Airway-management
tools, capnography, agent analysis, and principles of assisted ventilation are discussed.
The discussion of imaging technologies in the OR (Smith, Rane, and Melendez) is
enlarged by Harrington (Imaging Devices), who describes the basics of radiation physics
and the theory of operation of the X-ray machine (tube and housing, collimators, filters,
and grids, film and film cassettes, and power supply). An overview of fluoroscopy and the
video chain is given. Harrington then describes a typical table, overhead tube, control
console, processors, multiloaders, and dry imaging. The film processor is explained, as
are dark room films and daylight films. Specialty units are described, including mammography,
tomography, bone-density analyzers, interventional radiology (special procedure
rooms), and the cytoscopy room. He concludes with the portable C-arm and a
general discussion of the techniques for effective management of imaging devices.
Machine vision can be defined as the “acquisition and processing of images to identify or
measure the characteristics of objects.” Rosow and Burns (Machine Vision) provide useful information
on the three steps required for successful machine-vision applications: Conditioning,
acquisition, and analysis. They illustrate this with two case studies: (1) the EndoTester—a virtual
instrument-based quality control and technology assessment system for surgical video systems,
and (2) a VabVIEW-based wound measurement system. This chapter underscores the
application of clinical engineering in the research and design of diagnostic technologies.
The specialties of perinatology (DeFrancesco) (i.e., the care of the newborn before,
during, and after birth), has made tremendous strides over the last few decades, owing
largely to the rapid and simultaneous and synergistic advances in medical devices, pharmaceuticals,
and clinical procedures. The flow of patients through a typical facility is
described from prelabor, labor and delivery, and postpartum support areas. A typical floor
plan for a labor and delivery area and individual room layouts are described. Changes in
the patient environment (i.e., the building infrastructure) that have resulted in a safer and
more efficient environment are noted. The tertiary-care facility often incorporates neonatal
intensive care units and pediatric intensive care units to provide support for premature
infants and critically ill infants in outlying hospitals without adequate support facilities.
The special needs of security, data communications, climate control, medical gases, and
vacuum-power distribution to support perinatal care is described. Explanations are given
of most of the typical technologies such as maternal/fetal monitors, neonatal monitors,
incubators, radiant warmers, apnea monitors, phototherapy units, ventilators, ultrasonic
scanners, and the electronic medical record. The new therapeutic system of Inhaled Nitric
Oxide (INOvent) delivery and monitoring is described.
Goodman (Cardiovascular Techniques and Technology) begins with some anatomy and
discussion of cardiovascular disease. He then explains diagnostic technologies for cardiovascular
disease, including noninvasive static and stress tests in diagnostic offices
(e.g., electrocardiograms, phonocardiograms, and Holter monitors) and invasive diagnostic
tests in the cardiac catheterization laboratory (e.g., cardiac output monitors and cardiac
catheters). Hospital-based surgical interventions for cardiovascular disease in the
operating room and cardiac catheterization laboratory, such as angioplasty, are explained.
Cardiovascular care medical devices, including intra-aortic balloon pumps, cell savers,
pacemakers, and defibrillators, are addressed.
The next chapter, Beds, Wheelchairs, and Other General Hospital Devices, explains
that all medical devices must perform satisfactorily and must not pose a threat to patient
or operator safety. Clinical engineering departments have shied away from such low-tech
medical devices as beds, wheelchairs, and stretchers, perhaps because these items are not
sophisticated enough and because the skill level of the department’s staff members
exceeds that required to service these items. Case studies demonstrate that the failure or
misuse of the simplest general hospital medical devices can cause, and has caused, death
and serious injury. Dyro shows that by matching skills and tasks, a clinical engineering
department can cost-effectively manage these oft-forgotten devices to the benefit and
safety of the patient population.
In the last chapter, a methodology is presented for determining the cause of a medical
device malfunction. The generalized and systematic techniques recommended are effective
in troubleshooting all medical devices, whether large or small, costly or inexpensive,
mechanical or electrical, complicated or simple. The methodology applies to all causes of
apparent medical devi