Vocational Higher Secondary

Education (VHSE)

Second Year

BIOMEDICAL EQUIPMENT TECHNOLOGY

Reference Book

Government of Kerala
Department of Education

State Council of Educational Research and Training (SCERT),

KERALA
2016
Reference Book

LIST OF CONTRIBUTORS
Participants:
1. Mini Kumary.C.K, Principal (Vocational Teacher in MOBE),
HCHMKMVHSS, Vallakkadavu,TVPM.
2. John Varghese, Principal (Vocational Teacher in MOBE),
VHSS, Muthukulam.
3. Ajadevi.S, Vocational Teacher in MOBE,
Madathil VHSS, Kollam
4. Suresh Kumar.G, Vocational Teacher in MOBE,
RVHSS, Valakom, Kollam.
5. Siny.S, Vocational Teacher in MOBE),
VHSS, Muthukulam.
Subject experts
6. Vijayakumar.K, Former HOD,
Biomedical Engineering Department,
Sree Chitra Thirunal Institute of Medical Sciences and
Technology(SCTIMST),TVPM.
7. Sharafudeen. S, Biomedical Engineer,
BSc.MLT Block,
Govt. Medical College, TVPM.

Academic Co - ordinator
Dr. A. Safeerudeen, R. O, SCERT

Prepared by :
State Council of Educational Research and Training
(SCERT)
Poojappura, Thiruvananthapuram 695012, Kerala
Website : www.scertkerala.gov.in e-mail : [email protected]
Phone : 0471 - 2341883, Fax : 0471 - 2341869
Typesetting and Layout : SCERT
© Department of Education, Government of Kerala

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

Foreword
Dear Learners,
This book is intended to serve as a ready reference for learners of
vocational higher secondary schools. It offers suggested guidelines
for the transaction of the concepts highlighted in the course content.
It is expected that the learners achieve significant learning outcomes
at the end of the course as envisaged in the curriculum if it is followed
properly.
In the context of the Right- based approach, quality education has to
be ensured for all learners. The learner community of Vocational Higher
Secondary Education in Kerala should be empowered by providing
them with the best education that strengthens their competences to
become innovative entrepreneurs who contribute to the knowledge
society. The change of course names, modular approach adopted for
the organisation of course content, work-based pedagogy and the
outcome focused assessment approach paved the way for achieving
the vision of Vocational Higher Secondary Education in Kerala. The
revised curriculum helps to equip the learners with multiple skills
matching technological advancements and to produce skilled
workforce for meeting the demands of the emerging industries and
service sectors with national and global orientation. The revised
curriculum attempts to enhance knowledge, skills and attitudes by
giving higher priority and space for the learners to make discussions
in small groups, and activities requiring hands-on experience.
The SCERT appreciates the hard work and sincere co-operation of
the contributors of this book that includes subject experts, industrialists
and the teachers of Vocational Higher Secondary Schools. The
development of this reference book has been a joint venture of the
State Council of Educational Research and Training (SCERT) and
the Directorate of Vocational Higher Secondary Education.
The SCERT welcomes constructive criticism and creative suggestions
for the improvement of the book.
With regards,

Dr. P. A. Fathima
Director
SCERT, Kerala

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Sl No Content Page No

1. About the Course 5

2. Major skills (with sub skill ) 5
3. Syllabus 7
4. Surgical/Analytical & Therapeutic
Equipment Overview of Module 3 7
5. Unit 1: Operation Theatre Equipment 11
6. Unit 2 : Central Sterile Supply Department (Cssd) 18
7. Unit 3 : Central Medical Gas Distribution System 28
8. Unit4 : Laboratory And Blood Bank Instruments 34
9. Unit5: Dialysis Equipment 54
10. Unit 6: Therapeutic Equipments 58
11. Unit 7: Biomedical Waste Management 62
12. Unit 8: Audiometry 66
13. Unit 9: Major Equipments In Other Departments 69
14. Medical Imaging Overview Of Module 4 76
15. Unit 1: Radiography 76
16. Unit2 : Ultrasonography 85
17. Unit 3 - Modern Equipment In Medical Imaging 89
18. Unit 4 - Patient Safety 92
19. List Of References 99

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

ABOUT THE COURSE

A variety of electrical and electronic equipment are used in hospitals for various
diagnostic and therapeutic purposes; including operation theatre and also used for
anesthesia and surgical purposes. Modern medicine is emerging in new trend in
equipment technology. The success of the procedures and safety of patient depends
largely on the reliability, precision sensitivity and trouble free performance of these
equipment. It is also necessary that Biomedical equipment used in hospitals and
diagonostic centres should be standardized by callibrating in time. For this, we need
qualified and skilled technicians. But skilled hands are very less in this sector. Due to
the lack of these technicians Biomedical equipments remain in un operational
condition without adequate maintenance support especially in govt sector. So this
course can fill this lacunae providing trained manpower in almost all branches of
modern medicine like Cardiology, Nuerology,Physical Medicine, Medical imaging,
CSSD,Dialysis room,Manifold, etc.. They can get vertical mobility in all these
disciplines in medical field. This will lead to better service to the mankind aiming at
better healthcare management.
BET COURSE - MAJOR SKILLS
This course offers therapeutic/ analytical and surgical equipment in module 3 and
medical imaging equipment in module 4.
• Understand Production, properties and applications of X-rays, absorption of
X-rays, unit of X-ray the principle of radiography,
• Identify the block diagram of X-ray machine , types of X-ray machine, unit of
X rays- Mobile, stationary, OPG, C arm, mammography, digital X-ray. X-ray
film- Construction- processing and digital processing. AERB regulations and
general safety in radiography, Effect of X-ray in human body.
• Familiarize and identify operation theater equipment like OT lights, OTtables,
Anesthesia equipment, Elecrto surgical unit, and other OT equipments
• Aims and objectives of CSSD, workflow in CSSD, concept of sterilization -
definition and importance of sterilization, classification and methods of steril-
ization, equipment used for sterilization and their uses, autoclave , hot air oven.
Equipment safety and sterilization controls (chemical and biological controls),
and introduction to liquid oxygen supply.
• Identify and understand Microscopy - different types of microscopes, work-
ing principle, parts, magnification, adjustments, maintenance and uses of a com-
pound microscope
• Identify and understand photoelectric colorimeter - working principle, parts,
block diagram, procedure, maintenance and applications, introduction to
glucometers.

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• Identify and understand - PHmeter- working principle, parts, block diagram,

procedure, maintenance and applications, Clinical relevance of blood PH,
• Importance of general safety in hospitals, the effects of electricity on human
body, electric shock hazards and precautions to avoid shock, IEC document
and safety codes of biomedical equipment, grounding in Biomedical Equip-
ment, familiarize Rules and Ethics in medical field.
• Familiarize and identify - Centrifuge- parts, working, maintenance of table top
centrifuge, Fundamentals of Eletrolyte analyser, Blood gas analyser, incubator
and waterbath , Familiarise Automatic Hemoanalysers and blood cell counters,
General safety, equipment safety and Quality Control in Medical laboratories,
name and uses of Blood bank equipments-Blood bank refrigerators, Blod bank
centrifuges, cryo centrifuge,cry bath, deep freezers,Apheresis machines, do-
nor couch, blood bag sealer, platelet agitator, blood shaker.
• Familiarize and identify - concept of central medical gas supply system, basic
components, manifold, suction apparatus - parts, working and uses, introduc-
tion to pendant for gas supply, safety and precautions in manifold and pipeline
supply.
• Familiarize dialysis - Importance of dialysis, Types of dialysis - peritoneal
dialysis and hemo dialysis, Hemodialysis - fundamentals and applications
" Enlist therapeutic equipments- Radiotherapy , physiotherapy ,phototherapy,
magneto therapy equipment. Radiotherapy Equipment -
Physiotherapy equipment - Short wave diathermy, microwave diathermy, ul-
trasound diathermy, nerve and muscle stimulators, TENS, IFT, IR lamps,
CPRM,
• Familiarize biomedical waste management - definition and classification of
biomedical waste., steps in waste management, segregation, collection, stor-
age, transportation, disposal - equipment used, autoclave, incinerator, safety
aspects regarding biomedical waste.
• Enlist Fiber optic equipment in medicine and equipment in an ICU,
• Familiarize Enginering services, civil engineering, mechanical work shop, Elec-
trical.
• Understand ultra sound physics, principle of oscillation, circuit diagram- work-
ing of crystal oscillator, fundamentals of ultra sonography, medical applications
of ultra sonography
• Familiarize fundamentals of CT scanning, Fundamentals of MRI scanning.
Familiarization of modern imaging techniques- names only, Applications of PET,
SPECT, gamma camera.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

SYLLABUS
MODULE 3
Surgical/Analytical and Therapeutic Equipment
UNIT 1: OPERATION THEATRE EQUIPMENT
Basic fundamentals of operation theatre, List of OT equipment and its applications
(OT tables, OT lights, Anesthesia machines, Anesthesia ventilators, multi para monitor,
ESU, central suction, heart lung machine - names and uses only), Characteristics,
classification, types of OT table (mechanical, pneumatic and electrical) and light
(Lux, voltage and wattage), fundamentals of Anesthesia, parts of anesthesia machine
and applications, principle of surgical diathermy, different electrodes used in surgical
diathermy, different modes of operation in surgical diathermy (electrotomy,
coagulation, fulguration, desiccation), block diagram and description of ESU,
applications of ESU, safety in OT - general guidelines, equipment safety - ESU and
anesthesia machines, concept of modular OT.
UNIT 2 : CENTRAL STERILE SUPPLY DEPARTMENT (CSSD)
Aims and objectives of CSSD, workflow in CSSD, concept of sterilization -
defini9sion and importance of sterilization, classification and methods of sterilization,
equipment used for sterilization and their uses, autoclave - working principle - parts,
procedure, maintenance and uses, hot air oven - parts, procedure, maintenance
and uses. Equipment safety and sterilization controls (chemical and biological controls),
introduction to liquid oxygen supply.
UNIT 3 : CENTRAL MEDICAL GAS DISTRIBUTION SYSTEM
Introduction to concept of central medical gas supply system, basic components,
manifold, suction apparatus - parts, working and uses, introduction to pendant for
gas supply, safety and precautions in manifold and pipeline supply.
UNIT4 : LABORATORY AND BLOOD BANK INSTRUMENTS
Microscopy - introduction , different types of microscopes, working principle, parts,
magnification, adjustments, maintenance and uses of a compound microscope,
photoelectric colorimeter - working principle, parts, block diagram, procedure,
maintenance and applications, introduction to glucometers. PHmeter- working
principle, parts, block diagram, procedure, maintenance and applications, Clinical
relevance of blood PH, Centrifuge- parts, working, maintenance of table top
centrifuge, Fundamentals of Eletrolyte analyser, Blood gas analyser, incubator and

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waterbath , Familiarise Automatic Hemoanalysers and blood cell counters, General

safety, equipment safety and Quality Control in Medical laboratories, name and
uses of Blood bank equipments-Blood bank refrigerators, Blod bank centrifuges,
cryo centrifuge,cry bath, deep freezers,Apheresis machines, donor couch, blood
bag sealer, platelet agitator, blood shaker.
UNIT5: DIALYSIS EQUIPMENT
Introduction to dialysis - Importance of dialysis, Types of dialysis - peritoneal dialysis
and hemo dialysis, Hemodialysis - fundamentals and applications
UNIT 6: THERAPEUTIC EQUIPMENTS
Introduction to types of therapeutic equipments- Radiotherapy , physiotherapy
,phototherapy, magneto therapy equipment. Radiotherapy Equipment -
Physiotherapy equipment - Short wave diathermy, microwave diathermy, ultrasound
diathermy, nerve and muscle stimulators, TENS, IFT, IR lamps, CPRM, (names
and uses only is required)
UNIT 7: BIOMEDICAL WASTE MANAGEMENT
Introduction to biomedical waste management - definition and classification of
biomedical waste., steps in waste management, segregation, collection, storage,
transportation, disposal - equipment used, autoclave, incinerator, safety aspects
regarding biomedical waste.
UNIT 8: AUDIOMETRY
Anatomy of ear and mechanism of hearing. Types of audiometers - Pure tone
audiometer and speech audiometer, the parts and operation of pure tone audiometer,
the types and uses of hearing aids.
UNIT 9: FIBER OPTICS IN MEDICINE, (List of equipment
and its uses), laser and its uses, Engineering service - civil
engineering, medical, electrical.
Fiber optics in medicine(List out equipment and its uses) ,
civil engineering - water supply, mechanical work shop, air conditioning, electrical.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

MODULE 4
Medical Imaging
UNIT1: RADIOGRAPHY
Production, properties and applications of X-rays, absorption of X-rays, unit of X-
ray the principle of radiography, block diagram of X-ray machine , types of X-ray
machine, unit of X rays- Mobile, stationary, OPG, C arm, mammography, digital X-
ray. X-ray film- Construction- processing and digital processing. AERB regulations
and general safety in radiography, Effect of X-ray in human body.
UNIT2 : ULTRASONOGRAPHY
To understand ultra sound physics, principle of oscillation, circuit diagram- working
of crystal oscillator, fundamentals of ultra sonography, medical applications of ultra
sonography
Unit 3 - MODERN EQUIPMENT IN MEDICAL IMAGING
Fundamentals of CT scanning, Fundamentals of MRI scanning. Familiarization of
modern imaging techniques- names only, Applications of PET, SPECT, gamma
camera.
Unit 4 - PATIENT SAFETY
Importance of general safety in hospitals, the effects of electricity on human body,
electric shock hazards and precautions to avoid shock, IEC document and safety
codes of biomedical equipment, grounding in Biomedical Equipment, familiarize
Rules and Ethics in medical field.

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PART B
OVERVIEW OF MODULE 3
SURGICAL/ANALYTICAL &THERAPEUTIC EQUIPMENT
This module includes different surgical , analytical and therapeutic equipment used in
medical field. As a beginner in biomedical equipment technology, a learner can be
exposed to all these equipment. In unit 1 , general surgical equipment like OT table,
OT lights, surgical diathermy, anesthesia machines, anesthesia ventilators , and electro
surgical unit are included .
Importance of sterilization in a hospital environment , Types of sterilization ,Equipment
its applications, sterile materials and its supply is given in unit 2.
Central medical gas distribution system is given as third unit, It includes types of
medical gases, storage and supply through pipeline system. Suction apparatus its
working and application is also included in this unit.
Unit 4 include laboratory and blood bank instruments. Here in this module we cover
Microscopy, Maintenance, parts, uses and working of Photo electric colorimeter,
PH meter, Basic idea of Electrolyte analyzer, blood gas analyser, incubator and
waterbath. Biochemical and hematology auto analyzers are also included.
Introduction to blood cell counters and blood bank equipment is also given.
Hemodialysis equipment, radiotherapy equipment, physiotherapy equipment, are
introduced. An important department in medical field included is Biomedical waste
management. As a person working in a hospital environment one should understand
the importance of Biomedical waste management. Fundamentals of collection,
segregation, processing only is given.
An introduction to fiberoptic instruments,equipment in an ICU, civil, mechanical
and electrical departments is given for familiarization for the learner. Hospital computer
applications and and importance of hospital information system is also included.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

Unit 1
Operation Theatre Equipment
Introduction
Operation theatre is a space for surgical procedures in a hospital. It consists of a
preparatory area, pre surgical area and a procedure area. The procedure area is an
absolutely sterile area for during the surgery. All surgical equipment is kept in this
area.OT tables, OT lights, anesthesia cart, ESU, all other surgical tools are kept in
this area. Details of principle, parts, working and applications of ESU is also
included in the syllabus.
Learning Outcome
Upon completion of unit, the learner will be able to:-
3.1.1 Basic fundamentals of operation theatre.
3.1.2 List of OT equipments and its applications.
3.1.3 Familiarise OT table and light.
3.1.4 Familiarise fundamentals of anesthesia, parts of
anesthesia machine.
3.1.5 Understand the principles of diathermy.
3.1.6 Familiarise different electrodes used in surgical
diathermy.
3.1.7 Familiarise different modes of operation in surgical
diathermy.
3.1.8 Identify the block diagram and description of ESU.
3.1.9 Identify the applications of ESU.
3.1.10 Identify the general safety aspects and equipment
safety in OT.
Basic fundamentals of operation theatre
An operating theater is a facility within a hospital where surgical operations are
carried out in a sterile environment. Operating rooms are spacious, easy to clean,
and well-lighted. Operating rooms consist of overhead surgical lights, operation
table and may have equipment, viewing screens and monitors. Rooms are supplied
with wall suction, oxygen, and possibly other anesthetic gases. There is storage
space for common surgical supplies.

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Operation theatres are designed as per the requirements of the hospital like number
of beds, types of surgical procedures, number of surgeons, number of surgery per
day etc.
The operation theatre have mainly four zones - protective zone, clean zone, sterile
zone and disposal zone.
Protective zone - reception, waiting for patients, changing room, pre- anesthesia
room, store room, autoclave room ,control room for electricity.etc.
Clean zone - pre-operating room, recovery room, plaster room, x-ray unit, staff
room, anesthesia store
Sterile zone - operating room, scrub room, aesthesia room, instrument trolley area,
instant sterilization unit.etc..
Disposal room - disposal corridors, dirty wash up room.
An operation theatre should be supplied with uninterrupted power supply, air
conditioning and ventilation. Manifold facilities, service pendant provisions should
be made. Fixed service pendent are usually available with oxygen, compressed air
and vacuum outlet. High efficiency HEPA filters provide clean and sterile air in
operating rooms. Maintenance of OT aseptic standards is very much important to
minimize hospital acquired infections..
The significance of location, grouping and size has a role to play in planning OT.A
properly staffed , equipped and organized OT along with well framed policies and
procedures ,functions with high standards of efficiency.
List of OT equipment and its applications.
1. Operating table
2. Anesthesia machine
3. Anesthesia cart
4. Ventilator
5. Multiparameter monitor
6. Central suction
7. Heart-lung machine
8. Defibrillator
9. ESU
10. Pulse oximeter

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Applications OT equipment
1. The anesthesia machine - Minimize anaesthesia related risk to patient and staff.
2. The anesthesia cart - It contains the medications, equipment, and other sup-
plies that the anesthesiologist may need.
3. Multipara monitor- Records the BP, ECG, heart rate and oxygen saturation
4. The pulse oximeter machine- Measures the amount of oxygen contained in the
blood.
5. Automated blood pressure measuring machine- Measures BP automatically.
6. Heart-lung machine takes the temporary control of the heart and lung during
the surgery maintaining the circulation of blood and oxygen content of the body
OT table
The operating table is a table on which a patient is placed during a surgical operation.
Stationary operating table system is firmly anchored to the floor. So the additional
necessary medical devices can easily be brought to the operating area and positioned.
The advantage of the mobile operating table, on the other hand, is that the position
of the table can be changed within the operating room. However, the foot of the
table limits the leg space available to the surgical team.
Another special feature of the operating table system is the ability to establish
communication with diagnostics systems. (Angiography, MRI and CT etc). This is
only possible with stationary columns.
Surgical lights provide lighting in surgical suites to illuminate the surgical site for
optimal visualization without shadows during surgery.
Types of lamps include tungsten, quartz, and/or xenon halogens and light-emitting
diodes. Advantages of LED is less heat, longer life, better energy efficiency, pure
white colour,more colour rendition, improved shadow control.
The Halogen Operation Lights are designed to assists during critical operations where
focused source of bright light is required.
Familiarize fundamentals of anesthesia
When anaethesia is given, the patient loses consciousness. The usual method of
anaethesia is inhalation anaethesia. The most widely used anesthetic gases are
halogenated ethers such as enflurane, halothane, isoflurane, and desflurane coupled
with nitrous oxide. During anaethesia, required amount of oxygen is also supplied to

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the patient. In critical stage it is necessary to support the patient with controlled
ventilation also.
Four essential functions are
1. Provides oxygen
2. Mix anesthetic gas with vapours
3. Enable patient ventilation
4. Minimise anaesthesia related risk to patient and staff

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

Principles of diathermy
When a high frequency current is applied to
tissue, the tissue is heated locally. This
property can be used to cut, coagulate,
fulgurate and desiccate tissue. The frequency
of current used in surgical diathermy is in the
range 1-3 MHz
When the intracellular temperature reaches
60 degrees C, instantaneous cell death
occurs. If tissue is heated to 60-99 degrees
C, tissue desiccation (dehydration) occurs.
If the intracellular temperature rapidly reaches
100 degrees C, desiccation and coagulation
occur which prevent bleeding.
Different electrodes used in
surgical diathermy
There are two configuration of using surgical
diathermy electrode. They are 1. Monopolar
configuration 2 Bipolar configuration
In monopolar configuration the patient is attached to an electrode called dispersive
electrode, a relatively large metal plate. The surgeon uses a pointed or blade shaped
electrode called the "active electrode" to make contact with the tissue.
With "bipolar" instruments the current is applied to the patient using a pair of similarly-
sized electrodes.
Different electrodes
a. Lancet electrodes - For cutting application.
b. Needle electrodes - For epilation and desiccation
c. Ball type electrode - For coagulation
d. Loop electrodes - For opening up channels and extirpating growth.
Familiarize different modes of operation in surgical diathermy.
Cutting mode: Electrode touches the tissue. When this HF current passes through
the sharp edge of diathermy electrode, there is a high concentration of current at this
point and heat is produced. Sufficiently high power current is applied to the tissue.

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By increasing current level deeper level cutting take place. Normally continuous RF
waveis used for cutting.
Coagulating mode: when the system is operating in "coag mode" the voltage output
is usually lower than cutting mode and less power is delivered. Therefore, this
generates less heat. Tissue remains grossly unharmed, but cells are destroyed at the
point of contact. Smaller vessels are destroyed and sealed, stopping bleeding.
Desiccation: is the process making of extreme dryness. The amount of generated
heat is lower than that required for cutting. Needle point electrode is used here.
Fulguration mode: In this the superficial tissue is destructed without affecting deep
seated tissue. The electrode is held near the tissue without touching it. An electric
arc is developed between the electrode and tissue, which heat dries out the tissue.
Haemostasis mode: The simultaneous use of continuous RF wave for cutting and
burst of RF wave for coagulation is called haemostasis mode.
Identify the applications of ESU.
Identify the general safety aspects and equipment safety in OT
The general safety aspects of ESU fall into four main categories
1. Burns
2. High frequency current hazard. Electrical interference with the heart muscles
(ventricular fibrillation)3.Explosion hazards
1. Burns
A major hazard associated with ESU is burns caused by excess current flow. The
burn occurs at the dispersive electrode because of failure to achieve active adequate
contact. In a later case, injury occurs at a point where the patient is unintentionally
touching a ground object and contact is made over a small area of skin.
The risk of burns also occurs due to the presence of moisture ie the accumulation
blood or other fluids around the indifferent electrode can give rise to small, highly
conductive area. Burns resulting from small conductive area between the limbs can
be prevented by means of dry cloth placed between them.
2. High frequency current hazard
3. Explosion hazards
The spark associated with surgical diathermy can cause a dangerous explosion if
explosives such as ether, alcohol and explosives anaethetic gases are not kept away
from ESU.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

The use of non explosive gases such as nitrous oxides, fluothane or halothane is
recommended to prevent such shock hazards. It is also important to kept away,ESU
from all flammable gases.

Details of practicals
OT :
1. Operation theatre equipment : Collection of details using internet and prepar-
ing charts.
2. Field Visit to operation theatre
3. Preparation of vocational album using operation theatre lights, table, electro
surgical unit.
Sample questions
1. List out the different modes of operation in surgical diathermy
2. List out any five equipment used in operation theatre.
3. Draw the block diagram of ESU
4. write the safety precautions to be taken in using ESU.
5. The frequency off AC usually used in ESU is ----------------

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Unit: 2
Central Sterile Supply Departments CSSD
Introduction
This unit deals with the processes done
in the CSSD , Aims and objectives of
CSSD, work flow in a CSSD,
Importance of sterilization in a hospital,
methods of sterilization, equipments used
for sterilization ,their working, parts, and
applications.
The central sterile supply department
(CSSD) is an important facility of a
hospital which ensures a high standard
of sterilization and disinfection to minimize hospital acquired infections. CSSD services
are responsible for receiving, processing, storing, issue and control of professional
supply of instruments, equipments and surgicals.
SYLLABUS
Aims and objectives of CSSD, workflow in CSSD, concept of sterilization -
defini9sion and importance of sterilization, classification and methods of sterilization,
equipment used for sterilization and their uses, autoclave - working principle - parts,
procedure, maintenance and uses, hot air oven - parts, procedure, maintenance
and uses. ETO sterilization , Flash sterilizers, Equipment safety and sterilization
controls (chemical and biological controls)
LEARNING OUTCOMES
3.2.1 Identify the aims and objectives of CSSD
3.2.2 Familiarise work flow in CSSD.
3.2.3 Identify the definition and importance of sterilization
3.2.4 Classification and methods of sterilization.
3.2.5 Identify the equipment used for sterilization and their
uses.
3.2.6 Autoclave- Working principle, parts.
3.2.7 Hot Air Oven - Parts, procedure, uses.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

3.2.8 Familiarise general safety aspects and sterilization

control.
3.2.9 Idea about liquid oxygen supply
Aims and Objectives of CSSD
• To promote and provide: -Efficient, effective, Economical, Uniform source
of Sterile /Non sterile supplies to various users of hospital sub units for patient
care.
• Provide valuable assistance to purchasing department in selection of pre-tested
goods and to avoid duplication or obsolete instruments.
• Act as an adviser standardizing department for testing efficiency of new
products.Supplies sterile equipments to highly specialized units like OTs, ICUs,
ICCUs, CTVS, Urology, various wards and emergency units
• To initiate research to improve techniques and quality of sterilization.
• To educate student nurses and ancillary personnel & professionals.
• To organize efficient repair and maintenance of equipments handled by the
department.
• To take effective part in hospital infection control committee to curb Hospital
Acquired Infections
Components of CSSD

A Administrative office Dirty area

B Receiving area
Clean up/washing area
C Un sterile storage (Syringe, needle, instruments)
Glove processing area Clean area
Work area - sorting, inspecting, packing
of various trays
D Sterilization
Autoclaving Sterile area
Storage of sterile items

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Methods of Sterilization in CSSD

1. Sterilisation - high vacuum,pre-vaccum
2. Hot air sterilization
3. ETO sterilization
4. Chemical sterilization - Gluteraldehyde
5. Gamma sterilization
WORK FLOW IN A CSSD

Receiving

Reserve store

Disassembling area

Cleaning Condemnation and repair

Processing

Assembling

Sterilisation and storage

Distribution to users

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

Equipments in C.S.S.D
• Ultrasonic machine - For cleaning joint instruments, syringes & catheters.
• Washer disinfector - For cleaning & disinfection of instruments.
• Glove processing unit (glove washer, glove powder, glove dryer) - For glove
sterilizing and packing
• Drying cabinets -
* Hot air oven used for drying , washed instruments
• Ethylene oxide sterilization chamber -Sterilization of heat sensitive articles eg.
Plastic, rubber goods, biologicals, sensitive instruments.
• Sealing machine - To seal plastic wrapping for gas sterilization
• Autoclaves -For sterilization of various OT loads, linen, trays etc.
• Compressed air controlled pressure gun - Washing and drying of narrow lu-
men needle, catheter & instruments.
• Boilers - For steam generation
• Incubators -For microbiological testing of ampoules
• Ultraviolet cabinets - For storage of sterile instruments/sets for 72 hours.
• Furniture & fixtures - Sink, cupboards, assembly bench, folding tables, paper
bags, markers, furniture etc. and electrical points.

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STERILISATION
Sterilization is the removal of all kinds of microbes (bacteria, viruses, & fungi) in a
material or on the surface of an object both from vegetative and spore state.
Sterilization can be achieved by physical, chemical and mechanical means. Chemicals
used as sterilization are called disinfectants.
As microorganisms are seen everywhere it becomes necessary to destroy or remove
them because they cause infection. So it is important in a hospital environment to kill
all pathogenic as well as contaminants microorganisms. It is also necessary to avoid
infecting patients from surgical instruments, dressings, nursing equipments, food
materials and drugs. Hence sterilization of very importance in hospitals.
Methods of sterilization

Physical Chemical Mechanical

Alcohols Filtration
Aldehydes Vibrations
dyes
Drying Heat Radiation
Gases -ETO

Dry heat Moist heat

Flaming Below 100 C
Red heat At 100 C
Incineration Above 100 C - AUTOCLAVE
Hot air oven

METHODS OF STERILISATION
Heat: Heat is considered to be most reliable method of sterilization of articles that
can withstand heat. Heat acts by oxidative effects as well as denaturation and
coagulation of proteins. Those articles that cannot withstand high temperatures can
still be sterilized at lower temperature by prolonging the duration of exposure.
Moist heat is superior to dry heat in action. Temperature required to kill microbe by
dry heat is more than the moist heat.

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DRY HEAT:
Red heat: Articles such as bacteriological loops, straight wires, tips of forceps and
searing spatulas are sterilized by holding them in Bunsen flame till they become red
hot..
Flaming: This is a method of passing the article over a Bunsen flame, but not heating
it to redness.
Incineration: This is a method of destroying contaminated material by burning them
in incinerator. Articles such as soiled dressings; animal carcasses, pathological material
and bedding etc should be subjected to incineration.
Hot air oven: This method was introduced by Louis Pasteur. Articles to be sterilized
are exposed to high temperature (160o C) for duration of one hour in an electrically
heated oven. Since air is poor conductor of heat, even distribution of heat throughout
the chamber is achieved by a fan. The heat is transferred to the article by radiation,
conduction and convection. The oven should be fitted with a thermostat control,
temperature indicator, meshed shelves and must have adequate insulation. Articles
sterilized: Metallic instruments (like forceps, scalpels, scissors), glasswares (such as
petri-dishes, pipettes, flasks, all-glass syringes), swabs, oils, grease, petroleum jelly
and some pharmaceutical products.
Sterilization process: Articles to be sterilized must be perfectly dry before placing
them inside to avoid breakage. Articles must be placed at sufficient distance so as to
allow free circulation of air in between. Mouths of flasks, test tubes and both ends of
pipettes must be plugged with cotton wool. Articles such as petri dishes and pipettes
may be arranged inside metal canisters and then placed. Individual glass articles
must be wrapped in kraft paper or aluminum foils. Sterilization cycle: This takes into
consideration the time taken for the articles to reach the sterilizing temperature,
maintenance of the sterilizing temperature for a defined period (holding time) and the
time taken for the articles to cool down. Different temperature-time relations for
holding time are 60 minutes at 160o C, 40 minutes at 170o C and 20 minutes at
180o C. Increasing temperature by 10 degrees shortens the sterilizing time by 50
percent. The hot air oven must not be opened until the temperature inside has fallen
below 60o C to prevent breakage of glasswares.
Sterilization control: Three methods exist to check the efficacy of sterilization
process, namely physical, chemical and biological.
Physical: Temperature chart recorder and thermocouple.

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Chemical: Browne's tube No.3 (green spot, color changes from red to green)
Biological: 106 spores of Bacillus subtilis varniger or Clostridium tetani on paper
strips are placed inside envelopes and then placed inside the hot air oven.
MOIST HEAT:
Moist heat acts by coagulation and denaturation of proteins.
At temperature below 100 c- Pasteurization , Vaccine bath:, Inspissation:
At 100 c: Boiling: Boiling water (100o C) kills most vegetative bacteria and viruses
immediately Steam at 100o C: Instead of keeping the articles in boiling water, they
are subjected to free steam at 100o C. Traditionally Arnold's and Koch's steamers
were used.
At temperature above 100oC
Autoclave: Sterilization can be effectively achieved at a temperature above 100o
C using an autoclave. Water boils at 100o C at atmospheric pressure, but if pressure
is raised, the temperature at which the water boils also increases. In an autoclave the
water is boiled in a closed chamber. As the pressure rises, the boiling point of water
also raises. At a pressure of 15 lbs inside the autoclave, the temperature is said to be
121o C. Exposure of articles to this temperature for 15 minutes sterilizes them.
Substances like oil cannot be sterilized since moist heat doesn't have such penetrating
capacity.
Advantages of steam: It has more penetrative power than dry air, it moistens the
spores (moisture is essential for coagulation of proteins), condensation of steam on
cooler surface releases latent heat, condensation of steam draws in fresh steam.
Operation Of Autoclave: A simple autoclave has vertical or horizontal cylindrical
body with a heating element, a perforated try to keep the articles, a lid that can be
fastened by screw clamps, a pressure gauge, a safety valve and a discharge tap. The
articles to be sterilized must not be tightly packed. The screw caps and cotton plugs
must be loosely fitted. The lid is closed but the discharge tap is kept open and the
water is heated. As the water starts boiling, the steam drives air out of the discharge
tap. When all the air is displaced and steam start appearing through the discharge
tap, the tap is closed. The pressure inside is allowed to rise upto 15 lbs per square
inch. At this pressure the articles are held for 15 minutes, after which the heating is
stopped and the autoclave is allowed to cool. Once the pressure gauge shows the
pressure equal to atmospheric pressure, the discharge tap is opened to let the air in.
The lid is then opened and articles removed.

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Sterilization control: Physical method includes automatic process control,

thermocouple and temperature chart recorder.
Chemical method includes Browne's tube No.1 (black spot) and succinic acid (whose
melting point is 121o C) and Bowie Dick tape. Bowie Dick tape is applied to
articles being autoclaved. If the process has been satisfactory, dark brown stripes
will appear across the tape.
Biological method includes a paper strip containing 106spores of
Geobacillusstearothermophilus.
RADIATION:
Two types of radiation are used, ionizing and non-ionizing. Non-ionizing rays are
low energy rays with poor penetrative power while ionizing rays are high-energy
rays with good penetrative power.
Non-ionizing rays: Rays of wavelength longer than the visible light are non-ionizing.
Microbicidal wavelength of UV rays lie in the range of 200-280 nm, with 260 nm
being most effective. Microorganisms such as bacteria, viruses, yeast, etc. that are
exposed to the effective UV radiation are inactivated within seconds. Since UV
rays don't kill spores, they are considered to be of use in surface disinfection. UV
rays are employed to disinfect hospital wards, operation theatres, virus laboratories,
corridors, etc. Disadvantages of using uv rays include low penetrative power, limited
life of the uv bulb, some bacteria have DNA repair enzymes that can overcome
damage caused by uv rays, organic matter and dust prevents its reach, rays are
harmful to skin and eyes. It doesn't penetrate glass, paper or plastic. Ionizing rays:
Ionizing rays are of two types, particulate and electromagnetic rays. Electron beams
are particulate in nature while gamma rays are electromagnetic in nature.
FILTRATION:
Filtration separates microbes out.
SONIC AND ULTRASONIC VIBRATIONS:
Sound waves of frequency >20,000 cycle/second kills bacteria and some viruses
on exposing for one hour.
CHEMICAL METHODS OF DISINFECTION:
Disinfectants are those chemicals that destroy pathogenic bacteria from inanimate
surfaces. Some chemical have very narrow spectrum of activity and some have very
wide. Those chemicals that can sterilize are called chemisterilants. Those chemicals

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that can be safely applied over skin and mucus membranes are called antiseptics.
ALCOHOLS:
Mode of action: Alcohols dehydrate cells, disrupt membranes and cause coagulation
of protein. Examples: Ethyl alcohol, isopropyl alcohol and methyl alcohol Application:
A 70% aqueous solution is more effective at killing microbes than absolute alcohols.
70% ethyl alcohol (spirit) is used as antiseptic on skin. Isopropyl alcohol is preferred
to ethanol. It can also be used to disinfect surfaces. It is used to disinfect clinical
thermometers.
ALDEHYDES:
Mode of action: Acts through alkylation of amino-, carboxyl- or hydroxyl group,
and probably damages nucleic acids. It kills all microorganisms, including spores.
Examples: Formaldehyde, Gluteraldehyde PHENOL: Mode of action: Act by
disruption of membranes, precipitation of proteins and inactivation of enzymes.
Examples: 5% phenol, 1-5% Cresol, 5% Lysol (a saponified cresol),
hexachlorophene, chlorhexidine, chloroxylenol (Dettol)
HALOGENS:
Mode of action: They are oxidizing agents and cause damage by oxidation of essential
sulfydryl groups of enzymes. Chlorine reacts with water to form hypochlorous acid,
which is microbicidal. Examples: Chlorine compounds (chlorine, bleach, hypochlorite)
and iodine compounds (tincture iodine, iodophores) Applications: Tincture of iodine
(2% iodine in 70% alcohol) is an antiseptic.
SURFACE ACTIVE AGENTS:
Mode of actions: They have the property of concentrating at interfaces between
lipid containing membrane of bacterial cell and surrounding aqueous medium. These
compounds have long chain hydrocarbons that are fat soluble and charged ions that
are water-soluble. Since they contain both of these, they concentrate on the surface
of membranes. They disrupt membrane resulting in leakage of cell constituents.
Examples: These are soaps or detergents.
HYDROGEN PEROXIDE:
Mode of action: It acts on the microorganisms through its release of nascent oxygen.
Hydrogen peroxide produces hydroxyl-free radical that damages proteins and DNA.
Application: It is used at 6% concentration to decontaminate the instruments,
equipments such as ventilators. Disadvantages: Decomposes in light, broken down
by catalase, proteinaceous organic matter drastically reduces its activity.

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ETHYLENE OXIDE (ETO):

Mode of action: It is an alkylating agent. It acts by alkylating sulfydryl-, amino-,
carboxyl- and hydroxyl- groups. Properties: It is a cyclic molecule, which is a colorless
liquid at room temperature. It has a sweet ethereal odor, readily polymerizes and is
flammable. Application: It is a highly effective chemisterilant, capable of killing spores
rapidly. Since it is highly flammable, it is usually combined with CO2 (10% CO2+
90% EO) or dichlorodifluoromethane. It requires presence of humidity. It has good
penetration and is well absorbed by porous material. It is used to sterilize heat labile
articles such as bedding, textiles, rubber, plastics, syringes, disposable petri dishes,
complex apparatus like heart-lung machine, respiratory and dental equipments.
Efficiency testing is done using Bacillus subtilis varniger. Disadvantages: It is highly
toxic, irritating to eyes, skin, highly flammable, mutagenic and carcinogenic.
SONIC AND ULTRASONIC VIBRATIONS
Microwaves are not particularly antimicrobial in themselves, rather the killing effect
of microwaves are largely due to the heat that they generate. High frequency sound
waves disrupt cells. They are used to clean and disinfect instruments as well as to
reduce microbial load. This method is not reliable since many viruses and phages
are not affected by these waves.
Practical Activities
1. Working of simple autoclave - laboratory practical.
2. Working of hot air oven - Lab practical
3. Preparation of report on work flow in CSSD.
4. Visit to CSSD in a hospital and preparation of visit report.

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Unit -3
Central Medical Gas Distribution System
Introduction
In modern medicine supply of medical gases is of significant role. In olden days
gases were supplied in gas cylinders and the attenders used to roll it to the casualty
or operation theatres. Now central pipeline system is available in pipeline system in
all modern hospitals.
Learning objectives
3.3.1 An idea of medical gas distribution system
3.3.2 Identify the components of medical gas distribution system
3.3.3 Familiarise manifold.
3.3.4 Identify the parts, working and use of suction apparatus.
3.3.5 Discuss safety in manifold and distribution of medical gas.
I. Central Gas System
Certain gases like Oxygen, Nitrous Oxide and compressed air have achieved a
commendable position in the modem treatment procedure. They have played a very
significant role in saving a vast number of patients from the hands of death. They are
now became an unavoidable part of almost all the minor as well as major surgical
operations. A surgeon cannot imagine himself doing a surgery without these gases
being kept ready for supply in the theatre. Hence the gas supply system had now
became an indispensable part of any hospital.
The most convenient method of gas supply in hospital system is through pipe line
from a central storage. Hence this system is called centralised gas supply system or
pipeline system. The main part of the component system is a manifold from where
the gases are supplied to different destinations. Manifold is the place where the gas
cylinders and adjusting and monitoring panels are situated.
The gases generally supplied through pipe line system are:
(i) Oxygen (O2)
(ii) Nitrous Oxide (N2O)
(iii) Compressed Air and
(iv) Vacuum

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II. Supply of Oxygen

Hospital Oxygen supply is mainly done using different types of cylinders having a
general colour code as "Black body with white neck". There are mainly three types:
Bulk Type, Service type or A type and Boyle's type E type.
1. Bulk Type
This is meant for the central pipeline connection. Each cylinder has a capacity of
6800 litters at 140 kg/cm2 pressure. They are provided with "Bull Nose" fittings for
connecting with the central line.
2. Service Type or A Type
This type is mainly used as a portable cylinder. They are having a capacity of 1500
litters at 140kg/cm2 pressure. Oxygen is given to the patient through, flow meter. It
has also got "Bullnose" fittings. This is used in I.C.U s and wards for shifting the
patients.
3. Boyle's Type or E Type
This is designed for connecting with Boyle's machine. It is having "Pin Index"
connection for proper attachment with the machine. It is having a capacity of 750
litters at 140 kg/cm2 pressure
III. Supply of Nitrous Oxide (N2O)
Nitrous oxide is supplied in two different types with usual colour code as French
blue. Nitrous oxide is a very good anesthetic agent. It is used in hospitals for
maintaining the anesthesia during an operation. The two important types of cylinders
used for the supply of Nitrous Oxide are: Bulk type and E type.
Bulk Type
This is used in the manifold for the central line supply. Each cylinder has a capacity
of 16380 litters at 50 kg/cm2 pressure. They are having four pipeline connections.
No service type cylinders are used in the supply of Nitrous Oxide because Nitrous
Oxide is not required in I.C.U s and wards.
Boyle's Type or E Type
This is designed for connecting with the Boyle's apparatus. It is also having "pin
index" for making proper connection.
For distinguishing from E type Oxygen, Nitrous Oxide having different patterns of
knoch are used for connecting

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IV. Supply of Compressed Air

In a hospital system compressed air is also given through pipe line system. For this
the atmospheric air is compressed to 60 lb/cm2 and fed to the pipeline for supplying
towards I.C.Us. and operation theatres. Atmospheric air is taken into a chamber
through air filter. Air in the chamber is compressed with a piston. The to and fro
movement of the piston is achieved by means of an externally operated motor. Due
to compression, air becomes a high pressure, high temperature gas. Hence it should
be passed through cooling coils. For dissipating the heat produced by the frictional
movement of the piston, water cooling system is also provided. This compressed air
is then collected in a reservoir from where it is allowed to pass through a dryer to
make it perfectly dry at the user's end. A second stage regulator is provided to
maintain the pressure at 60 lb/cm2 after the dryer stage. At the user's end a grey
socket is provided over the self sealing valve as a colour code for compressed air.
Compressed air is mainly used in ventilators employed in I.C.Us.
V. Supply of Vacuum - Suction Apparatus
In large hospitals having a lot of operating rooms and I.C.Cs centrised suction system
is the best arrangement for providing suction. In this system suction or vacuum is
created at the central station and is supplied to the user's end through pipe lines
having self-sealing valves. A very big reservoir will be placed in the central station.
By means of compression motor air is sucked out from the reservoir and vacuum is
created in the reservoir. Other pipe lines provided for the supply of suction are
connected to the reservoir. In order to prevent the sucked thing from entering the
reservoir a suction apparatus is provided at the user's end. One black cover provided
over the self -sealing valve the colour code for suction
Suction Apparatus
Suction apparatus is an instrument used to suck body fluids and semi liquid materials
from a patient. It consists of bacteria filter, vacuum pump, bottle for collecting fluid
and a regulator. Figure shows
the constructional details of a
suction apparatus.
A medical suction machine has
a nonporous trap or bacteria
filter to collect the dirt or micro
organisms present in the body
fluids. Vacuum pump is used

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to create necessary vacuum for suction. By using tubing the fluids are sucked and
primarily collected in a bottle, from there it is drawn to the bacteria filter or trap. This
trap is connected in between the patient and vacuum inlet there for air is drawn in to
the piping system. An exhaust is provided on the filter to remove the dirt collected in
the trap.
A particular type of suction apparatus is used in the supply of vacuum, to prevent the
sucked air entering the reservoir at the users end. It also consists of a bacteria filter
a regulator and a collecting bottle.
Manifold
Manifold is the heart of the centralized hospital gas supply system. It is the place
where the cylinders of various gases to be supplied are stored. The central reservoir
for creating vacuum is also situated in the manifold. The various controls and
monitoring panels are also situated in the manifold. The following figure shows the
block diagram of the manifold gamy used in pipe line system in hospitals.
Manifold Control Panel
In medical gas pipe line system there are three types of panel controls being used:
1. Four cylinder layer.
2. Eight cylinder layer.
3. Sixteen cylinder layer.
The mechanism of all these systems are identical but the controls should have some
changes according to the varying capacities. The control panel is designed to deliver
a continuous supply of gas to the pipe line system at a standard pressure of 60 lb/
cm2. It is having three main pressure gauges and three pressure regulators. The
cylinder line called banks are connected to the second stage regulator through a first
stage regulator. There are pressure gauges before the first line to show the condition
of that cylinder line. The first stage regulator is used to feed the cylinder line through
the second stage regulator. By adjusting this we can set the line which should run
first. The second stage regulator is presetted to a value by means of its control
screw adjustment. Normally it should be kept at 60 lb/cm2. It is called the "line
pressure". The line which is going is called the "running line" and the other line is
called the "reserve line". With proper adjustment of the first stage regulators, the
reserve line will take over the charge immediately after the finishing of the running
line.

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Indicators are provided to inform the operator which line is empty. Then he can
change those cylinders and charge it as reserved line.
Maintenance of the Manifold
There are two red light indicators on the monitoring panel which will glow when a
corresponding tank becomes empty.
1. Release the control lever of the first stage regulator of the empty line.
2. Close all the cylinders in that tank.
3. Uncouple and remove all the empty cylinders.
4. Replace them with filled cylinders. Care should be taken to release a puff of
gas from each cylinder to dislodge any dust or grit that may be present in the
valve outlet.
5. Open all the cylinder walls. Red signal should now be off.
6. Adjust the control lever of the first stage to make that tank as reserve. This is
done by releasing both tanks and then charge the new one over the light run-
ning than the first.
7. Check all the connection points with soap solution for gas-tight.
Routine Service.
1. The apparatus should be clean.
2. Rubber, Nylon and other such type of washers should be changed within a
period of three months.
3. Periodical servicing should be done in every six months.
VII. Precautions.
1. The couplers should be clean.
2. Test for leakage with soap solution only.
3. Smoking is forbidden in the manifold
4. Always open the cylinder valves slowly.
PRACTICALS

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1. Hospital visit and report preparation of central medical gas distribution system.
List preparation of colour coding in various gases used in a hospital.
VIII. TE Questions
1. Central gas supply system is used to distribute different hospital gases. List out
the different hospital gases and also mention where it is used.
2. In a hospital system, manifold is an essential part. Define manifold
3. Sujjest an apparatus used for removing liquid or semi solid substance from
human body and explain briefly with the help of necessary diagram
4. General colour code of Oxygen cylinder is ______
5. General colour code of Nitrous Oxide cylinder is ______
6. Grey socket is provided over the self sealing value as a colour code for _______
7. Black cover provided over the self sealing value is the colour code for _____

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Unit : 4
Laboratory and Blood Bank Instruments
SYLLABUS
Microscopy - introduction, different types of microscopes, working principle, parts,
magnification, adjustments, maintenance and uses of a compound microscope,
photoelectric colorimeter - working principle, parts, block diagram, procedure,
maintenance and applications, introduction to gluco meters. PH meter- working
principle, parts, block diagram, procedure, maintenance and applications, Clinical
relevance of blood PH, Centrifuge- parts, working, maintenance of table top
centrifuge, Fundamentals of Eletrolyte analyzer, Blood gas analyzer, incubator and
water bath , Familiarise Automatic Hemoanalysers and blood cell counters, General
safety, equipment safety and Quality Control in Medical laboratories, name and
uses of Blood bank equipments-Blood bank refrigerators, Blood bank centrifuges,
cryo centrifuge, cry bath, deep freezers, Aphaeresis machines, donor couch, blood
bag sealer, platelet agitator, blood shaker.
LEARNING OUTCOMES
3.4.1 Identify the different types of microscope.
3.4.2 Understand the working principle, parts, magnification
adjustments, care and uses of a compound microscope.
3.4.3 Understand the working principle, parts, block diagram,
procedure and applications of a photoelectric colorimeter.
3.4.4 Familiarise semi and fully auto analyser
3.4.5 Understand the principle, procedure, block diagram and
working of pH meter.
3.4.6 Understand the clinical relevance of pH of blood.
3.4.7 Familiarise the parts and working of table top centrifuge.
3.4.8 Naming and uses of electrolyte.
3.4.9 Naming and uses of haemo analysers and blood cell
counters.
3.4.10 Familiarise safety and quality control aspects in a
laboratory.
3.4.11 Naming and uses of blood bank equipment.

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Microscopy
Microscopy is the technical field of using microscopes to view objects that cannot
be seen with the naked eye (objects that are not within the resolution range of the
normal eye). There are three well-known branches of microscopy: optical, electron,
and scanning probe microscopy.
Different types of microscopes
1. Optical Microscopes:
These microscopes use visible light to make an image. The light is refracted with
optical lenses. The first microscopes that were invented belong to this category. The
price of optical microscopes varies from very cheap to nearly unaffordable. Optical
microscopes can be further subdivided into several categories:
Compound Microscope: These microscopes are composed of two lens systems, an
objective and an ocular (eye piece). The maximum useful magnification of a compound
microscope is about 1000x.
Stereo Microscope (dissecting microscope): These microscopes magnify up to about
maximum 100x and supply a 3-dimensional view of the specimen. They are useful
for observing opaque objects.
Confocal Laser scanning microscope: Unlike compound and stereo microscopes,
these devices are reserved for research organizations. They are able to scan a sample
also in depth. A computer is then able to assemble the data to make a 3D image.
2. Electron Microscopes
Electron microscopes are the most advanced microscopes used in modern science.
The electron microscopes essentially function on the principle of a beam of electrons
that strikes any objects that comes to its path to magnify it. Electron microscopes
are designed specifically for studying cells and small particles of matter, as wells as
large objects.
3. Scanning Probe Microscopes:
Scanning Probe Microscope helps visualize individual atoms. The image of the atom
is computer-generated, however. It provides the researchers an imaging tool for the
future where a small tip measures the surface structure of the sample. These specialized
microscopes provide high image magnification to observe three dimensional
specimens. If an atom projects out of the surface, then a higher electrical current
flows through the tip. The amount of current that flows is proportional to the height
of the structure. A computer then assembles the position data of the tip. An enhanced

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3D image is generated.
Compound microscope.
Compound microscope is an optical instrument for forming magnified images of
small objects, consisting of an objective lens with a very short focal length and an
eyepiece with a longer focal length, both lenses mounted in the same tube.
Working Principle
The most commonly used microscope for general purposes is the standard compound
microscope. It magnifies the size of the object by a complex system of lens
arrangement.
It has a series of two lenses; (i)
the objective lens close to the
object to be observed and (ii) the
ocular lens or eyepiece, through
which the image is viewed by eye.
Light from a light source (mirror
or electric lamp) passes through
a thin transparent object (Figure
4.4).

The objective lens produces a magnified 'real image' first image) of the object. This
image is again magnified by the ocular lens (eyepiece) to obtain a magnified 'virtual
image' (final image), which can be seen by eye through the eyepiece. As light passes
directly from the source to the eye through the two lenses, the field of vision is
brightly illuminated. That is why; it is a bright-field microscope.
Compound Microscope Parts
A high power or compound microscope achieves higher levels of magnification than
a stereo or low power microscope. It is used to view smaller specimens such as cell
structures which cannot be seen at lower levels of magnification.
Essentially, a compound microscope consists of structural and optical components.
These key microscope parts are illustrated and explained below.
STRUCTURAL COMPONENTS
The three basic, structural components of a compound microscope are the head,
base and arm.

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Head/Body houses the optical parts in the upper part of the microscope
Base of the microscope supports the microscope and houses the illuminator
Arm connects to the base and supports the microscope head. It is also used to carry
the microscope.
When carrying a compound microscope always take care to lift it by both the arm
and base, simultaneously.
Parts of a Compound
Microscope:
The parts of a compound microscope are
of two categories as given below:
(i) Mechanical Parts: Eyepiece Tube,
Nosepiece, Coarse and Fine Focus
knobs, Stage, Stage Clips and Con-
denser Focus Knob.
(ii) OPTICAL parts: Eyepiece Lenses,
Objective Lenses, light source, con-
denser and Iris Diaphragm

Eyepiece or Ocular is what you look

through at the top of the microscope. Typically, standard eyepieces have a magnifying
power of 10x. Optional eyepieces of varying powers are available, typically from
5x-30x.
Eyepiece Tube holds the eyepieces in place above the objective lens.
Objective Lenses are the primary optical lenses on a microscope. They range from
4x-100x and typically, include, three, four or five on lens on most microscopes.
Objectives can be forward or rear-facing.
Nosepiece houses the objectives. The objectives are exposed and are mounted on
a rotating tower so that different objectives can be conveniently selected. Standard
objectives include 4x, 10x, 40x and 100x although different power objectives are
available.

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Coarse and Fine Focus knobs are used to focus the microscope. Increasingly, they
are coaxial knobs - that is to say they are built on the same axis with the fine focus
knob on the outside. Coaxial focus knobs are more convenient since the viewer
does not have to grope for a different knob.
Stage is where the specimen to be viewed is placed. A mechanical stage is used
when working at higher magnifications where delicate movements of the specimen
slide are required.
Stage Clips are used when there is no mechanical stage. The viewer is required to
move the slide manually to view different sections of the specimen.
Aperture is the hole in the stage through which the base (transmitted) light reaches
the stage.
Illuminator is the light source for a microscope, typically located in the base of the
microscope. Most light microscopes use low voltage, halogen bulbs with continuous
variable lighting control located within the base.
Condenser is used to collect and focus the light from the illuminator on to the specimen.
It is located under the stage often in conjunction with an iris diaphragm.
Iris Diaphragm controls the amount of light reaching the specimen. It is located
above the condenser and below the stage. Most high quality microscopes include
an condenser with an iris diaphragm.
Condenser Focus Knob moves the condenser up or down to control the lighting
focus on the specimen.
There are two optical systems in a compound microscope:
Magnification adjustments of a compound microscope.
1. Turn on the illuminator.
2. Place a slide or specimen on the stage with the sample directly above the
aperture and, if possible, fasten it to the stage with the stage clips..
3. Ensure the iris diaphragm is completely open, allowing the maximum amount of
light to reach the slide and the lenses. Caution: Do not use the iris diaphragm to
control the light, it is to control resolution and contrast - use the dimmer in-
stead.
4. Rotate the nosepiece so that the objective lens with the lowest level of magni-
fication is directly above the sample. Reminder: Using lower magnifications
first helps to select the part of the specimen of interest and then adjust further.

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5. Look through the binocular eyepieces and adjust the iris diaphragm until the
amount of light is satisfactory. More light is better than less light, but the com-
fort of the viewer's eyes should also be taken into account.
6. Turn the coarse adjustment knob until the specimen comes into broad focus.
Caution: you should not use the coarse focus with a high magnification objec-
tive for fear of the objective making contact with the slide.
7. Turn the fine adjustment knob until the specimen comes into sharp focus.
8. The viewer should then be able rotate the nosepiece to higher settings and
bring the sample into more and more detail with a minimal amount of refocus-
ing.
Care and Use of the Microscope
1. Clear space on the bench before getting the microscope from the cabinet
2. Grasp the microscope with two hands - one on the arm and the other under the
base
3. When you remove the microscope from the cabinet, do it slowly and carefully
4. Place the microscope directly on the bench, never on top of papers or books
5. Remove the dust cover and store it in the scope cabinet
6. Verify that the rheostat is set for minimum light (1) and the lamp switch is off
(O)
7. Plug in the scope, turn on light and adjust the rheostat light to 6
8. Lower the stage (or raise head)
9. Check that the condenser is flush with the stage and the iris Close one eye at a
time to compare images. If they differ, adjust the microscope for your eyes as
detailed below
10. Once the slide is perfectly focused and the image is centered on low power,
use the knurled nosepiece to click the next larger lens into place. DO NOT
USE THE COARSE FOCUS KNOB after increasing diaphragm is open
11. Using the knurled nose ring, rotate and click the shortest, red (4X) lens into
place
12. Load a slide, being sure it sits flat on the stage, held by the spring clip
13. Use the large, coarse-focus knob only with the lowest (4X) power objective.

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14. While looking into the eyepieces, slowly turn the coarse knob, moving lens
closer to stage. As soon as you see a hint of color, switch to the small, fine
focus knob and focus the object.
15. Magnification. Only use the fine focus knob to focus with a higher power lens.
PRACTICAL DETAILS
COMPOUND MICROSCOPE
Aim
To study parts and operation of a compound Microscope.
The essential parts of compound Microscope are
1. Mechanical parts
2. Optical Parts
Mechanical Parts
The mechanical parts consist of foot, limb, sub-stage, stage and different mechanical
adjustments. The foot is triangular or Horse shoe shaped and the microscope rest
on it. The limb or the body of the microscope is attached to the foot by means of a
hinge joint. The limb carries the body tube at the upper end and the stage and sub-
stage at the lower end, the body tube carries the eyepiece at the upper end and the
revolving nose piece containing the objectives at the lower end. The body tube can
be moved up and down by adjustment screws for the purpose of the focusing. This
is usually achieved by rack and pinion arrangement. There are two type of screws,
a pair each for coarse adjustment and fine adjustment. The stage is a rigid platform
in which the object to be viewed is kept. The stage has a central hole for the passage
of light to illumination of the object. Below the stage is the sub-stage which carries
the condenser and iris diaphragm. There is also an adjusting knob for lowering and
raising the condenser.
Optical part
The optical part consists of magnifying and illuminating parts. The magnifying parts
include the objective and eye piece lens. The objective lenses are low power high
power and oil immersion objective. The objective is visualised through the eyepiece.
Microscope can be monocular or binocular type.
The illuminating parts are the condenser iris diaphragm and mirror. The condenser is
a system of lens, which concentrate light form the illuminating source to the object.
Iris diaphragm is located just below the condenser. It can be closed to reduce the

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

light or open for more light by control hand provided with the shuttle. The mirror is
plain concave mirror and is seen below the condenser. It helps to reflect the light into
the sub-stage condenser.
Adjustment of Microscope:
1. Low power
The low power objective is placed in position, so that objective lens comes in a line
with the eye piece. The condenser is lowered. The iris diaphragm is half opened and
concave mirror is turned towards the light source. Object is kept on the stage looking
though the eye-piece, lower the body tube until a clear magnified image of the object
is obtained by moving the coarse adjustment. For getting a more clear image the fine
adjustment is used.
2. High power
The high power objective is placed in position. The condenser is half raised the iris
diaphragm 3/4th opened and concave or plane mirror can be used.
3. Oil Immersion objective.
Oil immersion objective is placed in position. Condenser is fully raised and iris
diaphragm is fully opened. Turn the plane mirror to the light source. Place a drop of
oil on the slide and bring the body to till the objective lens just touches the oil. Make
fine adjustment and focus the object.
Procedure:
1. Place the microscope on stable place having a convenient height to see through
the eyepiece with out bending. Place it near the window if day light is used for
illumination. A built in lamp or external lamp can be used for illumination.
2. Set the mirror towards the light source to get maximum light intensity
3. Put the slide on the stage in the space provided between the clips.
4. Revolve the nose piece and align designed objective in position. The objective
must click into the slot provided.
5. Look through the eye-piece and adjust the iris diaphragm according to objec-
tive used.
6. Adjust the coarse and fine adjustment to make the object more clear.

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Result:
PH meter
Clinical relevance of blood PH
The term pH means potentials of Hydrogen.
pH is a measure of the hydrogen ion concentration of a solution. Solutions with a
high concentration of hydrogen ions have a low pH and solutions with low
concentrations of H+ ions have a high pH.
The equation that defines pH is given as follows:
pH=-log [H+] concentration
This is read:
The pH is equal to minus the log of the H+ concentration.
For example is the H+ concentration is very low, let's say about 0.0000001M, and
then the pH is
pH= -log [.0000001] which is the same as -log [1 X 10-7]
The term log [1 X 10-7] = -7
- (-7) = 7
We know that pH is a measure of the acidity or alkalinity of a fluid. The pH may
range from 0 to 14. Solutions with a pH less than 7 are acidic and solutions with a
pH greater than 7 are basic or alkaline. Pure water has a pH of 7... Blood is normally
slightly basic, alkaline, with a pH range of 7.35 to 7.45. To function properly, the
body maintains the pH of blood close to 7.40.
An important property of blood is its degree of acidity and alkalinity, and this is
referred to as acid-base balance. The acidity or alkalinity of the blood is indicated
on the pH scale. The acidity level increases when the level of acidic compounds in
the blood rises or when the level of alkaline compounds in the blood falls. Alkalinity
levels increases with the reverse process.
Our bodies live and die at the cellular level. The billions of cells in our bodies must
maintain alkalinity, in order to function and stay alive. The first line of defense against
disease is a proper pH balance. Disease can only grow in an acidic body, which
makes a condition favorable for the growth of bacteria, yeast, fungus, mold, viruses,
and any other unwanted organisms. Cancer always strikes those with an over-acidic
body. So balancing your pH is widely considered to be the single most important
thing you can do for your health.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

PH meter- working principle, parts, block diagram, procedure,

PH meter- working principle
A pH meter provides a value as to how acidic or alkaline a liquid is. It simply
measures the voltage between two electrodes and display the result converted into
the corresponding pH value.
An acidic solution has far more positively charged hydrogen ions in it than an alkaline
one, so it has greater potential to produce an electric current in a certain situation. A
pH meter measures the voltage (electrical potential) produced by the solution whose
acidity we're interested in, compares it with a reference the voltage and uses the
difference in voltage (the "potential difference") between them to find out the pH
They comprise a simple electronic amplifier and a pair of two electrodes or sometimes
a combination electrode.
PH meter parts, block diagram

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A glass electrode is sensitive to hydrogen ions concentration of solution under test.

A glass electrode, has a silver-based electrical wire suspended in a solution of
potassium chloride, contained inside a thin bulb (or membrane) made from a special
glass containing metal salts (typically compounds of sodium and calcium).
The other electrode is called the reference electrode Reference electrode acts as a
baseline or reference for the measurement. It has a potassium chloride wire suspended
in a solution of potassium chloride. A reference electrode is insensitive to hydrogen
ions concentration of solution under test.
Modern pH electrode is a combination electrode, which combines both the glass
and reference electrodes into one body.
For pH meters to be accurate, they have to be properly calibrated. They usually
need testing and adjusting before you start to use them. So calibrate a pH meter by
dipping it into buffers (test solutions of known pH) and adjust the meter accordingly.
Another important consideration is that pH measurements depend on temperature.
Some meters have built-in thermometers and automatically correct their own pH
measurements as the temperature changes. Alternatively, you can also correct the
temperature yourself and allow the pH measurements at a desired temperature.
Procedure of a pH meter.
Rules:
1. The electrode should be in solution when it is "measuring" pH.
2. When out of solution, it should be in stand-by mode.
3. Keep the electrode in solution as much as possible even when not measuring
pH.
4. When rinse electrode with water, blot the water off gently using kimwipes -
especially around tip of electrode.
Two point calibration of electrode (in most cases we use pH 4.0 and 7.0 stan-
dards). If the solution you are making has a pH over 8.0, use pH 7.0 and 10.0
standards for 2-point calibration. Remove parafilm from the electrode (both
bottle and air hole near top). Rinse electrode in water
1. Place electrode in acid pH standard (4.0) - pink solution
2. To turn on pH meter, press standby
3. Press 2pt calibration button (should read 4.00
4. If reads 4.0 press enter - if not, see Dr. Rowland before proceeding

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

5. The electrode will then measure conductance. Once it stabilizes press enter to
accept reading.
6. The electrode will then measure temperature. Again, once stabilizes press en-
ter.
7. Finally press standby to complete measure of 4.0 pH point in calibration
Rinse electrode with water
8. Place electrode in neutral pH standard (7.0) - yellow solution
9. Repeat steps 2 - 6 above.
10. After temperature reading, the meter will provide a measure of the electrode
efficiency. Measures above 90% efficiency are acceptable. If the electrode
reading is below this, see Dr. Rowland. If above 90% press enter to accept.
11. Press standby to complete calibration.
Rinse electrode with water and place in 7.0 buffers to store. Be sure to place parafilm
over the hole in the electrode and seal the electrode to the buffer container to prevent
evaporation of the buffer.
To measure pH of solution: Place electrode in solution you wish to pH. Be sure that
it is stirring slowly during measure and pH adjustment. Add acid/base as needed to
reach desired pH. When complete, put pH meter in stand-by mode. Remove
electrode from solution and rinse thoroughly with water. Blot dry and put back in
yellow pH storage buffer. Place parafilm over the hole and around the bottle to
minimize evaporation.
Parts block diagram photoelectric colorimeter
Applications photoelectric colorimeter
Procedure photoelectric colorimeter
Photoelectric colorimeter
Working principle of a photoelectric colorimeter
A colorimeter is a device is most
commonly used to determine the
concentration of a known solute in a
given solution by the application of the
Beer-Lambert law, which states that
the concentration of a solute is
proportional to the absorbance.

45
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The Beer-Lambert law (or Beer's law) state that, when a monochromatic light pass
through a solution, absorbance (A) of the solution is directly proportional to the
concentration(c) of the solution and path length (b) that solution.
Now absorbance A is directly proportional to path length and concentration of that
solution.
A? b c A= a b c
A - Absorbance of solution
a - Absorbtivity of solution
C - Concentration of solution
b - Path length of solution
Experimental measurements are usually made in terms of transmittance (T), which is
defined as:
T=I/Io
where I is the light intensity after it passes through the sample and I o is the initial light
intensity. The relation between A and T is:
A = -log T = - log (I / I o ).
A colorimeter has following parts:
1. light source (often an ordinary low-voltage filament lamp)
2. filter (the device that selects the desired wavelength)
3. cuvette chamber (the transmitted light passes through this compartment where
the glass containing the colored solution are kept)
4. detector (this is a photosensitive element that converts light into electrical sig-
nals)
5. Galvanometer (measures electrical signal quantitatively)
The output from a colorimeter may be displayed by an analogue or digital meter and
may be shown as transmittance (a linear scale from 0-100%) or as absorbance (a
logarithmic from zero to infinity).
Applications photoelectric colorimeter
photoelectric colorimeter is used to determine the concentration of colored
compounds in solution. It is used extensively for identification and determination of
concentrations of substances that absorb light.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

PRACTICAL DETAILS
Procedure:
1. Before switching on the instrument, check the meter for mechanical zero and
adjust (only if necessary by the small screw below the meter). Switch on the
instrument and check electrical zero.
2. A preset potentiometer is provided with the access from the bottom of the
optical plate. If it is necessary to correct the zero, lift the optical place reach
our to the present and adjust the zero while looking after the meter.
3. Select the appropriate filter on the filter disc.

4. Place the test tube containing the solvent in the holder. The test tube holder
should be placed in position, so that the side pin sets in the slot on the top plate.
5. Press push button and adjust the sensitivity control for 100% transmission read-
ing on the meter. Rotating the coarse control towards you to increase the inten-
sity of the light.
6. Replace the test tube containing solvent with the one containing with standard
solution
7. Press push button and take reading.
Auto analyser
An automated analyser is a medical laboratory instrument designed to measure
different chemicals and other characteristics in a number of biological samples quickly,
with minimal human assistance.
These measured properties of blood and other fluids may be useful in the diagnosis
of disease.
An auto analyser sequentially measures blood chemistry through a series of steps of
mixing, reagent reaction and colorimetric measurements. So it is called continuous
flow analysis (CFA).
It consists of the following.
a) Sampler: Aspirates samples, standards, wash solutions into the system
b) Proportioning pump: Mixes samples with the reagents so that proper chemical
color reactions can take place, which are then read by the colorimeter
c) Dialyzer: separates interfacing substances from the sample by permitting selec-

47
Reference Book

tive passage of sample components through a semi permeable membrane

d) Heating bath: Controls temperature (typically at 37 °C), as temp is critical in
color development
e) Colorimeter: monitors the changes in optical density of the fluid stream flowing
through a tubular flow cell. Color intensities proportional to the substance con-
centrations are converted to equivalent electrical voltages. ª Recorder: Dis-
plays the output information in a graphical form.
These instruments typically determine levels of albumin, alkaline phosphates,
aspartate transaminase (AST), blood urea nitrogen,bilirubin, calcium, cholesterol,
creatinine, glucose, inorganic phosphorus, proteins, and uric acid in blood serum or
other bodily samples.
Types of analyzers
Semi-auto analyzer: Here, the samples and reagents are mixed and read manually
Batch analyzer: The reagent mixture is mixed and fed automatically. One reagent is
stored in the machine at a time enabling one batch of a specific test to be automatically
conducted e.g. RA 100.
Random Access auto analyzers: These analyzers can store more than one reagent.
Samples are placed in the machine and the computer is programmed to carry out
any number of selected tests on each sample e.g. Hitachi 912
Some of the terms commonly used in auto analysers are:
Batch analysis wherein several samples are processed for analysis in the same
analytical run.
one after another and the results are printed in the sequential order that they are fed.
Continuous flow analysis Here the samples of one batch are sequentially subjected
to the same analytical reactions at the same rate, each sample being separated from
the previous one by air.
Sequential analysis, where each sample in the batch enters the analytical process
Single channel analysis (single test analysis) each of the samples is analysed by a
single process. Result of a single parameter is produced.
Multiple channel analysis (multiple test analysis) each of the samples is subjected to
multiple analytical processes and sets of test results are obtained.
Random access analysis: Any sample may be analysed at random by a signal to the

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processing system. eg. of such systems are Ektachem, Hitachi 912 etc.
Familiarise the parts and working of table top centrifuge.
http://www.who.int/medical_devices/innovation/hospt_equip_9.pdf
Basic working principle
In a solution, particles whose density is higher than that of the solvent sink (sediment),
and particles that are lighter than it float to the top. The greater the difference in
density, the faster they move. If there is no difference in density (isopycnic conditions),
the particles stay steady.
The centrifuge works using the sedimentation principle, where the centripetal
acceleration causes denser substances and particles to move outward in the radial
direction. At the same time, objects that are less dense are displaced and move to
the center.
Tabletop Centrifuge
Low-speed tabletop centrifuges generally operate at up to 10,000 revolutions per
minute (rpm) and may be non-refrigerated or refrigerated. Low-speed tabletop
centrifuges are used primarily to spin red blood cells.
High-speed centrifuges generally operate at 10,000 to 30,000 rpm and some are
refrigerated to cool the rotor chamber. High-speed tabletop centrifuges units are
used for most preparative applications and can collect microorganisms, cells, cellular
debris, and precipitates. They can also separate viruses and cellular organelles.
Product parts
Basic centrifuge components include
1. An electric motor, a shaft and rotor heads on which the centrifuge head turns,
and a motor drive assembly.
2. If the centrifuge is refrigerated, a compressor and associated components are
included.
3. The centrifuge head contains the cups or shields that cover the rotor and turns
on a spindle.
4. Other basic components include a power switch, braking device, potentiom-
eter, timer and tachometer.
5. Some models are equipped with an LCD (liquid crystal display) or LED (light-
emitting diode) display and a keyboard.

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Reference Book

working of table top centrifuge

Operator loads the samples into the rotor head within the instrument housing, and
closes the lid.
The appropriate time, rpm, braking, and temperature (if refrigerated) information is
programmed, usually by flipping a switch, by adjusting a potentiometer, or by using
a keyboard.
Some units also permit selection of the degree of braking to be applied to the shaft
following centrifugation.
Lab and Blood Bank Instruments
1. Compound Microscope
Parts, operation and maintenance of compound microscope.
Diagram
Parts of compound microscope
Adjustments of compound microscope namely low power high power and oil
immersion objectives.
Procedure of focusing a microscope
Care of compound microscope.
2. Photoelectric colorimeter
To study the operation of photoelectric colorimeter and determine the concentration
of unknown solution.
Principle
Block diagram
Procedure
Uses.
3. pH Meter
Study the operation of pH meter and to find the pH of a given solution.
Principle
Parts
Procedure
Applications.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

4. Prepare an album containing list of equipments and its use in medical lab and
blood bank by doing OJT or conducting a field visit.
TE QUESTIONS
1. Explain the working principle of compound microscope using image formation
diagram.
2. Prepare a list of optical and mechanical parts of a compound microscope
3. A slide has to be viewed under high power objective lens of microscope. List
out the steps for adjustments to be done for the same.
4. State the working principle of photoelectric colorimeter.
5. Draw the block diagram of photoelectric colorimeter and explain its parts.
6. pH value of human venous blood is ----------.
7. Explain the commonly used pH electrodes.
8. Draw the block diagram of pH meter and explain its parts.
9. pH is defined as -------------
Electrolyte analyser
Electrolyte analyzer test object is diverse, whether serum or whole blood or plasma
can, urine sample, dialysis fluid samples from even liquid can also directly measure
the hydration, is the function is very powerful a medical instrument. Electrolyte analyzer
can detect the inorganic salt ions, sample calcium ions tiny material, etc.
Now let's introduce electrolyte analyzer principle of work:
Electrolyte analyzer have use ion selective electrode method to achieve precise
measurement of the testing. The apparatus are six electrodes: sodium, potassium
and chlorine, calcium ions, lithium and CST electrode. Each electrode has a ion
selective film, will be measured and samples corresponding ion responses, the
membrane is a ion exchanger, and ionic charge reaction and change the membrane
potential, it can detect the liquid, samples and membrane potential between. Film on
both sides of the two electric potential tested value will produce the current, samples,
reference electrode, reference electrode liquid form "loop" side, membrane, internal
electrodes liquid, internal electrodes are the other side.
Internal electrodes fluid and sample the difference between the concentration of the
ions will work on both sides of the film electrode in create electrochemical voltage,
through high voltage of the conductance of the internal electrodes to lead to the

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Reference Book

amplifier, reference electrode also led to the

location of the amplifier. Through the test a
known precisely the concentration of the
ions standard solution for calibration curve,
and the test sample the concentration of the
ions.
Only provides the electrolyte analyzer
perlong medical treatment for users to serve Electrolyte analyser
as reference.
BLOOD GAS ANALYSER
An arterial blood gas (ABG) test is a blood gas test of blood from an artery; it is thus
a blood test that measures the amounts of certain gases (such as oxygen and carbon
dioxide) dissolved in arterial blood. An ABG test involves puncturing an artery with
a thin needle and syringe and drawing a small volume
of blood. The most common puncture site is the radial
artery at thewrist,[1] but sometimes the femoral artery
in the groin or other sites are used. The blood can
also be drawn from an arterial catheter. An ABG
test measures the blood gas tension values of arterial
oxygen tension (PaO2), arterial carbon dioxide
tension (PaCO2), and acidity (pH). In addition,
arterial oxygen saturation (SaO2) can be determined.
Such information is vital when caring for patients with BLOOD GAS ANALYSER
critical illness or respiratory disease. Therefore, the
ABG test is one of the most common tests performed on patients in intensive care
units (ICUs). In other levels of care, pulse oximetry plus transcutaneous carbon
dioxide measurement is an alternative method of obtaining similar information less
invasively.
Incubator
In microbiology laboratory incubators are used to
grow bacteria at temperature preferably 37 c .It can
give temperature 30 - 100 C., thermostatically
controlled .Heated using electric coil and is made up
of double walled gun metal or stainless steel chamber.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

Hemoanalysers
Hematology analysers are automatic analysers which give all hamatilogical
investigations at a mtime. Automated cell counters
sample the blood, and quantify, classify, and
describe cell populations using both electrical and
optical techniques. Electrical analysis involves
passing a dilute solution of the blood through an
aperture across which an electrical current is flowing.
The passage of cells through the current changes
the impedance between the terminals (the Coulter
principle). A lytic reagent is added to the blood
solution to selectively lyse the red cells (RBCs),
leaving only white cells (WBCs), and platelets
intact. Then the solution is passed through a second detector. This allows the counts
of RBCs, WBCs, and platelets to be obtained. The platelet count is easily separated
from the WBC count by the smaller impedance spikes they produce in the detector
due to their lower cell volumes.
BLOOD BANK EQUIPMENTS
Blood bank equipments include the following equipments.
Blood bank refrigerators, Blood bank centrifuges, cryo centrifuge, cryo bath, deep
freezers, Apheresis machines, donor couch, blood bag sealer, platelet agitator, blood
shaker.
The blood bank refrigerator is an essential piece of equipment in the
immunohematology department and provides safe and convenient storage of whole
blood, blood components (e.g., blood cells, plasma), and reagents. Blood bank
refrigerators ensure freshness and integrity of blood and blood components.
The refrigeration system includes an electrically powered compressor, a condenser,
a capillary tube or expansion valve, an evaporator, and interconnecting tubing. A
thermostat regulates the refrigerator temperature. In many models, the compressor
and motor are connected to the same shaft and sealed in a compact, airtight
compartment, making more space available for storage. Systems are either cylindrical
with rotating shelves or rectangular with pullout drawers or shelves. A temperature
alarm is either included or optional. An emergency power system is necessary in the
event of a power failure. Configurations include tabletop, or floor units.

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UNIT : 5
Dialysis Equipment
Unit 5 - Dialysis Equipments
3.5.1 Identify the importance and types of dialysis.
3.5.2 Familiarise haemo dialysis machine.
Dialysis is the removal of waste materials and toxic substancesand restoration of
normal volume and composition of body fluid by means of an artificial kidney.
Dialysis, (diàlysis, meaning dissolution,, dià, meaning through, and , l?sis, meaning
loosening or splitting) is a process for removing waste and excess water from the
blood and is used primarily as an artificial replacement for lost kidney function in
people with kidney failure.
Dialysis may be used for those with an acute disturbance in kidney function (acute
kidney injury, previously acute renal failure) or progressive but chronically worsening
kidney function-a state known as chronic kidney disease .
The kidneys have important roles in maintaining health. When healthy, the kidneys
maintain the body's internal equilibrium of water and minerals (sodium, potassium,
chloride, calcium, phosphorus, magnesium, sulfate). The acidic metabolism end-
products that the body cannot get rid of via respiration are also excreted through the
kidneys. The kidneys also function as a part of the endocrine system, producing
erythropoietin, calcitriol and renin. Erythropoietin is involved in the production of
red blood cells and calcitriol plays a role in bone formation.
Dialysis is an imperfect treatment to replace kidney function because it does not
correct the compromised endocrine functions of the kidney. Dialysis treatments replace
some of these functions through diffusion (waste removal) and ultrafiltration .
Severe dysfunction of kidney is treated by dialysis.Dialysis is carried out by a machine
called artificial kidney.The artificial kidney is used in conditions like acute renal failure
due to circulatory shock or mercury poisining and chronic or permanent renal failure.
Principle of dialysis
Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid
across a semi-permeable membrane. Diffusion is a property of substances in water;
substances in water tend to move from an area of high concentration to an area of
low concentration.
Blood flows by one side of a semi-permeable membrane, and a dialysate, or special

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer
of material that contains holes of various sizes, or pores. Smaller solutes and fluid
pass through the membrane, but the membrane blocks the passage of larger
substances (for example, red blood cells, large proteins). This replicates the filtering
process that takes place in the kidneys, when the blood enters the kidneys and the
larger substances are separated from the smaller ones in the glomerulus.
TYPES OF DIALYSIS
The two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes
and excess water from the blood in different ways.
Hemodialysis removes wastes and water by circulating blood outside the body
through an external filter, called a dialyzer, that contains asemipermeable membrane.
The blood flows in one direction and the dialysate flows in the opposite. The counter-
current flow of the bloodand dialysate maximizes the concentration gradient of solutes
between the blood and dialysate, which helps to remove more urea andcreatinine
from the blood. The concentrations of solutes (for example potassium, phosphorus,
and urea) are undesirably high in the blood, but low or absent in the dialysis solution,
and constant replacement of the dialysate ensures that the concentration of undesired
solutes is kept low on this side of the membrane.
The dialysis solution has levels of minerals like potassium and calcium that are similar
to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis
solution level is set at a slightly higher level than in normal blood, to encourage
diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic
acidosis that is often present in these patients. The levels of the components of
dialysate are typically prescribed by a nephrologist according to the needs of the
individual patient.
In peritoneal dialysis, wastes and water are removed from the blood inside the body
using the peritoneum as a natural semipermeable membrane. Wastes and excess
water move from the blood, across the peritoneal membrane, and into a special
dialysis solution, called dialysate, in the abdominal cavity.
Peritoneal dialysis
In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run
through a tube into the peritoneal cavity, the abdominalbody cavity around the
intestine, where the peritoneal membrane acts as a partially permeable membrane.
The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels

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Reference Book

that lines and surrounds the peritoneal, or

abdominal, cavity and the internal abdominal
organs (stomach, spleen, liver, and
intestines).
Diffusion and osmosis drive waste products
and excess fluid through the peritoneum into
the dialysate until the dialysate approaches
equilibrium with the body's fluids. Then the
dialysate is drained, discarded, and
replaced with fresh dialysate.
HEMO DIALYSIS
Patients arterial blood is passed continuously Schematic diagram
or intermittently through the artificial kidney of peritoneal dialysis
and then to the body through the vein.
Heparin is used as an anticoagulant while tha blood is passing through the
machine.Inside the artificial kidney, the blood passes through a dialyser called
hemofilter, which contains minute channels
interposed between two cellophane
membranes.The cellophane menbraanes are
porous in nature.The outer surface of these
membranes is bathed by the dialysing fluid
called dialysate. The used dialysate is
onstantly replaced by fresh dialysate.
Urea,creatinine,phosphate and other
unwanted substances from the blood pass
into the dialysate by concentration
gradient.The essential substances required
by the body diffuse fron dialysate into blood.
In addition to the dialyser, the machine has several blood pumps with pressure
monitors which enables easy flow o f blood from patient ot the machine and back to
the patient. It also has pumps for flow of fesh dialysate and for drainage of used
dialysate.

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 BIOMEDICAL EQUIPMENT TECHNOLOGY

PRACTICAL
Dialysis Equipment
1. Field visit to haemo dialysis room and preparation of field visit report.
TE QUESTIONS
1. What is the importance of dialysis?
2. Distinguish between haemo dialysis and peritoneal dialysis

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UNIT 6
Therapeutic Equipments
Introduction to types of therapeutic equipments- Radiotherapy , physiotherapy
,phototherapy, magneto therapy equipment. Radiotherapy Equipment -
Physiotherapy equipment - Short wave diathermy, microwave diathermy, ultrasound
diathermy, nerve and muscle stimulators, TENS, IFT, IR lamps, CPRM, (NAMES
AND USES ONLY IS REQUIRED. )
Unit 6 - Therapeutic Equipment
3.6.1 Name and uses of radio therapeutic equipment.
3.6.2 Naming and uses of physiotherapy equipment
Therapeutic Equipment
Name and uses of radio therapeutic equipment.
Introduction
Radiotherapy is the techninique of appying radiations for therapeutic urpoes.
Cancer is one of the leading causes of death in the world. It is managed by one or
combination of three methods of treatment: surgery, chemo therapy, and radiation
therapy. More than half of all cancer patient receive radiation therapy either as primary
or adjunctive treatment. Radiation therapy is given to the patient from one of the two
types of sources: gamma rays from radioactive materials or X rays from a particle
accelerator.
1. Use of HV X ray machine
Before 1951 radiation therapy was carried out by X-ray machine operating at tube
voltage in the range 400 kV. They are bulky difficult to operate and maintain. As a
result they did not receive wide acceptance.
2. Betatron
The betatron produces high energy X ray beam as well as several electron beam of
various enegy.Because of their greater penetration through thick body section betatron
were found to be well suited for treating tumors of the chest and pelvis.
They are also not popular because of heavy weight, size and difficulty in the operating
procedure of equipment.

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3. Linear Accelerator
A linear accelerator (LINAC) is the device most commonly used for external beam
radiation treatments for patients with cancer. The linear accelerator is used to treat
all parts/organs of the body. It delivers high-energy x-rays to the region of the patient's
tumor.
4. Intensity modulated radiation therapy (IMRT)
Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation
therapy used to treat cancer and noncancerous tumors. IMRT uses advanced
technology to manipulate photon and proton beams of radiation to conform to the
shape of a tumor.
5. Gamma Knife Radio surgery machine
The principle of Gamma Knife treatment is the delivery of high-dose ionizing radiation
through 201 cobalt-60 sources. It can treat even
the most challenging, hard-to-reach brain tumors
and abnormalities that traditional brain surgery
can't. It doesn't require incisions, so there's no
general anesthesia and no risk of bleeding or
infection. The side effects, such as headaches
and nausea, are rare and usually temporary. It
exposes patients to less radiation than other types
of radio surgery.
6. Cyber knife
The Cyber Knife Robotic Radio
surgery System is a non-invasive
alternative to surgery for the treatment
of both cancerous and non-cancerous
tumors anywhere in the body, including
the prostate, lung, brain, spine, liver,
pancreas and kidney. The treatment -
which delivers beams of high dose
radiation to tumors with extreme
accuracy.
Phototherapy Equipment
A treatment for jaundice in the newborn that involves the exposure of an infant's
bare skin to intense fluorescent light.

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Phototherapy treatment help reduce the amount of bilirubin pigment in the skin.
Brachytherapy
The treatment of cancer, especially prostate cancer, by the insertion of radioactive
implants directly into the tissue.
IR lamps, CPRM
3.6.2 Naming and uses of physiotherapy equipment.
Diathermy machine in Physiotherapy
Diathermy is a therapeutic treatment through heating. In diathermy, a high-frequency
electric current is delivered via shortwave, microwave, or ultrasound to generate
deep heat in body tissues. This is most commonly prescribed for joint conditions
such as rheumatoid arthritis and osteoarthritis.
There are
1. Short wave diathermy machine
Short-wave radio frequencies in the range 1-100 MHz (shortwave diathermy)
As the high-frequency waves travel through the body tissues between the condensers
or the coils, they are converted into heat. The degree of heat and depth of penetration
depend in part on the absorptive and resistance properties of the tissues that the
waves encounter.
Short wave diathermy usually is prescribed for treatment of deep muscles and joints
that are covered with a heavy soft-tissue mass, for example, the hip. In some instances
short wave diathermy may be applied to localize deep inflammatory processes.
2. Ultrasound diathermy machine
Employs high-frequency acoustic vibrations which, when propelled through the
tissues, are converted into heat. This type of diathermy is especially useful in the
delivery of heat to selected musculatures and structures because there is a difference
in the sensitivity of various fibers to the acoustic vibrations; some are more absorptive
and some are more reflective. For example, in subcutaneous fat, relatively little energy
is converted into heat, but in muscle tissues there is a much higher rate of conversion
to heat.
Microwaves diathermy machine
The frequency of micro wave is 300 MHz or 30000 MHz Microwave diathermy is
used in the management of superficial tumours with conventional radiotherapy and
chemotherapy.
External muscle stimulator
Electrical muscle stimulator (EMS), also known as neuromuscular electrical stimulator
(NMES) or electromyostimulator stimulate the muscle using electric impulses. The
various uses are as follows.
• Relaxation of muscle spasms;

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• Prevention or retardation of disuse atrophy;

• Increasing local blood circulation;
• Muscle re-education;
Transcutaneous electrical nerve stimulation (TENS or TNS)
Transcutaneous electrical nerve stimulation (TENS or TNS) is the use of electric
current produced by a device to stimulate the nerves for therapeutic purposes.
It is worth noting that the term TENS could represent the use of ANY electrical
stimulation using skin surface electrodes which has the intention of stimulating nerves.
EMS and TENS devices look similar, with both using long electric lead wires and
electrodes. TENS is for blocking pain, where EMS is for stimulating muscles.
Interferential Therapy
The basic principle of Interferential Therapy (IFT) is to utilise the significant
physiological effects of low frequency electrical stimulation of nerves without the
associated painful and somewhat unpleasant side effects sometimes associated with
low frequency stimulation. Recently, numerous 'portable' interferential devices have
become easily available. Despite their size, they are perfectly capable of delivering
'proper' interferential therapy, though some have limited functionality and ability for
the practitioner to 'set' all parameters. Most multifunction stimulators include all
interferential modes,
Spinal cord stimulator
Spinal cord stimulatation is a term relating to the use of electrical stimulation of the
human spinal cord for the relief of pain
Magnetic stimulation
A problem with eclectic stimulation is that it is pain full. It is also possible to stimulate
both brain and nerve magnetically. Magnetic pulse is generated by passing a brief
high current pulse though a coli of wire. The technique has an advantage in that the
stimulation is painless.
Infrared Curing Lamp
Infrared energy is a form of radiation, which falls between visible light and microwaves
in the electromagnetic spectrum
An infrared heater or heat lamp is a body with a higher temperature which transfers
energy to a body with a lower temperature through electromagnetic radiation.
Depending on the temperature of the emitting body, the wavelength of the peak of
the infrared radiation ranges from780 nm to 1 mm. No contact or medium between
the two bodies is needed for the energy transfer. Infrared heaters can be operated in
vacuum or atmosphere.

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Unit 7:
Biomedical Waste Management

Hospital waste or Health care waste are produced from a hospital. Hospital waste
means Any solid os liquid waste material including is container and any other
intermediate product which is generayed during short term or lomg term care
consisting of observational , diagnostic ,therapeutic, and rehabilitative services, for a
person suffering from disease,injury and foe parturient or during research pertaining
to production and testing of biological during immunization of human beings.
Biomedical waste management is now a days very important in a multispecialty
hospital. If proper care is not taken for waste management ,it may cause hazardous
effects in people and environment like infections ,water, air and soil pollution.it may
also lead to many health hazards. This unit deals with types of biomedical waste,
equipment used for its management in a hospital.
SYLLABUS
• Introduction to biomedical waste - definition and classification of biomedical
waste., steps in waste management, segregation, collection, storage, transpor-
tation, disposal - equipment used, autoclave, incinerator, safety aspects re-
garding biomedical waste.
Learning outcomes
3.7.1 Classification of biomedical waste
3.7.2 Identify the steps in biomedical waste management.
3.7.3 Identify the methods of disposal of waste.
3.7.4 Identify the equipment used in waste management.

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Biomedical waste :
Definition
Biomedical waste : Any waste generated during diagnosis, treatment, or immunization
of human beings or animals or research activities.Biomedical wate include clinical
waste, laboratory waste, non-clinical waste, kitchen waste and radioactive waste.
Biomedical waste are the following
Category 1 : Human anatomical waste
Category 2 : Animal waste
Category 3 : Microbiology and biotechnology wate
Category 4 : Sharps
Category 5 : Cytotoxic drugs and medicines
Category 6 : Soiled waste
Category 7 : Solid waste
Category 8 : liquid waste
Category 9 : Incineration ash
Category 10 : Chemical waste
The hospital waste management program
1. Generation and segregation of waste
2. Collection and storage of waste
3. Transportation of water
4. Treatment of waste
5. Treatment of waste
6. Disposal of waste

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Colour coding for collection of biomedical waste

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Sl no Category of waste Recommended

colour code
1 Syringe,blood bag,catheters,etc. Red
2 Sharps (Infected or not) White
3 Infected waste (not containing sharps) Yellow
4 Chemical and pharmaceutical waste
(other than cytotoxic drugs, radio active wastes,
high pressure containers Black
5 Clinical waste that need autoclaving blue

Segregation of waste is defined as the separation of different types of waste by

sorting at the site of collection.
Collection of hospital waste is the process ,which is done after segregation, and in a
way, both can be considered as being complimentary to each other. several guidelines
are given by WHO, and other statutory rules in our country.
Storage is the duration of time the wastes are kept in the area of generation and
transit, till the point of disposal.
Transportation is the way of transferring the waste to the processing and disposal
centers. Vehicles for external transport include van, lorry properly labeled and obeying
all statutory rules of BMW Management.
Processes include liming, incineration, sanitary landfills, autoclaving, microwave
technology, hydropulping, landfill, pit burial, composting etc.. The technique depends
on the type of waste and method adopted.
Biomedical waste management and handling rules 1998 and Kerala state Pollution
control board guidelines are usually followed for these purposes.

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Unit : 8
Audiometry
Audiometry is a branch which deals with the investigations of auditory disfunction.
Investigations are done to differentiate between different types of hearing loss.

Audiometer is an instrument used for diagnosing the degree of deafness. Pure tone
audiometer is commonly used for this purpose.
Pure tone audiometry investigates the difference between the sound pressure level
required to produce hearing in the individual under test and that required to produce
hearing in an average normal person. It is very helpful in evaluating the functional
status of the auditory system, to predict the outcome of surgical procedures and to
assess the value of therapeutic measures and selection of hearing aid.
This unit covers the structure of ear, mechanism of hearing, types of audiometers,
parts of audiometer and hearing aids .
Unit 8 - Audiometry
3.8.1 Understand the anatomy of ear and mechanism of hearing.
3.8.2 Identify pure tone audiometer and speech tone audiometer.
3.8.3 Identify the parts and operation of pure tone audiometer.
3.8.4 Identify the types and uses of hearing aids
Ears are the reception organs of sound. The ear consists of three parts.
1. External Ear
2. Middle Ear
3. Inner Ear
External Ear
External ear consists of pinna, auditory
canal and tympanic membrane.
The outermost part of the ear is called
Pinna or auricle. Pinna is a tunnel like
flap of cartilage and skin which serves
to direct the sound waves into the
auditory canal. The auditory canal is a

Structure of Ear

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convoluted tubeof volume of about 1 cm. The auditory canal terminates at tympanic
membrane.
Middle Ear
The tympanic membrane is followed by the middle ear cavity. It is exposed to
atmospheric pressure only through the Eustachian tube which is connected to pharynx
and nose or mouth. The middle ear consists of a chain of three small bones known
as males, Incus and Stapes.
Inner Ear
The inner ear is coupled to the middle ear cavity through a very small membrane
called the oval window. The inner ear or cochlea is a filled rolled coiled passage in
the temporal bone.
Mechanism of Hearing
Sound waves are longitudinal waves. These waves generate pressure changes in the
medium [air] which is picked up by our aural mechanism. Sound waves from the
outer ear travels through the auditory canal and pushes against the tympanic
membrane. The distance upto which the membrane moves is a measure of loudness
of sound. The sound pressure incident on the tympanic membrane is transmitted to
the inner ear through the chain of bones and oval window. The receptor cells of the
cochlea transforms the sound energy into action potential. These action potentials
are transmitted to the brain through the auditory nerve with a speed of 100 m/s.
Pure Tone Audiometers
Pure tone audiometry is the most widely used technique for determining the hearing
loss. Pure tone audiometer produces test tones in octave steps from 125 to 8000
Hz.
A pure tone audiometer basically consists of an LC oscillator having an inductance
and tuning capacitance of close tolerance. The oscillator is coupled to an output
amplifier stage to produce the required power levels. The sound signals are directed
to the ear acoustically by means of an earphone or a loud speaker. Then the responses
are recorded.
Speech audiometer
These are used to carry out tests with spoken voices. These tests are carried out
with spoken voices. These tests are done for prescribing hearing aids.
Speech audiometer uses a tape recorder for producing speech stimuli. The spoken

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voice from the tape recorder is presented acoustically to the ear via a pair of
headphones. A noise generator is also provided for generating the masking noise.
Speech audiometer also incorporates live voice facilities. But it is of very little use
owing to unreliability of live voice speech tests.

TE QUESTIONS

1. Bones in the middle ear are --------, --------------- and --------------.

2. Audible range of frequency of human ear is -------------- to ---------------
Hz.
3. Explain the mechanism of hearing.
4. Name the transducers used in audiometer.
5. State and explain the types of audiometers.
6. Distinguish between pure tone audiometer and speech audio mater.
7. List out the different types of hearing aids and its applications.

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Unit : 9
Major Equipment In Other Department
LEARNING OBJECTIVES
3.9.1 Familiarise the applications of fibre optics in medicine.
3.9.2 List out the equipment based on fibre optics, endoscope,
laproscope, bronchoscope and laryngoscope.
3.9.3 Familiarise other engineering services in a hospital - Civil,
Electrical, mechanical, and computer engineering.
Note: Name and uses only is required.
OPTICAL FIBERS IN MEDICINE
An optical fiber (or optical fibre) is a flexible, transparent fiber made by drawing
glass (silica) or plastic to a diameter slightly thicker than that of a human hair.[1]
Optical fibers are used most
often as a means to transmit light
between the two ends of the
fiber and find wide usage in fiber-
optic communications, where
they permit transmission over
longer distances and at higher
bandwidths (data rates) than wire
cables. Fibers are used instead
of metal wires because signals travel along them with lesser amounts of loss; in
addition, fibers are also immune to electromagnetic interference, a problem from
which metal wires suffer excessively.[2][3] Fibers are also used forillumination, and
are wrapped in bundles so that they may be used to carry images, thus allowing
viewing in confined spaces, as in the case of a fiberscope.[4] Specially designed
fibers are also used for a variety of other applications, some of them being fiber
optic sensorsand fiber lasers.[5]
Optical fibers typically include a transparent core surrounded by a transparent
cladding material with a lower index of refraction. Light is kept in the core by the
phenomenon of total internal reflection which causes the fiber to act as a waveguide.[6]
Fibers that support many propagation paths or transverse modes are called multi-
mode fibers (MMF), while those that support a single mode are called single-mode
fibers (SMF). Multi-mode fibers generally have a wider core diameter and are used

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for short-distance communication links and for applications where high power must
be transmitted.[citation needed] Single-mode fibers are used for most communication
links longer than 1,000 meters (3,300 ft).[citation needed]
An important aspect of a fiber optic communication is that of extension of the fiber
optic cables such that the losses brought about by joining two different cables is
kept to a minimum.[7] Joining lengths of optical fiber often proves to be more complex
than joining electrical wire or cable and involves careful cleaving of the fibers, perfect
alignment of the fiber cores, and the splicing of these aligned fiber cores. For
applications that demand a permanent connection a mechanical splice which holds
the ends of the fibers together mechanically could be used or a fusion splice that
uses heat to fuse the ends of the fibers together could be used. Temporary or semi-
permanent connections are made by means of specialized optical fiber connectors.[8]
The field of applied science and engineering concerned with the design and application
of optical fibers is known as fiber optics.
A technology that uses glass (or plastic) threads (fibers) to transmitdata. A fiber
optic cable consists of a bundle of glass threads, each of which is capable of
transmitting messages modulated onto light waves.
Fiber optics has several advantages over traditional metal
Optical fibres can also have applications in: - Medicine - Biological and genetics
research - Defence - Industrial materials processing - Chemical and pollution sensing
- Next generation lasers - Optical data processing - Transmitting light beyond the
near-IR
ENDOSCOPE
Endoscopy means looking inside and typically refers to looking inside the body for
medical reasons using an endoscope, an instrument used to examine the interior of a
hollow organ or cavity of the body. Unlike most other medical imaging techniques,
endoscopes are inserted directly into the
organ.
There are many different types of endoscope,
and depending on the site in the body and
the type of procedure, endoscopy may be
performed by a doctor or a surgeon, and the
patient may be fully conscious or
anaesthetised. Most often the term

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endoscopy is used to refer to an examination of the upper part of the gastrointestinal

tract,known as an esophagogastroduodenoscopy.[1]
For non-medical use, similar instruments are called borescopes.
LIGHT SOURCES
• Tungsten filament lamp
• Halogen reflector lamp
- optimal use of light
• Rare-earth xenon lamp
- high intensity light
- true color display (xenon daylight effect)
Optical fibres are narrow tubes of glass fibresFor
withexample broncoscope
a plastic coating that carry light
from one end to the other. The light bounces off the walls of the fibre and can even
bounce around corners. The properties of optical fibres make them useful for a
wide range of applications including:
• Medical - to transmit pictures of organs and arteries
• Fiber optic technology is opening exciting new fields of application in the medi-
cal industry. The physical
• characteristics of fiber make it a natural choice for many uses. Optical fiber has
become widely used in imaging,
• laser delivery systems, illumination, sensors and equipment interconnects. Op-
tical fibers provide a compact and
• flexible conduit for light or data delivery in diagnostic and interventional medi-
cal applications. In order to be
• effec tive, optical fibers require robust, precise interconnects that integrate
seamlessly into the medical theater.
• Diamond has the expertise to make these interconnects a reality.
• Fiber optic solutions applicable for several medical sectors, such as:
• ILLUMINATION
• IMAGE TRANSFER
• DIAGNOSTIC DEVICES

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• SURGICAL INSTRUMENTATION
• THERAPEUTIC APPLICATIONS
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery,
or keyhole surgery, is a modern surgicaltechnique in which operations are performed
far from their location through small incisions (usually 0.5-1.5 cm) elsewhere in the
body.
There are a number of
advantages to the patient with
laparoscopic surgery versus the
more common, open procedure.
Pain and hemorrhaging are
reduced due to smaller incisions
and recovery times are shorter.
The key element in laparoscopic
surgery is the use of a
laparoscope, a long fiber optic
cable system which allows viewing of the affected area by snaking the cable from a
more distant, but more easily accessible location.
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery,
or keyhole surgery, is a modern surgicaltechnique in which operations are performed
far from their location through small incisions (usually 0.5-1.5 cm) elsewhere in the
body.
There are a number of advantages to the patient with laparoscopic surgery versus
the more common, open procedure. Pain and hemorrhaging are reduced due to
smaller incisions and recovery times are shorter. The key element in laparoscopic
surgery is the use of a laparoscope, a long fiber optic cable system which allows
viewing of the affected area by snaking the cable from a more distant, but more
easily accessible location.
Laryngoscopy (larynx + scopy) is a medical procedure that is used to obtain a view
of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate
tracheal intubation during general anesthesia or cardiopulmonary resuscitation or for
procedures on the larynx or other parts of the upper tracheobronchial tree.

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With a global population that's both growing and

living longer, the world's healthcare providers are
increasingly looking to advanced biomedical
instrumentation to enable more efficient patient
diagnosis, monitoring, and treatment. In this
context, biomedical sensing applications of optical
fiber are of growing importance. At the same
time, recent advances in minimally invasive
surgery (MIS) demand smaller disposable
sensing catheters.
Endoscopic imaging applications of fiber-optics are well established, but the intrinsic
physical characteristics of optical fibers also make them extremely attractive for
biomedical sensing. Uncabled fibers (typically less than 250 ?m diameter) can be
inserted directly into hypodermic needles and catheters, so that their use can be
both minimally invasive and highly localized-and fiber-optic sensors (FOS) made
with them can perform remote multipoint and multiparameter sensing. Optical fibers
are immune to electromagnetic interference (EMI), chemically inert, nontoxic, and
intrinsically safe. Their use will not cause interference with the conventional
electronics found in medical theaters. And, most importantly, the immunity of fibers
to electromagnetic and radio frequency (RF) signals makes them ideal for real-
time use during diagnostic imaging with MRI, CT, PET, or SPECT systems, as
well as during thermal ablative treatments involving RF or microwave radiation.
Optical fiber sensors comprise a light source, optical fiber, external transducer,
and photodetector. They sense by detecting the modulation of one or more of the
properties of light that is guided inside the fiber-intensity, wavelength, or polarization,
for instance. The modulation is produced in a direct and repeatable fashion by an
external perturbation caused by the physical parameter to be measured. The
measurand of interest is inferred from changes detected in the light property.
Extended activity
LASER
A laser is a device that emits light through a process of optical amplification based
on the stimulated emission of electromagnetic radiation. The term "laser" originated
as an acronym for "light amplification by stimulated emission of radiation".[1][2]
The first laser was built in 1960 by Theodore H. Maiman at Hughes Research
Laboratories, based on theoretical work by Charles Hard Townes and Arthur

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Leonard Schawlow. A laser differs from other sources of light in that it emits light
coherently. coherence allows a laser to be focused to a tight spot, enabling applications
such as laser cutting and lithography. Spatial coherence also allows a laser beam to
stay narrow over great distances (collimation), enabling applications such as laser
pointers. Lasers can also have high temporal coherence, which allows them to emit
light with a very narrow spectrum, i.e., they can emit a single color of light. Temporal
coherence can be used to produce pulses of light as short as a femtosecond.
Among their many applications, lasers are used in optical disk drives, laser printers,
and barcode scanners; fiber-optic and free-space optical communication; laser
surgery and skin treatments; cutting and welding materials; military and law
enforcement devices for marking targets and measuring range and speed; and laser
lighting displays in entertainment.
Medical areas that employ lasers include:
• angioplasty
• cancer diagnosis
• cancer treatment
• cosmetic dermatology such as scar revision, skin resurfacing, laser hair re-
moval, tattoo removal
• dermatology to treat melanoma
• lithotripsy
• laser mammography
• medical imaging
• microscopy
• ophthalmology (includes Lasik and laser photocoagulation)
• optical coherence tomography
• prostatectomy
• plastic surgery, in laser liposuction
• surgery to ablate and cauterize tissue
Engineering Services
Engineering and maintenance department is responsible for ensuring safe and
economical operation and maintenance of hospital facilities and,nsive equipment.The
department should be capable of providing technical and management support .It is

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responsible for the preventive maintenance, inventory control,repair and uninterrupted

supply of power also.
Engineering servicing other than Biomedical engineering are
1. Electrical Engineering
2. Mechanical Engineering
3. Civil Engineering.
All these services in a hospital have got an important role in safe health care delivery.
It is responsible for maintaining a safe environment, repair of equipment, action
during breakdown or an emergency situation supervision of engineering works
preventive maintenance etc.
Preventive maintenance plays an important role in the equipment planning of a hospital.
The engineering department is involved from the stage of framing specifications of
equipments to the selection, installation and maintenance of the equipment [AMC].
The contract is mainly for maintenance, repair and other payments
Electrical Engineering
Electrical division should provide uninterrupted power supply to the hospital 24 x 7.
It mainly consists of
• Electrical substation
• Generator room for uninterrupted power supply.
• HT & LT electrical installation and associated accessories.
• Other electrical accessories
Mechanical Services
Mechanical services include steam boilers, Linen and Laundry, Dietary equipment,
housekeeping equipment, sterilization equipment, mechanical medical equipment like
hydraulic bed, wheel chair, physiotherapy equipment etc.
Air conditioning division involves the following functions. Refrigerators, Deep freezers,
Split A/C, Centralised A/C system including AC plant, mortuary cabinets etc.
Civil Engineering
Construction of hospital blocks and its maintenance comes under this
wing.construction and maintenanceof civil nature, carpentry,painting,plumbing,etc.,
water supply system,waste ater drainage system ..all come under this department.

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MODULE 4
Medical Imaging
Overview
Medical Imagin is the technique and process of creating visual representation of the
interior of a boy for clinical analysis and medical intervention. The visual representation
of the function of organs and tissues help in the diagnosis as well as treatmernt.
Medical imaging include readiography, ultrasonography, elementary details of CT,
MRI, PET, SPECT and gamma camera. Rediography include radiograph prepration
dtudy of X ray machine and processing. Ultrasonography includes study of ultra
sound, parts of machine and its uses in medical field.
Patient safety is also included in this module. Effects of elecrticity on human body,
grounding of equipment and other safety aspects are also included in this module.
Unit 1 - Introduction to radiography
4.1.1 To understand the production, properties and
applications of X-rays.
4.1.2 Familiarise absorption of X-rays, unit of X-ray
4.1.3 To understand the principle of radiography.
4.1.4 To understand the block diagram of X-ray machine
4.1.5 Familiarise the types of X-ray machine, unit of X rays-
Mobile,stationary, OPG, C arm
Mamography- digital X-ray.
4.1.6 Familiarise X-ray film- Construction- processing and
digital processing.
4.1.7 Familiarise AERB regulations and general safety in
radiography.
Effect of X-ray in human body.
X rays
X rays are electromagnetic radiations of very short wavelength coming at the end of
electromagnetic spectrum and is discovered by Wilhelm Conrad Roentgen in
November 1895. According to quantum theory, x-rays consist of small packets of
energy

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I. Properties of X-rays
1. X-rays have high penetrating power
2. Their speed in vacuum is same as that of light in vacuum i.e., 3x108 m/s
3. X-rays causes secondary emission in all matter through which they pass
4. They exhibits all phenomenon shown by light
5. They ionize gases.
6. They affect photographic films.
7. Kill living tissues
8. They do not deflect in electric field and magnetic field
9. They produce fluorescence and phosphorescence when incident on fluores-
cent and phosphorescent substance
II. Applications
1. They find use in radiography, radio therapy [treatment of cancer]
2. X-rays are used in CT, angiography, mammography .
3. They are used in fluoroscopy.
III. Production of X-rays
X-rays are produced when fast moving electrons are suddenly decelerated by
impinging on a target. The device used for the production of X-rays is known as X-
ray tube
Working

X-Ray tube - working Principle

When the cathode is heated by passing a current through it, electrons are emitted
from it. The amount of electron emitted from the cathode depends upon the heater

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current. The anode will be kept at very high positive potential with respect to the
cathode. The electron emitted from cathode will be greatly accelerated by the very
high anode voltage. These fast moving electrons are then suddenly decelerated by
impinging on the target anode resulting in the production of X-rays. The target material
is tungsten
The intensity of X-rays depends on the heater current. Penetrating power of X-rays
depend on the target material and target voltage, the anode voltage for diagnostic of
X-rays unit is 30 to 100 kV.
Two types of X-rays tubes are
(i) Stationary anode & (ii) Rotating anode
Unit of X-ray radiation
Roentgen is a measure of the quantity of X-ray radiation. The other units are milli-
Roentgen and micro-Roentgen. Roentgen express incident energy, RADS give an
indication of how much of this incident energy is absorbed and REM is a measure of
the relative biological damage caused.
Visualisation of X-rays
Visualisation of X-rays is accomplished by means of screens. In diagnostic radiography
two types of screens are used. They are intensifying screen in radiography and
fluorescent screen in fluorography. Even though these two techniques are different,
the physical phenomenon taking place in both the case is the same. X-rays are
absorbed when passed through certain materials. These materials re-emits energy in
the form of visible photons. The amount of light being emitted is proportional to the
x-ray energy. Hence any pattern of intensity of x-ray beam will be converted into an
identical visible pattern.
Principle of radiography
In radiography, intensifying screen may be used in conjunction with x-ray film to
produce a better defined pattern of x-rays. If we allow x-rays to incident directly on
the film, owing to the high energy of x-ray beam and small thickness of film, they will
just pass through the film without producing well defined image. If an intensifying
screen is used, the x-rays will first hit on the screen, material and get absorbed. The
screen material re-emits the x-ray photons in form of visible pattern. The number of
visible photons emerging from screen will be very high as compared to the number
of the incident x-ray photons. Hence large number of visible photons are now
available to hit the x-ray film. This increased number of photons will produce a large
latent image on the film

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IV. Block diagram of X-ray Machine

The entire circuit of an x-ray machine may be divided into two sections. One of
these section is used for producing a high voltage which is applicable to the anode
of the x-ray tube. It comprise of a high voltage step up transformer followed by
bridge rectifier circuit. The current through the tube is measured by a millimeter. The
voltage can be altered between exposures by means of a kV selector. The voltage
can be measures from the kV meter. The duration of application of kV is determined
by the timer which in turn is controlled by the exposure switch. The main voltage
fluctuations are compensated with the help of voltage compensator
The second part of the circuit is controlling the heating of the filament. The filament
is heated with 6 to 12 V of AC supply at a current of 3 to 5 Ampere. The filament
temperature determines the tube current and therefore has an attached mA selector.
A rheostat connected on primary of filament transformer is used for controlling the
filament current
V. X-ray film
The visible pattern helpful for medical diagnosis is produced on the x-ray film. Double
coated x-ray films are commonly used in radiology. In this type of film both sides are
coated with photographic emulsion. During the exposure to x-ray certain changes
takes place on the
emulsion material
resulting in the ultimate
production of a visible
pattern. The emulsion
material consists of a
thin layer of gelatin over
which silver bromide crystals are suspended uniformly. There are two layer of emulsion
which are supported and separated by a polyester. This is called the film base. The

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film base is transparent and clear and has a light blue colour. The emulsion layers are
very sensitive to pressure, temperature, light and other atmospheric conditions. The
two emulsion layers are protected by thin hard layers of gelatin.
The x-ray film consist of four layers
1. Film base
This is the middle part of the film. It is made up of cellulose try acetate and has a
thickness of about 1/5 mm
2. Subbin Layer
Subbin layer has a thickness of about 1/100 mm. It is made up of cellulose try
acetate and gelatin
3. Emulsion Layer
This is the most important layer of the x-ray film. It has got a uniform thickness of
about 1/20 mm. it is made up of silver bromide and gelatin
4. Super Coating
This layer is very thin and hard. It act as protective cover for the emulsion layer
VI. Production of Patterns on the Film
When X -rays are passed through a body, various parts of the body will absorb
different quantity of X -ray energy. Hence the X -ray beam emerging from the body
will have varying intensities at different portions. This beam of varying intensities is
then allowed to fall on the X-ray film. Therefore different parts of the film will absorb,
different number of X-ray photons. This results in the formation of an invisible image
on the film. The photosensitive silver bromide crystals have already received an
image of the pattern. This image known as the latent image must undergo some
chemical process so as to make it visible
VII. Developing of the Film
The first stage of processing is known as developing. During this the bromide crystals
which are affected during exposure are converted to tiny, opaque, black silver specks.
The crystals which are not affected by X -rays remain unchanged (yellowish
transparent state). The region which had exposed to a greater intensity of X-rays
during exposure will look black. This is due to the large number of opaque black
silver specks present there. On the other hand the region which was exposed to the
lower intensity portion of the X-ray beam will have lower amount of black silver
specks and will look less blackish. Hence the image is made visible)

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VIII. Fixing
A visible pattern was obtained on the film through the process of developing. But
the film cannot be preserved in the above form. The crystals of bromide which were
not affected by X-rays should be removed from the film. At the same time the silver
specks formed during developing should be fixed in the same position. This process
is known as fixing. During the process of fixing, the unaffected crystals are washed
away in the chemical solution while leaving the crystals containing the pattern on
their earlier positions on the film. Thus the crystals containing the pattern are fixed on
the film and the gelatine (super coating) gets hardened.
IX. Washing of the Film
After fixation, the chemicals present on the film should by washed away This is done
by washing the film in running water for about 15 minute
X. Drying of the Film
This is the final stage of film processing. It can be done either in open air or in the
drying chamber
XI. Precautions
Since the film is highly sensitive to light, utmost care should be taken while handling
the film. It should not be exposed to light during processing. Hence processing
should be done only in a dark room. During exposure the film is kept inside a tight
box called cassette. Also the film should not be exposed to bade atmospheric
conditions such as high temperature, humidity or pressure. This will result in
undesirable blackening throughout the film. This condition is referred to as fog. This
will reduce the contrast of radiography.
XII. Different types of X-ray machines
(i) Portable X-ray Unit
It can be dismantled, packed into a small case and conveniently carried to the site.
The tube heed is so constructed that the x-ray tube and the high voltage generator
are enclosed in one earthed metal case filled with oil. The x-ray is usually a small
stationary anode type. The maximum radiographic output found on portable uits is
in the range of 15-20 mA at 90-95 kV
(ii) Mobile X-ray unit
Mobile unit carries the control table and the column supporting the x-ray tube
permanently mounted on the mobile base. Mobile units much heavier than the portable

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units. This units have a radiographic output of upto 300mA and a maximum of 125kV.
Mobile units make use of stored energy, this may be from the capacitor discharge or
battery powered inverter circuits
Mammographic x-ray machine
Mammography is an x-ray imaging procedure used for examination of female breast.
It is primarily used for diagnosis of breast cancer and in the guidance of needle
biopsies.
OPG (Orthopantomogram)
An OPG is a panoramic or wide view x-ray of the lower face, which displays all the
teeth of the upper and lower jaw on a single film. It demonstrates the number,
position and growth of all the teeth including those that have not yet surfaced or
erupted. It is different from the small close up x-rays dentists take of individual teeth
c arm
C-arm is a medical imaging device that is based on X-ray technology and can be
used flexibly in a clinic. The name is derived from the C-shaped arm used to connect
the X-ray source and X-ray detector to one another.
The C-arm systems are commonly used for
studies requiring the maximum positional
flexibility such as:
Angiography studies
Therapeutic studies
Cardiac studies
Orthopedic procedures
Digital Radiography
Digital radiography is a form of X-ray imaging, where digital X-ray sensors are used
instead of traditional photographic film. Advantages include time efficiency through
bypassing chemical processing and the ability to digitally transfer and enhance images.
Also, less radiation can be used to produce an image of similar contrast to
conventional radiography.
Instead of X-ray film, digital radiography uses a digital image capture device. This
gives advantages of immediate image preview and availability; elimination of costly
film processing steps; a wider dynamic range, which makes it more forgiving for
over- and under-exposure; as well as the ability to apply special image processing

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techniques that enhance overall display quality of the image.

Digital radiography is a form of X-ray imaging, where digital X-raysensors are used
instead of traditional photographic film. Advantages include time efficiency through
bypassing chemical processing and the ability to digitally transfer and enhance images.
AERB Regulations and General Safety In Radiography
The Atomic Energy Regulatory Board (AERB) was constituted on November 15,
1983 by the President of India by exercising the powers conferred by Section 27 of
the Atomic Energy Act, 1962 (33 of 1962) to carry out certain regulatory and safety
functions under the Act. The regulatory authority of AERB is derived from the rules
and notifications promulgated under the Atomic Energy Act, 1962 and the
Environmental (Protection) Act, 1986. The headquarters is in Mumbai
The mission of the Board is to ensure that the use of ionising radiation and nuclear
energy in India does not cause undue risk to health and the environment
Ionising radiation, such as medical X-rays, is used in medicine as an essential tool
for protecting and improving human health since its discovery at the end of 19th
century. Over 90 % of the workload in diagnostic radiology in many countries is the
general radiography and is a major contributor to the collective population dose. It
is therefore essential, from the radiological safety view point, to exercise strict
regulatory control over the safe use of such beneficial application of ionizing radiation.
The regulatory framework for controlling safe use of ionizing radiation sources,
including medical X-rays, is mainly based on the following;
• Atomic Energy Act, 1962
• Atomic Energy (Radiation Protection) Rules {AE(RP)R}, 2004
• Notification No. GSR 388 on," The Radiation Surveillance Procedures for
Medical Applications of Radiation, 1989"
• The Safety Code for Medical Diagnostic X-ray Equipment and Installations
{No. AERB /SC/MED-2 (Rev.1), 2001}
The national regulatory authority, i.e., Atomic Energy Regulatory Board (AERB)
has been set up to carry out certain regulatory and safety functions envisaged under
Sections 16, 17 and 23 of the Atomic Energy Act 1962. Chairman, AERB has been
notified as the Competent Authority for the enforcement of radiation protection in
the country.

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The Safety Code (No. AERB /SC/MED-2(Rev.1), 2001), published by AERB is

intended to govern radiation safety in design, installation and operation of X-ray
equipment for medical diagnostic purposes. The implementation of provisions of the
Safety Code ensures the radiation protection of occupational workers, patients and
public at large. Some of the regulatory requirements of the Safety Code are:
• Only those X-ray units should be procured by the users which have been Type
Approved by the Competent Authority.
• Installation and room lay-out should be in accordance with the specifications
of the Safety Code.
• User should ensure that on acquisition (by purchase, transfer, gift, lease or
loan) of X-ray equipment, it is registered with the Competent Authority.
• The Radiological Safety Officer (RSO) should conduct periodic radiological
protection survey of X-ray installation and maintain records on routine Quality
Assurance (QA) tests on X-ray unit.
• All radiation workers should use appropriate personnel monitoring badges (TLD
badges).
Conclusion
Radiation safety includes
1. TLD badge-Exposure to radiation is measured using thermo luminescent do-
simeter badge.
2. PPE - Personal protective equipment like lead apron , lead gloves.
3. Radioactive shielding
4. Radiation safety officers are posted for evaluation.
5. Display of safety symbols.
PRACTICALS
1. Implementation of 555 timer using kit.
2. Working of X ray machine [OJT]
3. Study of X ray film by collection and by using internet.
XIII. TE Questions
1. The target of x-ray tubes are made of ___________
2. Explain how x-rays are produced in x-ray tubes

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3. Describe the structure and composition of an x-ray film

4. Draw block diagram of an x-ray machine and explain the function of each
block
5. What are the properties of x-rays
6.
Developing Drying

This is the flow chart of film processing in the dark room. Complete the flow chart
and explain
7. X-ray was first discovered by ___________
8. The penetration depth of X-rays depend on tube___________
9. X-rays are ___________ radiations
10. The image is formed on the ___________ layer of X-ray film
11. Name the different types of X-ray machines
12. List out the odd one
a. Filament b. Grid c. Target d. Intensifying screen
Ultra Sound Scanning
Unit 2 - Ultra sonography
4.2.1 To understand ultra sound physics
4.2.2 To understand the principle of oscillation
4.2.3 To understand the circuit diagram- working of crystal
oscillator.
4.2.4 Familiarise ultra sonography.
4.2.5 To identify medical applications of ultra sonogrsphy
Oscillators
Oscillations are simply speaking vibrations of any desired frequency. A circuit which
is capable of producing oscillations is known as Tank circuit. A tank circuit consists
of a parallel combination of an inductor and a capacitor.

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Oscillator
Oscillator is a circuit which is capable of producing oscillations of any desired
frequency.
Types of Oscillators
Depending on the circuit components and type of oscillations, oscillators are divided
mainly into 4 types. They are
1. Hartley Oscillator
2. Collpits Oscillator
3. Crystal Oscillator
4. RC phase shift Oscillator
Crystal Oscillator
The main part of a crystal oscillator is a crystal which vibrates with its natural frequency.
The principle of crystal oscillator is piezo electric effect.
Piezo Electric Effect.
When a mechanical force is applied at the surface of
certain crystals such as quartz or Roschelle salt, a
potential difference will develop at the opposite face
of the crystal. This phenomenon is called piezo electric
effect.
The circuit diagram of a crystal oscillator is shown
below.
The experiment can be done by using oscillator kit.
5.
Ultra Sound Scan
Ultrasound scan is a painless test that uses sound waves to create images of organs
and structures inside your body. It is a very commonly used test. Ultrasound is a
high-frequency sound that you cannot hear but it can be emitted and detected by
special machines. An ultrasound scan, also referred to as a sonogram. Ultrasound
scans are used to detect problems in the liver, heart, kidney or the abdomen. They
may also be useful in helping the surgeon when carrying out some types of biopsies.

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Principle
Ultrasound travels freely through fluid and soft tissues. However, ultrasound bounces
back (is reflected back) as echoes when it hits a more solid (dense) surface. For
example, the ultrasound will travel freely though blood in a heart chamber. But,
when it hits a solid valve, a lot of the ultrasound echoes back. It is recorded and the
image is formed.
This is a type of scanning in which sound waves of 2 to 20 MHZ are used. A
transducer is used for delivering the ultra sound energy to the patient. The vibrating
part of the transducer is called crystal.
What is an ultrasound test used for?
It is used in many situations. The way the ultrasound bounces back from different
tissues can help to determine the size, shape and consistency of organs, structures
and abnormalities. So, it can:
• Help to monitor the growth of an unborn child and check for abnormalities. An
ultrasound scan is routine for pregnant women.
• Detect abnormalities of heart structures such as the heart valves. This type of
ultrasound scan is called echocardiography. See the separate leaflet called
Echocardiogram for more details.
Help to diagnose problems of internal organs such as the:
• Liver
• Gallbladder
• Pancreas
• Thyroid gland
• Lymph nodes
• Ovaries
• Testes
• Kidneys
• Bladder
• Appendix
• For example, it can help to determine if an abnormal lump in one of these
organs is a solid tumour or a fluid-filled cyst. Ultrasound also helps look for

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stones in the gallbladder or kidney.

• Help determine the nature of breast lumps. Ultrasound is one of the tests used
to establish if a lump is non-cancerous (benign) or breast cancer.
• Help diagnose problems with muscles, tendons and joints. For example, ultra-
sound scans are used to help diagnose:
• Frozen shoulder
• Tennis elbow
• Morton's neuroma
• Carpal tunnel syndrome
• Detect abnormal widening of blood vessels (aneurysms).
• Guide internal biopsies. A biopsy is a procedure in which a sample of tissue is
taken. Some biopsies are taken using a thin needle, and the needle is guided to
the right place with an ultrasound scan. For example, if you have a lump in your
breast, you may have a sample of the lump taken away. The sample is then
examined under the microscope to see if your lump is cancerous or not.
Some specialist ultrasound techniques
In some situations, a clearer picture can be obtained from a probe that is within the
body. So a small probe, still attached by a wire to the ultrasound machine, can be:
• Swallowed into the gullet (oesophagus). This may be used to obtain clearer
images of the internal organs, particularly the stomach, upper gut and pan-
creas. See separate leaflet called Endoscopic Ultrasound Scan for more de-
tails.
• Placed in the vagina or rectum to obtain clearer images of inner organs, such as
the womb (uterus), ovaries or prostate gland.
• Used to help guide a surgeon during an operation, in order to look deeper into
structures.
Ultrasound may also be used for treating certain conditions, particularly those of
muscles, tendons and joints. The scan may be used to guide an injection which can
help to treat the problem. Doing the injection with the help of an ultrasound scan
makes sure it reaches exactly the right place. For example, ultrasound-guided
injections are a common way to treat shoulder problems such as a frozen shoulder.

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Ultrasonography and Modern Equipment in Medical Imaging

1. Oscillators- fabrication of crystal oscillator by using kit.
2. CT and MRI scan - collection of pictures and preparation of album.
3. Other medical imaging equipment- Preparation of e-album.
TE QUESTIONS
1. Explain the working of crystal oscillator
2. What is the frequency of ultrasonic waves.
3. List out the medical application of ultrasonography.
4. Modern Imaging
Unit 3 - Modern equipment in imaging
4.3.1 To familiarise CT scanning.
4.3.2 To familiarise MRI scanning.
4.3.3 Identify modern imaging techniques- names only
5. Applications of PET, SPECT, gamma camera.
CT scan
CT scan is a modern imaging technique in which the images are formed by using X
rays. CT stands for Computed Tomography or Computer Tomography.
Principle
In this method X rays are transmitted throughout the body and a multidirectional
scanning of the patient is done. From this multiple data are collected. Then computer
performs some calculations and obtain necessary information. Finally a two
dimensional picture called slice is obtained.
A calculation based on the data obtained from the scan is made by the computer.
The output unit then produces a visual image of the patient.
A typical CT Scan machine
Scan Artifacts
There are many sources of errors which can produce artifacts during recording.
They are
1. Noise
2. Motion artifacts

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3. Artifacts due to high differential absorption in adjacent tissues.

4. Technical errors and computer artifacts.
Applications
CT is now an investigative procedure which is more clear than X ray. It detects
bone injuries, of
CT is helpful in detecting arteriovenous malformations like angiomas before its rupture.
CT is helpful in the treatment of cancer.
MRI Scanning
This imaging technique uses the RF region of the electromagnetic spectra for
producing an image.
MRI stands for Magnetic Resonance
Imaging. Here the patient is placed in
a magnetic field which causes the
magnetization of the protons of the
hydrogen atoms in the body. Now a
radio frequency pulse at resonance
frequency is transmitted into the patient
under controlled conditions. As a result
a nuclear magnetic resonance signal is Figure of a MRI Scanning machine
produced. These signals during their
return from higher nuclear energy level to ground state are processed by the computer
to produce an image.
MRI has the following advantages.
1. Absence of harmful radiations like X rays, gamma rays etc.
2. Superior resolution and contrast
3. Direct multi planar imaging.
Modern Imaging Techniques
PET
A positron emission tomography (PET) scan is an imaging test that allows your
doctor to check for diseases in your body.
The scan uses a special dye that has radioactive tracers. These tracers are injected
into a vein in your arm. Your organs and tissues then absorb the tracer. When

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highlighted under a PET scanner, the tracers help your doctor to see how well your
organs and tissues are working. The PET scan can measure blood flow, oxygen use,
glucose metabolism (how your body uses sugar), and much more.
A PET scan is typically an outpatient procedure. This means you can go about your
day after the test is finished.
SPECT
Single-photon emission computed tomography (SPECT) is a nuclear medicine
tomographic imaging technique using gamma rays.[1] It is very similar to conventional
nuclear medicine planar imaging using a gamma camera.[2]However, it is able to
provide true 3D information. This information is typically presented as cross-sectional
slices through the patient, but can be freely reformatted or manipulated as required.
The technique requires delivery of a gamma-emitting radioisotope (a radionuclide)
into the patient, normally through injection into the bloodstream. On occasion, the
radioisotope is a simple soluble dissolved ion, such as an isotope of gallium(III).
Most of the time, though, a marker radioisotope is attached to a specific ligand to
create a radioligand, whose properties bind it to certain types of tissues.
Gamma Camera
A gamma camera, also called a scintillation camera or Anger camera, is a device
used to image gamma radiation emitting radioisotopes, a technique known as
scintigraphy. The applications of scintigraphy include early drug development and
nuclear medical imaging to view and analyse images of the human body or the
distribution of medically injected, inhaled, or ingested radionuclides emittinggamma
rays.
Construction

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A gamma camera consists of one or more flat crystal planes (or detectors) optically
coupled to an array of photomultiplier tubes in an assembly known as a "head",
mounted on a gantry. The gantry is connected to a computer system that both controls
the operation of the camera as well as acquisition and storage of acquired images.
The construction of a gamma camera is sometimes known as a compartmental
radiation construction.
Modern Equipment in Medical Imaging
1. The rays used in CT scanner is ------------.
2. Expand CT and MRI
3. Name the parts of CT scanner.
4. What is the basic principle of MRI .
5. Write short note on MRI Scanner
6. Expand PET and give its applications.
UNIT 4
PATIENT SAFETY
Unit 4 - Patient safety
4.4.1 To familiarize the importance of general safety in
hospitals.
4.4.2 To understand the effects of electricity in human body.
4.4.3 To understand electric shock hazards and precautions
to avoid shock..
4.4.4 To understand IEC documents and safety codes.
4.4.5 To understand the grounding in Biomedical
Equipment.
4.4.6 Familiarise rules and ethics in medical field.
Importance of General Safety In Hospital
The chance to electric shock is associated with all the instruments and machines
operating with electric current. The medical instruments also is not an exemption
form it. But the situations where these are operated are entirely different from others.
The result of an electric shock from these instruments will be more serious and fatal
them others, since the patients lacking in resistive power subjected to it. The patients

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subjected to the electric shock in this case is more exposed to electricity than others.
Electrical shock may cause an unwanted cellular depolarization's and its associated
muscle contraction or it may cause cell vaporization and tissue injury.
There for it is very important to design the medical instruments and equipment very
carefully to eliminate the chance of an electric shock. The equipment in the hospital
must be organized properly and up to the safety regulations and standards as
prescribed by the manufactures besides this a variety. A safety instruments are now
available in the market which help to ensure maximum safety for the patients and the
staff operating with different medical equipments in hospitals.
Effect of electric current on Human Body
The passage of electric current through our body can produce different responses
depending upon the magnitude of the electric current. Small amount of current will
produce only a tingling or slightly painful effect where as larger currents can produce
cell depolarization's and muscle contraction, cell vaporization and tissue burns and
even respiratory paralysis and death. The amount of current entering the body is
determined by various factors like the smoothness of the skin, moisture present on
the skin, the age of the patient and even the sex.
Effect of various levels of current on the Human Body

Current Effect
1 Milliampere Tingling sensations, threshold of perception
5 Millampere Slight shock felt, not painful but disturbing
6 to 20 MA Painful shock, let go range
50 MA Extreme pain, respiratory arrest severe muscular
contraction
100 MA Ventricular fibrillation
5A Possible burns, sustained myocardial contraction,
respiratory paralysis and probable death.

Classify the shock hazards associated with electric current in to two types.
1. Micro Shock
2. Macro or gross shock

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Micro Shock
Micro Shock is the physical response to a current applied to the surface of the heart
that produces undesired stimulation, muscle contraction and tissue injury. In this
case the current instead of being applied to the skin surface with high impendence is
by passed to the heart directly through highly conductive liquid column. This occurs
in the case of patients in the coronary care unit. The most dangerous situations
encountered during a micro shock is the ventricular fibrillation.
Macro Shock
The gross shock or macro shock is experienced by the subject due to an accidental
contract with a live electric wire at any part of the body on its surface. It may be
defined as the physiological response to an electric current applied on the surface of
the body that can create undesired stimulations, muscle contraction and tissue injury.
The amount of current required to generated a physical response differs from persons
to persons depending upon the skin resistance.
Threshold of Perception
The threshold of perception of electric shock is about 1 mA. At this level, a tingling
sensation is felt by the subject when there is a contract with an electrified object
through the intact skin.
Let - go Current
The maximum level of current that can be tolerated by a person without experiencing
muscle condition is called let - go current. Let go current for males was 16mA and
for females was 10.5 mA. When the current becomes greater than the let-go level,
the person looses control over his muscle movements and is not able to release his
grip from the current carrying conductor. This level of current is called the hold on
type current.
Precautions to avoid shock
1. Ensure proper grounding for all the instruments used is connection with the
patient use only power cords with three wires.
2. Provide isolated input circuits on monitoring equipment.
3. Ensure strict regular listing of the ground
4. The mechanical construction of the instruments or apparatus must be smooth
and compact to avoid the chance of injury to the operator or patient.

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5. Staff should be properly trained to operate the instruments.

6. The functional controls should be legibily marked at the front panel of the in-
struments.
7. The operating instructions should be clear and must be permanently displayed
at the front. It should be regarded as part of the instrument.
8. Adapter plugs are used in connection with certain portable instruments. Since
they doesn't ensure proper grounding special care my be taken against micro
shock.
9. No other apparatus should be used near a patient monitoring equipment.
10. Connectors for the probe and the patient lead must be standardized.
11. A voltage in excess of 5mv should exist between the instrument ground outlet
and any other ground points or conductive surfaces in the area.

Safety Codes for Electro Medical Equipment

The problem of ensuring a safe environment for the patients as well as for the
operators has been engaging the attention of all concerned in several countries at
the national and international levels. Various countries have laid down codes of
practice for equipment intended to be used in hospitals. The International Electro
technical Commission (IEC) comprising of representatives of various countries
had laid down a document, IEC 601 specifying the Universal standards for
manufactures of Electro medical equipment and regarding the hospital safety. Based
on this Indian standard Institutions (ISI) has also issued a national level standards
IS 8607 dealing with standards and regulation for general safty requirements of
electro medical equipments IS 8607 cover the following topics in different parts:
1. General
2. Protection from electrical hazards
3. Protection from mechanical hazards.
4. Protection from undesired and harmful radiations
5. Protection from explosion
6. Protection from excessive hear, fire…. Etc.
7. Construction of the equipment.

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8. Behaviour and reliability

Individual standards are specified for some of the important medical instrument such
as IS 8048 for electro cardiograph, IS 7620 for X-ray unit, IS 8885 for
electromyograph and IS 9286 for cardic defibrillators.
Grounding in Biomedical Equipment
Low resistance ground that can carry currents up to circuit-breaker ratings are clearly
essential for protecting against both macroshock and microshock, even an isolated
power system is used. A grounding system is
used. A grounding system protects patients by
keeping all conductive surfaces and receptacle
grounds the patient's environment at the same
potential. It also protects the patient from ground
faults at other location.
The grounding system has a patient equipment
grounding point, a reference grounding point, and
connections , as shown in figure the patient
equipment grounding point is connect individually
to all receptacle grounds, metal beds, metal door and window frames, water pipes,
and any other conductive surfaces.
These connections should not exceed 0.15Ohm. The difference in potential between
receptacle grounds and conductive surface should not exceed 40mV. Each patient
equipment grounding point must be connected individually to a reference grounding
point that is in turn connected to the building service ground.
Patient Safety
1. Precautions to avoid electric shock and safety codes - Chart preparati
TE Questions
1. Distinguish between microshock and macroshock.
2. Write down the precautions that has to be taken in a hospital to avoid electric
shock from bio medical instruments.
3. IS 8607 is safety code. Indentify where this code is used?
4. Let go current for men is___________________

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5. Micro shocks may occur

a) Due to flow of 1A current flow across the body surface
b) Due to 5amp current flow across the body for 1 minute.
c) Due to shortening of electrical leads in the pacemaker.
d) Due to flow of few mA current a cross the cardiac muscles.
6. Let to current are
a) Same for men and women
b) Same for all frequencies
c) Higher for men than women
d) Higher for persons having enormous weight.

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Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the
practice of medicine. As a scholarly discipline, medical ethics encompasses its practical
application in clinical settings as well as work on its history, philosophy, and sociology.
A common framework used in the analysis of medical ethics is the "four principles"
approach postulated by Tom Beauchamp and James Childress in their textbook
Principles of biomedical ethics. It recognizes four basic moral principles, which are
to be judged and weighed against each other, with attention given to the scope of
their application. The four principles are:[7]
• Respect for autonomy - the patient has the right to refuse or choose their treat-
ment. (Voluntas aegroti suprema lex.)
• Beneficence - a practitioner should act in the best interest of the patient. (Salus
aegroti suprema lex.) The term beneficence refers to actions that promote the
well being of others. In the medical context, this means taking actions that
serve the best interests of patients. However, uncertainty surrounds the precise
definition of which practices do in fact help patients.
• Non-maleficence - "first, do no harm" (primum non nocere). he concept of
non-maleficence is embodied by the phrase, "first, do no harm," or the Latin,
primum non nocere. Many consider that should be the main or primary consid-
eration (hence primum): that it is more important not to harm your patient, than
to do them good. This is partly because enthusiastic practitioners are prone to
using treatments that they believe will do good, without first having evaluated
them adequately to ensure they do no (or only acceptable levels of) harm.
Much harm has been done to patients as a result, as in the saying, "The treat-
ment was a success, but the patient died." It is not only more important to do
no harm than to do good; it is also important to know how likely it is that your
treatment will harm a patient. So a physician should go further than not pre-
scribing medications they know to be harmful - he or she should not prescribe
medications (or otherwise treat the patient) unless s/he knows that the treat-
ment is unlikely to be harmful; or at the very least, that patient understands the
risks and benefits, and that the likely benefits outweigh the likely risks.
• Justice - concerns the distribution of scarce health resources, and the decision
of who gets what treatment (fairness and equality). (Iustitia.)

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Other values that are sometimes discussed include:

• Respect for persons - the patient (and the person treating the patient) have the
right to be treated with dignity.
• Truthfulness and honesty - the concept of informed consent has increased in
importance since the historical events of the Doctors' Trial of the Nuremberg trials
andTuskegee syphilis experiment.
he principle of autonomy views the rights of an individual to self-determination. This
is rooted in society's respect for individuals' ability to make informed decisions about
personal matters. Autonomy has become more important as social values have shifted
to define medical quality in terms of outcomes that are important to the patient rather
than medical professionals. The increasing importance of autonomy can be seen as
a social reaction to a "paternalistic" tradition within healthcare.[citation needed] Some
have questioned whether the backlash against historically excessive paternalism in
favor of patient autonomy has inhibited the proper use of soft paternalism to the
detriment of outcomes for some patients. Respect for autonomy is the basis for
informed consent and advance directives.
LIST OF REFERENCES
h t t p : / / n s d l . n i s c a i r. r e s . i n / j s p u i / b i t s t r e a m / 1 2 3 4 5 6 7 8 9 / 6 9 1 / 1 /
ClinicalBiochem_Concepts.pdf
http://www.alibaba.com/showroom/fully-automatic-biochemistry-analyzer.html
h t t p : / / n s d l . n i s c a i r. r e s . i n / j s p u i / b i t s t r e a m / 1 2 3 4 5 6 7 8 9 / 6 9 1 / 1 /
ClinicalBiochem_Concepts.pdf (autoanalysers )
https://en.wikipedia.org/wiki/Medical_ethics
http//www,lifesteps.com
http//www. Funsci.com
http// www. Medikraft.com
http// medical hospoperationtables.html
http//.noah.org/science.xray/story.
Familiarise semi and fully auto analyser
h t t p : / / n s d l . n i s c a i r. r e s . i n / j s p u i / b i t s t r e a m / 1 2 3 4 5 6 7 8 9 / 6 9 1 / 1 /
ClinicalBiochem_Concepts.pdf
http://www.alibaba.com/showroom/fully-automatic-biochemistry-analyzer.html

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Reference Book

h t t p : / / n s d l . n i s c a i r. r e s . i n / j s p u i / b i t s t r e a m / 1 2 3 4 5 6 7 8 9 / 6 9 1 / 1 /
ClinicalBiochem_Concepts.pdf

1. Essentials of medical physiology by k.Sembulingam

2. Biomedical instrumentation Dr. M. Arumugham
3. Hospitals facilities planning and Management by GD KUNDERS
4. Biomedical Instrumentation and measurements by Leslie Cromwell
5. Handbook of Biomedical instrumentation by RS Khandpur
6. Introduction to Biomedical Equipment technology by Joseph j Carr
7. Essential physics for radiographers by john Ball
8. Medical physics by Mike Crundel, Keven proctor
9. Biomedical Instrumentation by John S Webstar
10. Hospital Administration by DC Joshi ,Mamta Joshi

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