CENTRIFUGE MACHINE

 A CENTRIFUGE MACHINE

A centrifuge is a system that separates the components of a liquid or a fluids (and even gases) by centrifugal force. It is a biological instrument used to separate liquid material due to its density and weight. It does this by spinning the liquid in a container at high speed. Centrifuges are primarily used in laboratories to prepare test samples for analysis. For example, a centrifuge can be used to separate plasma from  blood. This machine is equipped with a rotor in which the samples to be prepared are placed. To explain it better, it’s like getting butter out of buttermilk. There are several types of centrifuges that have one or more associated applications. So when choosing a centrifuge, you need to pay close attention to the needs

 What Is Centrifugation?

Centrifugation is the process of concentrating  natural forces acting on all particles of different densities to accelerate the natural separation process. Separate the particles  in the test tube according to their density. Centrifugation can be done by filtration or sedimentation methods. During filtration, a mesh screen is used to retain solid components and allow  liquid components to flow through. Filtering does not work to centrifuge blood samples because the blood components are too small.

In both processes, the particles are suspended in liquid and separated in the centrifuge. Separation is done by centrifugal force pushing objects outward  toward the tip of the tube in the case of blood tubes, while spinning in a circle.

 PRINCIPLES OF CENTRIFUGATION

In essence, centrifugation is separation by sedimentation. The denser particles sink to the bottom of the container while the lighter particles remain in suspension. Centrifugation displaces particles with slightly different densities and is influenced by these four factors:

· Density of sample and solution

· Temperature and viscosity

· Particle removal

· Rotation speed

Relative centrifugal force (RCF) or G-force is the quantity acceleration acting on the sample is applied. When RCF exceeds the buoyant and frictional forces in the sample, the particles  move away from the axis of rotation and cause sedimentation.

What Is a Centrifuge Used For?

Because centrifuges are excellent at separating particles by density, they are often used in laboratory settings where it is necessary to isolate certain biological components for testing. For example, in a blood sample,  red blood cells and plasma are mixed. After centrifugation, the red blood cells are at the bottom of the tube and the plasma at the top.

Centrifugation is necessary to investigate certain components, such as separating  blood plasma for analysis, isolating DNA, and even separating  urine sediments.

 

How Does a Centrifuge Work?

The purpose of the centrifuge  is to replicate and accelerate centrifugation to separate components in a sample. Due to the forces involved, these machines have been carefully designed to operate efficiently and ensure operator safety.

The Parts of the Centrifuge Machine

In the center of the centrifuge there is a powerful motor that generates the spin. The rotor is attached to this motor, in which  the containers that contain the tubes with the material to be centrifuged rest. These containers can be rotated at a 45 degree angle (fixed angle centrifuge), a 90 degree angle (horizontal centrifuge), or no angle (vertical centrifuge). Depending on the centrifuge, the tubes can be loaded at the angle  they  rotate (the fixed angle is a good example) or  loaded into a container that is placed at a different angle when turned on. This second methodology is called oscillating bucket and is a common feature in horizontal centrifuges.

 Depending on the selected centrifuge, different control elements are available. Some centrifuges are pre-programmed for one, two, or three processing settings. Some are fully custom programmable with a digital display. Regardless of the type of control, the centrifuge will run the motor according to the settings provided at start-up. During the run, the sample in the test tubes is separated into its various components so that they are ready for analysis.

 THE DIFFERENT TYPES OF CENTRIFUGES

1. STANDARD CENTRIFUGES:

These are models  that can be used for urinalysis, stool analysis, etc. They have a  speed of between 5,000 and 15,000 rpm.

2. MICRO CENTRIFUGES:

 They are generally used for small amounts of sample, such as capillary tubes. They are used mainly to draw blood. Its speed is greater than 10,000 rpm. These centrifuges  have a compact design.

ULTRA CENTRIFUGES:

These types are very fast running centrifuges. They are primarily used for advanced analysis in specialized laboratories or research facilities. Its speed is quite high, between 50,000 and 100,000 rpm.

4. MANUAL CENTRIFUGES:

They are manually operated  by one person using a crank at a  speed of approximately 3,000 rpm. There are a variety of rotors  installed in centrifugal machines, such as: B. High-performance swing-bucket rotor, high-performance fixed-angle rotor, etc. They are used in separation and extraction.

THE CENTRIFUGE MAY HAVE THE FOLLOWING FUNCTIONS:

HEMATOLOGY: 

These include haematocrit centrifuges, which effectively determine the volume of erythrocytes in the blood. It can often handle 24 capillaries at the same time and its maximum  speed is usually 12,000 rpm.

 MOLECULAR BIOLOGY:

Centrifuges are used here, for example for DNA extraction. In this category, we may also need a refrigerated centrifuge. Refrigerated centrifuges are used to process samples that must be kept at a constant / similar temperature. That is why it is important that they work at high speeds while maintaining the same temperature. In most cases, the temperature range of these centrifuges is between 20 and 40 degrees Celsius, making them suitable for DNA or RNA analysis.

BACTERIOLOGY:

Here centrifuges are used for  cytology of fluids from various sources, for example parasitological centrifuges can help to perform parasite concentration tests.

How to Use a Centrifuge Machine

Despite the complex principles of the centrifuge, the operation of the machine itself is quite simple. To use a centrifuge:

· Insert the sample from the test tube  into one of the portals

· If necessary, insert test tubes filled with water according to the number of samples to be analyzed to maintain equilibrium

· Replace the cap and select the desired settings

· Start the centrifuge and wait for the cycle to complete  

· When the centrifuge has stopped spinning, remove the scales and samples

· Each sample is now  separated into its various components and is ready for analysis

· Know  how a centrifuge  works is key to using it properly. .

Balancing the Centrifuge Machine

When using a centrifuge, you need to balance your samples. Balancing the centrifuge machine:

· Ensuring that all tubes are filled evenly  with liquids of similar  density

· Ensuring that the masses of the tubes are within 0.1 grams of each other

· Placing tubes opposite each other in the machine to avoid gravity at the center

· If you are testing an odd number of tubes, it may not be possible to find a balance. In these cases, fill another test tube with water and adjust for density and mass.

Care and Maintenance for the Centrifuge Machine

Make sure your centrifuge is properly cared for and maintained so that it provides reliable results, is safe to use, and lasts a long time. Perform these checks regularly:

· Training – Make sure  everyone who uses the centrifuge is familiar with them. Teach all lab workers how to balance samples, adjust speeds, and take safety precautions.

· Inspection: An inspection draws your attention to  problems with the centrifugal machine. Examine components for scratches or chemicals. All are signs of use and should be repaired as soon as possible.

· Warning: While using the centrifuge, look for signs that something is wrong. If the machine wobbles, vibrates, or grinds, stop it immediately.

 Cleaning and disinfection are the key to ensuring long-term good centrifuge performance. Using a neutral cleaning solution (such as an alcohol-based disinfectant) and a soft cloth, clean the following:

· Rotors

· Rotor chamber

· Accessories

· Interior

· Keyboards

· Touchscreens

 

PLASMA SURGERY

 PLASMA SURGERY

Plasma surgery is a specific waveform of electricity through the dual-pole or multi-pole probe within the physical structure to stimulate blood, mucosal and soft tissue or nucleus pulposus within the binary compound (Nacl) molecules to get plasma state. Then the plasma high-speed charged particles directly interrupt tissue molecular bonds, and cause organization of protein to vaporize into H2, O2, CO2, N2, CH4 and other low mass gas.

Plasma Surgery techniques are achieved with the plasma energy released as the kinetic, thermal, and light energy.

• Kinetic energy allows for new uses of the device and an enhanced tissue effect.
• The thermal energy of the pure plasma energy allows for a high level of control over the tissue      effect with the minimal thermal diffusion
• Light energy provides enhanced visibility of surgical field.

Advantages of plasma surgery

• Low working temperature 40-70°C, to reduce the thermal injury to surrounding tissue
• Probe into the diseased area inside physique to create precise and efficient treatment
• Dual-polar or multi-polar design, no electrical current to travel through patient
• Almost no bleeding during surgery, short operation time
• Minimally invasive surgery, small trauma, quick recovery

THE PLASMA SURGICAL SYSTEM

The Plasma Surgery System utilizes mechanical energy and highly controlled thermal effects to treat tissue through three key surgical actions namely kinetic dissection, Microlayer Vaporization and surface sealing. It’s developed to leverage the unique properties of pure plasma energy and offer surgeons the flexibility to perform no-touch, atraumatic surgery. The Plasma surgical system may be a safe, effective, and easy-to-use device designed for a spread of surgical applications.

Thus plasma surgical system is employed for cutting, stripping, puncture, vaporization, haemostasis, ablation, shrinkage and surgical repair of soppy tissues in open and closed surgeries.

• Kinetic Dissection allows surgeons to form clean and dry tissue planes and open adhered areas on or near sensitive structures.
• Microlayer Vaporization enables surgeons to perform more complete disease removal from surface tissue, layer by layer.
• Surface Sealing allows surgeons to dry and seal areas with small vessels and oozing surfaces, reducing the danger of leakage and complications.

THE RADIOFREQUENCY PLASMA SURGICAL SYSTEM   

   The radiofrequency plasma surgical  system transfers radiofrequency energy to the lesion tissue for ablation, cutting, coagulation or haemostasis by using it.

Working principle of Radio frequency surgical system

The Surgical System adopts unique technology of controlling radio frequency emitting, whose power output can exactly produce plasma energy. Optimized power output can produce plasma energy effectively and speedily while minimize the thermal energy within the joints.

Ablate

The radio frequency energy flows through the active electrode and returns electrode, and by the conductive saline, it generates precisely focused plasma sheath round the electrodes. The plasma sheath consists of massive charged particles, which might generate sufficient energy of strong oxidizing when accelerated by the electrical field. The generated energy is powerful enough to interrupt the organic molecular bonds within the tissue, and make the tissue rapidly dissolved into molecular and atoms level at a comparatively vasoconstrictor of 40-70˚C. The device provides rapid and efficient ablation and resection capabilities of soppy tissues at relatively low temperatures.

Coagulate

When RF energy acts on tissue, including blood, round the electrode tip it generates Joule heat and electromagnetic radiation effect which providing an instantaneous coagulation of tissue protein and sealing of small blood vessels, thus coagulation and haemostasis capabilities of target tissues are realized.

The medical procedure by plasma ablation creates well-distributed coagulative necrosis for efficient haemostasis while preserving the mucosa and plant tissue. Compared thereto of conventional surgical methods, its post-operative recovery is improved.

Different from the past thermal coagulation by warm temperature, plasma technology can make the working temperature controlled at 40-70˚C, and coagulate helical structure of collagen molecules meanwhile preserving the cells vitality.

Temperature control

The surgery by plasma technology is performed at a controlled temperature of 40-70°. Because the frequency is conducted into the saline solution to make the plasma sheath instead of into the tissues themselves, there’s minimal heat damage with these systems. Using special temperature control technology, the system stays at the best temperature for a stable and effective output.

Systematic Working Mode

There are two working modes for Radio frequency plasma surgical system.

 ABLATE  for resection and ablation activated at Yellow panel and Yellow lever.

COAG  for coagulation and haemostasis activated at Blue control board and Blue pedal.

Enhanced Coagulation

Enhanced coagulation mode can improve haemostasis capability while providing clear surgical vision.

Intelligent system

Designed with automatic identification of electrode, foot switch and electric cord, displayed on the device instrument panel, and automatic default power output value for various electrode designs.

Automatic Protection

The circuit system can constantly monitor power output and automatically suspend power output when there’s instantaneous peak current. For instance, the generator will automatically suspend radio frequency output when electrode contacts or is near metal, and automatically resumes work after electrode has returned to a correct distance.

Bipolar and Multi-polar Technology

Various bipolar and multipolar electrode designs are available. Around the electrode tip, sufficient and stable plasma layer is generated for rapid resection, ablation, coagulation and haemostasis of soppy tissues.

Foot Switch

The waterproof, pressure-resistant and convenient foot control has two working modes of ABLATE and COAG, each identified in several colors and dealing sounds.

Integrated Function

In one versatile single-use electrode, it provides ABLATE for resection and ablation, COAG for coagulation and haemostasis, and suction capabilities. The integrated suction electrode enhances surgical vision, controlled resection for rapid removal of soppy tissue.

Temperature Control Technology

The medical procedure by plasma technology is performed at controlled 40-70˚C. It uses a controlled, non-heat driven process during which bipolar radiofrequency (RF) energy excites the electrolytes in a very conductive medium, usually normal isotonic solution, to make a precisely focused and charged plasma gas. The energized particles within the plasma have sufficient energy to interrupt the organic molecular bonds within tissue, causing tissue to dissolve at relatively low temperatures of 40-70˚C. Radiofrequency current doesn’t pass directly through tissues, causing minimal tissue thermal effect. By temperature control technology, the generator automatically optimizes output value in keeping with the plasma layer status round the electrode tip and also the target tissue feature, by which electrode can provide a stable and efficient capabilities while keeping rock bottom working temperature.

Timer

When the special electrode with time control is chosen, the generator automatically recognizes the electrode and starts to count the active time by 100ms.

Advantages

•  Excellent Haemostasis Capability
• Flexible and Convenient for Surgeons
•  Less Damage and Thermal Penetration
• Lighter Post-operational Tissue Exudate and Swelling
• No Fibroplasia Caused from “Tear” Damage of Traditional Unloading Instruments 
• Widely Applicable in Knee, Hip, Shoulder, Elbow, Wrist and Foot & Ankle Arthroscopy
• Complementary to Traditional Mechanical Tools, and even to interchange Some Functions in        Cartilage-plasty

 

OXYGEN CONCENTRATOR

 OXYGEN CONCENTRATOR

An oxygen concentrator is a medical device which provides supplemental or additional oxygen to patients who has breathing problems. The device consists of a compressor, a sieve bed filter, an oxygen tank, a pressure valve, and a nasal cannula (or oxygen mask). Like an oxygen cylinder or oxygen tank, a concentrator provides oxygen to the patient through a mask or nasal tube. However, unlike the oxygen cylinder, the concentrator does not need to be refilled and can provide oxygen 24 hours a day. A typical oxygen concentrator can provide 5-10 litters (LPM) of pure oxygen per minute.

How does the Oxygen concentrator work?

The working principle of the oxygen generator is to filter and concentrate the oxygen molecules in the ambient air to provide patients with 90% to 95% pure oxygen. The oxygen concentrator’s compressor draws in ambient air and regulates the pressure of the supplied air. A sieve bed made of a crystalline material called zeolite separates the nitrogen from the air. The concentrator has two sieve beds, which can release oxygen into the cylinder and discharge the separated nitrogen into the air. This forms a continuous cycle that continuously produces pure oxygen. The pressure valve helps to adjust the oxygen supply from 5 litters to 10 litters per minute. The compressed oxygen is then delivered to the patient through a nasal cannula (or oxygen mask).

Who should use an oxygen concentrator and when?

According to the pulmonologists, only mild to moderate patients with oxygen saturation between 90% and 94% should use oxygen concentrators under the  medical guidance. Patients with oxygen saturations as low as 85 n also use oxygen concentrators in emergency situations or before admission. However, it was recommended that these patients switch to cylinders with higher oxygen flow and be admitted to the hospital as soon as possible. This device is not recommended for the ICU patients.

Different types of oxygen concentrators

oxygen concentrators are classified into two types:

Continuous flow:

This type of concentrator provides the same oxygen flow rate every minute, unless it is not turned off regardless of whether the patient is breathing oxygen or not.

 Pulse dose:

These concentrators are relatively smart because they can detect the patient’s breathing pattern and release oxygen when inhalation is detected. The oxygen released by the pulsed dose concentrator changes every minute.

 How are oxygen concentrators different from oxygen cylinders?

 Oxygen concentrators are the best alternative to steel cylinders and liquid medical oxygen that are relatively difficult to store and transport. Although concentrators are more expensive than steel cylinders, they are largely a one-time investment with low operating costs. Unlike steel cylinders, the concentrator does not need to be recharged, and can use only ambient air and electricity to produce oxygen 24 hours a day. However, the main disadvantage of the concentrators is that they can only supply 5-10 liters of oxygen per minute. This makes them unsuitable for critically ill patients who  requires 40 to 45 liters of pure oxygen per minute.

Advantages of Oxygen Concentrators

 For patients who need oxygen therapy, portable and home oxygen generators have many advantages. They are much less dangerous than traditional oxygen cylinders. If a traditional oxygen cylinder breaks or leaks, it will cause or increase the combustion rate of a fire. On the other hand, oxygen concentrators do not present this danger. Home and portable oxygen concentrators that can “produce” their own oxygen are more popular and more widely used than outdated oxygen tanks. Another important benefit is the easy and improved mobility of oxygen. Portable oxygen concentrators can provide users with needed oxygen anytime, anywhere, even on airplanes. The FAA (Federal Aviation Administration) stipulates that all passengers in need of oxygen must be able to carry FAA-approved portable oxygen generators on all US aircraft with more than 19 seats. Foreign airlines must also allow the use of portable oxygen concentrators on all flights to and from the continental United States.

 

CATH LAB

 CATH LAB

The cardiac catheterization laboratory, also known as the “cardiac cath lab,” is a special room where doctors can perform minimally invasive tests and procedures to diagnose and treat cardiovascular disease. Surgery performed in a cardiac catheterization laboratory almost always involves small flexible tubes called catheters, which can be used in place of surgery to access the heart and blood vessels. The catheter lab has special imaging equipment that is used to view the arteries and check the flow of blood in and out of the heart. This information helps the care team diagnose and treat blocked arteries and other problems.

Cardiac catheterization is used to:

• Assess or confirm the presence of coronary artery disease, valvular heart disease, or aortic disease
•  Assess myocardial function
• Determine if additional treatment is needed (for example, interventional surgery or coronary artery bypass graft or CABG, surgery)

During cardiac catheterization, an elongated tube called a catheter is inserted into a plastic introducer sheath (a short hollow tube inserted into a blood vessel in the leg or arm). With the help of a special X-ray machine, the catheter passes through the blood vessel to the coronary artery.

Contrast agent is injected through a catheter as it passes through the heart chambers, valves, and main vessels. This part of the procedure is called coronary angiography. Coronary artery disease is narrowing or blockage of the coronary (heart) arteries. After interventional surgery, the coronary arteries are opened, increasing blood flow to the heart.

The digital photo of the contrast material is used to identify the location of coronary artery stenosis or blockage. Additional imaging procedures, called intravascular ultrasound (IVUS) and fractional flow reserve (FFR), can in some cases be performed in conjunction with cardiac catheterization to obtain detailed images of the vessel wall. Currently, these two imaging procedures are only available in specialty hospitals and research center.

Using IVUS, place a miniature sound probe (transducer) on the tip of the coronary catheter. The catheter passes through the coronary arteries and uses high-frequency sound waves to generate detailed images of the inner walls of the arteries. IVUS produces accurate images of the location and extent of the patches.

Uses FFR to pass a special wire through the artery and administer a vasodilator. This test functionally performs a very high-quality stress test on a small section of arteries.

Cardiac Cath Lab Procedures

1) Cardiac Implant Closure Device

The percutaneous closure of the patent foramen ovale (the opening between the heart chambers) is done using a special closure device connected to the catheter.

2) Cardiac Stent

A small wire mesh tube (stent) is inserted into the blocked artery to restore blood flow to the heart muscle.

3) Cardioversion

A catheter placed in the heart to locate and map small clusters of heart cells that cause the abnormal rhythm. Send a signal along the catheter to silence the cells, which results in an abnormal rhythm.

4) Catheter Ablation

A catheter placed in the heart locates and maps the small groups of heart cells that cause abnormal rhythms. The signal is sent along the duct, silencing the cells causing the abnormal rhythm.

5) Coronary Arteriogram

Coronary arteriogram is an operation in which a very thin catheter or tube is passed from the groin, neck, or arm through the artery to the coronary arteries that surround the heart. The doctor uses the catheter to inject contrast medium into the blood of the coronary arteries. The dye shows up on the x-ray and highlights the coronary arteries. X-rays are called angiography. It’s a X-ray examination of the coronary arteries. The catheter is placed in the coronary arteries to evaluate the arteries and pumping chambers of the heart.

6) Electrophysiology Evaluation

 A study to understand the origin of heart rhythm disorders. The small catheter enters the heart through the femoral artery or brachial artery and is used to test the electrical system of the heart. It can induce the patient’s abnormal heartbeat for diagnosis and treatment.

7) Electrophysiology Syncope Study

A test to diagnose the cause of syncope. While monitoring the ECG and blood pressure, the patient’s bed is tilted from a flat position to an upright position. Once the individual’s response is recorded, treatment can begin to prevent recurrence.

8) Internal Cardioverter Defibrillator Implant

A small device implanted in the chest that can be used as a pacemaker or to generate a slight electric shock when needed to restore a normal heart rhythm.

9)  Angioplasty

The healthcare provider uses fluoroscopy during surgery. It is a special type of X-ray, just like X-ray “film.” When the contrast dye passes through the artery, it can help the doctor find the blockage in the heart artery. This is called coronary angiography.

Your healthcare provider may decide that you need another type of procedure. This may include removing plaque from the narrow part of the artery (rotation). In atherectomy, the provider may use a catheter with a rotating tip. When the catheter reaches the narrow part of the artery, the plaque is ruptured or cut to open the artery.

10)  Rotoblation

Rotablation (Rotational atherectomy) may be a complex and also the most challenging technique in coronary intervention utilized in patients with heavy calcification in coronary arteries (hardened arteries) to deliver stents in position to enhance blood flow. it's essentially a drilling technique through with the assistance of special diamond tip burr, which rotates at a speed of 150,000 to 200,000 rotations per minute. This drilling technique clears the within of the arteries to assist pass the balloon and stent easily. The tubes or catheters employed in this method are bigger than the conventional catheter.

Cardiac Catheterization Risks

Cardiac catheterization is usually safe. But as with any procedure that involves getting into your body, there are risks. Your doctor will discuss the risks with you and will carefully reduce your chances of developing these risks.

Risks may include:

• Blood vessel perforation
• Air embolism (when air enters the blood vessel; this can be fatal)
• Allergic reaction to dye
• Bleeding
• Thrombus
• Contusion
• Seizure
• Kidney infection from dye
• Stroke
• Uneven or irregular heart rhythm (arrhythmia)

CARDIAC CATH LAB EQUIPMENTS

X-ray Generators

The X-ray generator produces X-rays when an electrical current is applied in it. The X-ray generator could be a device that acts because the primary control mechanism for the whole fluoroscope. It’s through the X-ray generator that current is allowed to flow into the thermionic vacuum tube. The fundamental function of adjusting the voltage differential and current of the tube are controlled automatically to keep up optimal contrast and brightness. Generator types utilized in fluoroscopy include single phase, three phase, constant potential, and high frequency. High-frequency generators provide superior exposure reproducibility  , with the foremost compact size, lowest terms, and lowest repair costs. As a result, high-frequency generators are commonly utilized in new radiographic equipment. X-rays could also be generated in either an eternal or a pulsed mode. Automatic brightness control may be a standard feature of the bulk of contemporary fluoroscopes. Through this method mA and kVp are constantly monitored and adjusted to optimize the image.

X-ray Tube Assembly

The majority of x-ray tubes found in current cardiac cath labs contain only two focal spots. The little spot will have a nominal size of 0.5 to 0.6 mm with a kW rating for one exposure of 40 to 50 kW. The big focal spot are going to be 0.9 to 1.2mm in size with a kW rating of 80 to 110 kW. The massive focal spot kW rating  should be reasonably matched to the utmost kW of the generator. It’s used for cine or digital image recordings. The tiny focal spot is employed primarily for fluoroscopy. The tiny focal spot is additionally the proper choice for cine or digital image recordings of young children. The most common anode diameter provides a 100 mm diameter focal track. This diameter provides an affordable compromise between the specified tube loading and also the delay required to accelerate the anode rotational speed from low speed[approximately 4000 revolutions per minute (rpm)] used during fluoroscopy to high speed (10,000 rpm) used during cine acquisitions. The surface of the anode is usually a tungsten-rhenium alloy; the rhenium is added to smooth the surface of the anode and to cut back the loss of radiation output .

The body of the anode is sometimes graphite, which increases the warmth energy that can be stored without damage thanks to increases in temperature. The specified small anode angle could be a compromise between field coverage and warmth capacity rating of the tube. A minimum of a 9-degree angle is important to hide a 9-inch field of view (FoV) image intensifier at a Source Image Receptor Distance (SID) of 30 inches. The most anode chilling rate should be a minimum of 400,000 heat units per minute (HU/min). Units with medium to large workloads should be equipped with circulating liquid (oil or water) heat exchangers to more efficiently and quickly convey heat from the anode body of the encircling atmosphere outside the tube. This exchanger typically quite doubles the warmth dissipation rate of a fan-cooled housing which is often 100,000 HU/min. This accelerated cooling allows the cardiologist to continue the case, mixing fluoroscopy with cine acquisitions without a forced delay.

Tube Stand

The tube stand supports both the electron tube housing with collimator and therefore the image intensifier with imaging chain. It’s designed to keep up the alignment of the central ray for the x-ray beam to the middle of the image intensifier while the angle of the central ray changes within either the coronal or transverse plane of the patient’s body. This cranial-caudal or lateral rotation of the X-ray tube and image intensifier provides the required compound imaging angles required to minimize superposition within the image of the tortuous coronary arteries. The cardiologist places the anatomy of interest at the intersection of the 2 orthogonal rotations, the isocenter, to forestall the movement of the anatomy across the FoV of the image when the compound angles are adjusted. Translational movement of the image intensifier parallel to the central ray is accomplished by providing a variable focal spot to image receptor distance (SID) of a minimum of 90 to 120 centimetres(cm) . This enables the positioning of the input plane of the image intensifier as near the exit plane of the patient no matter the patient thickness or compound angle to reduce magnification and geometric unsharpness within the image. The stand should provide an extra movement (e.g. Rotation about its floor or ceiling support) to permit the equipment to be quickly removed from the vicinity of the patient when emergency access is required. Collision guards or slip clutches are provided to forestall further power-driven motion of the stand upon contact with the patient or other stationary objects.

Patient Table

Floor-mounted special procedure table tops in cath labs are typically supported by a pedestal base with motorized vertical motion sufficient to position any a part of the patient’s body at the vertical isocenter of the imaging plane. The tabletop should be wide enough to support the patient, but narrow enough to permit the positioning of the image intensifier adjacent to the exit plane of the patient during lateral imaging. The length of the table must be sufficient to comfortably support a tall adult, with some additional room. The composition of the many tabletops is often carbon fibre material. This composition provides the strength required to support a minimum of a 350-pound patient cantilevered from the pedestal support while minimizing the attenuation of the diagnostic x-ray. The tabletop must “float” with regard to the pedestal when electromagnets are released to permit axial and transverse motion of the tabletop relative to the isocenter of the imaging equipment. The longitudinal and transverse motion of the tabletop respectively should be at least at 100 cm and 30 cm

Control Console

 The control console for a cine system should have the flexibility to pick both fluoroscopic and cine technique factors. For fluoroscopic operations, there should be selection switches to vary from continuous to pulsed fluoroscopy. Pulsed fluoroscopy should be available from 30 pulses per second to a minimum of 7. 5 pulses per second . For all modes, the utilized kVp and mA should be displayed on an easy-to-read display indicator. Moreover, the cumulative fluoroscopy time should be displayed and a “5 minute (of elapsed fluoroscopy time) buzzer” should clearly be heard in both the procedure room and also the control booth. It’s also helpful to own a fluoroscopic lock switch which may “hold” a specific combination of “kVp/mA.” The utilized FoV of the image intensifier should even be clearly displayed on the control console. Some units allow manual selection of kVp/mA during fluoroscopy additionally to Automatic brightness Control (ABC) of fluoroscopy. The cine controls typically have a gaggle of pre-established programs from which to pick appropriate technique factors. In general, cine frame rates from 15 to 60 fps should be available. Adult cardiac cine is typically performed at 30 fps and pediatric frame rates range from 30 to 60 fps cine pulse widths are typically 2 to 10 msec .The X-ray tube potentials should start above 60 kVp so as to limit patient radiation dose and may go up to 120 kVp. Cine tube current values generally range from 50 to 800 mA. The ABC system automatically adjusts some combination of kVp, mA, and pulse width during cine operation to take care of the appropriate image quality. For cine, there should be several pre-programmed technique factors using different frame rates, starting kVps, starting pulse widths, and cine run durations. The control console should, at a minimum, display the cine kVp and mA(s) on an easy-to-read alphanumeric display. The sunshine levels exiting the image intensifier could also be indicated during cine filming as a relative check of proper cine film exposure. There should even be a button to mechanically advance the cine film (“jog” button). Finally, the control console should have an indicator to indicate the amount of film left within the cine film magazine. Digital imaging systems need similar function-related buttons. There should even be a “x-ray on” indicator and/or a door interlock indicator.

Grids

Cardiac imaging often employs lateral oblique projections that attenuate the x-Ray beam and produce a big number of scattered photons. The scattered photons tend to scale back the contrast of coronary arteries and obscure the visualisation of smaller arterial vessels and branches. Hence, the utilization of appropriate grid(s) to get rid of much of the scattered radiation leads to a contrast improvement and a capability to work out smaller vessel sizes. The usage of grids may lead to a rise of radiation dose to the patient by an element of two to 4 times. The best grid would offer a high percentage of primary radiation transmission and a high percentage of scatter radiation attenuation. The grid should be circular in shape so as to properly fit the image intensifier and to make sure the alignment to the central ray of the x-ray beam necessary to forestall grid cut-off of primary photons. Usually, carbon fiber interspace material is used so as to enhance primary radiation transmission. Although parallel and crossed grids are employed in the past for cardiac studies, the foremost common grid for these studies may be a focused grid. So as to accommodate a spread of SIDs, low grid ratios are utilized. Typically, grid ratios of 4:1 up to 8:1 are used . The focal length of the grid depends upon the x-ray tube/image intensifier mechanical web being used. Modern cardiac imaging systems typically have a capability to vary the SID from 80 cm up to 120 cm. The grids should have a usable focal range that accommodates these variations. It’s important to possess the grid lines mounted perpendicular to the TV raster lines to avoid interference patterns. Because the grids are stationary, thick grid lines would obscure small vessels. Therefore, thin grid lines with a high number of lines per inch are usually employed. Finally, there should be a mechanism to simply remove grids for physics/x-ray service test procedures. This feature also allows removal of the grid by the operator when air gap techniques are wont to geometrically magnify the pediatric patient’s small anatomy within the image

Television System

Digital recording of fluoro and cine images is usually taken from the television System. Hence, the television system should be designed to provide appropriate image quality for these studies. Foremost, the television system for cardiac studies should exhibit minimal persistence of the images so that frame rates up to 60 fps can be accommodated. This feature is termed minimal lag and must be measured with a dynamic test, such as the spinning spoke patterns.

Digital Imaging Systems

The challenge with digital imaging is that the sheer volume of the digital data. Typical diagnostic cardiac catheterization procedures in adults involve the imaging of 5 to 10 runs of a 6 to 7 second duration each with 30 fps. Thus, each patient study contains 2000 or more images. The minimum specifications of a 512 × 512 matrix and a pixel depth of 1 to 1.5 Bytes (8 to 12 bits) to capture the transmitted x-ray intensity data result in each image and also the entire study containing about 0.25 to 0.39 and 500 to 750 Megabytes (MB) of information, respectively. While the improved spatial resolution of a 1024 × 1024 matrix is preferred, the larger matrix size has disadvantages of increased quantum mottle and/or radiation dose to the patient still the maximum amount larger data rates and total image data. The info acquisition rates for a 512 × 512 matrix are typically 7.5 to 12 MB per second which is adequate 60 to 90 MHz; for the 1024 ×1024 matrix, the information rates would be fourfold greater. Bi-Plane Cardiac Cath systems double the information acquisition rates that will should be handled. For these reasons, most current equipment utilizes the 1024 × 1024 matrix only at lower frame rates of imaging; whereas, the 512 × 512 matrix is routinely used for many clinical studies . The spatial resolution of digital systems is set by the image acquisition equipment (e.g., video system), the matrix size, and therefore the image intensifier FoV. Generally, the calculated spatial resolution is capable half the matrix size/FoV in millimetres. For 512 × 512 matrix with a 150 mm FoV, the calculated spatial resolution would be about 1.7 LP/mm. The 1024 × 1024 matrix size would increase spatial resolution to about 2.5 to 3.0 LP/mm. while these values for spatial resolution are but cine film imaging, digital systems have improved dynamic range, image processing capabilities, noise suppression, and networking and have image storage/display advantages. Hence, many cardiac cath labs are utilizing digital cine image acquisition. Most current digital cine imaging is completed by digitizing the video signal from a high-quality camera. The analog signal from a television equipment goes to an data converter (ADC) and so it’s transmitted to the digital storage buffer for temporary storage. Within the future, one can expect the analog television cameras to get replaced by CCDs which will directly acquire the image as a digital image. Moreover, the image intensifier and TV camera is also replaced by a right away radiation detector/imaging system in a very few more years; such systems are currently under development and testing.

 

 

 

Suction Machine

 Suction Machine

A suction machine, also called an aspirator, may be a variety of medical device that's primarily used for removing obstructions  like mucus, saliva, blood, or secretions  from a person’s airway. When a personal is unable to clear secretions because of a scarcity of consciousness or an ongoing process, suction machines help them breathe by maintaining a transparent airway.

In practice care professionals use suction machines as an integral a part of a treatment plan when a patient’s airway is partially or completely obstructed.

Some common uses include:

• Removing respiratory secretions
• Assisting a patient whom vomiting while seizing or unconscious
• Clearing blood from the airway
•  Removing a remote substance from a patient’s windpipe and/or lungs (pulmonary aspiration)

Since suction machine can be used in the conjunction with other medical technologies to treat a variety of life-threatening conditions, aspirators have become a mainstay in both the pre-hospital and in-hospital settings.

Suctioning process

Suctioning is ‘the mechanical aspiration of pulmonary secretions from a patient with a man-made airway in place’. The procedure involves preparation of the patients , the suctioning event(s) and follow-up care. Suction is employed to clear retained or excessive lower tract secretions in patients who are unable to try and do so effectively for themselves. This might ensue to the presence of a synthetic airway, like an endotracheal or tracheostomy tube, or in patients who have a poor cough  to an array of reasons like excessive sedation or neurological involvement. Having a synthetic airway in place impairs the cough reflex and should increase mucus production. Therefore, within the neonatal and paediatric ICU, suctioning of a synthetic airway is probably going to be the foremost common procedure.

Oropharangeal and nasopharangeal suction could be a technique intended to stimulate a cough to get rid of excess secretions and/or aspirate secretions from the airways that can’t be off from a patient’s own spontaneous effort. A cough is also stimulated by a catheter within  pharynx (oropharangeal suction) or by passing a catheter between vocal cords and into trachea to stimulate a cough (nasopharangeal suction). The trachea is accessed by insertion of a suction catheter either via the nasal passage and pharynx (nasotracheal suction) or through the oral cavity and pharynx (orotracheal suction) using an airway adjunct. Nasotracheal suction is also undertaken directly via the nostril without an airway adjunct. However, in some situations, where repeated suction is anticipated and thus a nasopharyngeal airway should be utilised. Secretions are removed by the applying of sub-atmospheric pressure via wall mounted suction apparatus or portable suction unit.

The History of the Aspirator

The first conventional aspirator was introduced by a cardiologist whose  name was Pierre Carl Edouard Potain in 1869. His aspirator was a manual machine that used a pump to empty abscesses and fluid build-up within the chest, with the goal of preventing failure. When the electricity became reliable, suction machines transitioned from manual devices to electrically powered devices. However, until the late 1970s, aspirators were extremely large and were often permanently affixed to a wall.

Types of aspirators

1) Manual Suction Devices

A manual suction device is any device that makes suction without the utilization of battery or electricity. Many hospitals and emergency management agencies have moved off from them because the suction they create is commonly unpredictable and inconsistent.

These devices generally work by squeezing a pump to make a vacuum. They’re often attached to large canisters. For a few of those devices, the strength of the suction is heavily keen about the speed at which you squeeze the pump. Smaller devices, like the bulbs accustomed clear the nostrils and mouths of new-borns, are considered manual suction devices.

2) Stationary suction machines

For decades, fixed (stationary) equipment was the most common machine because they were reliable, effective, and durable. However, their lack of portability has many shortcomings. Patients cannot be provided with stationary suction machines during transportation, and they can only provide emergency care within the four walls of the hospital.

3) Portable suction machines

Portable suction machines are becoming more and more popular due to advances in suction and battery technology. Portable suction devices are designed to be lightweight and more easy to be move or transport, making them perfect for patients and healthcare professionals.

Manual, stationary and portable vacuum cleaners find their place in a modern care environment. Each has its own strengths, and healthcare professionals can use various types of suction devices during different stages of treatment.

Common Uses for Suction Machines

Suction machines are often used when a patient has liquid or semi-solid blockages in the throat, windpipe, or other oral cavity. However, the ideal suction device may vary depending on the condition of the patient. Here are some scenarios in which patients or professionals might use a portable suction machine.

Ongoing Patient Care

Patients may be need the portable suction devices at home if they are unable to remove their own secretions for various reasons. This includes palliative care patients who find it difficult or impossible to evacuate their own secretions, people with chronic diseases (COPD, ALS, cystic fibrosis, bronchiectasis, etc.) or patients who have had a tracheostomy.

Pre-hospital

Portable suction devices are very common in the preclinical setting because they play a crucial role in helping emergency services set up ABCs (airway, breathing, and circulation). In practice, pre-clinical service providers often use portable suction devices to treat a wide variety of patients. These include trauma victims with blood in the airways, victims of overdose with vomiting in the airways, and other victims who experience respiratory distress syndrome.

In-Hospital

Most hospitals have rooms equipped with fixed wall-mounted suction devices. Nursing teams often use stationary aspirators as part of standard procedures such as tracheostomies, sinus disease, and tonsillectomies. However, hospitals typically have some wearable devices for specific use cases. For example, if a patient needs an aspirator but there is no wall-mounted aspirator in the patient’s room, the care team will find and retrieve a portable aspirator instead of moving the patient to another room. Also, they are used to treat patients out of a room when hospitals are busy.

How Portable Suction Machines Work

Portable suction devices generate negative pressure that passes through a special plastic connecting tube, a so-called disposable catheter. The negative pressure creates a vacuum effect that draws blood, mucus, or similar secretions from the throat. The secretions are then automatically introduced into a collection container.

Portable suction devices rely on a number of key technologies to create negative pressure and remove secretions. Below is a list of the most common components within a suction machine.

Disposable or rechargeable batteries

The suction machines are built with powerful batteries to ensure they can provide suction capabilities when a reliable power source is not available.

Suction/vacuum pump

The vacuum pump is often located inside the aspirator. This causes negative pressure and is necessary for the suction machine to work.

Connection tubing

This connects the vacuum pump to the collecting tank. You should never touch the contents of the collection container.

Sterile patient tubing

The patient hose is connected to the suction tip and directs the patient’s secretions to the collection container. Sterile patient tubes must be disposed of properly after each suction session.

 Disposable canister

The disposable container holds the patient’s secretions and often provides overflow protection in the event that the patient sucks in too much fluid. This container must be disposable to ensure that all parts of the suction machine remain sterile.

Power cord

Portable suction machines come with a power cord that can be used to charge the machine when you’re close to a power outlet.

Filters

Ideally, a disposable canister should withstand the use of bacteria / virus filters to prevent contamination within the internal components of the aspirator. Certain filters can also be used to protect against dangerous dust and gases that can damage the machine

Troubles in Suction machine            

• LOW or NO pressure at end of Filter
• LOW or NO pressure at Regulator Port
• Machine is not plugged in or is not turned on.
• Suction pressure is not properly set
•  LOW or NO pressure at Patient Port
•  LOW or NO pressure at end of Suction Tubing

 

 

ROLES OF REHABILITATION ENGINEERS & HOW REHABILITATION ENGINEERING IMPROVES THE QUALITY OF LIFE FOR INDIVIDUALS?

 ROLES OF REHABILITATION ENGINEERS 

                

They may suggest commercially available equipment to solve the problem of the disabled.

Example :

Rehabilitation engineers assisting workers in wheelchairs can choose commercially available components to set up an ergonomic workstation with height-adjustable desks and desks, as well as computer monitors and keyboards that are repositioned as workplaces. A rehabilitation engineer working in a rehabilitation centre may recommend electronic assistive devices used in daily life to activate the appliances and lights in her kitchen.

They adjust and personalize technology and create unique solutions to meet the needs of people with disabilities.

Example:

A rehabilitation engineer working in the school system has a pre-schooler with limited leg movement and can modify an electric toy car so that it can be driven by manual control instead of pedals. Another rehabilitation engineer working in a resource center could make wheelchair camera mounts for amateur photographers who use wheelchairs.

They can develop new technologies and new products to solve the problems faced by the disabled.

 Example:

Rehabilitation engineers invented a voice activation system to operate mobile phones and PDAs. Rehabilitation engineers also invented a wheelchair-mounted power supply system that draws power from the wheelchair’s battery to provide backup power for the ventilator.

They can test whether equipment and products comply with consumer safety and compliance with state, federal and international regulations.

Example:

Perform stress, performance and failure analysis tests for rehabilitation engineers working in independent test labs to determine the structural integrity of the wheelchair. They can also use crash test dummies to analyze the safety of wheelchair fastening systems in vehicles.

Rehabilitation engineers complement the work of other professionals, such as physical therapists, occupational therapists, and speech pathologists. They use a unique engineering perspective to solve problems and provide technical assistance for technical systems and solutions that are generally beyond the reach of physicians.

HOW REHABILITATION ENGINEERING  IMPROVES THE QUALITY OF LIFE FOR INDIVIDUALS?

1.REHABILITATION ROBOTICS

Rehabilitation robots can provide personalized, task-oriented, long-term, intensive, standardized, and repeatable training for stroke or other non-progressive brain injury patients. The application and utility of robotic orthotics is a rapidly developing field with many promising but unproven parallel research directions. Due to the potential and rapid expansion of this treatment category, it is necessary to introduce some basic knowledge. There are many designs of robotic or electric upper limb orthoses. Most of them are sensing exoskeletons, whose motion is consistent with human joints, and provides natural arm motion. These single-joint or multi-joint movements can be completely driven by the robot, controlled by electromyography (EMG) signals or a hybrid control system. The complexity and analytical capabilities of robot-assisted therapy enable neurorehabilitation specialists to use general clinical measurements of motion range, spasticity, and pain as clinical endpoints, turning to coordinated measurements of multiple joints in patients. Functional performance of the upper limbs.

2.VIRTUAL  REHABILITATION

For patients suffering from various diseases, such as musculoskeletal problems, stroke paralysis, and cognitive deficits, virtual reality can be used as an enhancement to traditional therapies. This method is called “augmented rehabilitation.” Or, virtual reality can completely replace traditional interventions, in which case rehabilitation is “virtual reality-based.” If the intervention is carried out remotely, it is called “tele rehabilitation”. Simulation exercises have been developed for stroke patients using the “teacher’s object” method or the video game method. Simulation of musculoskeletal patients using virtual replicas of rehabilitation equipment (such as rubber balls, electric putties, nail boards). A virtual environment is provided that induces phobias to patients with cognitive impairment. Enhanced rehabilitation has been shown to be effective for stroke patients in the chronic stage of the disease. Rehabilitation treatment based on virtual reality has improved patients with fear of flying, Vietnam syndrome, fear of heights and chronic stroke.

3.PHYSICAL PROSTHETICS

Physical prosthetics, such as smart prosthetics with electric ankles, exoskeletons, right-handed upper extremities, and hands. This is an area where researchers continue to advance design and functionality to better mimic natural limb movement and user intent.

Physical prosthetics are designed to restore normal function to missing parts of the body. The rehabilitation of amputees is mainly coordinated by physical therapists, as part of an interdisciplinary team composed of physical therapists, prosthetists, nurses, physical therapists, and occupational therapists.  Prosthetics can be created manually or using computer-aided design (CAD), which is a software interface that helps creators use computer-generated 2D and 3D graphics and analysis and optimization tools to design and analyze. 

4.SENSORY PROSTHETICS

Sensory prosthetics, such as the retina and cochlear implants, to restore some lost functions, provide navigation and communication, increase independence, and integrate into the community.

5.BRAIN COMPUTER INTERFACES

The brain-computer interface allows people with severe disabilities to communicate and obtain information. These technologies use electrical impulses from the brain to enable people to move the cursor of a computer or robotic arm so that they can touch and grab objects or send text messages.

The brain-machine interface (BMI) is a system that records, decodes, and finally converts brain signals into effector actions or behaviours, which do not necessarily involve the movement system. In the past 20 years, more and more BMI systems have been developed for communication, control and rehabilitation of different types of equipment.

6.MODULATION OF ORGAN FUNCTION

As an intervention for urinary incontinence and fecal incontinence and sexual dysfunction. Recent advances in neuromodulation of the peripheral nervous system are expected to address organ function in the event of a spinal cord injury.