tag:blogger.com,1999:blog-7340654176206085322024-03-21T10:22:51.514+08:00Biomedical Instrumentation & PlanningDennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-734065417620608532.post-76494295613094489482022-03-24T12:00:00.002+08:002022-03-25T10:09:52.498+08:00Extracorporeal Membrane Oxygenation (ECMO)<div style="text-align: left;"><h4 style="text-align: left;"><b>Extracorporeal Membrane Oxygenation, or ECMO</b> <span style="font-weight: normal;">for short, is an advanced
therapy that is sometimes used to treat people with life-threatening heart and
lung failure, to do the work of the heart and lungs
when a patient’s own organs are too sick or weak to work on their own.
It is effectively a modified heart-lung bypass machine—a machine that
takes over heart and lung function (meaning it adds oxygen to and
removes carbon dioxide from a patient’s blood supply). </span></h4></div><p> But unlike a heart-lung bypass machine, which is designed for short-term
use (during heart surgery, for instance), ECMO machines provide
long-term heart and lung support over a period of hours, days, or even
weeks to give a patient’s heart and lungs time to heal and regain
function. It provides a kind of bridge, a temporarily replacement that keeps the
functions of the heart and lungs going while doctors treat the
underlying problem. </p><p></p><p>ECMO can be used for patients of all ages, from infants to adults. It
can help patients with a range of severe heart and lung conditions, from
cardiac arrest to respiratory failure. But in most cases, ECMO therapy
is used only when all other conventional treatments have failed to
resolve the underlying heart or lung disorders. </p><p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMqukpmjYlrmZu8gPZ50_9yhRopz4Pye3LHTB3J8sFUjlU_YBEtwvqbrU4IsvZMISe-u3pzQwWXRtp3gZtNsexAKsll8usCNo12W7bv0w1nARxkNPiV2X1alBTh10rrelKxFfszAnVmRXrXHL5S-IoLmUxdNI7wEkf5al-R7V7IzIbNiZVhsky9ix5/s226/images5.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="226" data-original-width="223" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMqukpmjYlrmZu8gPZ50_9yhRopz4Pye3LHTB3J8sFUjlU_YBEtwvqbrU4IsvZMISe-u3pzQwWXRtp3gZtNsexAKsll8usCNo12W7bv0w1nARxkNPiV2X1alBTh10rrelKxFfszAnVmRXrXHL5S-IoLmUxdNI7wEkf5al-R7V7IzIbNiZVhsky9ix5/w197-h200/images5.jpg" width="197" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">ECMO Machine<br /></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqbrwh8Zyw37VMRshSAM-hrrDaP7M8xVQwSSoBhNaiR268WYhZsb34w7aVyD9GMyPl2LAQ8wNxVeRRqsbuwpyK0fxVp0P2q6GUYrUF83naiKPoFl26DyItQM-WUEAQ0u6YgWHbg8xNSnCLfc95j0eDyKDVe2Z-pNiPnpHXN7bFsaoNSYamAqQAQEFG/s650/ECMO8.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="450" data-original-width="650" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqbrwh8Zyw37VMRshSAM-hrrDaP7M8xVQwSSoBhNaiR268WYhZsb34w7aVyD9GMyPl2LAQ8wNxVeRRqsbuwpyK0fxVp0P2q6GUYrUF83naiKPoFl26DyItQM-WUEAQ0u6YgWHbg8xNSnCLfc95j0eDyKDVe2Z-pNiPnpHXN7bFsaoNSYamAqQAQEFG/w320-h222/ECMO8.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The complete ECMO Machine </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;">c</td><td class="tr-caption" style="text-align: center;"><br /></td></tr></tbody></table></p><div class="separator" style="clear: both; text-align: center;"></div> <br /><p></p><h3 style="text-align: left;"><b>Connecting To ECMO</b></h3><p>Connecting a patient to the ECMO machine requires surgery. The ECMO
machine connects to a patient through plastic tubes called cannulas.
After giving the patient an anticoagulant, a medication that prevents
blood from clotting, the doctor inserts cannulas into large arteries and
veins located in the chest, neck, or legs. Once connected, the ECMO
machine draws blood from the patient, which it then passes through the
cannulas and into an artificial lung that infuses the blood with oxygen
and removes carbon dioxide. The ECMO machine then warms this treated
blood to body temperature and pumps it back into the patient. In cases
where a patient’s heart cannot circulate blood on its own, a mechanical
pump takes over the heart’s role and pumps blood through the patient’s
circulatory system.
</p><p>ECMO therapy is frequently a treatment of last resort. It is recommended
when other treatments have failed to resolve the underlying problem,
but there is still a possibility of recovery. </p><p>The doctors continue to administer sedatives and pain
medications after surgery to keep patients as comfortable and pain-free as possible, perform routine chest X-rays, run regular
blood tests to assess oxygen and carbon dioxide levels that allow doctors to evaluate and track
the patient’s lung and heart health and to check for
possible infections. </p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0E1Tb4318IuRbvK9SFhxjuAM1g9JFj5rRreWfVI-yd4ljamD3ykq1eyd0QgNbVD6DZX44-Eo8mhdEmvwV5aauoPmCZ7Z1LTLCneftBlHg7ZiRbLY7N8Nsd0EEUUGJJG6OqLA4bmhSmyAGciKoWtdUjM7v0TqxoforVRhDudmbQ6P-lIUR2sKn6rZY/s255/images2.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="197" data-original-width="255" height="248" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0E1Tb4318IuRbvK9SFhxjuAM1g9JFj5rRreWfVI-yd4ljamD3ykq1eyd0QgNbVD6DZX44-Eo8mhdEmvwV5aauoPmCZ7Z1LTLCneftBlHg7ZiRbLY7N8Nsd0EEUUGJJG6OqLA4bmhSmyAGciKoWtdUjM7v0TqxoforVRhDudmbQ6P-lIUR2sKn6rZY/w320-h248/images2.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Basic setting up of the ECMO<br /></td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP9Im9-taWKWLlsvAZHLzhhTZbCUamsNrEPgV9vAOzyyFTKOGFEDQCAvSaCYDMUBBusR1It_mA7gBwEcUEK4mP0mDICwN43J9yPuvnk6gOShg_MZSTL4n0X8oeViVybAANOe9FX1oAYxzSMDusVWgzgZYPtiniNNb7Pb-GUCIwG-b63HxU4GDcoWau/s270/images6.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="187" data-original-width="270" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP9Im9-taWKWLlsvAZHLzhhTZbCUamsNrEPgV9vAOzyyFTKOGFEDQCAvSaCYDMUBBusR1It_mA7gBwEcUEK4mP0mDICwN43J9yPuvnk6gOShg_MZSTL4n0X8oeViVybAANOe9FX1oAYxzSMDusVWgzgZYPtiniNNb7Pb-GUCIwG-b63HxU4GDcoWau/w320-h222/images6.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Connecting to a patient<br /></td></tr></tbody></table><p></p><p><br /></p><p></p><h3 style="text-align: left;"><b>Applications</b></h3><div class="fact-sheet-details-content-section__content"><p>While there is no fixed list of conditions for which ECMO is used, doctors may recommend its use in the following situations:<br /></p>
<ul><li>
<span></span>Respiratory failure (when the lungs fail to maintain adequate oxygen levels or remove enough carbon dioxide from the blood)
</li><li>
<span></span>Heart transplantation
</li><li>
<span></span>Lung transplantation
</li><li>
<span></span>Cardiac arrest (when the heart fails to pump blood effectively)
</li><li>
<span></span>Cardiogenic shock (when the ventricles of the heart do not function properly, resulting in insufficient blood flow)
</li><li>
<span></span>Pulmonary embolism (when an artery in the lungs is blocked)
</li><li>
<span></span>Birth defects of the heart
</li><li>
<span></span>Acute Respiratory Distress Syndrome, <a data-link-type="Internal" href="https://www.yalemedicine.org/conditions/ards" target="_self">ARDS</a> (a type of respiratory failure that prevents adequate oxygen from getting to the lungs and blood)
</li></ul></div><p> </p><h2 class="section-title__text fact-sheet-details-content-section__content-heading fact-sheet-details-content-section__section-4-title" id="why-is-ecmo-used-in-some-covid" tabindex="-1"><span class="fact-sheet-details-content-section__title-html-text">Why Is ECMO used in some COVID-19 Patients?</span></h2><div class="section-title__text fact-sheet-details-content-section__content-heading fact-sheet-details-content-section__section-4-title" id="why-is-ecmo-used-in-some-covid" style="text-align: left;" tabindex="-1">Some people severely affected by COVID-19 develop a life-threatening
lung condition called acute respiratory distress syndrome, or ARDS for
short. People with ARDS struggle to get enough oxygen into their lungs
and blood due to a buildup of fluid in air sacs called alveoli. Some
COVID-19 patients with ARDS who do not respond to conventional treatment
may benefit from ECMO therapy. </div><div class="section-title__text fact-sheet-details-content-section__content-heading fact-sheet-details-content-section__section-4-title" id="why-is-ecmo-used-in-some-covid" style="text-align: left;" tabindex="-1"><br /></div><div class="section-title__text fact-sheet-details-content-section__content-heading fact-sheet-details-content-section__section-4-title" id="why-is-ecmo-used-in-some-covid" style="text-align: left;" tabindex="-1"><p>In general, doctors aim to take patients off ECMO therapy as quickly
as possible. Because it is used for patients with a range of conditions,
each with its own recovery timetable, the length of time someone is on
ECMO therapy can vary greatly. Some patients need it for only a few
hours while others may require days or weeks of ECMO support.</p><p> </p><p>Once the patient reaches a point at which the ECMO machine is no
longer necessary, the ECMO team will begin the process of weaning in which
they steadily decrease the patient’s blood flow through the machine.
Over several hours, they track the patient’s response to this reduction
in ECMO support. If the patient responds well, and the ECMO team
concludes that discontinuation of ECMO is safe, a surgeon will remove
the cannulas. </p>
<p> </p><p>After coming off ECMO, a patient might require a ventilator to
provide breathing support. As soon as the patient is able to breathe
without assistance, doctors will remove the ventilator. But patients may
still need to stay in the hospital for days or weeks, at least until
vital signs are stable. Many will also need physical therapy to help
regain muscle strength, as well as speech therapy to aid recovery after
long-term use of a ventilator’s breathing tube. </p><p> </p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/Hd5Pxazn-Rg" width="320" youtube-src-id="Hd5Pxazn-Rg"></iframe></div><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> Ref: Youtube.com: "I almost died" by CNA </span><br /><p></p><p><br /></p><p></p><h2 class="section-title__text fact-sheet-details-content-section__content-heading fact-sheet-details-content-section__section-6-title" id="what-are-the-risks-associated" tabindex="-1"><span class="fact-sheet-details-content-section__title-html-text">What are the risks associated with ECMO?</span></h2></div>ECMO therapy itself comes with its own set of risks including:
<ul><li>
<span></span>
<strong>Bleeding</strong>: Bleeding affects up to 50% of ECMO
patients and, in some cases, can be life-threatening. ECMO therapy
requires the use of anticoagulants, medications that thin the blood (and
prevent the formation of clots) to keep the blood flowing through the
body and ECMO machine. But these medications also increase the
likelihood of excess bleeding. As a result, hemorrhaging may occur in a
number of places, including the lungs, stomach, mouth, nose, and brain.
Doctors watch for signs of bleeding; medication or surgery may be
necessary to stop it. </li><li>
<span></span>
<strong>Kidney Failure</strong>: In some cases, patients on ECMO do
not circulate enough blood to their kidneys, resulting in kidney failure
and the potential need for dialysis, a machine that does some of the
work normally done by kidneys. Kidney function usually returns after the
patient is removed from the ECMO machine, though sometimes the kidneys
do not recover, and the patient will require lifelong dialysis
treatment.
</li><li>
<span></span>
<strong>Bacterial Infection</strong>: Because cannulas are inserted
into veins and arteries in ECMO therapy, bacteria can have direct access
to the patient’s blood stream. If unchecked, infections may result,
such as bacterial pneumonia. If infection is suspected, patients are
treated with a course of antibiotics and cannulas may be replaced. </li><li>
<span></span>
<strong>Stroke</strong>: In rare cases, ECMO patients develop small
blood clots that can reduce the flow of blood to the brain. This raises
risk for stroke.
</li><li>
<span></span>
<strong>Pulmonary Embolism</strong>: Though it is rare, some
patients on ECMO develop a blood clot that blocks blood flow in the
lungs. Pulmonary embolism can cause permanent damage to the lungs, as
well as damage to other organs as the lungs may be unable to provide
enough oxygen to the body. </li></ul><p><span> </span><span> </span> </p><p><span> </span><span> </span><span> </span>Reference: www.yalemedicine.org/conditions/ecmo <br /></p>
Note: Information on this page is provided for interest only on a 'best effort' basis and does not constitute personal advice. Always discuss medical conditions and related mattyers with your doctor(s).DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com0tag:blogger.com,1999:blog-734065417620608532.post-49364465212767266882019-05-20T18:11:00.003+08:002019-12-27T09:17:26.359+08:00PROTON THERAPY<span style="color: blue;">Proton beam therapy is a type of radiotherapy that uses a beam of high
energy protons, which are small parts of atoms, rather than high energy x-rays
(called “photons”) to treat specific types of cancer.</span>
<span style="color: blue;"><br />
Proton beam therapy enables a dose of high energy protons to be precisely
targeted at a tumour, reducing the damage to surrounding healthy tissues and
vital organs which is an advantage in certain groups of patients or where the
cancer is close to a critical part of the body such as the spinal cord.</span>
<span style="color: blue;"><br /></span>
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Proton therapy cancer treatment begins when each proton
begins its journey at the injector located within an electric field. In the
field, hydrogen atoms then separate into negatively charged electrons and positively
charged protons. The protons travel through a vacuum tube within a
pre-accelerator. This process boosts their energy to two million electron
volts. The protons continue in the vacuum tube and begin their high-speed
journey in the synchrotron. They travel around the synchrotron about 10 million
times per second. Each time they circulate, a radiofrequency cavity within the
ring delivers a boost of energy. This increases the protons' energy to between
70 and 250 million electron volts. The voltage achieved is enough to place them
at any depth within the human body.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTZ-dsfKSFa2aY0ZzAcOqPC_NzRrt2225pWeJs01vsoBtJ5TJanS5_DR1mvBdPLGuBkBGdxVWineki1UiojD9L7yj1POYr7Css5e6W1LGD4ufQDjQcGr8jYH1JuAknzH3LBfKi6RCTj68/s1600/Proton3.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1600" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTZ-dsfKSFa2aY0ZzAcOqPC_NzRrt2225pWeJs01vsoBtJ5TJanS5_DR1mvBdPLGuBkBGdxVWineki1UiojD9L7yj1POYr7Css5e6W1LGD4ufQDjQcGr8jYH1JuAknzH3LBfKi6RCTj68/s640/Proton3.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig shows the superconducting Synchrotron and the Proton Beam Transport System</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBAXybICrw6q1nFuBm363_gerFiHQU3-56qEQWUadd7xR8rZlJOptIi1Xmo_HOT0c0FZcWodfKQkDSQdDzxD7byPjxMzf4uG49hRKZWkD270WeN0unsMyyjbxpi4LvOrFFnrKEBTQFTdc/s1600/Proton2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBAXybICrw6q1nFuBm363_gerFiHQU3-56qEQWUadd7xR8rZlJOptIi1Xmo_HOT0c0FZcWodfKQkDSQdDzxD7byPjxMzf4uG49hRKZWkD270WeN0unsMyyjbxpi4LvOrFFnrKEBTQFTdc/s640/Proton2.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Beam Transport System</td></tr>
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<span style="color: blue;">After leaving the synchrotron, the protons move through a
beam transport system, continuing in the vacuum tube through a series of
steering and focusing magnets that guide them to the proton treatment rooms.
Each proton treatment room has a beam delivery system, or nozzle, is the last
device the protons travel through before entering the body. The nozzle shapes
and spreads out the proton beam in three dimensions. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFQLNQUCbwhfBYZ6vcQUJziNPiS-n5Qing8CCpdXZo-eaJACAthyphenhyphenFmGYJtKXVajdO6FIK-Xd4WeNmjcGaTaEaslWmCE5j-5TOntbwTCiej_H29znqz2jHOWT8G19V_bRMfzcygGzGBt5A/s1600/Proton+Magnet+focus+the+beam+and+direct+it+into+each+treatment+room..jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="350" data-original-width="550" height="406" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFQLNQUCbwhfBYZ6vcQUJziNPiS-n5Qing8CCpdXZo-eaJACAthyphenhyphenFmGYJtKXVajdO6FIK-Xd4WeNmjcGaTaEaslWmCE5j-5TOntbwTCiej_H29znqz2jHOWT8G19V_bRMfzcygGzGBt5A/s640/Proton+Magnet+focus+the+beam+and+direct+it+into+each+treatment+room..jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig above shows Proton Magnet focus the beam and direct it into each treatment room.</td></tr>
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<span style="color: blue;">Radiation oncologists must determine location, shape, and
tissue density of the target tumor before determining the number of protons to
deliver. They must also calculate the depth that the protons must travel in
order to calculate the speed and shape of the beam. These decisions render a
beam that is highly accurate and practically ‘tailor made’ for a specific
treatments.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkpLbAtiYwAXpzgN5vCq9XeZ_5WVs8c7LUcdliot-TtSbcLIbkzarFJ5tibwW-jdJy4V2n0Dg_Vu7Rgk7eLGiiMeYLXc9qC2OyyuslbDDqbF8u_Rg9ruJObiavyhn2jxp6WTRcX9MTqn4/s1600/Proton4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkpLbAtiYwAXpzgN5vCq9XeZ_5WVs8c7LUcdliot-TtSbcLIbkzarFJ5tibwW-jdJy4V2n0Dg_Vu7Rgk7eLGiiMeYLXc9qC2OyyuslbDDqbF8u_Rg9ruJObiavyhn2jxp6WTRcX9MTqn4/s640/Proton4.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Treatment Gantry of a Proton Therapy System</td></tr>
</tbody></table>
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<span style="color: blue;">After leaving the nozzle, the protons enter the patient's
body.</span></div>
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<span style="color: blue;">The equipment in the proton therapy treatment rooms vary
based on the conditions treated. One proton treatment room may have a
stationary beam with two branches – one branch for irradiating eye tumors and
the other for central nervous system tumors and tumors of the head and neck.
The other treatment rooms may have gantries – wheels that are 35 feet in diameter
that revolve around the patient to direct the beam exactly where needed. From
the patient's perspective, all that is visible is a revolving, cone-shaped
device. </span></div>
<span style="color: blue;">Proton beam therapy is only suitable for certain types of cancer, such as
highly complex brain, head and neck cancers and sarcomas as it does not lead to
better outcomes for many cancer cases than using high energy x-rays, which is
still considered the most appropriate and effective treatment for the majority
of cancers.</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">Like high energy x-ray radiotherapy, proton beam therapy is painless, but
patients may experience side effects similar to those experienced from other
forms of radiotherapy.</span><br />
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<span style="color: blue;"><b><span style="font-family: "times new roman" , serif; font-size: 18.0pt;">How
Does Proton Therapy's Effectiveness Compare to IMRT or Other X-ray Treatments?</span></b></span></div>
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<span style="color: blue;">Because proton beams can be delivered in higher doses and
with far more accuracy, proton therapy typically can control cancer with fewer
treatments than IMRT. This pinpoint accuracy also results in fewer long-term
side effects (since the radiation does not spill over and damage healthy tissue
and organs) meaning that patients treated with proton therapy experience a
higher post-treatment quality of life as compared to IMRT and even conventional
x-ray treatments.</span></div>
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<span style="color: blue;"><b><span style="font-family: "times new roman" , serif; font-size: 18.0pt;">Is
Proton Radiation Therapy Ever Combined?</span></b></span></div>
<span style="color: blue;">Yes. Conformal proton therapy is often used in conjunction with X-ray
therapy. This method boosts the dose to sites of gross disease and allows
irradiation of a large tissue volume. Depending on the amount of cancer within
a particular lymph node and type of cancer that is present, a patient may be at
risk for harboring microscopic nests of cancer cells within the nodes. These
nodes may lie at some distance from the primary tumor and may not be irradiated
if conformal proton treatment alone is delivered to the tumor.</span><br />
<span style="color: blue;">The objective of the treatment plan is to treat both the primary tumor and
any areas where a microscopic tumor might hide. X-ray treatment alone will
limit the total dose of radiation that can be given due to the high doses it
delivers to large amounts of healthy tissue. Therefore, conformal proton
radiation therapy is used to treat the primary tumor, and is then followed by
X-ray therapy to treat the regional nodes. By giving some of the treatment with
conformal protons, the total X-ray dose can be reduced substantially.</span><br />
<span style="color: blue;">This reduces the risk of complications and permits treatment of potentially
involved lymph nodes. Microscopic cancer within these nodes might be missed if
X-rays were not used.</span><br />
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<span style="color: blue;"><span style="font-size: large;"><b><span style="line-height: 107%;">Side-Effect</span></b></span></span></div>
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<span style="color: blue;">Since proton therapy allows the radiation to unfold directly
in the tumour, the surrounding tissue and organs are protected to the best of
their ability. If a reaction – i. e. a side effect – occurs, only the
irradiated body region is usually affected. This can lead to irritation of the
skin or mucous membranes, which usually recede completely within two to three
weeks after treatment. Sometimes, however, a kind of permanent scarring can
also occur as a late consequence.</span></div>
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<br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>Information on this page is provided for interest only on a "best efforts" basis and does not </i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>constitute personal advice. Always discuss <a href="http://biomedicaltech.blogspot.sg/p/cancer-related.html#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by safesaver">medical</a> conditions and related matters with your doctor.</i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i> </i></span></span> </div>
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<i><span style="color: #cc0000;"><span style="font-size: x-small;"><span style="line-height: 107%;">Reference: https://protons.com/proton-advantage/how-does-proton-therapy-work</span></span></span></i></div>
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DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com1tag:blogger.com,1999:blog-734065417620608532.post-41473948116808505802016-11-26T15:32:00.000+08:002019-07-14T17:28:15.604+08:00HYBRID OPERATING ROOM<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">A hybrid operating room is where major procedures that combines a conventional surgical and interventional procedure guided by fluoroscopic or MRI imaging in a hybrid room without interruption.</span></span><br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Traditional fixed C-arms produce 2D fluoroscopy or 3D rotational angiography but with the advanced technology nowadays, C-arms are able to acquire CT-like 3D images and used for image guided surgery and also in intra-operative imaging like flow analysis. With these newer fluoroscopic C-arms where the device image intensifiers are of the digital flat panel detectors has thus enabled the fluoroscopy techniques to transit into three dimensional CT-like imaging capability.</span></span><br />
<span style="color: blue;"><span style="color: blue;"><br /></span></span>
<span style="color: blue;"><span style="background-color: white;">Hybrid operating rooms are currently used mainly in cardiac, vascular and neurosurgery, but could be suitable for a number of other surgical disciplines.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBOHE7xuJ1vyzFsWjwT3HyI5VIaPT6taAponRDD_ckpzeit-Td579urIaGd2d1UXQ5Mf95tybw_kZpufcZK3Cy2C7iHQkoMmXnUXFlA7ZFCLcsugXbCznooc7ms4N3QqCrHOSgRReWlJ4/s1600/Hybrid_operating_theatre_gemelli_rome.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="171" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBOHE7xuJ1vyzFsWjwT3HyI5VIaPT6taAponRDD_ckpzeit-Td579urIaGd2d1UXQ5Mf95tybw_kZpufcZK3Cy2C7iHQkoMmXnUXFlA7ZFCLcsugXbCznooc7ms4N3QqCrHOSgRReWlJ4/s400/Hybrid_operating_theatre_gemelli_rome.jpg" width="400" /></a></div>
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<b><span style="color: #cc0000; font-family: "arial" , "helvetica" , sans-serif;">PLANNING THE HYBRID ROOM</span></b><br />
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Before planning a hybrid operating room, a clear vision of the utilization should be established. It should address the requirements and the needs of various surgical specialties, procedures and workflow. </span></span><span style="background-color: white;"><span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">To ensure a smooth workflow in the room, all parties working together should state their needs and requirements, which will impact the room design and determining various resources like space, medical, and imaging equipment. This may require professional project management and several iterations in the planning process with the vendor of the imaging system, as technical interdependencies are complex. The result is always an one solution tailored to the needs and preferences of the interdisciplinary team and the hospital<span style="font-size: 15px;">.</span></span></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDHQB26IXbj6ZE_04uDEPUaOPZ7gK8xj1kY65IhvurhV0_2Z4Lv9uUsAsaArfKf3GsLcc2M4KLxu0Yn51AiTf470P_5Kd6x5NOiRMt5j28ZOsCOuLCFIubk-yVYzrfuk2uiADTiSQAyVM/s1600/Hybrid-OR-Operating-Room-3D-Design-Siemens-Zeego-Skytron-Booms-Surgical-Lights.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="428" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDHQB26IXbj6ZE_04uDEPUaOPZ7gK8xj1kY65IhvurhV0_2Z4Lv9uUsAsaArfKf3GsLcc2M4KLxu0Yn51AiTf470P_5Kd6x5NOiRMt5j28ZOsCOuLCFIubk-yVYzrfuk2uiADTiSQAyVM/s640/Hybrid-OR-Operating-Room-3D-Design-Siemens-Zeego-Skytron-Booms-Surgical-Lights.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><i>Reference: hybridoperatingroom.com</i></span></td></tr>
</tbody></table>
<span style="background-color: white; color: #242424;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 15px;"><br /></span></span></span>
<span style="background-color: white;"><span style="color: #cc0000; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 15px;"><b>LIGHTS, MONITORS AND OTHER DEVICES</b></span></span></span><br />
<span style="background-color: white; color: #242424;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 15px;"><b><br /></b></span></span></span>
<span style="background-color: white;"><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Multiple movable and flexible booms need to be installed in the OR. If there are 2 booms to be installed, a boom of every side of the operating table should be considered to serve the operating team. Collision of the ceiling mounted display with the surgical lights or other ceiling mounted devices should be avoided. Large displays are now available and capable of integrating multiple video inputs on various sizes and therefore decreasing the needs for multiple screens. A dedicated ceiling plan with all ceiling-mounted components including air conditioning should be drawn to ensure the function and usability of all devices.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></span><br />
<span style="background-color: white;"><br /></span>
<span style="color: blue;"><span style="background-color: white;">The hybrid OR facilitates a whole new spectrum of cardiac surgical therapies, and will therefore become an essential resource of every cardiovascular centre. The trend towards hybrid OR is more of a revolution than an evolution due to the rapid integration into the surgical techniques. The hybrid OR itself represents an extreme complex working environment that demands careful planning by all stakeholders. Bundling all clinical, technical and architectural expertise as well as a realistic view of what is achievable is key for a successful hybrid OR project. </span></span><br />
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<br /><iframe width="320" height="266" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/cd611qRufc8/0.jpg" src="https://www.youtube.com/embed/cd611qRufc8?feature=player_embedded" frameborder="0" allowfullscreen></iframe></div>
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<span style="color: #990000; font-family: "arial" , "helvetica" , sans-serif;"><i>Reference: cardenjennings.metapress.com & hybridoperatingroom.com & www.maquet-hybridoperatingroom</i></span>DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com1tag:blogger.com,1999:blog-734065417620608532.post-9857129684741461702016-11-24T11:46:00.000+08:002019-12-27T09:19:11.423+08:00Wireless Telemetry System<span style="color: blue;">The Philips <i>MX40</i> Telemetry device combined with the PIIC iX central monitoring system, is an excellent choice for most hospitals that can expect to leverage the broad networking capabilities and configurability of the system. It may be especially advantageous for larger hospitals that want to access telemetry data and manage system configurations from multiple care areas.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhydnoVeQ2kdMAQmRA64bS3s4thGjhnuCq-3uFo0uoHg3AjiZR6SLe5iC6B3VAN1LIMY-L7OmqEEs3Ocx3oeuhAbbwfqBS01fnkO4AU3RverRcjzsejJBX9Tx11ojYqgbwSEaXaesVfuIc/s1600/images+%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhydnoVeQ2kdMAQmRA64bS3s4thGjhnuCq-3uFo0uoHg3AjiZR6SLe5iC6B3VAN1LIMY-L7OmqEEs3Ocx3oeuhAbbwfqBS01fnkO4AU3RverRcjzsejJBX9Tx11ojYqgbwSEaXaesVfuIc/s200/images+%25281%2529.jpg" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAbVZflvTIowkbOa3ARpKbV-kEMwE5swUrOdTCZWY_i9X7fwxT8QlP-BVqXKJp7C__eD04u5kWiR3HjZxgt-VFbKbc5oCIeP4YCZ_7zcuVpqYg_01D0vV_QgN8m1jHwFB-jWqSzLwCH2o/s1600/Telemetry.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAbVZflvTIowkbOa3ARpKbV-kEMwE5swUrOdTCZWY_i9X7fwxT8QlP-BVqXKJp7C__eD04u5kWiR3HjZxgt-VFbKbc5oCIeP4YCZ_7zcuVpqYg_01D0vV_QgN8m1jHwFB-jWqSzLwCH2o/s200/Telemetry.png" width="105" /></a></div>
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<br />
<span style="color: blue;">The<i> MX40</i> device offers most of the features that we believe transmitters with integrated displays should offer to enhance patient safety in many of today's telemetry settings, including:</span><br />
<ul>
<li><span style="color: blue;">The option to have alarms annunciated, and messages displayed, at the device;</span></li>
<li><span style="color: blue;">A color display with up to two waveforms, and numeric patient data with alarm limits;</span></li>
<li><span style="color: blue;">The ability to silence and pause alarms at the MX40;</span></li>
<li><span style="color: blue;">The ability for the MX40 to transition to the functionality of a mini-arrhythmia detection capability and alarms.</span></li>
</ul>
<span style="color: blue;"><br /></span>
<span style="color: blue;">Telemetry systems were developed to monitor patients who are at risk for cardiac events but not acutely ill enough to warrant continuous bedside monitoring. Today, they often offer additional measurements that can be used to monitor conditions like hypoxia and compromised respiratory status. Patients on telemetry monitoring are often ambulatory for part of the day.</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">The IntelliVue MX40 telemetry system comprises the following:</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">a) The patient-worn MX40 telemetry device, which is used to acquire patient data and relay it wirelessly using Philips' IntelliVue Smart-hopping 1.4 GHz WMTS network or the hospital's industrial, scientific and medical (ISM) 802.11a/b/g/n wireless network.</span><br />
<ul>
<li><span style="color: blue;">The device is powered interchangeably by either a rechargeable Li-ion battery or three AA alkaline batteries and is equipped with a 1.70 × 2.26-inch color display.</span></li>
</ul>
<ul>
<li><span style="color: blue;">The MX40 monitors ECG, detects arrhythmias, and displays continuous ST and QT segments, SpO2, and impedance respiration, when connected to the PIIC iX or when communication is lost between the device and PIIC iX.</span></li>
</ul>
<ul>
<li><span style="color: blue;">The display on the MX40 can show numerics and up to two waveforms (i.e., ECG, SpO2, or impedance respiration).</span></li>
</ul>
<span style="color: blue;"><br /></span>
<span style="color: blue;">b) The PIIC iX platform, which can be used to control multiple types of Philips monitors across multiple care areas. The PIIC iX includes a telemetry central station, consisting of a PC and one or two flat-panel screens for clinical review. In a networked, multi-care-area configuration, the PIIC iX can be used to easily transfer patients from one care area to another or to allow overview monitoring of multiple care areas.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGxEJxS3VZmUCJFbmrOhRiYQK3q73LbHNjsFUs6H1Vgia4hCg74W-W3kQtVQ-_654MyS2qjGnuoRNJKiqy1ZngTwFEfvDiY1D-AJcopDaHmqm4iAUAbdPE3giOewP4WoZ8gBgy8M9TQ7Y/s1600/70721-9759559.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGxEJxS3VZmUCJFbmrOhRiYQK3q73LbHNjsFUs6H1Vgia4hCg74W-W3kQtVQ-_654MyS2qjGnuoRNJKiqy1ZngTwFEfvDiY1D-AJcopDaHmqm4iAUAbdPE3giOewP4WoZ8gBgy8M9TQ7Y/s320/70721-9759559.jpg" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg67SeTtmYAs70qkv2ieKcWuKKxVpxqAmfk9Hapc3yTafiCMCXwhpB4Z7sZdCP37ogAgxFiDrzm1jWCAFr0MeDsJSxkIQcRjUVD5lAADirgvnaovGGDQHtXkMF466BZy9dlWgE5n4kNY-g/s1600/70721-7493857%25281%2529.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg67SeTtmYAs70qkv2ieKcWuKKxVpxqAmfk9Hapc3yTafiCMCXwhpB4Z7sZdCP37ogAgxFiDrzm1jWCAFr0MeDsJSxkIQcRjUVD5lAADirgvnaovGGDQHtXkMF466BZy9dlWgE5n4kNY-g/s320/70721-7493857%25281%2529.jpg" width="320" /></a></div>
<ul>
<li><span style="color: blue;">The PIIC iX can accommodate up to 32 patients (either single or dual displays, depending on PC screen size).</span></li>
<span style="color: blue;">
</span></ul>
<ul>
<li><span style="color: blue;">Central stations are usually located at unit nursing stations and hallways. Some facilities consolidate patient monitoring in remote areas, where a team of technicians is given responsibility for monitoring central station screens. The PIIC iX is adaptable to either of these models.</span></li>
</ul>
<ul><span style="color: blue;">
</span>
<li><span style="color: blue;">The following diagram depicts the workflow of the PIIC iX platform. Note that the "IBE" shown in the diagram is the IntelliBridge Enterprise, a bidirectional interface between the Philips clinical informatics system and the hospital information systems; it is used to exchange admission/discharge/transfer (ADT) information, laboratory information, patient orders, and data between the Philips system and the electronic health record. (Image courtesy of Philips).</span></li>
</ul>
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<br />
<i><span style="color: #990000; font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><span style="font-size: x-small;"><span style="color: #990000;"><i>Information on this page is provided for interest only on a "best efforts" basis and does not </i></span></span></span></i><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>constitute personal advice. Always discuss <a href="http://biomedicaltech.blogspot.sg/p/cancer-related.html#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by safesaver">medical</a> conditions and related matters with your doctor.</i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i> </i></span></span> <br />
<i><span style="color: #990000; font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Source: ecri institute</span></i>DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com4tag:blogger.com,1999:blog-734065417620608532.post-3470099233457645252016-07-13T16:33:00.002+08:002019-12-27T09:17:46.965+08:00SOTERA WIRELESS ViSi MOBILE SYSTEM <span style="color: blue;">The Sotera Wireless Vital Signs Mobile
system continuously monitors patient vital signs, including pulse rate
(PR), heart rate (HR), respiration rate (RR), NIBP, and pulse oximetry
(SpO</span><sub style="color: blue;">2</sub><span style="color: blue;">), as well as level of motion on adult patients in
inpatient lower-acuity care settings. Continuous noninvasive blood
pressure (cNIBP) is achieved by taking a baseline measurement with a
standard NIBP cuff and then using pulse arrival time to estimate changes
from baseline. </span><a href="https://www.ecri.org/components/HDJournal/Pages/Eval-Sotera-Wireless-ViSi-Mobile.aspx?tab=2#TAG_1up" id="TAG_1up" name="TAG_1up"></a><span style="color: blue;">The system analyzes and interprets vital signs data to alert clinicians to emergent events like high HR or low SpO</span><sub style="color: blue;">2</sub><span style="color: blue;">. The system also displays trending data to help clinicians detect early signs of patient deterioration. </span><br />
<br />
<span style="font-size: small;"><span style="color: blue;">This system offers optional 3- or 5-lead ECG for monitoring purposes (i.e., not diagnostic, and no arrhythmia detection). </span></span><br />
<br />
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<br />
<span style="color: blue;">Central workstation is available and allows control of system for up to 32 patients at a time. Just like the cetntral monitors in the ICU, it can used to:</span><br />
<br />
<br />
<br />
<span style="color: blue;">- Admit and discharge patients</span><br />
<span style="color: blue;">- View graphical and list trends for 3- or 5-lead ECG, SpO<sub>2</sub>, temperature, PR, and RR</span><br />
<span style="color: blue;">- View real-time data, including visible and audible alerts and alarms</span><br />
<span style="color: blue;">- Communicate to secondary alarm notification systems or middleware for clinician notification</span><br />
<span style="color: blue;">- Send patient vitals data and alarms to patient electronic medical record (EMR) via an HL7 (Health </span><br />
<span style="color: blue;"> Level 7) interface.</span><br />
<br />
<span style="color: blue;"><span id="DeltaPlaceHolderMain"> Remote viewing screen is available for viewing of near-real-time patient data, trending information, and alerts/alarms through WLAN, etc.</span> </span><br />
<span style="color: blue;"><span id="DeltaPlaceHolderMain"></span></span><br />
<span id="DeltaPlaceHolderMain"></span><br />
<br />
<span style="color: blue;">The Sotera Wireless Vital Signs Mobile
system is a good choice for low-acuity continuous vital signs monitoring
applications on a medical-surgical floor. The system has simple
patient setup.<span id="DeltaPlaceHolderMain"> </span>Trending information is potentially helpful to detect
patient deterioration. </span><br />
<span style="color: blue;">The use of continuous noninvasive blood pressure (cNIBP) is impressive and potentially much more comfortable for the
patient than periodic NIBP cuff inflation. Sotera provides the widest
variety of alerts for emergent events and status changes. This system is
not designed to provide trend alerts or early warning scoring. It is
probably best suited to sick patients who need constant monitoring and
alerting for emergent events. Battery life is short; two wrist units are
required per bed for 24-hour coverage.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg6Zbb4AJBtriVy2d08ogHpYKmAtcDUe3pED2byXHW_TjQpwJyu406Ckre1XUwn8T1VzFXrQs14Y47YiuY57CHGBFqQcNfWjx88SGJGQ74ZVvZricPS9b1Q3kfw9-02zTTN6FUBHM8GcQ/s1600/Sotera-components_MS16536_6.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg6Zbb4AJBtriVy2d08ogHpYKmAtcDUe3pED2byXHW_TjQpwJyu406Ckre1XUwn8T1VzFXrQs14Y47YiuY57CHGBFqQcNfWjx88SGJGQ74ZVvZricPS9b1Q3kfw9-02zTTN6FUBHM8GcQ/s320/Sotera-components_MS16536_6.jpg" width="205" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><i><span style="font-size: small;">System components of the Sotera ViSi Mobile System</span></i></span></td><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><br /></span></td></tr>
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<span style="color: #990000;"><span style="font-size: x-small;"><i>I</i></span></span><span style="color: lime;"><i><span style="color: lime;"><span style="font-size: x-small;"><span style="color: #990000;"><i>nformation on this page is provided for interest only on a "best efforts" basis and does not </i></span></span></span></i></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>constitute personal advice. Always discuss <a href="http://biomedicaltech.blogspot.sg/p/cancer-related.html#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by safesaver">medical</a> conditions and related matters with your doctor.</i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i> </i></span></span> <br />
<span style="color: lime;"><i><span style="color: #990000;">Source: ecri institute</span></i></span><br />
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<br />DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com2tag:blogger.com,1999:blog-734065417620608532.post-35417448194432532962013-02-01T15:00:00.003+08:002017-01-22T12:02:29.816+08:00Real Time Location System (RTLS)<h2>
</h2>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">I thought I write about the system which is really not a biomedical instrumentation but it helps to manage asset by tracking equipment location with ease by locating them during periodic maintenance or in times of clinical needs for the patients where equipment are needed from the various available locations. It can also manage equipment utilization by tracking their utilization time by areas where repurchasing of asset could be kept to a minimum through maximized use of the equipment, etc.</span></span><br />
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Figure by courtesy of Ekahau.<br />
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">In this write-up, the standard wireless-based network <span style="font-size: x-small;"><span style="font-size: small;">802.11 tracking technology</span><b><span style="font-size: x-small;"> </span></b></span>is taken as a model for the function of real-time locating. Where the current hospital or institution wi-fi network already exists within the premises, it actually helps reduce the cost of implementation by <span style="font-size: small;">piggy-back </span>onto the existing wi-fi infrastructure. </span></span><br />
<br />
<h3>
<span style="color: #660000;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;">System Components</span></b></span></h3>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> Consisting of an positioning engine that runs on an application software to deliver the visibility of the assets and together with a web accessed Vision software and the required number of RFID active tags, the system with its multiple complex algorithms measures and verifies equipment location, location status over a single unified infrastructure.</span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Active RFID tags wirelessly communicate with the positioning engine</span> <span style="font-family: "arial" , "helvetica" , sans-serif;">to determine the location, etc. </span></span><br />
<br />
<br />
<h3>
<span style="color: #660000;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;">Methodology</span></b></span></h3>
<span style="color: blue;"><br /></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">There are many methodology for performing range calculation and they include the following:</span></span><br />
<ul><span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Angle of Arrival;</span></span></li>
<span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Time of Arrival;</span></span></li>
<span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Time Difference of Arrival (TDOA);</span></span></li>
<span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Received Signal Strength (RSS);</span></span></li>
<span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Time of Flight (ToF);</span></span></li>
<span style="color: blue;">
</span>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Symmetrical Double Sided Two Way Ranging (SDS-TWR). </span></span></li>
</ul>
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<ul>
</ul>
<ul>
<li><span style="color: blue;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;">Angle of Arrival</span></b></span></li>
</ul>
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">A method determining the direction of RF propagation from the RFID tag to the reader. The direction of the transmitted signal is being sensed by a direction sensitive antenna at the reader. The angle is determined by the angle made between the reader to the tag with that of the pre-defined direction, e.g., north. Most frequently two or more readers of know positions are using in the calculation of the location of the tag by adopting the simple triangulation association. This method of measurement often requires a complex set of between four (4) to 12 antenna arrays situated in a horizontal line at several cell site locations. <i>The accuracy increases with the number of antenna arrays used. Resulting angle measurements are rather sensitive against multi-path propagation and is best suited for direct line-of-sight measurements between tags and readers.</i></span></span><br />
<br />
<br />
<ul>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Time of Arrival (TOA) </b></span></span></li>
</ul>
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">TOA measures propagation delay of the RF signal between transmitted (tag) and the received (readers)<b>. </b>Calculation of T<span style="font-size: x-small;">1</span> - T<span style="font-size: x-small;">0</span><b>, </b>the time lag of the departure of a signal from a source of the antenna to the reader; it is the time required for a signal to travel from the antenna to the reader.Multiplying the propagation time T1 - T0 by the propagation speed of the signal, the propagation delay can be converted into a distance between the tag and the reader.</span></span><br />
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">To determine the position of the tag in a 2D plane, at least three (3) readers are required to take TOA measurements. To determine the tag position in 3D space, at least four (4) readers are required. The location of the tag can be seen as intersection of the circles. <i>The accuracy of the method relies on the synchronization of the clock between the tag and the reader.</i></span></span><br />
<br />
<br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><b><span style="color: blue;">Time Difference of Arrival (TDOA)</span><i> </i></b></span></li>
</ul>
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">TDOA measures the difference in transmission times between the tag and the reader. Instead of relying on the intersection of the spheres, TDOA method measures the distance by the intersections of the parabolas. TOA records the time the antenna sends a signal to the readers. TDOA records the time the reader received the signal. Like TOA, TDOA also requires that each signal to be transmitted synchronously either at the same time or with some known delay between the signal transmission. TDOA requires 3 or 4 readers at know fixed locations to receive synchronously from the tag and record when the signal is received. The received time difference between the readers is sent to the location engine for calculation which uses an algorithm to provide the estimated position of the tag. </span></span><br />
<br />
<br />
<ul>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Received Signal Strength Indication (RSSI) </b></span></span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: blue;">This method requires at least three (3) access point to simultaneously tracked the location of the tag. The signal strength received from reader determines the location of the tag. The distance between the tag and the reader is determined by converting the value of the signal strength at the reader into a distance measurement based on the known signal output at the tag and on a particular path-loss model. </span><i><span style="color: blue;">RSSI requires a dense deployment of Access Points. An adequate underlying path-loss must be found for both non-line-of-sight and non-stationary environments. Estimated distance are somewhat unreliable. </span> </i></span><br />
<br />
<ul>
<li><span style="color: blue;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;">Time of Flight</span></b></span></li>
</ul>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">This method measures elapsed time for a transmission between a tag and a reader based on the estimated propagation speed of a typical signal through a medium. This method is based on a time value, clock accuracy is significantly more important than other methods. Here, the departure time is compared to the arrival time and using an estimating the propagating speed of the signal. <i>ToF requires highly accurate clocks. Any clock offset and drift will corrupt the ranging accuracy. Also the signal can be affected by interference from the other signals, noise, and multi-path propagation. </i></span></span><br />
<br />
<br />
<ul>
<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Round Trip Time (RTT)</b></span></span></li>
</ul>
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">To overcome the inherent difficulties of ToF, RTT provides a method whereby the ranging signal can be send and acknowledged, a process know as 'round tripping.' Using both data signal and acknowledgement mitigates against the problems with clock synchronization. RTT uses highly preditable hardware generated Acknowledgement packets where MAC processing time assumed to be equal on both nodes. Timestamps on the physical layer is used but not on application layer. <b> </b><i> </i></span></span><br />
<br />
<br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><b> <span style="color: blue;">Symmetric Double Sided Two Way Ranging (SDS-TWR) </span></b></span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: blue;">This method overcomes the shortfall of the RTT by emplying a range signal sent out by the reader and an acknowledgement from the tag to cancel out the requirements for clock synchronization. It builds on that advantage by providing protection against multi-path propagation and noise by its Chirp Spread Spectrum Modulation technique. To eliminate the drift and offset of the clock, range measurements are taken by both the tags and the reader to provide two measurements that can then be averaged. The result is a reasonably accurate measurement of within 1 meter, even in the most challenging of environments. </span><b> </b></span><br />
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<span style="background-color: #cccccc;"><span style="color: orange;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #660000;">RTLS Solutions</span></span></b></span></span><br />
<br />
<span style="background-color: #cccccc;"><span style="color: orange;"><span style="background-color: white;"><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">There are many visibility applications in RTLS namely Asset Management, Equipment Maintenance, Temperature and Humidity Monitoring, Patient & Staff Safety and Workflow & Resource Management. I will try to stress on two aspects of the visibility solutions as follows:</span></span></span><b><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #660000;"> </span></span></b></span></span></div>
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<li><span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><b><span style="font-family: "arial" , "helvetica" , sans-serif;">Equipment Maintenance<span style="color: black;"><span style="font-size: small;"> <span style="color: blue;">& Asset Manage<span style="font-size: small;">ment </span></span></span></span></span></b></span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1urq5xCWPKnX2Bc0tnyQ4gDhhTA8GRv1JKiFjBG9P6lYwq0MmBJYDXpxnhXG0hP_KTdjfWmCn2KBgwSVseP71gr37DUarlCLiMoNQ_kdL4iltk5afffetcTBH7KHCutidr5bvPlAOnkw/s1600/Aeroscout_Equipment+Maintenance+App+Note_1_0002.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="352" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1urq5xCWPKnX2Bc0tnyQ4gDhhTA8GRv1JKiFjBG9P6lYwq0MmBJYDXpxnhXG0hP_KTdjfWmCn2KBgwSVseP71gr37DUarlCLiMoNQ_kdL4iltk5afffetcTBH7KHCutidr5bvPlAOnkw/s400/Aeroscout_Equipment+Maintenance+App+Note_1_0002.jpg" width="400" /></a></div>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: black;"><span style="font-size: small;"><span style="color: blue;"><span style="font-size: small;"><span style="color: black; font-size: x-small;"><span style="font-size: small;"><span style="font-size: x-small;"><span style="font-size: small;"> </span></span></span></span></span></span></span></span></span></span><b><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: black;"><span style="font-size: small;"><span style="color: blue;"><span style="font-size: small;"> </span></span></span></span></span></b><br />
<ul>
</ul>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Vision
software is a front-end application software that enables clinical
engineers to monitor the locations, status and condition of assets. It
provides a graphical user interface to process incoming tag data ,
reporting tools, and interface capabilities to alert users via a third
party maintenance management system, e.g., ECRI AIMS. However a standalone RTLS system will still perform the necessary task of locating, </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: x-small;"><span style="font-size: small;"><span style="font-size: x-small;"><span style="font-size: small;"> </span></span></span></span></span></span></span><span style="font-family: "arial" , "helvetica" , sans-serif;">alerting, reporting, storing of<b> </b></span></span><br />
<div style="text-align: justify;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: blue;">historical data, etc. With an integrated maintenance management system, all status data and locations can be automatically populated from the RTLS. </span></span></div>
<span style="color: blue;"><br /></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The
location of each tagged equipment is displayed on the map of the
institution in Vision software. It can display a complete building view
to enable an at-one-glance view of the distribution of the assets. </span></span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> Each tag periodically transmit signal to report their location over the wifi network. The location engine then collects the tag signal that are received by all the wi-fi access points that hears a tag. This information is used to determine the location of the tag. </span></span><br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The
status of the equipment availability can be determined through several
means, for example, an activation of a call button on the tag to
indicate maintenance is required. Alert can also be designed to generate when equipment has been placed in an area demarcated as service or maintenance purposes. </span></span><br />
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<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"> <span style="color: blue;"><b>Patient and Staff Safety</b></span></span></li>
</ul>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b> </b></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuTtyTjMa9cwuaiCEa3si9OAh31Bp2jJykNnBAVkh7ZtHtS4_1Si3kyj1NvcvWUD2vtYBE5p5FhoL-Gl6PJsoQzMOP1j6ydINBEB-1PlRaxo1ClZ30LKrnWRUkt1g38e3iXSDPyOKuiqg/s1600/01+February+2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuTtyTjMa9cwuaiCEa3si9OAh31Bp2jJykNnBAVkh7ZtHtS4_1Si3kyj1NvcvWUD2vtYBE5p5FhoL-Gl6PJsoQzMOP1j6ydINBEB-1PlRaxo1ClZ30LKrnWRUkt1g38e3iXSDPyOKuiqg/s1600/01+February+2013.jpg" /></a><span style="font-family: "arial" , "helvetica" , sans-serif;">Staff members wearing WiFi tags can easily call for help by merely clicking a button on the tag. Security and other staff members are immediately notified of a duress event, identifying the staff member and location.</span></span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Patient such as elderly patients wearing tags with call button, can trigger panic or distress alerts. Notifications along with the patient's location are sent to staff and security. <b> </b></span></span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;"></span><br />
<h3 style="text-align: left;">
<b><span style="color: #660000;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></b></h3>
<h3 style="text-align: left;">
<b><span style="color: #660000;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Problems with RTLS</span></span></b><b><span style="color: #660000;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></b></h3>
<b><span style="color: #660000;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: blue;">Poor Locating Determination</span> </span></span></b><br />
<br />
<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">2.4GHz, a relatively short wavelength used for wifi data transmission is susceptible to signal loss. For the purpose of discussion, we will take RSSI as the method for measuring the location of the tag. RSSI calculate the distance using the received signal strength</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> between the access points </span> as the basis for determining the location. The accuracy of the location will somehow depend on the continuity of the received RF signals. </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Due to the nature </span>of the 2.4GHz, it is easily interrupted by moving assets especially human bodies that obstruct the path of the tags and APs. In a dynamic environment of a hospital, the result is consistently unpredictable signal loss, making meaningful and accurate determination of location impossible. </span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: blue;"><b>Triangulation</b></span> </span><br />
<br />
<span style="color: blue;"><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Wifi<span style="font-size: small;">-based tracking sy<span style="font-size: small;">stem pro<span style="font-size: small;">moters incorrectly used triangular to describe how multiple AP<span style="font-size: small;">s determine <span style="font-size: small;">the location of a tag<span style="font-size: small;">. This misuse<span style="font-size: small;"> of the te<span style="font-size: small;">rmin<span style="font-size: small;">ology vastly overstates the accuracy and the precision of wifi. T<span style="font-size: small;">riangulation is <span style="font-size: small;">the location</span> of an unknown point</span></span></span></span></span></span></span></span></span></span></span></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">by the formation of a triangle consisting of the unknown point and two known points in a triangle. The two known location APs must be able to measure the azimuth, or the angle within a reference plane, to a tag in order to make a triangle. Since wifi APs has no notion of azithmus or even that all three locations are in the same plane, how can APs triangulate anything? The fact of the matter is they can't. </span></span><br />
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">This can potentially create problem for a hospital. Hospitals expect their WiFi tracking system to locate patients and equipment with clinically significant accuracy by the exact room and hallway. WiFi cannot reliably accomplish this function. </span></span><br />
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Some proprietary WiFi system can perform Cartesian coordinate estimation or other calculation such as time of flight, but this custom-engineered solutions are very expensive and the accuracy varied. </span></span></span><br />
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<span style="color: blue;"><b><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Noi<span style="font-size: small;">se</span></span></span></b></span><br />
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<span style="color: blue;"><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><span style="font-size: small;">Wi<span style="font-size: small;">Fi tags generate noise on the communication network. <span style="font-size: small;">Exce<span style="font-size: small;">ss RF noise<span style="font-size: small;"> reduces t<span style="font-size: small;">he effective range of every AP by <span style="font-size: small;">up to </span>30%<span style="font-size: small;">, interferring with and jamming up communication. Self calibrating WiFi technology that overcomes<span style="font-size: small;"> this problem is available<span style="font-size: small;"> but required sign<span style="font-size: small;">ificant additional cost. </span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="color: blue;"><b><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">Access Point Insufficient & Wrong Place</span></span></span></span></span></span></span></span></span></span></span></span></span></b></span><br />
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<span style="color: blue;"><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">Hospital may think that they a<span style="font-size: small;">re saving money by building their track<span style="font-size: small;">in<span style="font-size: small;">g system on top of the<span style="font-size: small;">ir existing WiFi netw<span style="font-size: small;">ork. They may soon face with <span style="font-size: small;">considerable expe<span style="font-size: small;">n<span style="font-size: small;">se</span></span> to upgrade their netw<span style="font-size: small;">ork. The placement of the APs sufficient<span style="font-size: small;"> for a typical hospital WiFi network just isn't dense enough to be used for tracking. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="color: #cc0000;"><i><span style="font-family: "times" , "times new roman" , serif;"><span style="color: blue;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="color: black;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">Reference: wirelessdesignmag.com; aeroscout website; ekahau website<span style="font-size: small;">; nanotron technologies.</span> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></i></span><br />
<span style="color: #cc0000;"><i><span style="font-family: "times" , "times new roman" , serif;"><span style="color: blue;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="color: black;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">Referenc<span style="font-family: "times" , "times new roman" , serif;">e: Ekahau Real-time locating system</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></i></span><b><span style="font-size: small;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"> </span></span></span></span></span></span></span></span></span></span></span></span></span></b><br />
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<br />DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com0tag:blogger.com,1999:blog-734065417620608532.post-16162958886078047722012-07-18T09:46:00.001+08:002019-12-27T09:18:28.085+08:00Linear Accelerator<span style="color: #990000;"><b><span style="font-family: "arial" , "helvetica" , sans-serif;">Getting the Necessary Shielding Right</span></b></span><br />
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The use of heavy concrete or ordinary concrete in conjunction with steel to construct the primary barrier of the room is the basic design requirement leading to the construction of the safe facility meant for the use of the medical linear accelerator.</span></span> </div>
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<span style="color: #990000;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Concrete and Concrete Materials</i></span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Today heavy concrete are widely used method for the protection against radiations in Radiation Therapy. Traditionally, it has a limiting effect of heavy aggregates to the baryte gravels and sands. A considerable improvement in the characteristics has occurred, producing concrete with a much higher specific gravity, increasing the density from 3 to 4 if not more to 5.4 which can be realised. These new performance are necessary for widening the common use in radiation therapy. </span></span></div>
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<span style="font-family: "arial";"><span style="color: #990000;"><b><i>Concrete & Metal as a combination</i></b></span> </span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">I</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">f</span> not carried out correctly, the metal layer could potentially result in a source of photoneutron production where it presents a problem of radiation exposure beyond its shield. </span><span style="font-family: "arial" , "helvetica" , sans-serif;">The problem resulting from photoneutron production in the shielding occurs only for the primary beam barriers and not for the secondary barriers. It becomes more pronounce for larger field. To do calculations of photoneutron production, it is necessary to fold the incident photon spectrum into the cross-section curve for photoneutron production as a function of photon energy. </span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Assuming that bare iron or steel plate or slab is considered, and the neutron production from a lead plate of 1.8MeV for a 15MV x-ray beam to 2.2MeV for a 25MV x-ray beam, the neutron from an iron plate would have a lower average energy because of the high threshold energy. A conservative treatment is to consider 2.2MeV in all cases. If the metal is very thick, the neutron penetrating to the other side will be significantly degraded in energy. A significantly good example is to consider that all the neutrons are created in the first x-ray Tenth-Value-Layer (TVL) and then decrease the average energy in the remaining thickness accordingly to National Council on Radiation Protection recommendation.</span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The neutrons will be produced in circular areas, typically of the order of 4.5 meters and 3 meters away from the isocentre for the walls and ceilings, respectively. This yields radii of 137cm and 100cm respectively. They are nearly uniform sources, too large to treat as point sources when you are close to them. </span><span style="font-family: "arial" , "helvetica" , sans-serif;">At one meter, a lead plate would give a fluence-to-dose of 14 rem/week. For iron plate, it would give 1.7 rem/week. </span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Clearly, the above present a true problem that must be alleviate in some manner. This can be accomplished by the use of some neutron shielding materials after or before the metal plate. Preferably one does both the options. Since the photoneutron production is isotropic, if the metal plate is on the inside surface of the room, the neutron will add a small amount of whole body neutron dose to the patient and a certain amount of room activation. X-ray shielding on the inside of the metal plate will virtually always be concrete. The neutron production will be decreased simply by the x-ray attenuation of the intervening concrete. The usual x-ray TVL's are adequate since pair production is not important in concrete. Note the neutron dose inside the room is attenuated very fast with the inside concrete layer, since the neutron TVL's are less than half of the x-ray TVL's. One x-ray TVL of concrete inside the metal plate will decrease the neutron production by a factor of 10 and will attenuate the resultant neutrons by a factor of 100, in the point source approximation. </span></span></div>
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<span style="color: #990000;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Designing the Room </b></span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">Fig (b) Good Design</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfqIaWrpN7YhHoH358VfYldXRkeMWEKzvUrsRcyYokWPlABoFqwNmFs7EoBvWVCnnXR49CmVCniokZis7ix8Wqlnm6n8UX8EUNFPI2W8aLmz1EIcdTylFWfF_tRphL2CDgmJHW_xtkYbM/s1600/18+July+2012+%282%29.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="151" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfqIaWrpN7YhHoH358VfYldXRkeMWEKzvUrsRcyYokWPlABoFqwNmFs7EoBvWVCnnXR49CmVCniokZis7ix8Wqlnm6n8UX8EUNFPI2W8aLmz1EIcdTylFWfF_tRphL2CDgmJHW_xtkYbM/s200/18+July+2012+(2).jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig (a) Bad Design</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Fig (c), Typical Room Plan </td></tr>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">In planning the room size, we try to accommodate as many makes and models as possible during the planning stage.</span></span> </div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">In addition, maximum <i>couch</i> and <i>gantry</i> movements (both vertical & horizontal) must be considered. These will decide how big is the room size and its minimum ceiling height.</span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">Fig (d), Cross-Sectional View of AA</td></tr>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Base plate</i> for the Linac has to ne planned in advance where the provision of the base pit is necessary. </span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Coolant pipes</i> for the supply and return of cooling media to the heat exchanger are to be considered as well at the point of planning the pit and its size. Not forgetting the trunking for the electrical services to be provided as well.</span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Ensure that upon sizing up the room and its height, there is a need to look at how the gantry and its associate equipment can be brought into the room. We can always use a template scale to size to manoeuvre the gantry and its equipment such that we do not neglect the part of accessing the room for the purpose of installing the system. </span></span></div>
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Others to be considered include the room lighting, laser positing light, observation cameras, intercom system, etc.</span></span><br />
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<span style="color: blue;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;"><span style="color: #990000;"><i>Information on this page is provided for interest only on a "best efforts" basis and does not </i></span></span></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>constitute personal advice. Always discuss <a href="http://biomedicaltech.blogspot.sg/p/cancer-related.html#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by safesaver">medical</a> conditions and related matters with your doctor.</i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i> </i></span></span> <br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;"><span style="font-size: xx-small;">Call, McCall Associates, Woodslide, CA; Jeffrey H. Kleck, Varian Associates, Palo Alto, CA</span>.</span></span><br />
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DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com2tag:blogger.com,1999:blog-734065417620608532.post-86144776951878776392011-04-07T13:46:00.011+08:002017-01-22T12:01:16.993+08:00Surgical Light - Implementation Process<span style="font-family: "arial" , "helvetica" , sans-serif;">Fig 1</span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2PKdhPCCJP7o4Ucxfkn4yV0nCpR_lysFtOQi8SU60bjY-7lNDOFlKBrNf7OV2SwoFbiUG_Xi-XLrAy-g4Nfxbg9-0w7b0hBcKTsTrmkJYvGiUUd-gIzyXYR64i1jVDF9a92emq-BPA-I/s1600/b%2526w.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5592730021207541586" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2PKdhPCCJP7o4Ucxfkn4yV0nCpR_lysFtOQi8SU60bjY-7lNDOFlKBrNf7OV2SwoFbiUG_Xi-XLrAy-g4Nfxbg9-0w7b0hBcKTsTrmkJYvGiUUd-gIzyXYR64i1jVDF9a92emq-BPA-I/s200/b%2526w.jpg" style="cursor: hand; display: block; height: 231px; margin: 0px auto 10px; text-align: center; width: 248px;" /></a> <br />
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<span style="background-color: white;"><span style="color: blue;"><span style="font-size: small;">Understand the need to decide on the workflow of the surgical process and also the surgeon operating position. The orientation of the surgeon's operating position plays an important role when come to setup design for each piece of operating device and structures that hold the surgical lights, service pendants, monitor screen, etc. </span></span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Fig 2</span><img alt="" border="0" id="BLOGGER_PHOTO_ID_5592716968663075634" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0jSbQW_kzI4TSxMUgDPkBZQxKmMW5AeJbCPfFDcoefjUC2bhyphenhyphen1Xcs6sGvMpeeMxeAVPqtEEk4D1kvIeJ4W4p1ZfBZoaMDMEJHKw6hNqYG0aXhqAJO2L2-xKZH6jJCJVDu-juq_1igadM/s200/Plan.jpg" style="display: block; height: 267px; margin: 0px auto 10px; text-align: center; width: 262px;" /> <br />
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<span style="color: blue;">The pictures above <i>(Fig 1)</i> and (Fig 2) show the design plans for the surgical lights and the service pendants. The surgical lights are position at the centre of the operating room. The centre stem holds and supports two main surgical light structures each with a monitor screen. This is a setup for four articulating arms with two rotating axes - one set for the first surgical lights with a monitor and the second set of axis for the second surgical light with the second monitor. </span></div>
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<span style="color: blue;">Notice that the circular movements for the articulating arms are an important factor determining a well-planned design so much so that they don't end up fighting for space where the needs arise during the surgery. Next we look at the height of the ceiling below <i>(Fig 3)</i> if there are sufficient space for the surgical lights, pendants, video camera, etc. Depending on the number of stacks/articulating arms to be installed, this ultimately affect the minimum height requirements for the installation. </span></div>
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Fig 3 </div>
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<span style="color: blue;">Next we planned the pendant position where the anaesthesia system would likely be stationed. The other pendants would be for the surgical equipment like the electrosurgical unit, aspirator, physiologic monitor, etc.</span></div>
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<span style="color: blue;">Fig 3 - Ceiling Height </span></div>
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<span style="color: blue;">Once the design has been firmed up, we need to cater for most important aspects of safety and that is the structural reinforcement of the current or new site where steel structure supports the weight of each piece of installation within the operating site, i.e, the ceiling structure. </span></div>
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<span style="color: blue;">Don't forget the next most important part within the operating theatre is also the airflow system. Ensure number of air exchange are not affected by the new installation.</span></div>
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<span style="color: blue;">Finally, consider the need to connect up the gases - oxygen, medical air, nitrous oxide, vacuum, gas scavenging, carbon dioxide, the electrical socket, equipotential point, and the LAN point. </span></div>
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<br />DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com3tag:blogger.com,1999:blog-734065417620608532.post-6880990405986166452011-01-20T14:53:00.013+08:002017-01-22T12:01:01.891+08:00LED Surgical Light<span style="color: blue;">From halogen to LED lightings. LED technology has been around for many years and until quite recently, the development of LED into surgical lightings has taken a new evolvement with benefits to the light characteristics. Its</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgV-Zkjzv5m_0AxMtwsXUFOoqIjAFHnXLNjGsWiE0pMIHUjD8RC64MuLlGnLfdzAUfcHpN1x4xU_ldXUsjAk-n-DnLWigujHi0RjsMq4QD-BSalWRrZo6e3RlawmkoB6olhpA3DYK12It8/s1600/Surgical+Theatre.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgV-Zkjzv5m_0AxMtwsXUFOoqIjAFHnXLNjGsWiE0pMIHUjD8RC64MuLlGnLfdzAUfcHpN1x4xU_ldXUsjAk-n-DnLWigujHi0RjsMq4QD-BSalWRrZo6e3RlawmkoB6olhpA3DYK12It8/s1600/Surgical+Theatre.jpg" width="320" /></a></div>
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<span style="color: blue;"> </span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8B_aQeS6Cm344WLLE9qSlEx2mQ9bc2bNwXhvjvA-cFUE1qg3cfeJfMUorYlmEFTvjxSM2Ooby3gZDToTenf_bfKa87QStYLMs2YcrvWEEHWcgvt2AhM2AsD6N-q5A0EGWKnp5RjK0mRM/s1600/LED+Lights.jpg"><img alt="" border="0" height="180" id="BLOGGER_PHOTO_ID_5564158139188418274" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8B_aQeS6Cm344WLLE9qSlEx2mQ9bc2bNwXhvjvA-cFUE1qg3cfeJfMUorYlmEFTvjxSM2Ooby3gZDToTenf_bfKa87QStYLMs2YcrvWEEHWcgvt2AhM2AsD6N-q5A0EGWKnp5RjK0mRM/s320/LED+Lights.jpg" style="float: left; height: 153px; margin: 0px 10px 10px 0px; width: 272px;" width="320" /></a><span style="color: blue;">benefits are aplenty: low heat thereby reduces energy consumption; multi-lens matrix combination creating 3D perception effects where lights are distributed and the effect is a homogeneous and shadow-free light output; excellent lifespan mininises outage, etc.</span></div>
DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com0tag:blogger.com,1999:blog-734065417620608532.post-3519334885268776402010-12-05T18:23:00.005+08:002019-12-27T09:18:50.987+08:00Da-Vinci Robotic-Assisted Surgery<span style="color: blue;">The use of robotics minimally invasive techniques minimize the physical and emotional impact of surgery on patients. Robotically-assisted MIS represents a third generation of surgery, one which builds upon the advances to open surgery introduced by MIS. Robotic technology takes surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with three-dimensional visualization of the operative site. With minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery. Many procedures require only several days in the hospital and promote reduced recovery time. Patients can often get back to their normal routines more quickly.</span><br />
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<span style="color: blue;">The new Da-Vinci Xi system is optimised for complex surgery with:</span></div>
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<li style="box-sizing: initial;"><span style="color: blue;">A new overhead instrument arm architecture designed to facilitate anatomical access from virtually any position. </span></li>
<li style="box-sizing: initial;"><span style="color: blue;">A new endoscope digital architecture that creates a simpler, more compact design with improved visual definition and clarity. </span></li>
<li style="box-sizing: initial;"><span style="color: blue;">An ability to attach the endoscope to any arm, providing flexibility for visualizing the surgical site. </span></li>
<li style="box-sizing: initial;"><span style="color: blue;">Smaller, thinner arms with newly designed joints that offer a greater range of motion than ever before. </span></li>
<li style="box-sizing: initial;"><span style="color: blue;">Longer instrument shafts designed to give surgeons greater operative reach. </span></li>
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<span style="color: blue;"><span style="background-color: white;">The system is capable of being operated from just about anywhere, it's most common to have the surgeon sitting right next to it, in the operating room with the patient. The benefit of the Da Vinci system isn't really the potential for remote access; instead, it's that the surgeon can use tiny robotic tools that mean a much smaller incision, along with visual enhancements like infrared imaging that provide valuable information than their eyes might not.</span></span><br />
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<span style="color: #990000;"><i><span style="font-size: x-small;"><span style="font-size: x-small;"><span style="color: #990000;"><i>Information on this page is provided for interest only on a "best efforts" basis and does not </i></span></span></span></i></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i>constitute personal advice. Always discuss <a href="http://biomedicaltech.blogspot.sg/p/cancer-related.html#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by safesaver">medical</a> conditions and related matters with your doctor.</i></span></span><br />
<span style="font-size: x-small;"><span style="color: #990000;"><i> </i></span></span> <br />
<span style="color: #990000;"><i><span style="font-size: x-small;">Reference</span>: www.<span style="background-color: white;"><span style="font-family: "arial" , sans-serif; white-space: nowrap;">intuitivesurgical.com</span></span></i></span>DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com0tag:blogger.com,1999:blog-734065417620608532.post-77246706756100217942009-04-08T11:10:00.002+08:002017-01-22T12:00:13.983+08:00A Perspective Freehand Sketch of an Operating Theatre<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJbFTirpHda-5gb5RhzxzBTAgvGE7c-XJc39KtSvL_z3AHW-8VyyOMZp3x35wIBWaff7VgF1cfErZnBurdp_7BAxhQX8IWRInz9EQFJjBLlCsWq8kUiI7udtPiDRZhPyMq-hNElHINbbE/s1600-h/MOT.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322153673092917090" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJbFTirpHda-5gb5RhzxzBTAgvGE7c-XJc39KtSvL_z3AHW-8VyyOMZp3x35wIBWaff7VgF1cfErZnBurdp_7BAxhQX8IWRInz9EQFJjBLlCsWq8kUiI7udtPiDRZhPyMq-hNElHINbbE/s320/MOT.png" style="cursor: hand; float: left; height: 245px; margin: 0px 10px 10px 0px; width: 320px;" /></a> <br />
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<span style="color: blue;">In designing Operating Theatre, once must look at the importance of accesses to the surgeon and nurses in terms of electrical power, light intensity, medical gases, etc. Light intensity must be strong enough as to provide the correct color temperature, intensity, focus (effectively suppose to be shadowless) and penetration, etc.</span></div>
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<span style="color: blue;">You will notice that two gas pendant arranged diagonally to provide gases for the anaesthetic unit. The gas pendant also serves as an electrical bank for all surgical equipment. Additional electrical sockets can be found on the walls. </span></div>
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<span style="color: blue;">The other aspect of design is the ventilation system, the number of air exchanges. Loading factors for the ceiling to take the load of the surgical lights, gas pendant, monitor screens, cameras, etc need to be factor in before the start of the implementation.</span>DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com3tag:blogger.com,1999:blog-734065417620608532.post-3561322167348491942009-04-06T19:22:00.000+08:002009-04-06T19:25:16.014+08:00A fresh start............Has just started this blog. Will have more posting in the months to come.DennisRogerhttp://www.blogger.com/profile/02704644742086425748noreply@blogger.com0