Report on Hospital Training

By G.Santhosh BE (Biomedical Engg.), SSN College of Engineering, Chennai

From 20th to 26th June, 2012 At Chettinad Health City, Chennai

Bonafide
This is to certify that G.Santhosh (31510121041) has undergone hospital training at Chettinad hospitals and Research centre from 20th to 26th of June,2012 and has submitted a report on the same.

HOD, BME Chettinad Health City

Dean Chettinad Health City

Table of Contents
1. Objective of the training 2. Departments a) Cardiology b) Nephrology c) Neurology d) Clinical Labs e) ENT f) CSSD g) Blood Bank h) Physiotherapy & Dermatology i) ICU j) Radiology k) Dental & Ceramic Lab l) Gas Plant m) Operation Theatre 3. Acknowledgement

Objective of the Training

As a student of Bio-Medical Engineering, it is essential for me to get a practical first-hand look at different diagnostic, therapeutic and life-support equipments used in hospitals. Also, it is essential to know about the operation and handling of the instruments. This training also gave me some inspiration to bring more development in some machines of the bygone era in a more cheap and indigenous manner. Moreover, details about different manufacturers and instrument models were also made known which helped me in understanding the business end of things well. This has been a very useful and interactive type of learning in which i learned a lot of new medical phenomena due to the different case-studies as well. I hereby present this Report on the different equipments used and the working principle behind them.

- G.Santhosh BE (Biomedical Engg.) SSNCE

Departments & Equipments

1. CardiologyThis is a very integral and important department in almost every hospital. It usually deals with the study of circulatory system, especially the heart. The heart is a vital cog in our body machine and performs the function of pumping blood to all parts of the body. This department consists of diagnostic and therapeutic equipments as given below.

A) ElectrocardiogramIt is a very important diagnostic tool, probably the most widely used in this field. It measures the electrical activity of the heart using electrodes and plots the voltage across time. The machine used here is a GE Marquette MAV which is a single-channel portable machine. It consists of a lead junction, LED monitor, control panel and a printer. The 10 electrodes which consist of 6 suction cup precordial chest and 4 metal limb electrodes form the 12 leads used internationally. These electrodes transmit the electrical signals to the machine which amplifies the signals and displays using the LCD monitor. The internal amplifier, time base oscillator and filters are all adjustable according to our requirement. The data can also be printed on special ECG paper on which the wave is plotted using an inbuilt XY plotter. When the electrodes are fixed, a gel is used to improve the interface and reduce motion artifacts. The machine comes with a battery back-up and also a right-leg driven isolation to prevent electrocution.

Another technique used is the Treadmill ECG where a special treadmill whose speed and slope increases every 3 minutes is used. This is used when stressed heart studies is required and uses different type of pre gelled flexible adhesive electrodes so that better signal is obtained. Although lot of pathogenesis can be done by ECG, the anatomical study of heart cannot be done and so the particular spot of damage or blocks cannot be identified.

B) EchocardiogramIt is a special type of ultrasound scanning which is done on the heart and its valves to sense any blocks, damage or even leakages. The machine used here is GE which uses an ultrasound probe which consists of a trans-receiver and transmits the received echo in the form of electrical signals. These signals then are used to produce images based on the brightness or B-scan. The intensity and frequency can be adjusted. An additional Doppler shift indicator is used to identify blocks and leakages. Also the flow of blood towards and away from the probe is indicated. The beam can be given in a pulsed mode to identify point defects. Another improvement is the introduction of the Trans-esophageal Echo where an invasive probe with similar ultrasound transducer is employed inside the esophagus so that more accurate images are obtained.

C) ECG HolsterIt is an improved and very portable machine used to record continuous ECG in very chronic patients. It consists of only 5 chest electrodes and an integrated display/storage device which uses digital microprocessor which controls the amplification and filtering the signals.

D) SpygmocorIt is the latest and very accurate measurement of the Aortic pressure in a non-invasive way. It follows the principle of difference in the absorbance of light by blood and uses a single-piece optical transducer with a LED display to display the pressure value and curve.

E) DefibrillatorsIt is a very important life-saving device used to re-activate the heart after defibrillation. It uses electric pulses ranging from 2 to 14 kJ power to restore the hearts function. The current is transferred through paddles which are in 2 different sizes for adults and pediatrics and ECG leads are also connected. The machine consists of an auto-transformer and amplifiers. It has an AED (automatic external defibrillation) mode which automatically delivers pulses based on the abnormalities in the ECG wave obtained. A gel is used to improve the interface as well as to prevent burns to the skin.

F) EECPEnhanced external counter-pulsation is a non-invasive therapy used for treating heart diseases, primarily coronary artery blocks. It uses pressure cuffs around the legs and buttocks through which air is pumped so as to pump the blood in an opposite direction (collateral circulation) so as to enhance the development of new vascular pathways. The Vasomedical EECP machine uses a microprocessor controlled pump to apply the pressure in between each pulse which is determined by the ECG of the patient. The pressure applied is 250 to 300 bar. This is used for patients on who bypass or angioplasty cannot be performed due to fatigue.

G) PacemakersThese are small compact machines used to give periodic electrical impulses so as to help the heart pump the blood periodically. These machines are battery operated and consist of a small electrode through which the electrical pulses are given. The pulses are timed according to a programmed timer which synchronizes it with the persons heart beat.

2. Nephrology- (Dialyzer)
This is the department which deals with the kidney and the problems associated with it. It primarily consists of important equipment called the dialyzer. Its function is to filter the blood and provide the required electrolytes and maintain the pH. It consists of a motor which controls the flow of blood between the machine and body. There are also additional pumps for transporting electrolyte and bicarbonate solution. There is a mixing tube where all these are mixed after the blood is passed through a series of micro-filters. Also, a small amount of Heparin is added so that blood doesnt coagulate. The most important is a light sensor which senses the presence of solids and coagulation by differing transmittance. There is also a leakage sensor which stops the motor immediately. The control panel is very important as it helps in controlling the amount of electrolytes, pH and pressure of blood. It also gives alarms in case of abnormal pressure or coagulation. The machine used is Siemens There is also separate primer for cleaning the machine after every patient use. The mixing tube is to be replaced for each patient and can be used after cleaning with another special washer which automatically cleans the tube by Formalin.

3. NeurologyThis department deals with studies of the brain and neural activities. It primarily aims at understanding the working as well as the pathogenesis of the brain. It consists of primarily only diagnostic equipments while therapy currently is only surgical procedure or drugs.

A) ElectroencephalogramIt involves the study of electrical activity of the brain. It is done by the use of surface electrodes on the scalp and is a very sensitive process. The instrument consists of an electrode junction which amplifies and filters the signals which are displayed on a computer screen after being produced by an ADC. The machine, RMS 3000X uses the same software. The additional equipment includes a photo stimulating light to study the optical pathway. For more accurate results, a cap with gel filled electrodes is used and is available in 3 different sizes. The electrode impedance matching is automatic and proper grounding is very essential. There is also a Video EEG facility used for Epilepsy and sleep apnea studies. Here, the patient is connected with EEG throughout the day along with continuous video coverage and respiration rate measurement. This is done for pathogenesis of the type of Epilepsy and the different physical effects. Methods like sleep deprivation and hyper-ventilation are used to induce epilepsy.

B) ElectromyogramIt is the study of muscle activity and nerve conduction rate with and without simulation. The machine used is RMS 250MX and uses electro-simulator for simulating different muscles. The simulation used is proximal and distal to identify the blocks in neural pathways and degenerative muscle masses. The needle electrodes are used in measurement of the potentials. Also audio and

visual pathway testing are done by using light and auditory stimuli. The response is measured from the Occipital lobe where these pathways are present. The different disorders are given here = Myopathy which is the muscle degeneration resulting in numbness and slow response. This is identified by measurement of muscle action potential during movement. Neuropathy which is nerve degeneration and is identified by external simulation and the resultant response time. Auditory failure by measuring the potential at ear lobe after giving auditory stimulus. Pathogenesis and type of blindness by measuring Occipital lobe potential after giving changing visual stimulus. The earthing and filtering is very essential as the measurement is very sensitive and even slightly charged cloth can influence the measurements.

4. Clinical LabThis is an integral part of every hospital and clinic all over the world. It deals with the microbiologic, pathologic, biochemical and immunological studies of body samples. It is the essential step where most of the diseases are identified and even effects of different drugs are studied.

A) IncubatorIt is a storage device used in all the labs to maintain the samples at optimum temperature (35-38o C) so that the metabolism stays intact. Also a certain amount of humidity is maintained so that the life can be extended. This usually consists of an air-tight chamber to avoid contamination with a thermostat and heat field to maintain the temperature and humidity. The samples are usually stored in test tubes or as culture media plates. The life of samples ranges to 2 days in this. The other type is a BOD incubator which is used to store fungal samples. The temperature here is 20-27o C as this the optimum growth value for fungi. Moreover the continuous supply of oxygen is essential due to high biochemical demand. The fungi are grown in cotton-plugged test tubes and identified by color such as black (Aspergillum) and pink (Mucae). The medium is potato based agar and life ranges to 1 day in this.

B) BactecIt is a special type of bacteria growth detector. It does it with the principle of light scattering based on amount of growth. Each test tube here is filled with a media and labeled with a special chemical at the base to allow transmission of specific wavelength of light. The structure consists of a vertical stand where the 60-80

samples are arranged in circular fashion. This stand rotates every few minutes to avoid sedimentation and promote growth. There is a light source and receiver behind each test tube and the value of bacterial growth is determined and recorded by the equipment to produce a print-out. The instrument is to be calibrated every 6 months for accuracy.

C) AutoclaveIt is a type of sterilization equipment used to prepare culture media and sterilize test tubes by passing steam. The temperature is 121oC and pressure at 15 lb/in2. The media plates are to be packed in plastic covers and kept for 30 minutes when the chamber is sealed. The instrument made of steel consists of a steam jacket which releases the steam by heating water under pressure. There is also an emergency steam release vent to reduce pressure.

D) Hot Air OvenIt is another sterilization unit for dry sterilization of metal equipment and other plastic cuvettes. It is used at a temperature of 180oC for 30 min while I hour for 160oC. The equipment consists of an air-sealed chamber with a thermostat and suction to clean the air.

E) Blood Gas AnalyzerAlso called as ABG (arterial blood gas) analyzer, it is a vital instrument which measures the pH, pCO2, pO2 and concentrations of sodium, potassium, calcium and chloride ions in the blood. The amount of blood to be given is just 500UL to 1mL and the different values are estimated by the different electrodes used such as Sanz, Clark, etc. There are also different buffers and a cleaning hypochlorite to clean the electrodes after every use.

All electrodes work on a basic principle of diffusion gradient resulting in transfer of ions and creation of potential difference. This is converted to concentration and displayed. This machine also needs to be calibrated for accurate results.

F) Auto-analyzerThis is the most advanced and efficient instrument used in clinical biochemistry. It is completely automated from start to finish and can perform up to 40 different tests for 250 samples in 15-30 minutes. The following steps are performed inside the MERCK machine = The samples are loaded onto the given slots in the input belt in test tubes which are bar coded. The bar code contains all information regarding the test to be done and the sample details which is read by the code reader. The reagents for all tests are loaded into the reagent belt from which the required reagents are taken with a mechanical reagent arm. The cuvettes are formed by the machine automatically from the plastic film extruded from the cartridge. The reagents and samples are added by the respective arms from the belts which are rotated by use of stepper motors and are mixed by the sampler arm itself. The UV/light is produced by the sources and the wavelength is selected by diffraction grating. This is passed through the sample and a colorimeter is used to measure the absorbance and thus the concentration. The cuvettes are then automatically disposed and the readings are given. Another type of auto-analyzer which is used for enzyme estimation uses the chemi-luminescence principle to quantify the enzyme. Here the cuvette is coated

with the antibody and the sample with a marker is allowed to bind. Then the reagent is added to produce a color by chemical reaction whose intensity estimates the amount of enzyme.

G) ELISA Reader & WasherThis is an important immunological technique which is used to identify different diseases like HIV-AIDS, Hepatitis, etc. It works on the principle of absorbance of different antibodies on complement antigens. The complements are linked by an enzyme so that their antibodies can in turn be used to form color by chemical reaction. The intensity of the color determines the absorbance of light and can be used to find the presence of different antigens in blood. A row of wells is used to load the samples and the reagents. Then after the reaction occurs, a washer is used where the no. of wash cycles and amount of soaking time can be set. Then after drying, the comb is kept in an ELISA reader which measures absorbance by using a light source and photo-receiver. The source and the receiver moves from well to well and records the readings and converts the absorbance to concentration which can indicate presence or absence of the pathogen. Nowadays, even automatic machines like Siemens ELIS 90 are used which performs every step from loading the samples to reading automatically using the 3 mechanical arms for loading, washing and recording absorbance.

5. ENTThis is a very important department which deals with the auditory and respiratory systems. It primarily consists of diagnostic and some therapeutic equipment. The main aspect of this department is the cleanliness to be maintained as it may affect the patient.

A) EndoscopyIt is a dual-use instrument used for both diagnosis and therapy of disorders in throat and bronchi. It consists of a flexible thick tube whose body is made up of optical fibers, water tube and flexible motors to change direction. The head of the scope consists of a camera lens, light, water outlet and another port to insert forceps or knife to take samples. The tube is 2-3 cm thick and is inserted through the nasal cavity. The tube is cleaned by Sidex for 30 minutes. This can also be used for other parts of body like Bronchoscopy Colonoscopy Gastroscopy Reticuloscopy Uroscopy, etc.

B) SpirometryIt is the measurement of lung volumes and capacities to identify irregularities in the lungs. The electronic spirometer consists of a turbine attached to an odometer which measures amount of air by revolutions of turbine o air being blown. There also exists another model which plots a graph as the flow is

measured by a flow pressure transducer such as bellows. It can measure all types of capacities and breathing rate except residual capacity.

C) Helium DilutionIt is a technique which is used to find residual volume by injecting helium along with normal air so that it can be used to identify the resultant pressure that indirectly gives the residual volume of lung. This technique is to be performed under special care as excessive helium can cause respiratory problems.

D) AudiometryIt is a test carried out to check the hearing ability of patients. It is done by giving beeps of varying frequencies and intensities to check the hearing. The patient is given a switch to indicate whether sound is heard. The type of hearing loss can also be identified by the frequency to hearing curve. The instrument also provides a dual purpose for speech therapy where it is used for simulation.

E) Lung PlethysmographyIt is a technique used to measure the lung volume and pressure by using the concept of plethysmography where IR is used to find difference in the pressure. A light source and photo-detector to measure difference in absorbance with changing air flow and pressure. The patient is asked to breathe through a spirometer while this process also takes place simultaneously so that more accurate and efficient results are obtained.

6. CSSDThe Central Sterile Service Department is a very important arm of every hospital as it provides sterile instrument and water to all departments of the hospital. Modern techniques are used for sterilization in a more accurate and quicker way.

A) AutoclaveIt is used for steam/wet sterilization of materials like linen, articles, dressings, etc. It uses only RO water and up to a temperature of 121oC. The pressure of external jacket is 15-20 pounds while in chamber, it is 15-20 kg/cm2. Each cycle lasts for about 1 hour where the following occur Fast vacuum to remove air Sterilization for 30 minutes Fast exhaust of water for 10 minutes Vacuum dry to remove steam for 20 minutes Indicators are used to identify problems with sterilization which are either chemical or biological and are identified by color changes and death of bacteria respectively. The different manufacturers are Reliance & Ossler and both have safety valves and steam exhausts for protection. The autoclaves are of single and double door types where 1 door is unsterile and other is sterile. Sometimes the steam is centrally supplied by boiler or by heaters attached to the autoclaves. All articles are covered by cloth so that tarnishing and damage doesnt occur. The expiry ranges to 7 days.

B) Gas SterilizerThis is used to sterilize plastic syringes, catheters, rubber sheets, section tubes, nebulizers, etc by using Ethylene Oxide (Et-O) at 37-60oC. The machine used is a 3M 8XL Sterivacuum and consists of a chamber with a cartridge holder for Et-O. The process of sterilization takes 11-13 hours and consists of the following steps Free-running to initialize for 1 hour Gas exposure/sterilization for 1-3 hours Furage for 1 hour Aeration to remove poisonous Et-O for 8 hours. The articles are usually packed in plastic covers and are sealed to make it air-tight so that Ethylene poisoning doesnt take place. The indicators here are chemical strips which change from green to lemon yellow for proper sterilization. The expiry ranges from 4-6 months.

C) Ultrasound CleaningThis is used for pre-cleaning all articles before steam/gas sterilization. The instrument should be filled with water and the instruments after being kept in a container are lowered in the water. The ultrasonic vibrations are used to heat water to kill any mild pathogens and remove all stains.

D) Flash SterilizationIt is primarily used in operation theaters to do the cleaning in short time. It is a small-scale autoclave which maintains 134oC for 4-7 minutes. The instruments used include surgical knives, forceps and other sewing equipments.

7. Blood BankIt is a separate entity where the collection, screening, storage and separation of constituents of blood are carried out. Modern instrumentation has made these processes faster and more accurate leading to better transfusion results and newer treatments.

A) Donation ChairIt is an adjustable chair which is used to collect the blood from donors. It consists of a hydraulic system to move the chair horizontally and vertically. Also there is an electronic weighing machine which stops the blood collection after 350ml automatically by blocking the flow through syringe. There is also an attachment called the cell separator which can separate only WBCs or platelets depending on pore size of filters in the tube. The remaining blood is again infused back into the patient.

B) Micro ID TypingThe latest automated technique used for blood typing and back-pairing is gel microtyping. Here, small cuvettes are filled with gels and are provided as packets. These are labeled accordingly and then samples and reagents are added in micro-liters by pipettes. The packets are then loaded into an ID centrifuge cum typer which first mixes the samples with reagents by centrifugation at 910rpm and then identifies the type and back-pairing by recording level of colored band in the gel. The machine used is Diamed ID. At one time, 48 samples can be tested for ABO groups, Rh factor and antibody pairing.

C) Cryostorage & BathsThe storage of collected blood is very essential and is done at -40/-80oC for about 1-1.5 years. The constituents need to be separated by 6 days or it can only be used as whole. The fresh frozen plasma is required for treatment of Leukemia and is prepared by cryobath which thaws the frozen plasma to 4oC slowly so that ice crystals dont get formed. The plasma bath is used to obtain ordinary plasma or blood by thawing to 37oC and storing it. The plasma separator is an automatic machine which separates plasma from blood by applying pressure on the lower bag. All these machines are Technopopulus products.

D) Platelet AgitatorThis is used to maintain the stability of platelets by constant agitation to avoid coagulation. It consists of moving plates on which the platelet bottles are kept at a temperature of 40oC.

E) MultifugeIt is a refrigerated centrifuge used to isolate the different constituents like platelets, RBCs, different WBCs, etc from blood. The speed and temperature is adjusted so that different constituents are separated from blood. The plasma separates at 1300rpm at 4oC while RBCs separate at 40oC and 1550rpm. The instrument can also double as an incubator to store blood up to 6 days at ambient temperature. The machine used is GE Marquette 30S.

8. Dermatology & PhysiotherapyThese are 2 important departments which are associated with the rehabilitation of skin, muscular and skeletal systems. The instruments used are exhaustively therapeutic and are mostly used superficially. The only aspect common to all these is requirement for proper grounding as it can pose a dangerous hazard.

A) Shortwave DiathermyIt is a technique which is used to cut and coagulate warts and other growth on skin. It employs high temperature electrodes which produce of high intensity waves which have short wavelengths and high energy. The pointed electrodes are used to cut and incise while the blunter ones are used in coagulation of wounds. The earth plate is held by the patient or attached to the bed. It is also used in treatment of joint pains with very low intensity and 27MHz.

B) UV TherapyAlso called as psolaren UV treatment, it employs use of UV-A (315-400 nm). The instrument consists of a chamber inside which the patient is exposed to the ultraviolet radiations produced by the deuterium lamp. The intensities used are 10mW/cm2 and needs to be applied for 30 minutes every days so that progress is seen. The machine is Dermindia PUVA.

C) MicrodebriderIt is a instrument used to apply skin ointments so that they are directly deposited in the dermis. The instrument consists of a high pressure nozzle which helps in direct deposition of the drug in form of spray/powder into the dermis.

The pressure can be adjusted with requirement so that the effective distribution occurs. The machine used is Dermindia PUVA.

D) Laser TherapyIt is used for treatment of ulcers and also joint pain due to damaged tendons. The lasers width and intensity can be changed according to application. The wavelength used is 640nm for better penetration.

E) Ultrasound TherapyIt is a therapy used in painless and heatless treatment of ulcers and sprains. The quartz crystals are used to produce vibrations of up to 1-3 MHz for deeper and superficial use. The electrode used is a carbon electrode which is kept on the site of damage and vibrations are applied for treatment.

F) ElectrosimulatorIt is used to simulate unused and damaged muscles by applying external currents so that nerve networks are formed at the site. The Galvanic mode is used for muscles without any nerve connection while Faradic is used for weak muscles. The improvement can be adjudged by the nerve conduction studies. The supply to body is limited to 10-15mA so that heating effects doesnt occur.

G) Electronic TractionThis is a modern technique used to provide traction for the pelvic and cervical areas. The belt is attached to a machine which sets the tension, rest time and traction time. The healing is done due to stretching of muscles causing spasms to loosen and the pain gets relieved. The bed is provided with the machine and provides enough movement and flexibility to ensure patient comfort.

9. ICUThe intensive care units in a hospital are very important and are of different types like general, surgical, neonatal and cardiac. The patients have to be under continuous surveillance and need to be given constant medication. The development of automation and central control for all patients care has led to easier and effective catering to all patients.

A) Vital Signs MonitorThis is the most important observation equipment used in the ICU. It has a display where the ECG, blood pressure, respiratory rate, heart rate, SpO2, temperature, etc. The different parameters are also set threshold values above or below which an alarm sounds. The different measurements are done by the following The ECG and heart rate is measured by adhesive chest electrodes. The respiratory rate and SpO2 are measured by finger light

plethysmography. The blood pressure by non-invasive oscillometric pressure sensor or by invasive catheter. The temperature by a thermo-electronic sensor. The safety of the patient is very important and so earthing is very important. An extra aspect of the Siemens Servo 300 is that it has an automatic external defibrillator which gives electric shock to restart the heart in case of attacks.

B) VentilatorIt is very important equipment used to assist critical patients in breathing. It supplies oxygen and air at 400 bar which are mixed in a blender in a 1:2 ratio. The equipment is first tested using a rubber patient bladder. The pressure and volume are controlled according to the modes which such as assist, total control and SIMV. The vent can be invasive (inter-tracheal tube) or non-invasive (mask). The instrument needs to be calibrated every month and the tubes need to be cleaned by passing air or steam. The PEEP and IED values need to be maintained at 5 cm water and 0.5. The instrument consists of an air pump and suction pump to control inhalation and expiration. Apart, it also needs a pressure and volume gauges for adjustment.

C) Syringe PumpsThese are used to administer drugs and other fluids from syringes in a uniform manner according to requirement. The stepper motor controls a pressure pusher according to set volume. The pump also can administer subcutaneously leading to whole body distribution. The pump used here is AKAS and can accommodate all sizes of syringes.

D) Infusion PumpsIt is used to supply drugs, saline and even nutrition fluids in an intravenous manner. It administers the fluid either in an automated or patient-controlled manner. It has a drip indicator which works on light obstruction principle and a peristaltic drive to move the fluid according to required volume and pressure.

E) IncubatorThis equipment, also called as lullaby warmer is used for the care of neonates and provides a safe and sterile environment. The radiant type is usually a portable and battery-operated one which provides just a temperature of 37oC by radiating plates and is used when the baby needs to be transported for scanning or operating. The open core type which is Nelcar gives control for temperature, vacuum suction, SIPAP and phototherapy. There is also a ventilator and vital sign monitor attached to it. The phototherapy used is UV light to treat jaundice.

10.

Radiology-

It is a very important diagnostic section of every hospital. It is a rapidly developing field which is used for internal body imaging by using ionic radiation which penetrates into the body and gives us high-resolution images.

A) X-Ray ImagingThis is the first technique to be used for internal body imaging using the Xrays and is mainly used in the imaging of skeletal system. The X-rays are generated by bombarding an electron beam on the tungsten target to produce mostly heat and only 3% X-rays. An oil bath is used to cool the tube so that power dissipation is reduced and the X-rays are focused using electromagnetic plates. The patient is exposed to the rays with a photo-chemical plate underneath. The film is then developed by chemicals, fixed and dried in the dark room. The bones which are denser and absorb the rays appear white and so fractures and tears are easily seen. Nowadays computerized radiography is used where the films are produced by computers as soon as exposure is done.

B) FluoroscopyIt is a technique where X-rays are coupled with a fluorescent screen camera to get live images on a screen. These images are used for analysis of the internal organs and show the flow of fluid inside the body distinctively. The image intensifier and CCD cameras are used for the continuous image production. This technique is employed for investigations of gastro-intestinal and urinal tracts.

C) Computed TomographyAlso called CT scan, it is a technique of capturing continuous X-ray images of a particular area from all directions in a number of slices. The circular tube

contains a source and detector (2 mm) which are opposite to each other. This is particularly used in angioplasty and bone studies. The machine here is a Philips 6slice machine. The X-rays are emitted and the detector absorbs the transmitted radiation. This is converted into digital data which is processed to get images. The dye injection can be done to bring a contrast to flow of fluids. The imageing can be done in all 360 o by rotating the patient bed. This technique can be enhanced by increasing the number of slices and resolution.

D) MammographyThis is the special imaging of breasts for tumors or cysts which is done by similar X-ray principle. The only difference is the application of extra pressure so that the images are obtained accurately as there is no bone for differentiation. The tumor appears brighter due to the higher absorption.

E) UltrasonographyThis is an exhaustive imaging tool used for mainly abdominal and urological studies. This method uses a surface transducer which produces the ultrasonic waves by piezo-electric crystals. Then, these waves are transmitted into the body and the echo is received. The intensity and time of echo is used to determine the brightness of the spot to form an image. The frequency used is 3.5-20MHz and the obstructive tumors and cysts can easily be differentiated. Also, the development of fetus is studied by this method. The latest addition is the Doppler color coding which involves the use of Doppler frequency shift to indicate the flow of blood towards or away from the probe. The A-scan can also be plotted so that functional attributes can be studied.

F) Magnetic Resonance ImagingAlso called MRI, this advanced imaging technique is used to mainly image soft tissue organs like brain and spine. The instrument consists of a circular tube with 3 coils which are the RF, magnet and echo coils. The patient is also covered with a coil. The magnetic field is produced in the tube which magnetizes the different ions in the tissues and fluids. These orient in a paramagnetic form, producing a magnetic field which is detected by the echo coils in the K-space which is converted to digital data. This data is then processed to form images. The flow of fluids can be used to differentiate the blood vessels and nerves by special filters. There is no necessity for any dye injections. The magnetic and RF cols are constantly pumped with Helium gas to maintain the magnetism.

G) OrthopantomographyThis technique is used in the imaging of the oral cavity and the jaws. The Planmaca machine uses voltages up to 80kV and can take a 360o image of the jaws. The different damage to teeth and jaw nerves can be identified. The machine consists of a source and film on opposite sides which rotate around the patient to take the image by X-rays transmission.

11.

Dental and Ceramic Lab-

This is a special department which is associated with dental treatments and process of manufacturing dentures. The process of dental treatment is very sensitive and requires precision instruments which are bio-compatible.

A) Dental ChairThis is a special chair designed for more head inclination to enable easier treatment angle for the dentist. The elevation and slope can be adjusted by hydraulic gear system. The following tools are used in the treatment Vacuum suction is used to remove overlying water and dust. Ultrascaler is a fast rotating cutter made from tungsten carbide and is used to remove plaque and other stains. Microtere piece is slower rotating cutter used in root canal treatment and consists of several types of burrs and tips used for different applications. Washers which employ high speed water and air to wash off medication. Curing light to restore the original state of teeth after applying of filling cement.

B) Ceramic Lab Powder Dispenser and Vibrator are used to convert ceramic blocks to powder before cutting and casting is done. The vibrations help in drying and dispersal of the powder. It also fills the pores in dentures. Acrylizer is used to heat the ceramic to 47oC so that it gets tempered enough for cutting. Pindex and Die Cutter are used to drill holes and trim the dentures to the measured size.

 Muffle Furnace and Sand Blaster are used to prepare metal dentures by coating with alumina gel and layering the metal on it. Lathe is used for shaping (high speed) and angling (low speed). Electro-Polisher is used to polish the finished dentures.

12.

Gas PlantThis is an integral part of the hospital from which the central supply of

oxygen, nitrous oxide and vacuum suction are provided. The oxygen cylinders are white and N2O are blue. The capacity is 7 m3 and they are transmitted at a pressure of 400 bar. The O2 is used in all the areas for ventilation while N2O is used as an anesthetic. The dry nitrogen is also sent at 700 bar for bone drilling and cutting in orthopedic surgeries. The air compressors are used to supply purified medical air from atmospheric air and the filters used are Al gel and carbon. The different types of cylinders are A used as standby option in OTs B used for portable applications D used in central supply The liquid oxygen (-180oC) is also used to transmit oxygen by conversion to liquid using a pressure tank. The equipment and cylinders used are INOX Medigas.

13.

Operating TheatresThese are the very important parts of the hospital where all surgical

procedures are performed. These are of different types such as general, cardiology, neurology, orthopedic and CATH labs. All theatres must be equipped with automatic sliding doors, acrylic walls, vinyl floors, laminar air flows in all walls and UPS controlled power supply. All operating theatres also consist of an OT pendant and switch board to control and connect all power, gas, communication and lighting supplies. All equipments should be sterilized and calibrated periodically. The theatre is also maintained at a certain temperature and pressure.

A) Operating Table and LightsThese are essential parts of all OTs and are mandatory. The table has linear and vertical position adjustments which are remote-controlled. The lights used are Sim LED 5000/7000 and have controls for intensity, focus and direction. The table is usually kept in the centre so that easier access and more air are available.

B) Anesthesia MachineThis is mandatory equipment used to provide sedation to the patient and also to provide respiration control. It consists of 2 units which are the Boyles and the ventilator. The Boyles machine is used to provide the anesthetic along with the air and oxygen. It consists of different flowmeter which are used to set the amounts of air, oxygen and nitrous oxide to be supplied. There are also 2 sets of pressure gauges to indicate central and cylinder pressures of all gases. The washout is used

to remove air and N2O from the tubes and there is also emergency oxygen supply. An important safety is that plain nitrous oxide is not released unless the oxygen is supplied. The vaporizer is used to control and vaporize the anesthetics mixture with the air-oxygen-N2O mixture. The ventilator performs the action of providing ventilation control by bellows. The pressure, flow rate and SPO2 are set according to patient requirement. The CO2 absorber is used to recycle the carbon-di-oxide and there is also a manual ventilation option using air bags. The machine used is L&T EV 500 and Elite 615.

C) Heart-Lung MachineThis is primarily used in the cardiac open heart surgeries. It provides artificial circulation and respiration when the surgeries are performed. The 2 primary functional parts are the pump and the oxygenator. This pump out the oxygen deprived blood from the body and oxygenates it. The 2 types of pumps are centrifugal and peristaltic which perform pulling and pushing of the blood. The membrane oxygenator removes CO2 and refills the blood with O2. There is also a separate system to inject a fluid to cause cardioplegia and keep the heart tissues alive. The machine must always be primed before use and anti-coagulants must be added to prevent mass clotting.

D) C-ArmIt is a special imaging device used to image the heart while performing catheter surgeries and also for ophthalmological surgeries. It consists of a C shaped arm consisting of a source tube and receiver on opposite sides. The X-rays is used to obtain continuous video at a rate of 15 fps. Special contrast indicators

are added to view the flow of blood. The catheters are usually inserted from the thigh and can include even angioplastic balloons to cure blockages. The machine used is GE Innova 2100.

Acknowledgement
I wish to thank the dean and management of Chettinad Health City for granting me the opportunity to get a first-and view of the equipments used in the hospital and their working. I also would like to thank Mr. Hari Bhaskar and the Biomedical department for their excellent guidance and explanations about all equipments.