by patent
grant or registration of a utility
model _or_ design,_are_ reserved.

Register 5 English
Print No.: COMK-136.842.01.01.02 Doc. Gen. Date: 02.01
Replaces: AXB1-136.842.01.01.02
0-2 Revision

Chapter Page Revision

all all 01

MULTIX Compact K Register 5 COMK-136.842.01 Page 2 of 4 Siemens AG

Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Contents 0-3

Page
1 _______Requirements/Remarks _________________________________________ 1 - 1

Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1- 1

Tolerance Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 - 1
Maximum Torque Values (Table) . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-1
Required Test Equipment, Tools and Aids. . . . . . . . . . . . . . . . . . . . . . . .1- 2
Text Emphasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1- 3
Abbreviations Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1- 3
Definition of Terms for Cassettes and Radiation . . . . . . . . . . . . . . . . . . . .1-4
Special Symbols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1- 4

2 _______Column Stand _________________________________________________ 2 - 1

Adjusting the Stop for Column Rotation . . . . . . . . . . . . . . . . . . . . . . . . .2- 1

Horizontal Adjustment of the Tube Unit Support Arm . . . . . . . . . . . . . . . . . .2-1
Replacing the Support Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2
Support Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 - 4
Rotation Brake (Brake Assembly) for Tube Unit Rotation . . . . . . . . . . . . . .2-4
Central Beam Drift in the Longitudinal Direction . . . . . . . . . . . . . . . . . . . .2-5
Central Beam Drift in the Transverse Direction . . . . . . . . . . . . . . . . . . . . .2- 7
Checking the Central Beam for Parallelism to the Cassette Bucky . . . . . . . . . . .2-8
Adjusting the Collimator with Rotation Flange . . . . . . . . . . . . . . . . . . . .2- 9
Adjusting the Centered Position of the Rotation Flange . . . . . . . . . . . . . . .2-9
Adjusting the Time Switch for the Collimator Light Localizer . . . . . . . . . . . 2 - 10
Checking and Adjusting the Radiation Field to the Light Field . . . . . . . . . . 2 - 11
Checking and Adjusting Manual Format Collimation . . . . . . . . . . . . . . . 2 - 11
Checking the Line Light Localizer . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - 13
Width of the Light Beam of the Line Light Localizer . . . . . . . . . . . . . . . . . . 2 - 13

3 _______Table _________________________________________________________ 3 - 1

Transversely Adjustable Tabletop . . . . . . . . . . . . . . . . . . . . . . . . . . . .3- 1

Floating Adjustable Tabletop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3- 3
Removing the Tabletop with Adequate Room Space . . . . . . . . . . . . . .3- 3
Removing the Tabletop in Narrow Rooms. . . . . . . . . . . . . . . . . . . . . .3-4
Adjustment of the Cassette Bucky Guide . . . . . . . . . . . . . . . . . . . .3- 5

4 _______Changes to Previous Version_____________________________________ 4 - 1

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Requirements/Remarks 1 1-1

Safety Information 1

When performing the work steps and tests, the general safety information for medical
products must be observed.

Tolerance Data 1

General tolerances for linear dimensions per ISO 2768-V

Limit value over over over over over over over

for nominal 3 mm 6 mm 30 mm 120 mm 400 mm 1000 mm 2000 mm
measure- to to to to to to to
ment range 6 mm 30 mm 120 mm 400 mm 1000 mm 2000 mm 4000 mm
Admissible ± 0.5 mm ± 1mm ± 1.5 mm ± 2.5 mm ± 4 mm ± 6 mm ± 8 mm
tolerance

These tolerances apply for all dimensions listed in these instructions as long as no other
tolerance is expressly listed after the value.
A tolerance of ± 10% is admissible for torque values.

Maximum Torque Values (Table) 1

Nominal thread Screw material Steel per DIN 267 Brass

diameter CuZn
alloy
Hardness rating 4.6 4.8 5.8 8.8 10.9 12.9
M3 0.5 0.67 0.83 1.3 1.9 2.2 0.62
M 3.5 0.76 1.0 1.3 2.0 2.8 3.4 0.95
M4 1.1 1.5 1.9 3.0 4.2 5.1 1.4
M5 2.2 3.0 3.7 6.0 8.4 10.1 2.8
M6 3.8 5.1 6.4 10.2 14.4 17.3 4.8
M8 9.5 12.6 15.8 25.3 35.6 42.7 11.9
M 10 18.7 24.8 31.1 49.8 70.0 84.0 23.3
M 12 32.9 43.8 54.8 87.6 123.3 147.9 41.1

When checking mounting screws, use the corresponding torque value for hardness rating
8.8.
A tolerance of ± 10% is admissible for torque values.

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Medical Engineering Rev. 01 02.01 TD PS 21 Subsystem
1-2 Requirements/Remarks

Required Test Equipment, Tools and Aids 1

NOTICE All tools, test equipment and aids, with the exception of the
“standard installation tool kit”, are listed and specified in the
"Service Tools Catalogue".

• Standard installation tool kit

• Open-end wrench, 4 mm
• Spring balance, 100 N 44 29 122 RH 090
• ESD equipment, Type 8501 - 3M 97 02 606 Y 3121
• Digital multimeter
e.g.: Fluke 8060 A 97 02 101 Y4290
• Memory oscilloscope, Fluke 3390A 99 00 861 RE999
• Ground wire test meter 44 15 899 RV090
• Spirit level (measurement accuracy 1mm per meter)
• Spacer gauge (DIN 2275) 52 12 667 F1608
• Copper filter set (10 pcs., 0.3 mm) 44 06 120 RV090
• Torque wrench, 20-100 Nm 44 30 906 RH090

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Requirements/Remarks 1-3

Text Emphasis 1

WARNING All texts labeled with "WARNING" call attention to potential risk
for health and life.

CAUTION All texts labeled with “CAUTION” contain information about risks
and measures to avoid a dangerous situation.

NOTICE All texts labeled with “NOTICE” contain additional information

about the work step that follows and which is used for a better
understanding of the step or as a warning about unnecessary and
avoidable difficulties.

CAUTION Checks or adjustments that must be performed under radiation

are labeled with the radiation warning symbol .
While performing adjustments labeled this way, radiation protec-
tive clothing must be worn.

Abbreviations Used 1

FFA = Film-Focus distance (SID)

ISK = Allen screw
BWS = Bucky wall stand
TB = Collimator
DVM = Digital voltmeter
KRL = Cassette Bucky
DHA = Rotation around the horizontal axis
DVA = Rotation around the vertical axis

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1-4 Requirements/Remarks

Definition of Terms for Cassettes and Radiation 1

The terms”Length” and ”Width” that are used, as well as for insertion of cassettes
should be understood as shown in the sketch:

Length

Tabletop
24 cm x 30 cm cassette

*1

Width X

30 cm x 24 cm cassette

Patient
*1 The first digit
always indicates the
width!
Y

Special Symbols 1

- Symbol for working with radiation.

- Symbol for working with dangerous voltage.

- Symbol for torque value.

- Symbol for working with laser radiation.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2 2-1

1
2

1 2

Fig. 1 Fig. 2

Adjusting the Stop for Column Rotation 2

After releasing the foot stop, the column stand should engage in place in the 0°, ±90° and
180° positions without play. If this does not happen, the foot stop must be readjusted.
• Remove the stop (1/Fig. 1).
• Adjust the play of the stop using the adjustment screw (2/Fig. 1).
• Rotate the tube unit 90° to the left and to the right and in these positions, check and, if
needed, adjust the position.

NOTICE The action of the stop lever must be easy.

Horizontal Adjustment of the Tube Unit Support Arm 2

Check horizontal installation of the tube unit support arm using the spirit level. If it is not
horizontal, the position must be readjusted.
• To do this, remove the two half cowls of the cover panel over the SID carriage by
removing the 6 paneling screws.
• Loosen the 8 Allen screws for the support arm mount (1/Fig. 2); when doing this, the top
4 Allen screws should be loosened only slightly.
• Position the tube unit support arm horizontally using the two pressure screws (2/Fig. 2).
• Retighten the 8 Allen screws on the support arm mount.
• Reinstall the two half cowls of the cover panel over the SID carriage using the 6 paneling
screws.

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2-2 Column Stand

3
2
1

Fig. 3 Fig. 4

Replacing the Support Cable 2

• Move the tube unit support arm all the way down.
• Partially remove the cable holder (1/Fig. 3).
• Take the cable lead to the longitudinal brake out of the reverse slot of the column profile
(2/Fig. 3).
• Secure the counterweight fort he tube unit support arm in the top position using the M8 x
50 transport safety screw (3/ Fig. 3).
• Disconnect the plug-in connector for the SID brake (2/ Fig. 4) and pull out the cable
• Remove the eight M6 x 10 Allen screws (1/Fig. 4), slightly lift the tube unit support arm
and remove it.
• Carefully place the tube unit support arm down.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2-3

3 2

Fig. 5 Fig. 6

• Slightly lift the SID carriage; this will relax the cable and the anti-drop safety device will
respond.
• Remove the snap ring on the cable holder (1/Fig. 6) of the anti-drop safety device.
• Remove the cable guy from the SID carriage. When doing so, make sure that the insert
in the cable guy does not drop out.
• Lift out the head cover of the column by removing the six M8 x 25 countersunk Allen-
head screws (1/Fig. 5).
• Remove the snap ring on the counterweight (2/Fig. 5).
• Remove the stud sideways through the cable mount for the counterweight. When doing
this, make sure that the two inserts in the cable guy do not fall out.
• Loosen the 4 mounting screws for the cable return pulley (3/Fig. 5) until the cable can be
pulled out between the cable return pulley and the head cover.
• Install a new support cable in the reverse order of the instructions above. When doing
this, place the inserts from the old support cable into the cable guy for the new support
cable.
• Reinstall the tube unit support arm. If the anti-drop safety device has responded, pull
slightly on the support cable until the anti-drop safety device is released again.
• Move the tube unit support arm down until the support cable is completely tensioned.
• Remove the transport safety device from the counterweight.
• Adjust the support arm.

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2-4 Column Stand

2
1

Fig. 7

Support Arm 2

Rotation Brake (Brake Assembly) for Tube Unit Rotation 2

Checking the Air Gap of the Tube Unit Rotation Brake

• With the tube unit rotation brake released, the air gap should be 0.3 mm
(tolerance + 0.1mm).
Adjusting the Air Gap:
• Remove the cover panel by removing the eight M4 x 6 countersunk Allen-head screws.
• Loosen the three M6 set screws (1/Fig. 7) on the stop disk, the third set screw can be
reached by rotating the support arm 120 degrees.
• Press the S5 "Release tube unit rotation brake" key.
• Insert the spacer gauge on both sides (2/Fig. 7) into the air gap.
• Manually press the stop disk on the tube rotation brake, if needed engage the brake, and
retighten the three M6 set screws. Secure the set screws with Loctite.
• Remove the spacer gauge and reinstall the cover panel on the tube unit support arm.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2-5

Fig. 8

Central Beam Drift in the Longitudinal Direction 2

Prerequisite: The column must be positioned vertically; check using the spirit level.
The light field corresponds to the radiation field. For the check, see Page 2-13
Check:
• Move the tube unit into the 0 degree position.
• Position the tube unit with a vertical beam direction approx. 40 cm above the tabletop.
• Switch on the light localizer.
• Use the slide levers in the collimator to open the collimator plates in the transverse
direction and to collimate a narrow light field in the longitudinal direction.
• Mark the light field on the tabletop.
• Switch on the light localizer and move the tube unit to the max. SID; when doing this,
check the drift of the light field. The drift may not exceed 4 mm.
Correction:
• Remove the cover panel over the tube unit support arm by removing the eight M4 x 8
countersunk Allen-head screws.
• Loosen the counternut on the eccentric bearing using the special ring wrench which is
stored in the tube unit support arm (1/Fig. 8).
• Release the tube unit rotation brake with the S5 key.
• Adjust the eccentric bearing using a 4 mm Allen wrench (2/Fig. 8) so that the tube unit is
horizontal. Check using the spirit level on the bottom edge of the collimator.
• Recheck the drift of the central beam over the entire SID range. If needed, repeat the
adjustment until the central beam no longer drifts laterally.

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2-6 Column Stand
• Counter the counternut of the eccentric bearing with the special wrench, install the cover
panel over the tube unit support arm.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2-7

Fig. 9

Central Beam Drift in the Transverse Direction 2

Prerequisite: The column is positioned vertically; check using the spirit level.
The light field corresponds to the radiation field. For check, see Page 2-13
Check:
• Position the tube unit with a vertical beam direction approx. 40 cm above the tabletop.
• Switch on the light localizer.
• Using the slide levers on the collimator, open the collimator in the longitudinal direction
and collimate a narrow light field in the transverse direction.
• Mark the light field on the tabletop.
• Switch on the light localizer move the tube unit to the max. SID; when doing so, check the
drift of the light field. The drift may not exceed 4 mm.
Correction:
• Loosen the two top mounting screws on both sides (1/Fig. 9).
• Turn the tube unit in the half rings of the tube unit mount. When this is done, the
collimator may not be touched.
• Retighten the mounting screws.

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2-8 Column Stand

Checking the Central Beam for Parallelism of the Cassette Bucky2

• Mark the center of the tabletop in the longitudinal direction (e.g. with a piece of string that
is pulled tight).
• Switch on the light localizer.
• Adjust the light localizer centering cross to the mark.
• Move the column over the entire movement range and determine drift in the longitudinal
direction (tolerance less than/equal to 4 mm).

Correction:
• Reposition the table.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2-9

1 2

2 1

Fig. 10 Fig. 11

Adjusting the Collimator with Rotation Flange 2

• Lubricate the rotation flange in the collimator (PD2 Longtime):

- Tighten one of the 3 screws (1/Fig. 10) so that the collimator just no longer can be
turned.
- Hook a spring balance (100 N) to the lever (2/Fig. 10) for the rotation flange. Loosen
this screw until the collimator can be turned by pulling on the spring balance with a
force of 20 - 30 N.
- Adjust one of the two other screws to 40 - 50 N as described above and the 3rd screw
to 60 - 70 N with the spring balance.

Adjusting the Centered Position of the Rotation Flange 2

• Adjust the centered position of the collimator rotation flange:

- Loosen the Allen-head set screw (1/Fig. 11) (1.5 mm Allen wrench).
- Switch on the light localizer in the collimator and by turning the eccentric bearing
(2/Fig. 11) with an adjustable wrench (4 mm), adjust the light field so it is parallel to the
longitudinal edge of the tabletop. At the max. SID and with the collimator opened all the
way, the difference may be a max. of 3 mm.
- Tighten the Allen-head set screw (1/Fig. 11).

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2 - 10 Column Stand

1
1

Fig. 12 Fig. 13

Adjusting the Time Switch for the Collimator Light Localizer 2

• Remove the stop spring (1/ Fig. 12).

• Remove the cover panel from the collimator by removing the 4 Allen screws (2/ Fig. 12).
• The switch-on time can be changed from 30 s (setting when shipped) to 60 s using the
X4 jumper (1/ Fig. 13).

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2 - 11

Length

Light field
Marker

Side marker

Fig. 14

Checking and Adjusting the Radiation Field to the Light Field 2

Checking and Adjusting Manual Format Collimation 2

• Position the central beam so it is vertical and place a 20 cm x 30 cm (10”x12”) cassette

on the tabletop.
• Set a vertical SID of 115 cm, use the tape measure in the collimator to measure between
the collimator and the top surface of the cassette.
• Use the slide levers on the collimator to exactly set a display of 18 cm x 24 cm or
8” x 10”; the exposure is also used for the check of the manual format collimation.
• Switch on the light localizer.
• Place a radio-opaque marker (e.g. washer, coin) on the cassette as shown in Fig. 14.
• Place on a washer as a side marker.
• Trigger exposure: ( ; 50 kV; 5 mAs) and develop the film.
• Use a waterproof felt-tip pen to record the following data on the developed film: SID that
was set; focus size; film size; radiation field size

Y1
Film

Light field

X2 X1

Radiation field

Y2

Fig. 15

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2 - 12 Column Stand

2 1

Fig. 16 Fig. 17

Evaluation: Light Field to the Radiation Field

• Measure the difference between the edges of the light field and the edges of the radiation
field on all four sides (X1, X2, Y1, Y2) as shown in Fig. 15.
• Calculate the total difference in the X and Y directions (without regard to the
mathematical sign in front).
- The difference in width X and the difference in length Y may not exceed 12mm at
an SID of 115 cm.
Perform a correction of the light field only in emergency situations:
• Remove the reversing lamp cover (1/Fig. 16) on the collimator. To do this, remove the
four M4 x 6 countersunk Allen-head screws.
• Remove the cover panel.
The light localizer lamp is mounted on a spring loaded swing plate. By loosening or tight-
ening the fixed screw of the top right nuts with a 5.5 mm socket wrench, the light field can
be moved in the "width" direction (1/ Fig. 17).
By turning the bottom left nut to the left or right using a 5.5 mm socket wrench, the light
field can be moved in the "height" direction (2/ Fig. 17).
Evaluation: Manual Format Collimation
• Measure the length and width of the radiation field and compare these values to the
value that was set on the collimator scale
(SID 115 cm, length and width 18 cm x 24 cm or 8” x 10”).
• Calculate the difference of the radiation field size to the format that is set in the width and
length directions.
- The difference in both directions (length and width) may be a max. of 12mm each.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Column Stand 2 - 13

Collimator
1
centering
cross

2
Light field

Line light localizer

Fig. 18 Fig. 19

Checking the Line Light Localizer 2

Check:
• Check the alignment of the line light localizer to the centering cross.
• Set the vertical SID = 115 cm.
• Switch on the localizer and open the collimator all the way.
• Check centering of the line light localizer to the centering cross in the collimator (see Fig.
18).
• Move the tube unit between the min. and max. SID; while doing so, the line light localizer
must remain centered to the collimator centering cross over the entire SID range.
Correction:
• The mounting plate for the prism of the line light localizer can be moved laterally after
loosening the two M3 x 8 screws (1/ Fig. 19).

Width of the of the Light Localizer Light Beam 2

The factory adjustment should not be changed!

Correction:
• Remove the reversed lamp cover panel on the collimator. To do this, remove the four
M4 x 6 countersunk Allen screws.
• Remove the cover.
The width of the light beam can be adjusted at both slot plates.
• Adjustment must be symmetrical to the position of the prism for the line light localizer
(2/Fig. 19). Make sure that the gap remains parallel.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Table 3 3-1

1
2 1

Fig. 1 Fig. 2

There are two different table versions:

1. Transversely adjustable tabletop
2. Floating tabletop, i.e., adjustment longitudinally and transversely

Transversely Adjustable Tabletop 3

Removing the Tabletop

• Remove the side cover panels (1/Fig. 1) at the head and foot ends. To do this, remove
the six M4 Allen screws (2/Fig. 1) and countersunk washers for each.
• Remove the end stops for the table transverse movement at the head and foot ends
(1/Fig. 2). To do this, remove the two M6 x 16 Allen screws for each.
• Using 2 persons, hold the tabletop at the head and foot ends and move it out in the
direction of the operator’s side.
• Place down the tabletop.

NOTICE When installing the tabletop, the head and foot ends should be
pressed against the spring action and secured to the transverse
support strut with tape or cable ties. When doing this, make sure
that neither the brake piston nor the eccentric bearing is covered.
The spring loaded brake carriage may not get damaged (pre-
adjusted brake air gap).
Following installation, remove the tape or cable ties.

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3-2 Table

Fig. 3 Fig. 4

Adjusting the Eccentric Bearings

• Adjust the eccentric bearing at the head end (1/Fig. 3) so that a gap of approx. 0.1 mm
(thickness of a sheet of paper) is set between the bearing and the guide rail.
• The two eccentric bearings at the foot end (1/Fig. 4) are adjusted so that the bearing can
still just be turned by hand.

NOTICE The eccentric bearings are optimally adjusted if the eccentric

bearings can still just be stopped when moving the tabletop very
carefully.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Table 3-3

<1.15m <1.15m
>2.35m >2.35m

Fig. 5 Fig. 6

Floating Adjustable Tabletop 3

Removing the Tabletop with Adequate Room Space 3

NOTICE The bearings for longitudinal movement cannot be adjusted.

• Remove the safety stud (1/Fig. 5) on the front profile of the tabletop.
• Remove the two profile cover panels (2/ Fig. 5) on one side of the tabletop. To do this,
unhook the spring attached to one of the threaded studs.
• Remove the threaded stud.
• Pull out the tabletop sideways in the direction of the required minimum distance of
> 2.35m (Fig. 6).
• For the minimum room distance of < 2.35 m, see the next page.

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Medical Engineering Rev. 01 02.01 TD PS 21 Subsystem
3-4 Table

3 1
2

5
4 1

Fig. 7 Fig. 8

Removing the Tabletop in Narrow Rooms. 3

Distance between the table transverse support and the wall/Bucky wall stand more
than 115 cm but less than 235 cm, see (Fig. 6)
• Remove the head-end and foot-end profile cover panels (1/ Fig. 7) on the tabletop. To do
this, unhook the spring attached to one of the threaded studs (5/ Fig. 7).
• Remove the threaded stud.
• Remove the safety studs (3/Fig. 7) on the front profile of the tabletop.
• Remove the lateral plastic guide for the tabletop (2/Fig. 7).
• Move the tabletop in the head-end and foot-end directions as shown in Fig. 8 and
remove both head-end and foot-end stop bumpers (4/ Fig. 7 bzw.1/Fig. 8), installed on
the operator’s side of the longitudinal carriage.
• Move the tabletop back until the longitudinal stop (1/Fig. 8) is visible.
• Carefully lift up the tabletop at the operator’s and equipment side and slide it in the
opposite direction until the second stop is visible.
• With 2 persons, lift the tabletop over and out of the second longitudinal stop.
• Place down the tabletop.

NOTICE Make sure that the brakes are released and do not get damaged
by the tabletop. When installing the tabletop, the spring-loaded
brake carriage must be pressed down with the brake piston so
that the roller bearings and brake piston do not get damaged (pre-
adjusted brake air gap).

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Table 3-5

Fig. 9

Adjusting the Cassette Bucky Guide 3

• Adjust the eccentric bearings (1/Fig. 9) so that they can just still be turned when the
cassette Bucky is moved.

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Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering
Changes to Previous Version 4 4-1
No changes; initial publication.

Siemens AG Register 5 COMK-136.842.01 Page 1 of 2 MULTIX Compact K

Medical Engineering Rev. 01 02.01 TD PS 21 Subsystem
4-2 Changes to Previous Version

TD AX D 1 / Mehnert
TD PS 21 / Conrad, Tropia

MULTIX Compact K Register 5 COMK-136.842.01 Page 2 of 2 Siemens AG

Subsystem Rev. 01 02.01 TD PS 21 Medical Engineering