BIOMEDICAL REPORT

Malabar Institute Of Medical Sciences Ltd Kottakkal

Submitted by JAMSHEED ALI.P

AFEESUDDEEN.N BIOMEDICAL ENGINEERING

Biomedical Engineering is the application of engineering principles and techniques to the medical field. It combines the design and problem solving skills of engineering with medical and biological sciences to improve health care diagnosis and treatment.

X-ray

X-radiation (composed of X-rays) is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (31016 Hz to 31019 Hz) and energies in the range 100 eV to 100 keV. They are shorter in wavelength than UV rays and longer than gamma rays. In many languages, X-radiation is called Rntgen radiation, after Wilhelm Rntgen,[1] who is usually credited as its discoverer, and who had named it X-radiation to signify an unknown type of radiation.[2] Correct spelling of X-ray(s) in the English language includes the variants x-ray(s) and X ray(s).[3]

X-rays up to about 10 keV (10 to 0.10 nm wavelength) are classified as "soft" X-rays, and from about 10 to greater than 120 keV (0.10 to 0.01 nm wavelength) as "hard" X-rays, due to their penetrating abilities.[4] Hard X-rays can penetrate some solids and liquids, and all uncompressed gases, and their most common use is to image the inside of objects in diagnostic radiography and crystallography. As a result, the term X-ray is metonymically used to refer to a radiographic image produced using this method, in addition to the method itself. By contrast, soft X-rays hardly penetrate matter at all; the attenuation length of 600 eV (~2 nm) X-rays in water is less than 1 micrometer.[5] The distinction between X-rays and gamma rays is somewhat arbitrary. The most frequent method of distinguishing between X- and gamma radiation is the basis of wavelength, with radiation shorter than some arbitrary wavelength, such as 1011 m, defined as gamma rays.[6] The electromagnetic radiation emitted by X-ray tubes generally has a longer wavelength than the radiation emitted by radioactive nuclei.[7] Historically, therefore, an alternative means of distinguishing between the two types of radiation has been by their origin: X-rays are emitted by electrons outside the nucleus, while gamma rays are emitted by the nucleus.[7][8][9][10] There is overlap between the wavelength bands of photons emitted by electrons outside the nucleus, and photons emitted by the nucleus. Like all electromagnetic radiation, the properties of Xrays (or gamma rays) depend only on their wavelength and polarization (or, in a polychromatic beam, the distributions of wavelength and polarization).

Computed Tomography

X-ray computed tomography, also computed tomography (CT scan) or computed axial tomography (CAT scan), is a medical imaging procedure that utilizes computer-processed X-rays to produce tomographic images or 'slices' of specific areas of the body. These crosssectional images are used for diagnostic and therapeutic purposes in various medical disciplines.[1] Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.[2] CT produces a volume of data that can be manipulated, through a process known as "windowing", in order to demonstrate various bodily structures based on their ability to block the X-ray beam. Although historically the images generated were in the axial or transverse plane,

perpendicular to the long axis of the body, modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in medicine, CT is also used in other fields, such as nondestructive materials testing. Another example is archaeological uses such as imaging the contents of sarcophagi. Usage of CT has increased dramatically over the last two decades in many countries.[3] An estimated 72 million scans were performed in the United States in 2007.[4] It is estimated that 0.4% of current cancers in the United States are due to CTs performed in the past and that this may increase to as high as 1.5-2% with 2007 rates of CT usage;[5] however, this estimate is disputed.[6] Kidney problems following intravenous contrast agents may also be a concern in some types of studies.

Computed tomography of human brain, from base of the skull to top. Taken with intravenous contrast medium.

Patient Monitor

In medicine, monitoring is the observation of a disease, condition or one or several medical parameters over time. It can be performed by continuously measuring certain parameters by using a medical monitor (for example, by continuously measuring vital signs by a bedside monitor), and/or by repeatedly performing medical tests (such as blood glucose monitoring with a glucose meter in people with diabetes mellitus). Transmitting data from a monitor to a distant monitoring station is known as telemetry or biotelemetry. Vital parameters

Monitoring of vital parameters can include several of the ones mentioned above, and most commonly include at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in critical care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient. Some monitors can even warn of pending fatal cardiac conditions before visible signs are noticeable to clinical staff, such as atrial fibrillation or premature ventricular contraction (PVC).

Defibrillatior

Defibrillation is a common treatment for life-threatening cardiac dysrhythmias, ventricular fibrillation, and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. This depolarizes a critical mass of the heart muscle,

terminates the dysrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart. Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little, or in some

cases no training at all. View of defibrillator electrode position and placement.

A circuit diagram showing the simplest (non-electronically controlled) defibrillator design, depending on the inductor (damping), producing a Lown, Edmark or Gurvich Waveform

Electrocardiography

Electrocardiography (ECG or EKG from the German Elektrokardiogramm) is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body.[1] The recording produced by this noninvasive procedure is termed as electrocardiogram (also ECG or EKG). An ECG test records the electrical activity of the heart. ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker. See also stress test and Holter monitor (24h). Most ECGs are performed for diagnostic or research purposes on human hearts, but may also be performed on animals, usually for diagnosis of heart abnormalities or research.An ECG is the best way to measure and diagnose abnormal rhythms of the heart,[2] particularly abnormal

rhythms caused by damage to the conductive tissue that carries electrical signals, or abnormal rhythms caused by electrolyte imbalances.[3] In a myocardial infarction (MI), the ECG can identify if the heart muscle has been damaged in specific areas, though not all areas of the heart are covered.[4] The ECG cannot reliably measure the pumping ability of the heart, for which ultrasound-based (echocardiography) or nuclear medicine tests are used. It is possible for a human or other animal to be in cardiac arrest, but still have a normal ECG signal (a condition known as pulseless electrical activity). The ECG device detects and amplifies the tiny electrical changes on the skin that are caused when the heart muscle depolarizes during each heartbeat. At rest, each heart muscle cell has a negative charge, called the membrane potential, across its cell membrane. Decreasing this negative charge towards zero, via the influx of the positive cations, Na+ and Ca++, is called depolarization, which activates the mechanisms in the cell that cause it to contract. During each heartbeat, a healthy heart will have an orderly progression of a wave of depolarisation that is triggered by the cells in the sinoatrial node, spreads out through the atrium, passes through the atrioventracular node and then spreads all over the ventricles. This is detected as tiny rises and falls in the voltage between two electrodes placed either side of the heart which is displayed as a wavy line either on a screen or on paper. This display indicates the overall rhythm of the heart and weaknesses in different parts of the heart muscle. Usually, more than two electrodes are used, and they can be combined into a number of pairs (For example: left arm (LA), right arm (RA) and left leg (LL) electrodes form the three pairs LA+RA, LA+LL, and RA+LL). The output from each pair is known as a lead. Each lead looks at the heart from a different angle. Different types of EKGs can be referred to by the number of leads that are recorded, for example 3-lead, 5-lead or 12-lead ECGs (sometimes simply "a 12-lead"). A 12-lead EKG is one in which 12 different electrical signals are recorded at approximately the same time and will often be used as a one-off

recording of an ECG, traditionally printed out as a paper copy. Threeand 5-lead ECGs tend to be monitored continuously and viewed only on the screen of an appropriate monitoring device, for example during an operation or whilst being transported in an ambulance. There may or may not be any permanent record of a 3- or 5-lead ECG, depending on the equipment used.

Image showing a patient connected to the 10 electrodes necessary for a 12-lead ECG

Syringe Pump

A syringe driver or syringe pump is a small infusion pump (some include infuse and withdraw capability), used to gradually administer small amounts of fluid (with or without medication) to a patient or for use in chemical and biomedical research. The most popular use of syringe drivers is in palliative care, to continuously administer analgesics (painkillers), antiemetics (medication to suppress nausea and vomiting) and other drugs. This prevents periods during which medication levels in the blood are too high or too low, and avoids the use of multiple tablets (especially in people who have difficulty swallowing). As the medication is administered subcutaneously, the area for administration is practically limitless, although edema may interfere with the action of some drugs. Syringe drivers are also useful for delivering IV medications over several minutes. In the case of a medication which should be slowly pushed in over the course of several minutes, this device saves staff time and reduces errors. Syringe pumps are also useful in microfluidic applications, such as microreactor design and testing, and also in chemistry for slow

incorporation of a fixed volume of fluid into a solution. In enzyme kinetics syringe drivers can be used to observe rapid kinetics as part of a stopped flow apparatus.[1]

Infusion Pump

An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used. Infusion pumps can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. For example, they can administer as little as 0.1 mL per hour injections (too small for a drip), injections every minute, injections with repeated boluses requested by the patient, up to maximum number per hour (e.g. in patient-controlled analgesia), or fluids whose volumes vary by the time of day. Because they can also produce quite high but controlled pressures, they can inject controlled amounts of fluids subcutaneously (beneath the

skin), or epidurally (just within the surface of the central nervous system- a very popular local spinal anesthesia for childbirth)

Anaesthetic Machine

he anaesthetic machine or anesthesia machine is used by anaesthesiologists, nurse anaesthetists, and anaesthesiologist assistants to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuousflow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices. The original concept of Boyle's machine was invented by the British anaesthetist Henry Boyle (18751941) in 1917. Prior to this time, anaesthetists often carried all their equipment with them, but the development of heavy, bulky cylinder storage and increasingly elaborate airway equipment meant that this was no longer practical for most circumstances. The anaesthetic machine is usually mounted on antistatic wheels for convenient transportation.

Simpler anaesthetic apparatus may be used in special circumstances, such as the TriService Apparatus, a simplified anaesthesia delivery system invented for the British armed forces, which is light and portable and may be used effectively even when no medical gases are available. This device has unidirectional valves which suck in ambient air which can be enriched with oxygen from a cylinder, with the help of a set of bellows. A large number of draw-over type of anaesthesia devices are still in use in India for administering an air-ether mixture to the patient, which can be enriched with oxygen. But the advent of the cautery has sounded the death knell to this device, due to the explosion hazard. Many of the early innovations in U.S. anaesthetic equipment, including the closed circuit carbon-dioxide absorber (aka: the Guedel-Foregger Midget) and diffusion of such equipment to anaesthetists within the United States can be attributed to Richard von Foregger and The Foregger Company. In dentistry a simplified version of the anaesthetic machine, without a ventilator or anaesthetic vaporiser, is referred to as a relative analgesia machine. By using this machine, the dentist can administer a mild inhalation sedation with nitrous oxide and oxygen, in order to keep his patient in a conscious state while depressing the feeling of pain.

Ventilator

A medical ventilator (or simply ventilator in context) is a machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently. While modern ventilators are computerized machines, patients can be ventilated with a bag valve mask, a simple hand-operated machine. After Hurricane Katrina, dedicated staff "bagged" patients in New Orleans hospitals for days with simple bag valve units attached to endotracheal tubes, a "ventilator" system which can be used with no definite time limit. Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine). Medical ventilators are sometimes coloquially called "respirators," a term which stems from commonly used devices in the 1950's (particularly the "Bird Respirator"). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of "respirator" in this context is now a deprecated anachronism which signals technical unfamiliarity.In its simplest form, a modern

positive pressure ventilator consists of a compressible air reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable "patient circuit". The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When overpressure is released, the patient will exhale passively due to the lungs' elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold. The oxygen content of the inspired gas can be set from 21 percent (ambient air) to 100 percent (pure oxygen). Pressure and flow characteristics can be set mechanically or electronically. Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled turbopump. Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient's needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada, and the United States, respiratory therapists are responsible for tuning these settings while biomedical technologists are responsible for the maintenance. The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive. Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require intubation, which for long-term ventilator

dependence will normally be a tracheotomy cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Ultrasound

Ultrasound is a cyclic sound pressure wave with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" (audible) sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is approximately 20 kilohertz (20,000 hertz) in healthy, young adults. The production of ultrasound is used in many different fields, typically to penetrate a medium and measure the reflection signature or supply focused energy. The reflection signature can reveal details about the inner structure of the medium, a property also used by animals such as bats for hunting. The most well known application of ultrasound is its use in sonography to produce pictures of

fetuses in the human womb. There are a vast number of other applications as well.[1]

A fetus in its mother's womb, viewed in a sonogram (brightness scan)

Diathermy

In the natural sciences, the term diathermy means "electrically induced heat" and is commonly used for muscle relaxation. It is also a method of heating tissue electromagnetically or ultrasonically for therapeutic purposes in medicine. Surgical diathermy is usually better known as "electrosurgery." (It is also referred to occasionally as "electrocautery", but see

disambiguation below). Electrosurgery and surgical diathermy involve the use of high frequency A.C. electrical current in surgery as either a cutting modality, or else to cauterize small blood vessels to stop bleeding. This technique induces localized tissue burning and damage, the zone of which is controlled by the frequency and power of the device. Some sources[1] insist that electrosurgery be applied to surgery accomplished by high frequency A.C. cutting, and that "electrocautery" be used only for the practice of cauterization with heated nichrome wires powered by D.C. current, as in the handheld battery-operated portable cautery tools.

Autoclave

An autoclave is a device used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 C for around 1520 minutes depending on the size of the load and the contents.[1] It was invented by Charles Chamberland in 1879,[2] although a precursor known as the steam digester was created by Denis Papin in 1679.[3] The name comes from Greek auto-, ultimately meaning self, and Latin clavis meaning keya self-locking device.[4]

Autoclaves are widely used in microbiology, medicine, tattooing, body piercing, veterinary science, mycology, dentistry, chiropody and prosthetics fabrication. They vary in size and function depending on the media to be sterilized. Typical loads include laboratory glassware, surgical instruments, medical waste, patient pair utensils, animal cage bedding, and lysogeny broth.[5] A notable growing application of autoclaves is the pre-disposal treatment and sterilization of waste material, such as pathogenic hospital waste. Machines in this category largely operate under the same principles as conventional autoclaves in that they are able to neutralize potentially infectious agents by utilizing pressurized steam and superheated water. A new generation of waste converters is capable of achieving the same effect without a pressure vessel to sterilize culture media, rubber material, gowns, dressing, gloves, etc. It is particularly useful for materials which cannot withstand the higher temperature of a hot air oven. Autoclaves are also widely used to cure composites and in the vulcanization of rubber. The high heat and pressure that autoclaves allow help to ensure that the best possible physical properties are repeatably attainable. The aerospace industry and sparmakers (for sailboats in particular) have autoclaves well over 50 feet long, some over 10 feet wide.

Dialysis

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane. Diffusion describes a property of substances in water. Substances in water tend to move from an area of high concentration to an area of low concentration.[6] Blood flows by one side of a semi-permeable membrane, and a dialysate, or special 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.[6] The two main types of dialysis, hemodialysis and Peritoneal dialysis, remove wastes and excess water from the blood in different ways.[2]

Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of the blood and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and creatinine 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 peritoneal membrane of 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 which has a composition similar to the fluid portion of blood.

Heart Lung Machine

During an open-heart surgery (such as valve surgery), the heart-lung machine takes over the functions of the heart and lungs so that the heart can be carefully stopped. The surgeon can then operate in a blood-free surgical field. The heart-lung machine basically consists of a pump (to replace the heart) and an oxygenator (to replace the lungs). Acting as a mechanical heart and lungs, it keeps oxygen-rich blood flowing throughout the body after the patient's heart has been carefully stopped. In a process called perfusion , the machine receives the patient's blood, removes the carbon dioxide and other waste products, adds oxygen, warms (or cools) the blood and pumps it back through the body. Cooling the blood, in turn, lowers body temperature. This helps protect the body's organs while the heart-lung machine is in use. After the surgery is completed, the heart is restarted, the heartlung machine is stopped and the machine is disconnected from the patient.

The heart-lung machine can perform other tasks. For example, it can directly deliver medications into the recirculated blood. It can also minimize blood loss by vacuuming up and recirculating any blood that may get into the surgical field.

Endoscopy

An endoscopy involves examining the inside of a person's body using an endoscope. An endoscope is a medical device consisting of a long, thin, flexible (or rigid) tube which has a light and a video camera. Images of the inside of the patient's body can be seen on a screen. The whole endoscopy is recorded so that doctors can check it again. Endoscopy is a minimally invasive diagnostic medical procedure. It is used to examine the interior surfaces of an organ or tissue. The endoscope can also be used for enabling biopsies and retrieving foreign objects. Endoscopy is a noninvasive alternative to surgery for foreign object removal from the gastrointestinal tract.