Med Dev Assignment

List A: CT Scanner (Siemens SOMATOM go.Top)1.Description of the device1.1 Construction detailsFigure 1: Overall picture of the machineFigure 2: Side profile of the machine with a patientFigure 3: Components of a CT scannerFigure 4: How CT scanner worksThere are various parts to the machine:Table – For which the patient lies on to take his scan, the default table can hold up to 227kg with a scannable range of 160cm. The upgraded version can hold up to 300kg with a scannable range of 200cm.Wireless tablet – The radiographer will use this to check the patient’s information, select the type of test to be done and also preview the images after the scan is done. Bluetooth remote control – It is used to position the table for the patient. Camera – It helps the radiographer to keep an eye on the patient, spotting even the slightest movement from the patient during the scan.Injector arm – To place the injector where you need it to be.Paper roll holder, infusion stand, storage boxX-ray subsystemGantry: X-ray tube, x-ray generator, detector system, collimators and rotational frame1.2 FunctionComputed Tomography(CT) is a computerized x-ray imaging procedure which uses a single or dual X-ray sources and detector to produce detailed cross-sectional images (slices) of structures of the body. It uses a narrow beam of X-ray to circle around the patient’s body, providing images from different angles. The process is repeated till a certain number of slices, then they will be stacked in the computer to show 2-dimensional images of the patient’s body. The maximum number of slices this machine can achieve is 128.A scan begins when the detector ring rotates around the human body. The collimators which are located near the x-ray tube or next to the detector are aligned so that scatter radiation is minimized and the x-ray beam is properly defined for scanning.[8]For this machine, it has a few patient-centric technologies. This means that it is programmed to always have the patient’s safety as priority but not falling behind on the product produced. Firstly, it has a TwinBeam Dual Energy technology which uses low and high kV datasets to produce rich diagnostic information that a normal single source scan cannot deliver. It highlights, characterize and quantify material to produce such high quality image. Also, there is no dose penalty with this extra feature. Next, the CARE kV automatically tailors tube voltage to each patient and clinical indication. [2] This means dosages is lowered for kids taking such scans. CARE Child minimizes radiation exposure while maintaining the quality of the images. Last but not least the Tin filter technology helps to reduce doses in each scan and at the same time enhances contrast between soft tissue and air. It also improves image quality in bony structures which is very useful in orthopedic examinations.1.3 ApplicationComputed Tomography has many uses. Firstly, it allows direct imaging and differentiation of soft tissue structures like liver and fat. It is especially useful in searching for large space occupying lesions, tumors and metastasis and can not only reveal their presence, but also the size, spatial location and extent of a tumor. [5] Secondly, due to the high spatial resolution and good contrast, it can be used to view bony structures like shoulder or hip and bone fractures. Thirdly, it can be used in radiation therapy to plan treatments, determine how much the tumor has spread and how the tumour is responding to the treatment. Fourthly, it can be used to detect blood clots ar tumours in the head and brain, checking for any blood vessel damage. Last but not least, CT angiography can be used to look at the arteries of the heart and the cardiac plane. This helps to check for coronary artery disease or aneurysm in a patient. Figure 9: Image of the femoral Figure 10: Image of the chest showing vessels arteries with calcifications in the heart and pneumonia in both lungs1.4 Appendix and references[1] Healthcare.siemens.com. (2019). SOMATOM go.Top. [online] Available at: https://www.healthcare.siemens.com/computed-tomography/single-source-ct/somatom-go-top [Accessed 15 Jan. 2019].[2] SOMATOM go.Top. (2019). [ebook] Siemens Healthineers. Available at: https://static.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@ct/documents/download/mda4/mjc2/~edisp/siemens_healthineers-somatom_go.top-brochure_va20-05370416.pdf [Accessed 15 Jan. 2019].[3] National Institute of Biomedical Imaging and Bioengineering. (2019). Computed Tomography (CT). [online] Available at: https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct [Accessed 15 Jan. 2019].[4] WebMD. (2018). What Is a CT Scan?. [online] WebMD. Available at: https://www.webmd.com/cancer/what-is-a-ct-scan#1 [Accessed 15 Jan. 2019].[5] Imaginis.com. (2019). Applications and Clinical Benefits of CT Imaging | CT Scan | Imaginis – The Women’s Health & Wellness Resource Network. [online] Available at: http://www.imaginis.com/ct-scan/applications-and-clinical-benefits-of-ct-imaging [Accessed 16 Jan. 2019].[6] L. Hai Sie, (2016). [image] Available at: https://www.quora.com/How-does-a-CT-scan-work-Does-it-mean-a-group-of-x-rays-What-is-the-use-of-a-CT-scan-Where-is-it-used [Accessed 22 Jan. 2019].[7] Anon, (2013). [image] Available at: http://ctprotocol.blogspot.com/2013/03/electron-beam-ct.html [Accessed 22 Jan. 2019].[8] Ecri.org. (2018). CT Scanners. [online] Available at: https://www.ecri.org/components/HPCS/Pages/CT%20Scanners.aspx?tab=2 [Accessed 22 Jan. 2019].2.Hazard report2.1 Problem statementCT scans uses x-rays which produces ionising radiation. However, the level of exposure in a CT scan is higher than a normal x-ray. Most people are concerned with the amount of radiation they receive from the scan and how harmful it will be to them. Exposure to ionising radiation is known to increase risk of cancer and damage DNA. 2.2 Discussion related to the problemThere are many discussions going on debating about whether the radiation from CT scanners really pose a great risk to human health. However controlling the dosage of radiation is a more significant concern. Both the radiographers and the public should be aware of the amount of dosage each time they perform a scan. A typical CT exam delivers a radiation dose that is 100 to 400 times that of a single chest x-ray, which is one of the lowest-dose radiographic exams. [1] Therefore, many companies now are trying to upgrade the functions in their CT scanner to reduce the radiation dosage for each scan. This was one of the benefits stated above for the Siemens SOMATOM go.Top scanner. Overall, the benefits of CT scanner outweigh the cons.2.3 Possible solution and recommendationsFirstly, the radiographers and the public sector should be better educated so that they understand the machine and the amount of radiation they are undergoing. This is of main importance as they are the people involved in this. Secondly, quality control of the CT machine is important to ensure that there is no discrepancy in the settings. Engineers and technicians must ensure that it is set up properly. Thirdly, the use of CT scanners on a patient should be justified clearly and with explanation. This is to prevent any unwanted exposure to radiation. Last but not least, before every scan, radiologists should always check the parameters of the scanner. As different part of the body needs different amount of dosage for each scan. Wrong dosage could lead to symptoms such as hair loss, rashes and headaches. All these measures should be implemented and practised daily by the radiographers and engineers, so that hazards and concerns like these would gradually dissipate.2.4 Appendix and references[1] Imaginis.com. (2019). Applications and Clinical Benefits of CT Imaging | CT Scan | Imaginis – The Women’s Health & Wellness Resource Network. [online] Available at: http://www.imaginis.com/ct-scan/applications-and-clinical-benefits-of-ct-imaging [Accessed 16 Jan. 2019].[2] Ecri.org. (2007). Computed Tomography: Unquestionable Value, Unappreciated Risks. [online] Available at: https://www.ecri.org/components/HDJournal/Pages/CT-Unquestionable-Value%2c-Unappreciated-Risks.aspx?tab=2 [Accessed 22 Jan. 2019].[3] Ecri.org. (2018). CT Scanners. [online] Available at: https://www.ecri.org/components/HPCS/Pages/CT%20Scanners.aspx?tab=2 [Accessed 22 Jan. 2019].List B: Ventilators (Philips Respironics V680- Critical Care Ventilator)1.Description of the device 1.1 Construction detailsFigure 1: Overall picture of Philips Respironics V680- Critical Care VentilatorThere are various parts to the machine[3]:Oxygen tanks – To provide oxygen supply for the patientTransport kit – To hold extra oxygen tanksControl and display unit – The nurses will use this unit to change ventilator modes or settings, and monitor the patient’s current conditionEndotracheal tube – Tube that delivers gas to patient through the tracheaNIV mask – Non-invasive mask that delivers gas to patient through the mouthPneumatic unit – Includes humidifier, air flow regulator, inspiratory limb, expiratory limbAlarm system – To alert nurses of ventilator faults or potentially threatening patient conditionPower sources – Includes ventilator unit power supply, batteries and air pressure generatorSensors – Includes oxygen sensors, carbon dioxide sensors, pressure sensors, volume sensors, temperature sensorsFilter – To filter out bacteria, moisture, expired gas and particles from gas that is to be delivered to patient1.2 FunctionVentilators are life support appliances used to provide support for patients who cannot breathe on their own or who require assistance to maintain sufficient ventilation or oxygenation because of medical conditions[1]. The ventilator assists in patient breathing by adopting the function of a lung, pushing air into the lungs and expelling air afterwards. The volume of gas supplied by the ventilator and expired by the patient is known as Tidal Volume[4].Figure 2: Air flow of patient using medical ventilatorThe Philips Respironics V680- Critical Care Ventilator is described to be a “two-in-one” ventilator which can be used for invasive and non-invasive ventilation (NIV), catering to both critical care patients and regular patients respectively. The Philips Respironics V680- Critical Care Ventilator caters to both classes of patients with its dual-limb system to deliver advanced life support and its NIV function for acute or sub-acute NIV needs[2]. In addition, the V680 Critical Care Ventilator also has a myriad of algorithms programmed into it. Firstly, it uses Auto-Trak technology to automatically adapt to the patient’s breathing pattern and delivers oxygen to the patient based on the patient’s demand. Secondly, the V680 Critical Care Ventilator has the capability to estimate the dynamic compliance and resistance of exhalation and inhalation by estimating the change in volume over the estimated change in pressure. Lastly, for majority of cases, the V680 Critical Care Ventilator does not require the mode of ventilation to be changed and the patient to be inactive when ventilation is carried out in other modes other than in volume control ventilation (VCV). This ability of the V680 Critical Care Ventilator saves valuable nurse’s time from making sure that the patient is inactive.1.3 ApplicationThe ventilator can be applied in the operating theatre (OT) during surgeries and in the patient wards after surgeries to assist in patient recovery. Firstly, during surgery, the patient is unable to breathe on his own while under the influence of anesthesia since his muscles are paralysed[5]. Thus, the ventilator is essential to assist the patient in breathing while unconscious. Secondly, after surgery, the patient might not be well enough to breathe on his own or might require some medication which can be delivered through the nebulizer using a ventilator. In the event that a patient is unable to breathe on his own after surgery, the ventilator is used to help the patient breathe until he is able to breathe on his own. In the event that the patient is to be delivered medication through a nebulizer, the ventilator is used to maintain the patient under the medication till he wakes up and breathes on his own.1.4 Appendix and references[1] ECRI Institute. (9 December 2018). Ventilators: The Essentials [Online]. Available: https://www.ecri.org/components/HDJournal/Pages/Ventilators_The_Essentials-.aspx?tab=1 [Accessed: 18 January 2018][2] Philips. (2019). Hospital Respiratory- Ventilation [Online]. Available: https://www.philips.com.sg/healthcare/product/HCNOCTN323/respironics-v680/overview [Accessed: 19 January 2019][3] Deranged Physiology. (2018). Basic components of a mechanical ventilator [Online]. Available: https://derangedphysiology.com/main/cicm-primary-exam/required-reading/respiratory-system/Chapter%20501/basic-components-mechanical [Accessed: 22 January 2019][4] Temasek Polytechnic. (2019). Medical Devices EMD2002 . Chapter 4: Life saving and support devices-Part 2 “Ventilators: Respiration versus Ventilation”[5]Verywell Health. (14 November 2018). When a ventilator is necessary [Online]. Available: https://www.verywellhealth.com/when-a-ventilator-is-necessary-3156902 [Accessed: 22 January 2019] 2.Hazard report2.1 Problem statementVentilators are classified under Class IIb of the European Union Risk-Based Classification, posing a moderate-high risk to patient safety. One risk to patient safety that might be caused by ventilators is firstly, infection. One such infection is ventilator-associated pneumonia (VAP). Secondly, another risk of using ventilators is that it might cause pneumothorax. Thirdly, using a ventilator might cause lung damage as well as oxygen toxicity. Next, using a ventilator also puts the patient at risk of having blood clots and serious skin infections. Lastly, another possible problem from using ventilators is the damage to the patient’s vocal cords[1].2.2 Discussion related to the problemFirstly, the patient might get an infection such as VAP from using a ventilator. This is due to the breathing tube placed in the patient’s airway allowing bacteria to enter the lungs. Consequently, the breathing tube prevents the patient from coughing and expelling irritants out of the lungs. Patient’s that contract VAP would have a hard time being cured of their conditions as VAP makes it harder to treat their conditions. Secondly, the patient has a risk of contracting pneumothorax. This condition can affect the patient by causing pain, shortness of breath, and maybe even one or both of the lungs to collapse. Thirdly, the ventilator might cause lung damage and oxygen toxicity. This is due to the fact that pushing air with too much pressure into the lungs and with too high levels of oxygen can damage the lungs. Fourth, the patient might get blood clots and skin infections from using ventilators. These conditions however, mainly occur in patients who have been immobile for long periods of time or have certain diseases. Lastly, using a ventilator might damage the patient’s vocal cords. This is due to the breathing tube lodged in the patient’s airway.2.3 Possible solution and recommendationsAlthough there are a few risks to using ventilators, these risks can be resolved and avoided. For the first risk, VAP can actually be treated with antibiotics. Next, for the second and third risk, the problems can be avoided by regulating the amount and pressure of oxygen delivered into the lungs. The medical professionals can actually take better care to avoid these risks. As for the last two risks, the patient can overcome these problems by doing some exercises to stay mobile[2] and use lozenges or throat spray to ease the sore throat caused by using a ventilator[3].In conclusion, although there are risks associated with the usage of ventilators, ventilators are an essential life support machine which plays a crucial role in patient care. The risks associated with this device can be resolved through administering medication and monitoring the patient’s condition closely from the medical professional’s perspective. On the patient’s part, the patient can resolve these risks by staying active within his limits to prevent the problem from worsening.2.4 Appendix and references[1] National Heart, Lung and Blood Institute (NHLBI). (2019). Ventilator/Ventilator Support [Online]. Available: https://www.nhlbi.nih.gov/health-topics/ventilatorventilator-support [Accessed: 22 January 2019][2] Agency for Healthcare Research and Quality (AHRQ). (August 2017). Your Guide to Preventing and Treating Blood Clots [Online]. Available: https://www.ahrq.gov/patients-consumers/prevention/disease/bloodclots.html [Accessed: 22 January 2019][3] Verywell Health. (28 November 2018). Mouth and Throat Care After Surgery [Online]. Available: https://www.verywellhealth.com/mouth-and-throat-care-after-surgery-3156877 [Accessed: 22 January 2019]

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